Details
- Category
- Vendor
- Optum Financial
- Amount
- $1,778.00
- Date
- Sep 30, 2025
- Processed
- Feb 10, 2026 3:40 AM EST
- Original File
- Report_02102026_033911_000116.pdf
Summary
Quarterly Health Savings Account statement for Johan Jongsma covering the period July 1, 2025 through September 30, 2025, showing an ending cash balance of $1,778.00, zero year-to-date contributions, and a 2025 contribution limit of $9,550.00.
Notes
No notes yet. Click Edit to add notes.
OCR Text
---
## Page 1
The user wants me to transcribe ALL visible text on the page as clean markdown. I need to output ONLY the transcribed text with no commentary, no analysis, no preamble. I should use ### for sections, **bold** for labels, markdown tables for tabular data, and bullets for lists. I need to preserve all numbers, dates, and values exactly as shown.
Let me go through the document carefully:
Top left:
- Optum Financial®
- P.O.BOX 271629
- SALT LAKE CITY, UT 84127-1629
Top right:
- Account number: 412231515
- Statement dates: 07/01/2025-09/30/2025
Middle left (below QR codes):
- 0384224 SP 2105 -C01-P84528-
- JOHAN JONGSMA
- 851 BRIGHTWATERS BLVD NE
- SAINT PETERSBURG, FL 33704-3719
Below that:
- Thank you for being a
- HSA (health savings account)
- customer since 06/2018.
Right side box:
- Sign up for paperless delivery.
- Help reduce waste, receive important account information more quickly, and save on any fees assessed for paper mailings.
- Sign in to your online account to switch to email as your preferred communication method.
Main section header:
- Your quarterly HSA statement at a glance
Financial data:
- Beginning HSA cash balance as of 07/01/2025: $1,787.60
- Ending HSA cash balance as of 09/30/2025: $1,778.00
Below that:
- Your 2025 YTD contributions:
- $0.00
Circular chart area:
- $9,550
- Your 2025 contribution limit*
Next to the circle:
- $9,550.00 Amount you can still contribute
- $0.00 Your YTD contribution
Right side gray box:
- Helpful tips
- Contribute
- Leading financial advisors consider HSAs one of the most powerful savings accounts due to it's pre-tax savings and unlike a 401k, you can access and use your HSA for eligible expenses at any time before retirement age.
- Invest
- Take your HSA beyond medical cost savings. You may be able to use it as a smart investment option that can help you build a financial plan for today and tomorrow.
Bottom left footnote:
- *Your contribution amount can vary based on your Plan elections, eligibility and other factors. Please consult your legal, accounting or tax advisor to determine the amount applicable to your situation.
Left vertical text:
- 2105-01-01-0384224-0001-0874430
Let me format this properly as markdown.
I should structure this with:
- Header info
- Statement details
- Customer info
- Main statement section
- Financial summary (maybe a table?)
- Contribution section
- Tips section
- Footnote
Let me be careful to capture everything exactly as shown.
Looking at the layout:
- "Your quarterly HSA statement at a glance" is a section header.
- The balances are on separate lines with amounts aligned right.
- The 2025 YTD contributions is separate.
- The circular chart has "$9,550 Your 2025 contribution limit*"
- To the right of that are two items with gray squares: "$9,550.00 Amount you can still contribute" and "$0.00 Your YTD contribution"
- The helpful tips box is on the right.
Actually, looking at the circular chart area, there are two gray boxes to the right:
1. Light gray square: $9,550.00 Amount you can still contribute
2. Dark gray square: $0.00 Your YTD contribution
Wait, looking more carefully at the image, the circle shows "$9,550 Your 2025 contribution limit*" and to the right there are two line items with small squares (one light, one dark) indicating:
- $9,550.00 Amount you can still contribute
- $0.00 Your YTD contribution
Actually, the circle is a visual representation, and the text inside says "$9,550 Your 2025 contribution limit*".
