Q2 HSA Rollover Options

Please take a few moments to finalize your HSA rollover election.

Full Name*

E-mail*

Daytime Phone Number*

HSA Account Options (Check one box only)

Option #1

I would like to keep my First Financial HSA open.

I understand Q2 will now use Discovery Benefits for HSA Banking and that all contributions and deposits as of January 1, 2017 will be directed to the new account. I understand that in the event I am no longer employed by Q2, I am solely responsible for the First Financial and Discovery Benefits monthly HSA administration fees.

Option #2

I would like to close my First Financial HSA and transfer the remaining balance to the new Discovery Benefits HSA.

I understand Q2 will now use Discovery Benefits for HSA Banking and that all contributions and deposits as of January 1, 2017 will be directed to the new account. I understand during the transfer process there will be a black out period of approximately 2-4 weeks during which my First Financial HSA funds will not be available for use. I understand that in the event I am no longer employed by Q2, I am solely responsible for the Discovery Benefits monthly HSA administration fees.

Please follow the directions below to initiate your HSA funds transfer

Make sure your Discovery Benefits Account has been opened
Make sure you have a Signature Card on file with First Financial
- Missing signature cards will delay the transfer process
Download and complete the Discovery Benefits HSA Transfer Request Form (click the link below)
- Discovery Benefits HSA Transfer Request Form
- Make sure and provide your current First Financial account number on the form
Submit the Discovery Benefits HSA Transfer Request Form to Shelby O’Donnell:
Email: sodonnell@ffin.com

Fax: 325-627-7743

Mailing Address:

First Financial Bank

1010 N Judge Ely Blvd

Abilene, TX 79601