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Federal Free Printable Form 1099-LTC (Rev. October 2019) for 2022 Federal Long-Term Care and Accelerated Death Benefits

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Long-Term Care and Accelerated Death Benefits
Form 1099-LTC (Rev. October 2019)

9393 VOID CORRECTED PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. 1 Gross long-term care benefits paid OMB No. 1545-1519 Form $ 2 Accelerated death benefits paid PAYER’S TIN POLICYHOLDER’S TIN $ 1099-LTC Long-Term Care and (Rev. October 2019) For calendar year Accelerated Death Benefits 20 INSURED’S TIN POLICYHOLDER’S name File with Form 1096. Street address (including apt. no.) Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code City or town, state or province, country, and ZIP or foreign postal code Account number (see instructions) 4 Qualified contract (optional) 5 Check, if applicable (optional): Copy A For Internal Revenue Service Center 3 Check one: Per Reimbursed diem amount INSURED’S name Chronically ill Terminally ill Date certified For Privacy Act and Paperwork Reduction Act Notice, see the current General Instructions for Certain Information Returns. 1099-LTC (Rev. 10-2019) Cat. No. 23021Z www.irs.gov/Form1099LTC Department of the Treasury - Internal Revenue Service Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page Form CORRECTED (if checked) PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. 1 Gross long-term care benefits paid OMB No. 1545-1519 Form $ 2 Accelerated death benefits paid PAYER’S TIN POLICYHOLDER’S TIN $ 3 Per Reimbursed diem amount INSURED’S name POLICYHOLDER’S name Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code Account number (see instructions) Form 1099-LTC (Rev. 10-2019) 4 Qualified contract (optional) (keep for your records) 1099-LTC Long-Term Care and (Rev. October 2019) For calendar year Accelerated Death Benefits 20 INSURED’S TIN Copy B For Policyholder This is important tax information and is being furnished to the IRS. If you are required to file a return, a negligence Street address (including apt. no.) penalty or other sanction may be imposed on you if this City or town, state or province, country, and ZIP or foreign postal code item is required to be reported and the IRS determines that it has 5 (optional) Chronically ill Date certified not been reported. Terminally ill www.irs.gov/Form1099LTC Department of the Treasury - Internal Revenue Service Instructions for Policyholder A payer, such as an insurance company or a viatical settlement provider, must give this form to you for payments made under a long-term care insurance contract or for accelerated death benefits. Payments include those made directly to you (or to the insured) and those made to third parties. A long-term care insurance contract provides coverage of expenses for longterm care services for an individual who has been certified by a licensed health care practitioner as chronically ill. A life insurance company or viatical settlement provider may pay accelerated death benefits if the insured has been certified either by a physician as terminally ill or by a licensed health care practitioner as chronically ill. Long-term care insurance contract. Generally, amounts received under a qualified long-term care insurance contract are excluded from your income. However, if payments are made on a per diem basis, the amount you may exclude is limited. The per diem exclusion limit must be allocated among all policyholders who own qualified long-term care insurance contracts for the same insured. See Pub. 525 and Form 8853 and its instructions for more information. Per diem basis. This means the payments were made on any periodic basis without regard to the actual expenses incurred during the period to which the payments relate. Accelerated death benefits. Amounts paid as accelerated death benefits are fully excludable from your income if the insured has been certified by a physician as terminally ill. Accelerated death benefits paid on behalf of individuals who are certified as chronically ill are excludable from income to the same extent they would be if paid under a qualified long-term care insurance contract. Policyholder’s taxpayer identification number (TIN). For your protection, this form may show only the last four digits of your TIN (social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN)). However, the issuer has reported your complete TIN to the IRS. Account number. May show an account or other unique number the payer assigned to distinguish your account. Box 1. Shows the gross benefits paid under a long-term care insurance contract during the year. Box 2. Shows the gross accelerated death benefits paid during the year. Box 3. Shows if the amount in box 1 or 2 was paid on a per diem basis or was reimbursement of actual long-term care expenses. If the insured was terminally ill, this box may not be checked. Box 4. May show if the benefits were from a qualified long-term care insurance contract. Box 5. May show if the insured was certified chronically ill or terminally ill and the latest date certified. Future developments. For the latest developments related to Form 1099-LTC and its instructions, such as legislation enacted after they were published, go to www.irs.gov/Form1099LTC. CORRECTED (if checked) PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. 1 Gross long-term care benefits paid OMB No. 1545-1519 Form $ 2 Accelerated death benefits paid PAYER’S TIN POLICYHOLDER’S TIN $ 1099-LTC Long-Term Care and (Rev. October 2019) For calendar year Accelerated Death Benefits 20 INSURED’S TIN Per Reimbursed diem amount INSURED’S name POLICYHOLDER’S name Street address (including apt. no.) Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code City or town, state or province, country, and ZIP or foreign postal code Account number (see instructions) Form 1099-LTC (Rev. 10-2019) 4 Qualified contract (optional) (keep for your records) 5 (optional) Copy C For Insured 3 Chronically ill Date certified Copy C is provided to you for information only. Only the policyholder is required to report this information on a tax return. Terminally ill www.irs.gov/Form1099LTC Department of the Treasury - Internal Revenue Service Instructions for Insured A payer, such as an insurance company or a viatical settlement provider, must give this form to you and to the policyholder for payments made under a long-term care insurance contract or for accelerated death benefits. Payments include both benefits you received directly and expenses paid on your behalf to third parties. If you are the insured but are not the policyholder, Copy C is provided to you for information only because these payments are not taxable to you. If you are also the policyholder, you should receive Copy B. Insured’s taxpayer identification number (TIN). For your protection, this form may show only the last four digits of your TIN (social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN)). However, the issuer has reported your complete TIN to the IRS. Account number. May show an account or other unique number the payer assigned to distinguish your account. Box 1. Shows the gross benefits paid under a long-term care insurance contract during the year. Box 2. Shows the gross accelerated death benefits paid during the year. Box 3. Shows if the amount in box 1 or 2 was paid on a per diem basis or was reimbursement of actual long-term care expenses. If you are terminally ill this box may not be checked. Box 4. May show if the benefits were from a qualified longterm care insurance contract. Box 5. May show if you were certified chronically ill or terminally ill and the latest date certified. Future developments. For the latest developments related to Form 1099-LTC and its instructions, such as legislation enacted after they were published, go to www.irs.gov/ Form1099LTC. VOID CORRECTED PAYER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. 1 Gross long-term care benefits paid OMB No. 1545-1519 Form $ 2 Accelerated death benefits paid PAYER’S TIN POLICYHOLDER’S TIN $ 1099-LTC Long-Term Care and (Rev. October 2019) For calendar year Accelerated Death Benefits 20 INSURED’S TIN 3 Per Reimbursed diem amount INSURED’S name POLICYHOLDER’S name Street address (including apt. no.) Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code City or town, state or province, country, and ZIP or foreign postal code Account number (see instructions) Form 1099-LTC (Rev. 10-2019) 4 Qualified contract (optional) 5 Check, if applicable (optional): www.irs.gov/Form1099LTC Copy D For Payer Chronically ill Date certified For Privacy Act and Paperwork Reduction Act Notice, see the current General Instructions for Certain Information Returns. Terminally ill Department of the Treasury - Internal Revenue Service Instructions for Payer To complete Form 1099-LTC, use: • The current General Instructions for Certain Information Returns, and • The current Instructions for Form 1099-LTC. To get or to order these instructions, go to www.irs.gov/Form1099LTC. Filing and furnishing. For filing and furnishing instructions, including due dates, and to request filing or furnishing extensions, see the current General Instructions for Certain Information Returns. To file electronically, you must have software that generates a file according to the specifications in Pub. 1220. Need help? If you have questions about reporting on Form 1099-LTC, call the information reporting customer service site toll free at 866-455-7438 or 304-263-8700 (not toll free). Persons with a hearing or speech disability with access to TTY/TDD equipment can call 304-579-4827 (not toll free).
Extracted from PDF file 2021-federal-form-1099-ltc.pdf, last modified October 2019

