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IRS8889.xsl
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<?xml version="1.0" encoding="UTF-8"?>
<xsl:stylesheet xmlns:xsl="http://www.w3.org/1999/XSL/Transform" version="1.0">
<xsl:include href="PopulateTemplate.xsl"/>
<xsl:include href="CommonPathRef.xsl"/>
<xsl:include href="AddHeader.xsl"/>
<xsl:include href="AddOnTable.xsl"/>
<xsl:include href="IRS8889Style.xsl"/>
<xsl:output method="html" indent="yes"/>
<xsl:strip-space elements="*"/>
<xsl:param name="Form8889Data" select="$RtnDoc/IRS8889"/>
<xsl:template match="/">
<html lang="EN-US">
<head>
<title>
<xsl:call-template name="FormTitle">
<xsl:with-param name="RootElement" select="local-name($Form8889Data)"/>
</xsl:call-template>
</title>
<!-- No Browser Caching -->
<meta http-equiv="Pragma" content="no-cache"/>
<meta http-equiv="Cache-Control" content="no-cache"/>
<meta http-equiv="Expires" content="0"/>
<!-- No Proxy Caching -->
<meta http-equiv="Cache-Control" content="private"/>
<!-- Define Character Set -->
<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1"/>
<meta name="Description" content="IRS Form 8889"/>
<script language="JavaScript" src="{$ScriptPath}/FormDisplay.js" type="text/javascript"/>
<xsl:call-template name="InitJS"/>
<style type="text/css">
<xsl:if test="not($Print) or $Print=''">
<xsl:call-template name="IRS8889Style"/>
<xsl:call-template name="AddOnStyle"/>
</xsl:if>
</style>
<xsl:call-template name="GlobalStylesForm"/>
</head>
<body class="styBodyClass">
<form name="IRS8889">
<!-- Begin Header section 1 -->
<xsl:call-template name="DocumentHeader"/>
<div class="styBB" style="width:187mm;border-bottom-width:2px;">
<div class="styFNBox" style="width:31mm;height:22.2mm;border-right-width:2px;padding-top:.5mm;">
<div style="padding-top:1mm;font-size:8pt;">
Form<span class="styFormNumber"> 8889</span>
</div>
<!--General Dependency Push Pin-->
<xsl:call-template name="SetFormLinkInline">
<xsl:with-param name="TargetNode" select="$Form8889Data"/>
</xsl:call-template>
<br/>
<span class="styAgency">Department of the Treasury</span>
<br/>
<span class="styAgency">Internal Revenue Service</span>
</div>
<div class="styFTBox" style="width:125mm;">
<br/>
<div class="styMainTitle" style="height:8mm;">Health Savings Accounts (HSAs)</div>
<div class="styFST" style="height:5mm;font-size:7pt;margin-left:0mm;text-align:center;">
<span style="text-align:center;font-weight:bold;">
<div style="width:100%;height:4mm;padding-left:0px;margin-top:1mm;">
<div style="width:99%;height:4mm;float:left;">
<img src="{$ImagePath}/8889_Bullet_Sm.gif" alt="SmallBullet"/>
Information about Form 8889 and its instructions is available at <i>IRS.gov/form8889</i>.
</div>
<div style="width:99%;height:4mm;float:left;">
<img src="{$ImagePath}/8889_Bullet_Sm.gif" alt="SmallBullet"/>
Attach to Form 1040 or Form 1040NR.
<span style="width:8mm;"/>
<img src="{$ImagePath}/8889_Bullet_Sm.gif" alt="SmallBullet"/>
See separate instructions.
</div>
</div>
</span>
</div>
</div>
<div class="styTYBox" style="width:30mm;height:22.2mm;border-left-width:2px;">
<div class="styOMB" style="height:2mm;font-size:7pt;">OMB No. 1545-0074</div>
<div class="styTY">20<span class="styTYColor">12</span>
</div>
<div style="margin-left:3mm;text-align:left;font-size:7pt;">
Attachment<br/>Sequence No.
