401k hardship medical expense documentation
[DOCX File]Coquille Valley Hospital
https://info.5y1.org/401k-hardship-medical-expense-documentation_1_e9d9c2.html
Within 30 calendar days after we receive your completed application and documentation, we will notify you if you qualify for assistance. ... EXPENSE INFORMATION. ... such as a financial hardship, excessive medical expenses, seasonal or temporary income, or personal loss. ...
[DOC File]APPENDIX G (PAGE 1 OF 5)
https://info.5y1.org/401k-hardship-medical-expense-documentation_1_5ae72f.html
Do not include the value of life insurance or retirement plans when calculating assets (401K, pension funds, annuities, IRAs, Keogh plans, etc.) Total (Gross Income) {25} $ Total Debt / Expenses {36} $ Total Assets {46} $ INCOME MUST BE DOCUMENTED 1 Include combined monthly income and expenses from the borrower and co-borrower (if any).
[DOC File]SAMPLE PROFIT SHARING PLAN
https://info.5y1.org/401k-hardship-medical-expense-documentation_1_e728fb.html
Generally, a hardship distribution may only be made for payment of the following: ( Expenses for medical care (described in Section 213(d) of the Internal Revenue Code) previously incurred by you, your spouse or your dependents or necessary for you, your spouse or your dependents to obtain medical …
[DOCX File]WSHA Standard Financial Assistance Application form
https://info.5y1.org/401k-hardship-medical-expense-documentation_1_181a34.html
Provide documentation for family income . ... Stocks Bonds 401K Health Savings Account(s) Trust(s) Property (excluding primary residence) Own a business ... such as a financial hardship, excessive medical expenses, seasonal or temporary income, or personal loss. PATIENT AGREEMENT.
[DOC File]Sample Letter - Notification of Payroll Overpayment ...
https://info.5y1.org/401k-hardship-medical-expense-documentation_1_93e181.html
Title: Sample Letter - Notification of Payroll Overpayment - Represented Employees Author: OFM Accounting Last modified by: Jayda Williams Created Date
[DOCX File]Disclose and provide documentation of household income.
https://info.5y1.org/401k-hardship-medical-expense-documentation_1_00800a.html
Provide documentation of expenses. Expenses may not be considered if you do not provide documents supporting the amounts claimed. Disclose and provide documentation of household income. Failure to provide this information and documentation may result in a denial of your claim of financial hardship. Income. Your. Name: Your Social. Security. No ...
[DOC File]SUMMARY PLAN DESCRIPTION
https://info.5y1.org/401k-hardship-medical-expense-documentation_1_ed989b.html
If you qualify, you may apply for a hardship withdrawal to satisfy the following needs: (1) medical expenses for you, your spouse, children, dependents or a primary beneficiary designated by you under the Plan; (2) the purchase of your principal residence; (3) to prevent your eviction from, or foreclosure on, your principal residence; (4) to ...
[DOCX File]OAHHS Financial Assistance Application - Oregon
https://info.5y1.org/401k-hardship-medical-expense-documentation_1_2b43b1.html
Within 21 calendar days after we receive your completed application and documentation, we will notify you if you qualify for assistance. ... Stocks Bonds 401K Health Savings Account(s) Trust(s) ... such as a financial hardship, excessive medical expenses, seasonal or temporary income, or personal loss. PATIENT AGREEMENT ...
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