7474 VOID CORRECTED ISSUER’S name, street address, city or town, state or province, country, ZIP ISSUER’S TIN OMB No. 1545-2234 or foreign postal code, and telephone no. Qualifying PARTICIPANT’S TIN Form 1098-Q Longevity Annuity (Rev. December 2019) Contract 1a Annuity amount on start date For calendar year Information $ 20 1b Annuity start date 2 Check if start date may be Copy A accelerated For 3 Total premiums 4 FMV of QLAC Internal Revenue Service Center $ $ PARTICIPANT’S name 5a January dd 5b February dd File with Form 1096. $ $ 5c March dd 5d April dd For Privacy Act and Paperwork Street address (including apt. no.) $ $ Reduction Act 5e May dd 5f June dd Notice, see the $ $ current General 5g July dd 5h August dd Instructions for CertainInformation City or town, state or province, country, and ZIP or foreign postal code $ $ Returns. 5i September dd 5j October dd Account number (see instructions) Plan number $ $ 5k November dd 5l December dd $ $ Name of plan Plan sponsor’s EIN Form 1098-Q (Rev. 12-2019) Cat. No. 67073Z www.irs.gov/Form1098Q 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 |
CORRECTED (if checked) ISSUER’S name, street address, city or town, state or province, country, ZIP ISSUER’S TIN OMB No. 1545-2234 or foreign postal code, and telephone no. Qualifying PARTICIPANT’S TIN Form 1098-Q Longevity Annuity (Rev. December 2019) Contract 1a Annuity amount on start date For calendar year Information $ 20 1b Annuity start date 2 If checked, start date may Copy B be accelerated For Participant 3 Total premiums 4 FMV of QLAC $ $ PARTICIPANT’S name 5a January dd 5b February dd This information is $ $ being furnished 5c March dd 5d April dd to the IRS. Street address (including apt. no.) $ $ 5e May dd 5f June dd $ $ 5g July dd 5h August dd City or town, state or province, country, and ZIP or foreign postal code $ $ 5i September dd 5j October dd Account number (see instructions) Plan number $ $ 5k November dd 5l December dd $ $ Name of plan Plan sponsor’s EIN Form 1098-Q (Rev. 12-2019) (Keep for your records) www.irs.gov/Form1098Q Department of the Treasury - Internal Revenue Service |
Instructions for Participant The information on this Form 1098-Q is submitted to the IRS Box 1a. Annuity amount on start date. If the payments have by the issuer of your qualifying longevity annuity contract not started, shows the annuity amount payable on start date. (QLAC) to report the status of the contract. Prior to Box 1b. Annuity start date. If the payments have not started, annuitization, the value of any QLAC held by your plan or IRA shows the date on which the annuity is scheduled to start. The (section 401(a), 403(a), 403(b), or 408 (other than a Roth IRA); date reported is shown in the format month, day, and year, or eligible governmental plan under section 457(b)) is not mm/dd/yyyy. included when calculating the required minimum distribution (RMD) from your plan or IRA. Box 2. If checked, shows that the start date may be accelerated. You will receive this statement annually beginning with the first year in which premiums are paid and ending with the Box 3. Shows the cumulative total amount of premiums paid earlier of the year in which you attain age 85 or die. In the for the contract. Beginning in 2020, your cumulative total event of your death, if the sole beneficiary under the contract premiums paid for all QLACs cannot exceed $135,000. Also, is your surviving spouse, this annual statement will be QLACs purchased under an IRA cannot exceed 25% of your furnished to your surviving spouse until distributions total IRA account balances and QLACs purchased under an commence, or if earlier, the year in which your surviving employer’s plan cannot exceed 25% of your account balance spouse dies. in the plan. If you have paid more than that, contact your contract issuer. If you have questions about your QLAC, contact the issuer at the address and phone number shown on the front of the Box 4. Shows the fair market value (FMV) of your QLAC as of form. December 31 of the reporting year. Account number. May show an account or other unique Boxes 5a–5l. Show the amount of each premium paid for the number the issuer assigned to distinguish your account. contract and the date each premium payment was made in the reporting year. If there is more than one payment per Participant’s taxpayer identification number (TIN). For your month, the box for that month will include the total payments protection, this form may show only the last four digits of your for the month and the date of the last payment in the month. TIN (social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification Future developments. For the latest information about number (ATIN), or employer identification number (EIN)). developments related to Form 1098-Q and its instructions, However, the issuer has reported your complete TIN to the such as legislation enacted after they were published, go to IRS. www.irs.gov/Form1098Q. Plan number, name, and EIN. Shows, if the contract was purchased under a plan, the number of the plan, the name of the plan, and the EIN of the plan sponsor. |
VOID CORRECTED ISSUER’S name, street address, city or town, state or province, country, ZIP ISSUER’S TIN OMB No. 1545-2234 or foreign postal code, and telephone no. Qualifying PARTICIPANT’S TIN Form 1098-Q Longevity Annuity (Rev. December 2019) Contract 1a Annuity amount on start date For calendar year Information $ 20 1b Annuity start date 2 Check if start date may be Copy C accelerated For Issuer 3 Total premiums 4 FMV of QLAC $ $ PARTICIPANT’S name 5a January dd 5b February dd For Privacy Act $ $ and Paperwork 5c March dd 5d April dd Reduction Act Notice, see the Street address (including apt. no.) $ $ current General 5e May dd 5f June dd Instructions for $ $ Certain Information 5g July dd 5h August dd Returns. City or town, state or province, country, and ZIP or foreign postal code $ $ 5i September dd 5j October dd Account number (see instructions) Plan number $ $ 5k November dd 5l December dd $ $ Name of plan Plan sponsor’s EIN Form 1098-Q (Rev. 12-2019) www.irs.gov/Form1098Q Department of the Treasury - Internal Revenue Service |
Instructions for Issuer To complete Form 1098-Q, use: To file electronically, you must have software that • The current General Instructions for Certain generates a file according to the specifications in Pub. Information Returns, and 1220. The IRS does not provide a fill-in form option for Copy A. • The current Instructions for Form 1098-Q. Need help? If you have questions about reporting on To order these instructions and additional forms, go Form 1098-Q, call the information reporting customer to www.irs.gov/Form1098Q. service site toll free at 866-455-7438 or304-263-8700 Caution: Because paper forms are scanned during (not toll free). Persons with a hearing or speech processing, you cannot file Forms 1096, 1097, 1098, disability with access to TTY/TDD equipment cancall 1099, 3921, or 5498 that you print from the IRSwebsite. 304-579-4827 (not toll free). 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. |