<span class="styBoldText" style="font-size:9pt;">53</span>
</div>
</div>
</div>
<!-- End Header section 1 -->
<!-- Begin Name/SSN Header -->
<div class="styBB" style="width:187mm;">
<div class="styNameBox" style="width:105mm;height:9mm;font-size:7pt;">
Name(s) shown on Form 1040 or Form 1040NR<br/>
<xsl:choose>
<xsl:when test="$Form8889Data/PersonName">
<xsl:call-template name="PopulateText">
<xsl:with-param name="TargetNode" select="$Form8889Data/PersonName"/>
</xsl:call-template>
</xsl:when>
<xsl:otherwise>
<xsl:call-template name="PopulateReturnHeaderFiler">
<xsl:with-param name="TargetNode">Name</xsl:with-param>
</xsl:call-template>
</xsl:otherwise>
</xsl:choose>
</div>
<div class="styEINBox" style="width:50mm;height:9mm;font-size:7pt;padding-left:2mm;font-weight:normal;">
Social security number of HSA<br/>beneficiary. If both spouses have<br/>HSAs, see instructions
<span style="width:2px;"/>
<img src="{$ImagePath}/8889_Bullet_Sm.gif" alt="SmallBullet"/>
</div>
<div class="styEINBox" style="width:30mm;height:9mm;font-size:7pt;padding-left:2mm;padding-top:3mm;">
<span class="styEINFld" style="width:30mm; text-align:center;font-weight:normal;">
<xsl:choose>
<xsl:when test="$Form8889Data/RecipientsSSN">
<xsl:call-template name="PopulateSSN">
<xsl:with-param name="TargetNode" select="$Form8889Data/RecipientsSSN"/>
</xsl:call-template>
</xsl:when>
<xsl:otherwise>
<xsl:call-template name="PopulateReturnHeaderFiler">
<xsl:with-param name="TargetNode">PrimarySSN</xsl:with-param>
</xsl:call-template>
</xsl:otherwise>
</xsl:choose>
</span>
</div>
</div>
<!-- End Name/SSN Header -->
<!-- Begin Instruction (Header)-->
<div style="width:187mm;" class="styBB">
<div class="styPartDesc" style="padding-left:1mm;padding-top:2mm; padding-bottom:2mm;">
<span class="styItalicText">
Before you begin:
</span>
<span class="styNormalText">
Complete Form 8853, Archer MSAs and Long-Term Care Insurance Contracts, if required.
</span>
</div>
</div>
<!-- End Instruction (Header)-->
<!-- Begin Part I (Header)-->
<div style="width:187mm;" class="styBB">
<div class="styPartName" style="width:15mm;">Part I</div>
<div class="styPartDesc" style="padding-left:5mm;padding-top:1.5mm;padding-bottom:2mm;">
HSA Contributions and Deduction.
<span class="styNormalText">
See the instructions before completing this part. If you are filing jointly<br/>
and both you and your spouse each have separate HSAs, complete a separate Part I for each spouse.
</span>
</div>
</div>
<!-- End Part I (Header)-->
<!-- Part I (Body) -->
<div class="styBB" style="width:187mm;">
<!-- Begin (Line) 1 -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox">1</div>
<div class="styIRS8889LNDesc" style="height:4mm;width:137mm">
Check the box to indicate your coverage under a high-deductible health plan (HDHP) during<br/>
2012 (see instructions)
<span style="width:3px;"/>
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:16px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
<span style="width:3px;"/>
<img src="{$ImagePath}/8889_Bullet_Md.gif" alt="Bullet Image"/>
</div>
<!--+++++++++++++++++++ Yes/No Checkboxes +++++++++++++++++++-->
<div class="styIRS8889LNDesc" style="width:42mm;padding-left:0px;">
<div class="styIRS8889LNDesc" style="width:22mm;padding-top:3mm;">
<input type="checkbox" class="styCkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form8889Data/HDHPSelfOnlyCoverageInd"/>
<xsl:with-param name="BackupName">IRS8889HDHPSelfOnlyCoverageInd</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form8889Data/HDHPSelfOnlyCoverageInd"/>
<xsl:with-param name="BackupName">IRS8889HDHPSelfOnlyCoverageInd</xsl:with-param>
</xsl:call-template>
Self-only
</label>
</div>
<div class="styIRS8889LNDesc" style="width:19mm;padding-top:3mm;">
<input type="checkbox" class="styCkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form8889Data/HDHPFamilyCoverageInd"/>
<xsl:with-param name="BackupName">IRS8889HDHPFamilyCoverageInd</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form8889Data/HDHPFamilyCoverageInd"/>
<xsl:with-param name="BackupName">IRS8889HDHPFamilyCoverageInd</xsl:with-param>
</xsl:call-template>
Family
</label>
</div>
</div>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 1-->
<!-- Begin (Line) 2 -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox">2</div>
<div class="styIRS8889LNDesc" style="height:4mm;">
HSA contributions you made for 2012 (or those made on your behalf), including those made<br/>
from January 1, 2013, through April 15, 2013, that were for 2012. <span class="styBoldText">Do not</span> include employer<br/>
contributions, contributions through a cafeteria plan, or rollovers (see instructions)
<span style="width:3px;"/>