Let me structure this cleanly.
I need to make sure I capture the vertical text on the left side: "2105-01-01-0384224-0001-0874430"
Also the codes near the name: "0384224 SP 2105 -C01-P84528-"
Let me draft the markdown:
```
### Optum Financial®
P.O.BOX 271629
SALT LAKE CITY, UT 84127-1629
**Account number:** 412231515
**Statement dates:** 07/01/2025-09/30/2025
---
0384224 SP 2105 -C01-P84528-
**JOHAN JONGSMA**
851 BRIGHTWATERS BLVD NE
SAINT PETERSBURG, FL 33704-3719
> Thank you for being a HSA (health savings account) customer since 06/2018.
---
> **Sign up for paperless delivery.**
> Help reduce waste, receive important account information more quickly, and save on any fees assessed for paper mailings.
> Sign in to your online account to switch to email as your preferred communication method.
---
## Your quarterly HSA statement at a glance
| | |
|:---|---:|
| Beginning HSA cash balance as of 07/01/2025: | $1,787.60 |
| Ending HSA cash balance as of 09/30/2025: | $1,778.00 |
**Your 2025 YTD contributions:**
$0.00
---
**$9,550**
Your 2025 contribution limit*
| | |
|:---|---:|
| $9,550.00 | Amount you can still contribute |
| $0.00 | Your YTD contribution |
---
### Helpful tips
**Contribute**
Leading financial advisors consider HSAs one of the most powerful savings accounts due to it's pre-tax savings and unlike a 401k, you can access and use your HSA for eligible expenses at any time before retirement age.
**Invest**
Take your HSA beyond medical cost savings. You may be able to use it as a smart investment option that can help you build a financial plan for today and tomorrow.
---
*Your contribution amount can vary based on your Plan elections, eligibility and other factors. Please consult your legal, accounting or tax advisor to determine the amount applicable to your situation.
2105-01-01-0384224-0001-0874430
```
Wait, I need to check the formatting of the "Amount you can still contribute" section. Looking at the image, there are small gray square icons next to the amounts. But I should just transcribe the text.
Let me reconsider the structure. The user wants clean markdown. I should try to represent the layout accurately but cleanly.
Actually, looking at the document again, the "Sign up for paperless delivery" appears to be in a box on the upper right. The "Helpful tips" is in a gray box on the lower right.
For the contribution section, there's a circular chart graphic with "$9,550 Your 2025 contribution limit*" inside it, and to the right are two lines with gray squares:
- Light gray square: $9,550.00 Amount you can still contribute
- Dark gray square: $0.00 Your YTD contribution
I should capture this clearly.
Also, I notice the vertical text on the far left: "2105-01-01-0384224-0001-0874430"
Let me refine:
```
### Optum Financial®
P.O.BOX 271629
SALT LAKE CITY, UT 84127-1629
**Account number:** 412231515
**Statement dates:** 07/01/2025-09/30/2025
---
0384224 SP 2105 -C01-P84528-
**JOHAN JONGSMA**
851 BRIGHTWATERS BLVD NE
SAINT PETERSBURG, FL 33704-3719
Thank you for being a HSA (health savings account) customer since 06/2018.
> **Sign up for paperless delivery.**
> Help reduce waste, receive important account information more quickly, and save on any fees assessed for paper mailings.
> Sign in to your online account to switch to email as your preferred communication method.
---
## Your quarterly HSA statement at a glance
**Beginning HSA cash balance as of 07/01/2025:** $1,787.60
**Ending HSA cash balance as of 09/30/2025:** $1,778.00
**Your 2025 YTD contributions:**
$0.00
---
**$9,550**
Your 2025 contribution limit*
- $9,550.00 Amount you can still contribute
- $0.00 Your YTD contribution
---
### Helpful tips
**Contribute**
Leading financial advisors consider HSAs one of the most powerful savings accounts due to it's pre-tax savings and unlike a 401k, you can access and use your HSA for eligible expenses at any time before retirement age.
