Form 1098-Q - Qualifying Longevity Annuity Contract Information

Instructions for Participant

Plan name, number, and employer identification number. Shows, if

The information on this Form 1098-Q is submitted to the IRS by the

the contract was purchased under a plan, the name of the plan, the

issuer of your qualifying longevity annuity contract (QLAC) to report

plan number, and the employer identification number (EIN) of the plan

the status of the contract. The value of any QLAC purchased after July

sponsor.

1, 2014, held by your plan or IRA (section 401(a), 403(a), 403(b), 408

(other than a Roth IRA) or eligible governmental plan under section

Box 1a. Annuity amount on start date. If the payments have not

457(b)), is not included when calculating the required minimum

started, shows the annuity amount payable on start date.

distribution (RMD) from your plan or IRA.

Box 1b. Annuity start date. If the payments have not started,

You will receive this statement annually beginning with the first year

shows the date on which the annuity is scheduled to start. The date

in which premiums are paid and ending with the earlier of the year in

reported is shown in the format month, day, and year (mmddyyyy).

which you attain age 85 or die. In the event of your death, if the sole

Box 2. If checked, shows that the start date may be accelerated.

beneficiary under the contract is your surviving spouse, this annual

statement will be furnished to your surviving spouse until distributions

Box 3. Shows the cumulative total amount of premiums paid for the

commence, or if earlier, the year in which your surviving spouse dies.

contract.

If you have questions about your QLAC, contact the issuer at the

Box 4. Shows the fair market value (FMV) of your QLAC as of

address and phone number shown on the front of the form.

December 31, 2014.

Account number. May show an account or other unique number the

Boxes 5g–5l. Shows the amount of each premium paid for the

issuer assigned to distinguish your account (QLAC).

contract and the date each premium payment was made in 2014.

Participant's identification number. For your protection, this form

Future developments. For the latest information about developments

may show only the last four digits of your social security number

related to Form 1098-Q and its instructions, such as legislation

(SSN), individual taxpayer identification number (ITIN), adoption

enacted after they were published, go to

taxpayer identification number (ATIN), or employer identification

number (EIN). However, the issuer has reported your complete

identification number to the IRS.

Form 1098-Q - Qualifying Longevity Annuity Contract Information - 2014 Page 4