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:16px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<span style="padding-top:1px;">
<div class="styLNRightNumBox" style="height:6.5mm;border-bottom-width:0px;border-top-width:1px;border-top-color:#000000;"/>
<div class="styLNAmountBox" style="height:6.5mm;width:33mm;border-bottom-width:0px;border-top-width:1px;border-top-color:#000000;"/>
<div class="styLNRightNumBox" style="height:4mm;">2</div>
<div class="styLNAmountBox" style="width:33mm;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/HSAContributionAmt"/>
</xsl:call-template>
</div>
</span>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 2-->
<!-- Begin (Line) 3 -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox">3</div>
<div class="styIRS8889LNDesc" style="height:4mm;">
If you were under age 55 at the end of 2012, and on the first day of <span class="styBoldText">every</span> month during 2012,<br/>
you were, or were considered, an eligible individual with the <span class="styBoldText">same</span> coverage, enter $3,100<br/>
($6,250 for family coverage). <span class="styBoldText">All others,</span> see the instructions for the amount to enter
<span style="width:1px;"/>
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:12px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<span style="padding-top:1px;">
<div class="styLNRightNumBox" style="height:6.5mm;border-bottom-width:0px;"/>
<div class="styLNAmountBox" style="height:6.5mm;width:33mm;border-bottom-width:0px;"/>
<div class="styLNRightNumBox" style="height:4mm;">3</div>
<div class="styLNAmountBox" style="width:33mm;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/HSALimitedAnnualDeductibleAmt"/>
</xsl:call-template>
</div>
</span>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 3-->
<!-- Begin (Line) 4 -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox">4</div>
<div class="styIRS8889LNDesc" style="height:4mm;">
Enter the amount you and your employer contributed to your Archer MSAs for 2012 from Form<br/>
8853, lines 1 and 2. If you or your spouse had family coverage under an HDHP at any time<br/>
during 2012, also include any amount contributed to your spouse’s Archer MSAs
<span style="width:1px;"/>
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:13px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<span style="padding-top:1px;">
<div class="styLNRightNumBox" style="height:6.5mm;border-bottom-width:0px;"/>
<div class="styLNAmountBox" style="height:6.5mm;width:33mm;border-bottom-width:0px;"/>
<div class="styLNRightNumBox" style="height:4mm;">4</div>
<div class="styLNAmountBox" style="width:33mm;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/TotalArcherMSAContributionAmt"/>
</xsl:call-template>
</div>
</span>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 4-->
<!-- Begin (Line) 5 -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox">5</div>
<div class="styIRS8889LNDesc" style="height:4mm;">
Subtract line 4 from line 3. If zero or less, enter -0-
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:9px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<div class="styLNRightNumBox" style="height:4mm;">5</div>
<div class="styLNAmountBox" style="width:33mm;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/HSALimitedDeductibleAllwdAmt"/>
</xsl:call-template>
</div>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 5-->
<!-- Begin (Line) 6 -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox">6</div>
<div class="styIRS8889LNDesc" style="height:4mm;">
Enter the amount from line 5. But if you and your spouse each have separate HSAs and had<br/>
family coverage under an HDHP at any time during 2012, see the instructions for the amount to<br/>
enter
<span style="width:3px;"/>
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:16px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<span style="padding-top:1px;">
<div class="styLNRightNumBox" style="height:6.5mm;border-bottom-width:0px;"/>
<div class="styLNAmountBox" style="height:6.5mm;width:33mm;border-bottom-width:0px;"/>
<div class="styLNRightNumBox" style="height:4mm;">6</div>
<div class="styLNAmountBox" style="width:33mm;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/HSAFamilyDeductibleAmt"/>
</xsl:call-template>
</div>
</span>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 6-->
<!-- Begin (Line) 7 -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox">7</div>
<div class="styIRS8889LNDesc" style="height:4mm;">
If you were age 55 or older at the end of 2012, married, and you or your spouse had family<br/>
coverage under an HDHP at any time during 2012, enter your additional contribution amount<br/>
(see instructions)
