Tax Documents

 

Tax1099Sa

 

FDX / Data Structures / Tax1099Sa
Form 1099-SA, Distributions From an HSA, Archer MSA, or Medicare Advantage MSA
Extends and inherits all fields from Tax  
Tax1099Sa Properties
#IdTypeDescription
1payerNameAddressNameAddressPhonePayer's name, address, and phone
2payerTinstringPAYER'S TIN
3recipientTinstringRECIPIENT'S TIN
4recipientNameAddressNameAddressRecipient's name and address
5accountNumberstringAccount number
6grossDistributionnumber (double)Box 1, Gross distribution
7earningsnumber (double)Box 2, Earnings on excess contributions
8distributionCodestringBox 3, Distribution code
9fairMarketValuenumber (double)Box 4, FMV on date of death
10hsabooleanBox 5a, HSA
11archerAccountbooleanBox 5b, Archer MSA
12medicalSavingsAccountbooleanBox 5c, Medicare Advantage (MA) MSA
Tax1099Sa Usage:
/img/forms/Tax1099Sa/2022/v5.0/Tax1099Sa.Recipient.Form.annotated.fdx.png
FDX Data Structure as JSON
{
  "tax1099Sa" : {
    "taxYear" : 0,
    "corrected" : true,
    "accountId" : "",
    "taxFormId" : "",
    "taxFormDate" : "2020-07-01",
    "description" : "string",
    "additionalInformation" : "string",
    "taxFormType" : "BusinessIncomeStatement",
    "attributes" : [ {
      "name" : "string",
      "value" : "string",
      "boxNumber" : "string",
      "code" : "string"
    } ],
    "error" : {
      "code" : "string",
      "message" : "string"
    },
    "payerNameAddress" : {
      "line1" : "String64",
      "line2" : "String64",
      "line3" : "String64",
      "city" : "String64",
      "state" : "String64",
      "postalCode" : "string",
      "country" : "AD",
      "name1" : "String64",
      "name2" : "String64",
      "phone" : {
        "type" : "HOME",
        "country" : "string",
        "number" : "string",
        "extension" : "string"
      }
    },
    "payerTin" : "string",
    "recipientTin" : "string",
    "recipientNameAddress" : {
      "line1" : "String64",
      "line2" : "String64",
      "line3" : "String64",
      "city" : "String64",
      "state" : "String64",
      "postalCode" : "string",
      "country" : "AD",
      "name1" : "String64",
      "name2" : "String64"
    },
    "accountNumber" : "string",
    "grossDistribution" : 0.0,
    "earnings" : 0.0,
    "distributionCode" : "string",
    "fairMarketValue" : 0.0,
    "hsa" : true,
    "archerAccount" : true,
    "medicalSavingsAccount" : true
  }
}
Example Form PDF

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/img/forms/Tax1099Sa/2022/v5.0/Tax1099Sa.RecipCopy.png
Example Form JSON

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{
  "tax1099Sa" : {
    "taxYear" : 2022,
    "taxFormDate" : "2021-03-30",
    "taxFormType" : "Tax1099Sa",
    "payerNameAddress" : {
      "line1" : "12021 Sunset Valley Dr",
      "line2" : "Suite 230",
      "city" : "Preston",
      "state" : "VA",
      "postalCode" : "20191",
      "country" : "US",
      "name1" : "Tax Form Issuer, Inc",
      "phone" : {
        "number" : "8885551212"
      }
    },
    "payerTin" : "12-3456789",
    "recipientTin" : "xxx-xx-1234",
    "recipientNameAddress" : {
      "line1" : "1 Main St",
      "city" : "Melrose",
      "state" : "NY",
      "postalCode" : "12121",
      "country" : "US",
      "name1" : "Kris Q Public"
    },
    "accountNumber" : "111-23456",
    "grossDistribution" : 1000.0,
    "earnings" : 200.0,
    "distributionCode" : "A",
    "fairMarketValue" : 400.0,
    "hsa" : true
  }
}
Example Form JSON for QR Code Purposes

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Example Form PDF with QR Code

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/img/forms/Tax1099Sa/2022/v5.0/Tax1099Sa.RecipCopy.qr.png
Example Data As Flattened Map (Key, Value Pairs)

 

{
  "taxYear": "2022",
  "taxFormDate": "2021-03-30",
  "taxFormType": "Tax1099Sa",
  "payerNameAddress.line1": "12021 Sunset Valley Dr",
  "payerNameAddress.line2": "Suite 230",
  "payerNameAddress.city": "Preston",
  "payerNameAddress.state": "VA",
  "payerNameAddress.postalCode": "20191",
  "payerNameAddress.country": "US",
  "payerNameAddress.name1": "Tax Form Issuer, Inc",
  "payerNameAddress.phone.number": "8885551212",
  "payerTin": "12-3456789",
  "recipientTin": "xxx-xx-1234",
  "recipientNameAddress.line1": "1 Main St",
  "recipientNameAddress.city": "Melrose",
  "recipientNameAddress.state": "NY",
  "recipientNameAddress.postalCode": "12121",
  "recipientNameAddress.country": "US",
  "recipientNameAddress.name1": "Kris Q Public",
  "accountNumber": "111-23456",
  "grossDistribution": "1000.0",
  "earnings": "200.0",
  "distributionCode": "A",
  "fairMarketValue": "400.0",
  "hsa": "true"
}
Issuer Instructions

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/img/forms/Tax1099Sa/2022/v5.0/Tax1099Sa.IssuerInstr.png
https://storage.cloud.google.com/taxdochub-forms-png/2021/i1099sa.1.png
https://storage.cloud.google.com/taxdochub-forms-png/2021/i1099sa.2.png
https://storage.cloud.google.com/taxdochub-forms-png/2021/i1099sa.3.png
https://storage.cloud.google.com/taxdochub-forms-png/2021/i1099sa.4.png

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