More about the Federal Form 1099-LTC Corporate Income Tax TY 2021

We last updated the Long-Term Care and Accelerated Death Benefits in April 2022, so this is the latest version of Form 1099-LTC, fully updated for tax year 2021. You can download or print current or past-year PDFs of Form 1099-LTC directly from TaxFormFinder. You can print other Federal tax forms here.

Other Federal Corporate Income Tax Forms:

TaxFormFinder has an additional 774 Federal income tax forms that you may need, plus all federal income tax forms.

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1040 (Schedule B) Interest and Ordinary Dividends
941 (Schedule B) Report of Tax Liability for Semiweekly Schedule Depositors
Form 4684 Casualties and Thefts
1041 (Schedule D) Capital Gains and Losses
1120-S (Schedule K-1) Shareholder’s Share of Income, Deductions, Credits, etc.

Download all  tax forms View all 775 Federal Income Tax Forms


Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 1099-LTC from the Internal Revenue Service in April 2022.

Show Sources >

About the Corporate Income Tax

The IRS and most states require corporations to file an income tax return, with the exact filing requirements depending on the type of company.

Sole proprietorships or disregarded entities like LLCs are filed on Schedule C (or the state equivalent) of the owner's personal income tax return, flow-through entities like S Corporations or Partnerships are generally required to file an informational return equivilent to the IRS Form 1120S or Form 1065, and full corporations must file the equivalent of federal Form 1120 (and, unlike flow-through corporations, are often subject to a corporate tax liability).

Additional forms are available for a wide variety of specific entities and transactions including fiduciaries, nonprofits, and companies involved in other specific types of business.

Historical Past-Year Versions of Federal Form 1099-LTC

We have a total of ten past-year versions of Form 1099-LTC in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2021 Form 1099-LTC

Form 1099-LTC (Rev. October 2019)

2020 Form 1099-LTC

Form 1099-LTC (Rev. October 2019)

2019 Form 1099-LTC

2019 Form 1099-LTC

2017 Form 1099-LTC

2018 Form 1099-LTC

2016 Form 1099-LTC

2017 Form 1099-LTC

Long-Term Care and Accelerated Death Benefits 2015 Form 1099-LTC

2016 Form 1099-LTC

Long-Term Care and Accelerated Death Benefits 2014 Form 1099-LTC

2014 Form 1099-LTC

Long-Term Care and Accelerated Death Benefits 2013 Form 1099-LTC

2013 Form 1099-LTC

Long-Term Care and Accelerated Death Benefits 2012 Form 1099-LTC

2013 Form 1099-LTC

Long-Term Care and Accelerated Death Benefits 2011 Form 1099-LTC

2012 Form 1099-LTC


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