<span style="width:3px;"/>
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:20px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<span style="padding-top:1px;">
<div class="styLNRightNumBox" style="height:6.5mm;border-bottom-width:0px;"/>
<div class="styLNAmountBox" style="height:6.5mm;width:33mm;border-bottom-width:0px;"/>
<div class="styLNRightNumBox" style="height:4mm;">7</div>
<div class="styLNAmountBox" style="width:33mm;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/HSAAddnlContributionAmt"/>
</xsl:call-template>
</div>
</span>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 7-->
<!-- Begin (Line) 8 -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox">8</div>
<div class="styIRS8889LNDesc" style="height:4mm;">
Add lines 6 and 7
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:8px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<div class="styLNRightNumBox" style="height:4mm;">8</div>
<div class="styLNAmountBox" style="width:33mm;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/HSALimitedGrossContributionAmt"/>
</xsl:call-template>
</div>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 8-->
<!-- Begin (Line) 9 -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox">9</div>
<div class="styIRS8889LNDesc" style="width:97mm;height:4mm;">
Employer contributions made to your HSAs for 2012
<span style="width:3px;"/>
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:17px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<div class="styLNRightNumBox" style="height:4mm;">9</div>
<div class="styLNAmountBox" style="width:33mm;padding-right:8px;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/HSAEmployerContributionAmt"/>
</xsl:call-template>
</div>
<span style="padding-top:1px;">
<div class="styLNRightNumBox" style="background-color:lightgrey;height:4.5mm;border-bottom-width:0px;"/>
<div class="styLNAmountBox" style="height:4.5mm;width:33mm;border-bottom-width:0px;"/>
</span>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 9-->
<!-- Begin (Line) 10 -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox" style="padding-left:2mm;">10</div>
<div class="styIRS8889LNDesc" style="width:97mm;height:4mm;">
Qualified HSA funding distributions
<span style="width:3px;"/>
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:19px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<div class="styLNRightNumBox" style="height:4mm;">10</div>
<div class="styLNAmountBox" style="width:33mm;padding-right:8px;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/HSAQualifiedFundingDistriAmt"/>
</xsl:call-template>
</div>
<span style="padding-top:1px;">
<div class="styLNRightNumBox" style="background-color:lightgrey;height:2mm;"/>
<div class="styLNAmountBox" style="height:2mm;width:33mm;"/>
</span>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 10 -->
<!-- Begin (Line) 11 -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox" style="padding-left:2mm;">11</div>
<div class="styIRS8889LNDesc" style="height:4mm;">
Add lines 9 and 10
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:18px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<div class="styLNRightNumBox" style="height:4mm;">11</div>
<div class="styLNAmountBox" style="width:33mm;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/TotalHSAContributionAmt"/>
</xsl:call-template>
</div>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 11-->
<!-- Begin (Line) 12 -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox" style="padding-left:2mm;">12</div>
<div class="styIRS8889LNDesc" style="height:4mm;">
Subtract line 11 from line 8. If zero or less, enter -0-
<span style="width:3px"/>
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:16px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<div class="styLNRightNumBox" style="height:4mm;">12</div>
<div class="styLNAmountBox" style="width:33mm;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/HSALimitedContributionAmt"/>
</xsl:call-template>
</div>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 12-->
<!-- Begin (Line) 13 -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem" style="">
<div class="styIRS8889LNLeftNumBox" style="padding-left:2mm;padding-top:1.5mm">13</div>
<div class="styIRS8889LNDesc" style="height:4mm;padding-top:1.5mm">
<span class="styBoldText">HSA deduction.</span> Enter the <span class="styBoldText">smaller</span> of line 2 or line 12 here and on Form 1040, line 25, or Form<br/>
1040NR, line 25
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:13px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<div class="styLNRightNumBox" style="height:2mm;border-bottom-width:0px;"/>
<div class="styLNAmountBox" style="height:2mm;width:33mm;border-bottom-width:0px;"/>
