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Federal Free Printable 2019 Form 1099-LTC for 2019 Federal Long-Term Care and Accelerated Death Benefits

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Long-Term Care and Accelerated Death Benefits
2019 Form 1099-LTC

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 $ 2 Accelerated death benefits paid PAYER’S TIN POLICYHOLDER'S TIN $ OMB No. 1545-1519 2019 Long-Term Care and Accelerated Death Benefits Form 1099-LTC 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 2019 General Instructions for Certain Information Returns. 1099-LTC 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 $ 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 4 Qualified contract (optional) (keep for your records) OMB No. 1545-1519 2019 Long-Term Care and Accelerated Death Benefits Form 1099-LTC 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) Date certified Chronically ill 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 by either 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 $ 2 Accelerated death benefits paid PAYER’S TIN POLICYHOLDER'S TIN $ OMB No. 1545-1519 2019 Long-Term Care and Accelerated Death Benefits Form 1099-LTC 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 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 $ 2 Accelerated death benefits paid PAYER’S TIN POLICYHOLDER'S TIN $ OMB No. 1545-1519 2019 Long-Term Care and Accelerated Death Benefits Form 1099-LTC 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 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 2019 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 2019 General Instructions for Certain Information Returns, and • The 2019 Instructions for Form 1099-LTC. To get or to order these instructions, go to www.irs.gov/Form1099LTC. Due dates. Furnish Copy B of this form to the policyholder by January 31, 2020. Furnish Copy C of this form to the insured by January 31, 2020. File Copy A of this form with the IRS by February 28, 2020. If you file electronically, the due date is March 31, 2020. 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 2019-federal-form-1099-ltc.pdf, last modified October 2018

More about the Federal Form 1099-LTC Other TY 2019

We last updated the Long-Term Care and Accelerated Death Benefits in February 2019, so this is the latest version of Form 1099-LTC, fully updated for tax year 2018. 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.


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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 February 2019.

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Historical Past-Year Versions of Federal Form 1099-LTC

We have a total of eight 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:


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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