**Invest**
Take your HSA beyond medical cost savings. You may be able to use it as a smart investment option that can help you build a financial plan for today and tomorrow.
---
*Your contribution amount can vary based on your Plan elections, eligibility and other factors. Please consult your legal, accounting or tax advisor to determine the amount applicable to your situation.
2105-01-01-0384224-0001-0874430
```
Hmm, but the bullets might not capture the gray squares. Actually, looking at the image again, those look like legend items for the circular chart. The light gray corresponds to "Amount you can still contribute" and the dark gray corresponds to "Your YTD contribution".
But the user said "Transcribe ALL visible text". So I should include the text, but I don't need to reproduce the gray squares exactly. However, I should note that the amounts are aligned with labels.
Actually, looking very carefully at the image, the layout is:
[Circular graphic]
$9,550
Your 2025
contribution limit*
[To the right, two lines with small colored squares:]
[Light square] $9,550.00 Amount you can still contribute
[Dark square] $0.00 Your YTD contribution
So I could format this as:
**$9,550**
Your 2025 contribution limit*
| | |
|:--|:--|
| $9,550.00 | Amount you can still contribute |
| $0.00 | Your YTD contribution |
Or just as two lines. Actually, looking at the font sizes, "$9,550.00" and "$0.00" are bold or larger, and the text after is regular.
Let me try to be precise but clean. I'll use a table for the balance section since those are clearly aligned left and right.
For the contribution section, I'll present it clearly with the limit and then the breakdown.
Wait, I need to check if there's any other text. Let me scan once more.
Top left: Optum Financial logo text
Address: P.O.BOX 271629, SALT LAKE CITY, UT 84127-1629
Top right: Account number and dates.
Middle: The codes 0384224 SP 2105 -C01-P84528-
Name and address.
Handshake icon with "Thank you for being a HSA (health savings account) customer since 06/2018."
Paperless delivery box with icon.
Main title: "Your quarterly HSA statement at a glance"
Balances:
Beginning HSA cash balance as of 07/01/2025: $1,787.60
Ending HSA cash balance as of 09/30/2025: $1,778.00
YTD Contributions:
Your 2025 YTD contributions:
$0.00
Contribution section:
Circle with "$9,550 Your 2025 contribution limit*"
Legend:
$9,550.00 Amount you can still contribute
$0.00 Your YTD contribution
Helpful tips section:
Checkmark icon
Helpful tips
Contribute
[Text]
Invest
[Text]
Footnote:
*Your contribution amount can vary based on your Plan elections, eligibility and other factors. Please consult your legal, accounting or tax advisor to determine the amount applicable to your situation.
Left margin vertical text: 2105-01-01-0384224-0001-0874430
Okay, I think I have everything. Let me format this nicely.
One thing: the "Your 2025 YTD contributions:" is $0.00, and then in the circular chart legend it also says "$0.00 Your YTD contribution". These are the same value displayed in two places.
Also, the circular chart shows the limit is $9,550, and the amount you can still contribute is also $9,550.00, which makes sense if YTD is $0.
I'll format the main financial data as a table for clarity, or keep it as lines with bold labels. Tables might be cleaner for the alignment.
Actually, looking at the document, the balances are presented as:
Label on left, amount on right.
I could do:
**Beginning HSA cash balance as of 07/01/2025:** $1,787.60
**Ending HSA cash balance as of 09/30/2025:** $1,778.00
Or a table:
| Beginning HSA cash balance as of 07/01/2025 | $1,787.60 |
| Ending HSA cash balance as of 09/30/2025 | $1,778.00 |
But the first way is simpler and captures the text exactly.
For the contribution section with the circle, I should present the text that is inside the circle and the text to the right.
Final check on the "Helpful tips" section - it has two subsections: "Contribute" and "Invest".