<div class="styLNRightNumBox" style="height:4mm;">13</div>
<div class="styLNAmountBox" style="width:33mm;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/TotalHSADeductionAmt"/>
</xsl:call-template>
</div>
</div>
<div class="styIRS8889LineItem" style="">
<div class="styIRS8889LNLeftNumBox">
<span style="width:4mm"/>
</div>
<div class="styIRS8889LNDesc" style="height:4mm;">
<span class="styBoldText">Caution: </span>
<span class="styItalicText">If line 2 is more than line 13, you may have to pay an additional tax (see
instructions).</span>
<span style="width:3px;"/>
</div>
<span style="padding-top:1px;">
<div class="styLNRightNumBox" style="background-color:lightgrey;height:2mm;border-bottom-width:0px;"/>
<div class="styLNAmountBox" style="background-color:lightgrey;height:2mm;width:33mm;border-bottom-width:0px;"/>
</span>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 13-->
</div>
<!-- Begin Part II (Header)-->
<div style="width:187mm;" class="styBB">
<div class="styPartName" style="width:15mm;">Part II</div>
<div class="styPartDesc">
HSA Distributions. <span class="styNormalText">If you are filing jointly and both you and your spouse each have separate HSAs, complete<br/>
a separate Part II for each spouse.</span>
</div>
</div>
<!-- End Part II (Header)-->
<!-- Part II (Body) -->
<div class="styBB" style="width:187mm;">
<!-- Begin (Line) 14a -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox" style="padding-left:2mm;">14a</div>
<div class="styIRS8889LNDesc" style="height:4mm;">
Total distributions you received in 2012 from all HSAs (see instructions)
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:20px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<div class="styLNRightNumBox" style="height:4mm;">14a</div>
<div class="styLNAmountBox" style="width:33mm;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/TotalHSADistributionAmt"/>
</xsl:call-template>
</div>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 14a-->
<!-- Begin (Line) 14b -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox" style="padding-left:5mm;">b</div>
<div class="styIRS8889LNDesc" style="height:4mm;">
Distributions included on line 14a that you rolled over to another HSA. Also include any excess<br/>
contributions (and the earnings on those excess contributions) included on line 14a that were<br/>
withdrawn by the due date of your return (see instructions)
<span style="width:1px;"/>
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<span style="padding-top:1px;">
<div class="styLNRightNumBox" style="height:6.5mm;border-bottom-width:0px;"/>
<div class="styLNAmountBox" style="height:6.5mm;width:33mm;border-bottom-width:0px;"/>
<div class="styLNRightNumBox" style="height:4mm;">14b</div>
<div class="styLNAmountBox" style="width:33mm;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/HSADistributionRolloverAmt"/>
</xsl:call-template>
</div>
</span>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 14b-->
<!-- Begin (Line) 14c -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox" style="padding-left:5mm;">c</div>
<div class="styIRS8889LNDesc" style="height:4mm;">
Subtract line 14b from line 14a
<span style="width:1px;"/>
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<span style="padding-top:1px;">
<div class="styLNRightNumBox" style="height:4mm;">14c</div>
<div class="styLNAmountBox" style="width:33mm;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/HSANetDistributionAmt"/>
</xsl:call-template>
</div>
</span>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 14c-->
<!-- Begin (Line) 15 -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox" style="padding-left:2mm;">15</div>
<div class="styIRS8889LNDesc" style="height:4mm;">
Unreimbursed qualified medical expenses (see instructions)
<span style="width:3px"/>
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:18px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<div class="styLNRightNumBox" style="height:4mm;">15</div>
<div class="styLNAmountBox" style="width:33mm;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/UnreimbQualMedAndDentalExpAmt"/>
</xsl:call-template>
</div>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 15-->
<!-- Begin (Line) 16 -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox" style="padding-left:2mm;">16</div>
<div class="styIRS8889LNDesc" style="height:4mm;">
<span class="styBoldText">Taxable HSA distributions.</span> Subtract line 15 from line 14c. If zero or less, enter -0-. Also,<br/>
include this amount in the total on Form 1040, line 21, or Form 1040NR, line 21. On the dotted<br/>
line next to line 21, enter “HSA” and the amount
<span style="width:9px;"/>
