1099-LTC : Long-Term Care and Accelerated Death Benefits

FDX

#	Id	Type	Description
1	payerNameAddress	NameAddressPhone	Payer's name, address, and phone
2	payerTin	string	PAYER'S TIN
3	policyholderTin	string	POLICYHOLDER'S TIN
4	policyHolderNameAddress	NameAddress	Policyholder name and address
5	accountNumber	string	Account number
6	ltcBenefits	number (double)	Box 1, Gross long-term care benefits paid
7	deathBenefits	number (double)	Box 2, Accelerated death benefits paid
8	perDiem	boolean	Box 3, Per diem
9	reimbursedAmount	boolean	Box 3, Reimbursed amount
10	insuredId	string	INSURED'S taxpayer identification no.
11	insuredNameAddress	NameAddress	Insured name and address
12	qualifiedContract	boolean	Box 4, Qualified contract
13	chronicallyIll	boolean	Box 5, Chronically ill
14	terminallyIll	boolean	Box 5, Terminally ill
15	dateCertified	DateString	Date certified

The TXF standard does not support this form.