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Benefit Expense Transmittal” (Ms. Albers’s employee benefit
expense form) that Ms. Albers had completed. That form, which
Ms. Albers signed as employee and Mr. Albers signed as employer,
stated in pertinent part:
EMPLOYEE STATUS
Gross W-2 wage to employees during
2001 (other than benefits): _______[9]
* * * * * * *
BENEFIT TOTALS
1 Medical/Health Insurance Premium
(from Section 2)[10] 3586.00
* * * * * * *
7 Medical expenses from 2001 plan year
(from Sections 3 and 4)[10] 4630.00[11]
* * * * * * *
TOTAL 8216.00
READ, SIGN AND DATE
To the best of my [Ms. Albers] knowledge and belief, my statements
in this transmittal are complete and true. I am claiming only
eligible expenses incurred during the applicable plan year(s) and
for eligible plan participants. I certify that any part or all of
these expenses have not been reimbursed previously under this or
any other benefit plan and have not been previously claimed as a
tax deduction.
* * * * * * *
The employee listed [Ms. Albers] is or has been an employee for a
9No amount was shown in Ms. Albers’s employee benefit ex-
pense form as her “Gross W-2 wage * * * during 2001 (other than
benefits)”.
10Sections 2 and 4 of Ms. Albers’s employee benefit expense
form are not part of the record in this case.
11The amount shown is the amount, rounded down, of the total
(i.e., $4,630.58) of all of the medical expenses shown in “Sec-
tion 3 Medical Expenses” quoted below.
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Last modified: November 10, 2007