CORRECTED (if checked)

PAYER’S name, street address, city or town, state or province, country, ZIP 1 Rents 2 Royalties OMB No. 1545-0115
or foreign postal code, and telephone no.
$ $
OPTAVIA LLC
100 INTERNATIONAL DRIVE
3 Other income 4 Federal income tax withheld 2019
$ $ Form 1099-MISC
Baltimore, MD 21202-1099 5 Fishing boat proceeds 6 Medical and health care payments
Miscellaneous
(888) 678-2842 $ $ Income
PAYER'S TIN RECIPIENT'S TIN 7 Nonemployee compensation 8 Substitute payments in lieu of
dividends or interest Copy B
05-0524533 XXX-XX-9377 20619.42 For Recipient
$ $
RECIPIENT'S name, street address, city or town, state or province, country, 9 Payer made direct sales of $5,000 or 10 Crop insurance proceeds This is important tax
more of consumer products to information and is being
ZIP or foreign postal code a buyer (recipient) for resale $ furnished to the IRS. If you
Kristin Thornton 11 12
are required to file a return,
a negligence penalty or
other sanction may be
19005 Canyon Smt. 13 Excess golden parachute payments 14 Gross proceeds paid to an attorney
imposed on you if this
income is taxable and the
Trabuco Canyon, CA 92679 $ $
IRS determines that it has
not been reported.
15a Section 409A deferrals 15b Section 409A income

$ $
Account number (see instructions) FATCA filing 16 State tax withheld 17 State/Payer's state no. 18 State income
requirement
1643962 $ $
Form 1099-MISC (keep for your records) www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service

Instructions for Recipient - 1099-MISC (2019)