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:20px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<span style="padding-top:1px;">
<div class="styLNRightNumBox" style="height:6.5mm;border-bottom-width:0px;"/>
<div class="styLNAmountBox" style="height:6.5mm;width:33mm;border-bottom-width:0px;"/>
<div class="styLNRightNumBox" style="height:4mm;">16</div>
<div class="styLNAmountBox" style="width:33mm;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/TaxableHSADistributionAmt"/>
</xsl:call-template>
</div>
</span>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 16-->
<!-- Begin (Line) 17a -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox" style="padding-left:2mm;">17a</div>
<div class="styIRS8889LNDesc" style="height:4mm;">
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form8889Data/HSADistriAddnlPercentTaxExcInd"/>
<xsl:with-param name="BackupName">IRS8889HSADistriAddnlPercentTaxExcInd</xsl:with-param>
</xsl:call-template>
If any of the distributions included on line 16 meet any of the <span class="styBoldText">Exceptions to the Additional<br/>
20% Tax</span> (see instructions), check here
<span style="width:3px;"/>
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:16px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
<span style="width:5px"/>
<img src="{$ImagePath}/8889_Bullet_Md.gif" alt="Bullet Image"/>
<span style="width:7px"/>
</label>
<input type="checkbox" class="styCkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form8889Data/HSADistriAddnlPercentTaxExcInd"/>
<xsl:with-param name="BackupName">IRS8889HSADistriAddnlPercentTaxExcInd</xsl:with-param>
</xsl:call-template>
</input>
</div>
<span style="padding-top:1px;">
<div class="styLNRightNumBox" style="background-color:lightgrey;height:2mm;border-bottom-width:0px;"/>
<div class="styLNAmountBox" style="height:2mm;width:33mm;border-bottom-width:0px;"/>
<div class="styLNRightNumBox" style="background-color:lightgrey;height:4mm;border-bottom-width:0px;"/>
<div class="styLNAmountBox" style="width:33mm;border-bottom-width:0px;"/>
</span>
</div>
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<!-- End (Line) 17a-->
<!-- Begin (Line) 17b -->
<!-- \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ -->
<div class="styIRS8889LineItem">
<div class="styIRS8889LNLeftNumBox" style="padding-left:5mm;">b</div>
<div class="styIRS8889LNDesc" style="height:4mm;">
<span class="styBoldText">Additional 20% tax</span> (see instructions). Enter 20% (.20) of the distributions included on line 16<br/>
that are subject to the additional 20% tax. Also include this amount in the total on Form 1040,<br/>
line 60, or Form 1040NR, line 59. On the dotted line next to Form 1040, line 60, or Form<br/>
1040NR, line 59, enter “HSA” and the amount
<span style="width:3px;"/>
<!--Dotted Line-->
<span class="styBoldText">
<span style="width:16px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
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<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
<span style="width:11px"/>.
</span>
</div>
<span style="padding-top:1px;">
<div class="styLNRightNumBox" style="background-color:lightgrey;height:5mm;border-bottom-width:0px;"/>
<div class="styLNAmountBox" style="height:5mm;width:33mm;border-bottom-width:0px;"/>
<div class="styLNRightNumBox" style="background-color:lightgrey;height:4mm;border-bottom-width:0px;"/>
<div class="styLNAmountBox" style="width:33mm;border-bottom-width:0px;"/>
<div class="styLNRightNumBox" style="height:4mm;border-bottom-width:0px;">17b</div>
<div class="styLNAmountBox" style="width:33mm;border-bottom-width:0px;">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form8889Data/HSADistriAddnlPercentTaxAmt"/>
</xsl:call-template>
</div>
</span>
</div>
<!-- /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// -->
<!-- End (Line) 17b-->
</div>
<!-- END PREPARER SIGNATURE SECTION -->
<!-- Page Break and Footer-->
<div class="pageEnd" style="width:187mm;padding-top:1mm;">
<div style="float:left;">
<span class="styBoldText">For Paperwork Reduction Act Notice, see your tax return instructions.</span>
<span style="width:13mm;"/>
Cat. No. 37621P
</div>
<div style="float:right;">
<span style="width:40px;"/>
Form <span class="styBoldText" style="font-size:8pt;">8889</span> (2012)
</div>
</div>
<!-- END Page Break and Footer-->
<!--Begin Page 2 -->
<!-- Page Header -->
<div class="styBB" style="width:187mm;padding-top:.5mm;">
<div style="float:left;">Form 8889 (2012)<span style="width:148mm;"/>
</div>
<div style="float:right;">Page <span style="font-weight:bold;font-size:8pt;">2</span>
</div>
</div>
<!-- END Page Header -->
<!-- Begin Part III (Header)-->
<div style="width:187mm;" class="styBB">