Alright, here's my final output:
```
Optum Financial®
P.O.BOX 271629
SALT LAKE CITY, UT 84127-1629
**Account number:** 412231515
**Statement dates:** 07/01/2025-09/30/2025
---
0384224 SP 2105 -C01-P84528-
**JOHAN JONGSMA**
851 BRIGHTWATERS BLVD NE
SAINT PETERSBURG, FL 33704-3719
Thank you for being a HSA (health savings account) customer since 06/2018.
> **Sign up for paperless delivery.**
> Help reduce waste, receive important account information more quickly, and save on any fees assessed for paper mailings.
>
> Sign in to your online account to switch to email as your preferred communication method.
---
### Your quarterly HSA statement at a glance
**Beginning HSA cash balance as of 07/01/2025:** $1,787.60
**Ending HSA cash balance as of 09/30/2025:** $1,778.00
**Your 2025 YTD contributions:**
$0.00
---
**$9,550**
Your 2025 contribution limit*
**$9,550.00** Amount you can still contribute
**$0.00** Your YTD contribution
---
### Helpful tips
**Contribute**
Leading financial advisors consider HSAs one of the most powerful savings accounts due to it's pre-tax savings and unlike a 401k, you can access and use your HSA for eligible expenses at any time before retirement age.
**Invest**
Take your HSA beyond medical cost savings. You may be able to use it as a smart investment option that can help you build a financial plan for today and tomorrow.
---
*Your contribution amount can vary based on your Plan elections, eligibility and other factors. Please consult your legal, accounting or tax advisor to determine the amount applicable to your situation.
2105-01-01-0384224-0001-0874430
```
Wait, I need to check the exact formatting of the "Sign up for paperless delivery" section. It has a document icon next to it. The text is:
"Sign up for paperless delivery."
Then paragraph: "Help reduce waste..."
Then paragraph: "Sign in to your online account..."
Also, the "Helpful tips" has a checkmark icon.
The user said to use ### for sections, **bold** for labels, markdown tables for tabular data, bullets for lists.
I haven't used any tables yet. The balance lines could be a table. Let me consider:
| **Beginning HSA cash balance as of 07/01/2025** | $1,787.60 |
|:--|--:|
| **Ending HSA cash balance as of 09/30/2025** | $1,778.00 |
That might be cleaner. But the user said "preserve all numbers, dates, and values exactly as shown." The colon is part of the label in the original: "Beginning HSA cash balance as of 07/01/2025:"
So:
| Beginning HSA cash balance as of 07/01/2025: | $1,787.60 |
|:--|--:|
Actually, looking at the image, the colon is present.
Let me reconsider the contribution section. It looks like:
$9,550.00 Amount you can still contribute
$0.00 Your YTD contribution
These might be better as a list or table too.
Table format:
| $9,550.00 | Amount you can still contribute |
| $0.00 | Your YTD contribution |
Or with the gray squares mentioned somehow? No, just the text.
Actually, looking at the image once more, the "$9,550 Your 2025 contribution limit*" is centered in a circle. The two items to the right are aligned with the circle.
I think presenting it as:
**$9,550**
Your 2025 contribution limit*
| | |
|--|--|
| **$9,550.00** | Amount you can still contribute |
| **$0.00** | Your YTD contribution |
Or without table borders, just:
**$9,550**
Your 2025 contribution limit*
- **$9,550.00** Amount you can still contribute
- **$0.00** Your YTD contribution
But the original doesn't use bullets. It uses a visual layout with squares.
Actually, looking at the "Helpful tips" section, it has bold headers "Contribute" and "Invest".
Let me do one more careful pass of the text to ensure I have every character right.
Top right: "Account number: 412231515" - correct.
"Statement dates: 07/01/2025-09/30/2025" - correct.
Address: "P.O.BOX 271629" - correct.
"SALT LAKE CITY, UT 84127-1629" - correct.
Customer info line 1: "0384224 SP 2105 -C01-P84528-" - correct.
Customer: "
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