Independent Health Flexible Spending Account (FSA) Claim for UB Foundation (UBF)

Make a general claim for expense reimbursement on your Independent Health Flexible Spending Account. This is for use with the UB Foundation.

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Completing the PDF Form

  1. Read through all pages of the document to find specific instructions
  2. Enter requested information into the form
  3. Print the form
  4. Get required signatures
  5. Scan a copy of the signed form for your records
  6. Send the original, completed, signed form to:

Independent Health Corporation
Attn: FSA Administration
511 Farber Lakes Drive
Buffalo, NY 14221 

Need Help Completing the Form?

Joyce Weeman

Joyce Weeman

Benefits Specialist

UB Foundation

Phone: 716-645-8731


avatar of Lisa Adamshick

Lisa Adamshick

Benefits Manager

UB Foundation

Phone: 716-645-8733


Form Facts

Form Type: Downloadable, PDF document

Requirements: Adobe Reader

Updated: 6/07/2011

Owner: UB Foundation