Tax1099SA_V100

XSD

	<xsd:complexType name="Tax1099SA_V100">
		<xsd:annotation>
			<xsd:documentation>Form 1099-SA - Distributions From an HSA, Archer MSA, or Medicare Advantage MSA</xsd:documentation>
		</xsd:annotation>
		<xsd:complexContent>
			<xsd:extension base="ofx:AbstractTaxForm1099Type">
				<xsd:sequence>
					<xsd:element name="PAYERADDR" type="ofx:PayerAddressType" minOccurs="0"/>
					<xsd:element name="RECIPADDR" type="ofx:RecipientAddressType" minOccurs="0"/>
					<xsd:element name="PAYERID" type="ofx:GenericNameType" minOccurs="0">
						<xsd:annotation>
							<xsd:documentation>PAYER'S federal identification number</xsd:documentation>
						</xsd:annotation>
					</xsd:element>
					<xsd:element name="RECID" type="ofx:IdType" minOccurs="0">
						<xsd:annotation>
							<xsd:documentation>RECIPIENT'S identification number</xsd:documentation>
						</xsd:annotation>
					</xsd:element>
					<xsd:element name="ACCTNUM" type="ofx:GenericNameType" minOccurs="0">
						<xsd:annotation>
							<xsd:documentation>Account number</xsd:documentation>
						</xsd:annotation>
					</xsd:element>
					<xsd:element name="GROSSDIST" type="ofx:AmountType" minOccurs="0">
						<xsd:annotation>
							<xsd:documentation>Box 1. Gross distribution</xsd:documentation>
						</xsd:annotation>
					</xsd:element>
					<xsd:element name="EARNINGS" type="ofx:AmountType" minOccurs="0">
						<xsd:annotation>
							<xsd:documentation>Box 2. Earnings on excess cont.</xsd:documentation>
						</xsd:annotation>
					</xsd:element>
					<xsd:element name="DISTCODE" type="ofx:GenericNameType" minOccurs="0">
						<xsd:annotation>
							<xsd:documentation>Box 3. Distribution code</xsd:documentation>
						</xsd:annotation>
					</xsd:element>
					<xsd:element name="FMVON" type="ofx:AmountType" minOccurs="0">
						<xsd:annotation>
							<xsd:documentation>Box 4. FMV on date of death</xsd:documentation>
						</xsd:annotation>
					</xsd:element>
					<xsd:choice>
						<xsd:element name="HSA" type="ofx:BooleanType" minOccurs="0">
							<xsd:annotation>
								<xsd:documentation>Box 5a. HSA</xsd:documentation>
							</xsd:annotation>
						</xsd:element>
						<xsd:element name="ARCHER" type="ofx:BooleanType" minOccurs="0">
							<xsd:annotation>
								<xsd:documentation>Box 5b. Archer MSA</xsd:documentation>
							</xsd:annotation>
						</xsd:element>
						<xsd:element name="MSA" type="ofx:BooleanType" minOccurs="0">
							<xsd:annotation>
								<xsd:documentation>Box 5c. MA MSA</xsd:documentation>
							</xsd:annotation>
						</xsd:element>
					</xsd:choice>
				</xsd:sequence>
			</xsd:extension>
		</xsd:complexContent>
	</xsd:complexType>

OFX XML

<?xml version="1.0" encoding="UTF-8" standalone="no"?>
<?OFX OFXHEADER="200" VERSION="202" SECURITY="NONE" OLDFILEUID="NONE" NEWFILEUID="NONE"?>

<OFX>
    <SIGNONMSGSRSV1>
        <SONRS>
            <STATUS>
                <CODE>0</CODE>
                <SEVERITY>INFO</SEVERITY>
                <MESSAGE>Successful Login</MESSAGE>
            </STATUS>
            <DTSERVER>39210131000000</DTSERVER>
            <LANGUAGE>ENG</LANGUAGE>
            <FI>
                <ORG>fiName</ORG>
                <FID>fiId</FID>
            </FI>
        </SONRS>
    </SIGNONMSGSRSV1>
    <TAX1099MSGSRSV1>
        <TAX1099TRNRS>
            <TRNUID>_GUID_</TRNUID>
            <STATUS>
                <CODE>0</CODE>
                <SEVERITY>INFO</SEVERITY>
                <MESSAGE>SUCCESS</MESSAGE>
            </STATUS>
            <TAX1099RS>
                <TAX1099SA_V100>
                    <TAXYEAR>2020</TAXYEAR>
                    <PAYERADDR>
                        <ADDR1>12020 Sunrise Valley Dr</ADDR1>
                        <ADDR2>Suite 230</ADDR2>
                        <CITY>Prescott</CITY>
                        <STATE>VA</STATE>
                        <POSTALCODE>20191</POSTALCODE>
                        <PHONE>888-555-1212</PHONE>
                        <PAYERNAME1>Financial Data Exchange</PAYERNAME1>
                    </PAYERADDR>
                    <RECIPADDR>
                        <ADDR1>1 Main St</ADDR1>
                        <CITY>Melrose</CITY>
                        <STATE>NY</STATE>
                        <POSTALCODE>12121</POSTALCODE>
                        <RECIPNAME1>Kris Q Public</RECIPNAME1>
                    </RECIPADDR>
                    <PAYERID>12-3456789</PAYERID>
                    <RECID>xxx-xx-1234</RECID>
                    <ACCTNUM>111-23456</ACCTNUM>
                    <GROSSDIST>1000.00</GROSSDIST>
                    <EARNINGS>200.00</EARNINGS>
                    <DISTCODE>A</DISTCODE>
                    <FMVON>400.00</FMVON>
                    <HSA>Y</HSA>
                </TAX1099SA_V100>
            </TAX1099RS>
        </TAX1099TRNRS>
    </TAX1099MSGSRSV1>
</OFX>

FDX JSON

{
  "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
  }
}