Recipient's taxpayer identification number (TIN). For your protection, this form may show only Box 6. For individuals, report on Schedule C (Form 1040).
the last four digits of your social security number (SSN), individual taxpayer identification number Box 7. Shows nonemployee compensation. If you are in the trade or business of catching
(ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN). fish, box 7 may show cash you received for the sale of fish. If the amount in this box is SE
However, the payer has reported your complete TIN to the IRS. income, report it on Schedule C or F (Form 1040), and complete Schedule SE (Form 1040).
Account number. May show an account or other unique number the payer assigned to You received this form instead of Form W-2 because the payer did not consider you an
distinguish your account. employee and did not withhold income tax or social security and Medicare tax. If you believe
FATCA filing requirement. If the FATCA filing requirement box is checked, the payer is you are an employee and cannot get the payer to correct this form, report this amount on the
reporting on this Form 1099 to satisfy its chapter 4 account reporting requirement. You also may line for “Wages, salaries, tips, etc.” of Form 1040 (or Form 1040NR). You also must complete
have a filing requirement. See the Instructions for Form 8938. Form 8919 and attach it to your return. If you are not an employee but the amount in this box
Amounts shown may be subject to self-employment (SE) tax. If your net income from self is not SE income (for example, it is income from a sporadic activity or a hobby), report this
employment is $400 or more, you must file a return and compute your SE tax on Schedule SE amount on the “Other income” line of Schedule 1 (Form 1040) (or Form 1040NR).
(Form 1040). See Pub. 334 for more information. Note: If you are still receiving payments on Box 8. Shows substitute payments in lieu of dividends or tax-exempt interest received by your
which no income, social security, and Medicare taxes are withheld, you should make estimated broker on your behalf as a result of a loan of your securities. Report on the “Other income”
tax payments. See Form 1040-ES (or Form 1040 ES(NR)). Individuals must report these line of Schedule 1 (Form 1040) (or Form 1040NR).
amounts as explained in the box 7 instructions on this page. Corporations, fiduciaries, or Box 9. If checked, $5,000 or more of sales of consumer products was paid to you on a buy-
partnerships must report the amounts on the proper line of their tax returns. sell, deposit-commission, or other basis. A dollar amount does not have to be shown.
Form 1099-MISC incorrect? If this form is incorrect or has been issued in error, contact the Generally, report any income from your sale of these products on Schedule C (Form 1040).
payer. If you cannot get this form corrected, attach an explanation to your tax return and report Box 10. Report this amount on Schedule F (Form 1040).
your income correctly. Box 13. Shows your total compensation of excess golden parachute payments subject to a
Box 1. Report rents from real estate on Schedule E (Form 1040). However, report rents on 20% excise tax. See the Form 1040 (or Form 1040NR) instructions for where to report.
Schedule C (Form 1040) if you provided significant services to the tenant, sold real estate as a Box 14. Shows gross proceeds paid to an attorney in connection with legal services. Report
business, or rented personal property as a business. See Pub. 527. only the taxable part as income on your return.
Box 2. Report royalties from oil, gas, or mineral properties, copyrights, and patents on Schedule Box 15a. May show current year deferrals as a nonemployee under a nonqualified deferred
E (Form 1040). However, report payments for a working interest as explained in the box 7 compensation (NQDC) plan that is subject to the requirements of section 409A, plus any
instructions. For royalties on timber, coal, and iron ore, see Pub. 544. earnings on current and prior year deferrals.
Box 3. Generally, report this amount on the “Other income” line of Schedule 1 (Form 1040) (or Box 15b. Shows income as a nonemployee under an NQDC plan that does not meet the
Form 1040NR) and identify the payment. The amount shown may be payments received as the requirements of section 409A. This amount also is included in box 7 as nonemployee
beneficiary of a deceased employee, prizes, awards, taxable damages, Indian gaming profits, or compensation. Any amount included in box 15a that is currently taxable also is included in this
other taxable income. See Pub. 525. If it is trade or business income, report this amount on box. This income also is subject to a substantial additional tax to be reported on Form 1040
Schedule C or F (Form 1040). (or Form 1040NR). See the Form 1040 (or Form 1040NR) instructions.
Box 4. Shows backup withholding or withholding on Indian gaming profits. Generally, a payer Boxes 16–18. Show state or local income tax withheld from the payments
must backup withhold if you did not furnish your TIN. See Form W-9 and Pub. 505 for more Future developments. For the latest information about developments related to Form 1099-
information. Report this amount on your income tax return as tax withheld. MISC and its instructions, such as legislation enacted after they were published, go to
Box 5. An amount in this box means the fishing boat operator considers you self-employed. www.irs.gov/Form1099MISC.
Report this amount on Schedule C (Form 1040). See Pub. 334.

CORRECTED (if checked)

PAYER’S name, street address, city or town, state or province, country, ZIP 1 Rents 2 Royalties OMB No. 1545-0115
or foreign postal code, and telephone no.

2019
$ $
OPTAVIA LLC 3 Other income 4 Federal income tax withheld
100 INTERNATIONAL DRIVE $ $ Form 1099-MISC
Baltimore, MD 21202-1099 5 Fishing boat proceeds 6 Medical and health care payments
Miscellaneous
(888) 678-2842 $ $ Income
PAYER'S TIN RECIPIENT'S TIN 7 Nonemployee compensation 8 Substitute payments in lieu of
dividends or interest
05-0524533 XXX-XX-9377 20619.42 Copy 2
$ $
RECIPIENT'S name, street address, city or town, state or province, country, 9 Payer made direct sales of $5,000 or 10 Crop insurance proceeds
ZIP or foreign postal code more of consumer products to a To be filed with
buyer (recipient) for resale $ recipient’s state
Kristin Thornton 11 12 income tax return,
when required.
19005 Canyon Smt. 13 Excess golden parachute payments 14 Gross proceeds paid to an attorney
Trabuco Canyon, CA 92679 $ $
15a Section 409A deferrals 15b Section 409A income

$ $
Account number (see instructions) FATCA filing 16 State tax withheld 17 State/Payer's state no. 18 State income
requirement
1643962 $ $
Form 1099-MISC www.irs.gov/Form1099MISC Department of the Treasury - Internal Revenue Service