IRS 1094-C 2017 free printable template

120118 1094-C Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns Form Department of the Treasury Internal Revenue Service Part I Go OMB No. 1545-2251 CORRECTED to www.irs.gov/Form1094C for instructions and the latest information. Applicable Large Employer Member ALE Member 1 Name of ALE Member Employer 2 Employer identification number EIN 3 Street address including room or suite no. Signature For Privacy Act and Paperwork Reduction Act Notice see separate...instructions. Title Cat. No. 61571A Date Form 1094-C 2017 Page 2 a Minimum Essential Coverage Offer Indicator b Section 4980H Full-Time Employee Count for ALE Member c Total Employee Count for ALE Member d Aggregated Group Indicator All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 120316 Page 3 Other ALE Members of Aggregated ALE Group Enter the names and EINs of Other ALE Members of the Aggregated ALE Group who were members at any time during the calendar year. 4 City or town 5...State or province 6 Country and ZIP or foreign postal code 7 Name of person to contact 8 Contact telephone number 9 Name of Designated Government Entity only if applicable For Official Use Only 17 Reserved. 18 Total number of Forms 1095-C submitted with this transmittal 19 Is this the authoritative transmittal for this ALE Member If Yes check the box and continue. If No see instructions ALE Member Information 21 Is ALE Member a member of an Aggregated ALE Group Yes No If No do not complete...Part IV. 22 Certifications of Eligibility select all that apply A. Qualifying Offer Method B. Reserved D. 98 Offer Method Under penalties of perjury I declare that I have examined this return and accompanying documents and to the best of my knowledge and belief they are true correct and complete. 4 City or town 5 State or province 6 Country and ZIP or foreign postal code 7 Name of person to contact 8 Contact telephone number 9 Name of Designated Government Entity only if applicable For Official...Use Only 17 Reserved. 18 Total number of Forms 1095-C submitted with this transmittal 19 Is this the authoritative transmittal for this ALE Member If Yes check the box and continue. 18 Total number of Forms 1095-C submitted with this transmittal 19 Is this the authoritative transmittal for this ALE Member If Yes check the box and continue. If No see instructions ALE Member Information 21 Is ALE Member a member of an Aggregated ALE Group Yes No If No do not complete Part IV. If No see...instructions ALE Member Information 21 Is ALE Member a member of an Aggregated ALE Group Yes No If No do not complete Part IV. 22 Certifications of Eligibility select all that apply A. Qualifying Offer Method B. Reserved D. 98 Offer Method Under penalties of perjury I declare that I have examined this return and accompanying documents and to the best of my knowledge and belief they are true correct and complete. 4 City or town 5 State or province 6 Country and ZIP or foreign postal code 7 Name...of person to contact 8 Contact telephone number 9 Name of Designated Government Entity only if applicable For Official Use Only 17 Reserved. 18 Total number of Forms 1095-C submitted with this transmittal 19 Is this the authoritative transmittal for this ALE Member If Yes check the box and continue. If No see instructions ALE Member Information 21 Is ALE Member a member of an Aggregated ALE Group Yes No If No do not complete Part IV.

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How to fill out IRS 1094-C

Instructions and Help about IRS 1094-C

How to edit IRS 1094-C

To edit the IRS 1094-C form, you can use pdfFiller, which allows users to fill in and modify the fields of the form digitally. Start by uploading your completed form to pdfFiller. Next, utilize the editing tools to update any required information, such as employer details or covered individuals. After making the changes, ensure to save your document for later use or submission.

How to fill out IRS 1094-C

Filling out the IRS 1094-C requires attention to detail and precise data entry. First, gather all necessary information about your organization and the employees it offers health coverage to. Complete the form by filling in the required sections, which include employer information, the number of full-time employees, and details on health coverage offered. Utilize pdfFiller to assist in managing errors and ensuring all data is accurately reported.

About IRS 1094-C 2017 previous version

What is IRS 1094-C?

What is the purpose of this form?

Who needs the form?

When am I exempt from filling out this form?

Components of the form

What are the penalties for not issuing the form?

What information do you need when you file the form?

Is the form accompanied by other forms?

Where do I send the form?

About IRS 1094-C 2017 previous version

What is IRS 1094-C?

The IRS 1094-C is a tax form used by applicable large employers (ALEs) to report information regarding the health insurance coverage they offer to their employees. This form is part of the requirements under the Affordable Care Act (ACA) and helps the IRS determine whether ALEs are complying with health coverage mandates. Employers must submit this form annually to report health coverage details for the previous year.

What is the purpose of this form?

The primary purpose of the IRS 1094-C is to provide the IRS with detailed information on the health coverage offered by applicable large employers. This data is crucial as it helps officials regulate compliance with the Employer Shared Responsibility provisions set forth by the ACA. Additionally, the form supports the IRS in verifying if employees are receiving the necessary health coverage and if employers are adhering to their obligations.

Who needs the form?

Applicable large employers, specifically those with 50 or more full-time equivalent employees, must complete and submit the IRS 1094-C form. Additionally, any employer that sponsors self-insured plans must also file this form, regardless of the number of employees. It is essential for these employers to accurately report their health coverage offerings to ensure compliance with federal regulations.

When am I exempt from filling out this form?

Employers may be exempt from filing the IRS 1094-C if they qualify as a small employer with fewer than 50 full-time equivalent employees. Additionally, employers who are not subject to the Employer Shared Responsibility provisions (e.g., certain religious employers or certain types of government entities) could be exempt. It is important to evaluate your specific situation and confirm your exemption status before filing.

Components of the form

The IRS 1094-C form consists of several key components that must be filled out correctly. These components include Section A, which captures employer information; Section B, which details the number of full-time employees; and Section C, which outlines the type of health coverage offered. Accurate completion of these sections is essential for effective reporting and compliance with ACA requirements.

What are the penalties for not issuing the form?

Failing to issue the IRS 1094-C form can result in significant penalties for applicable large employers. The IRS may impose a penalty of $250 for each form not filed or inaccurately filed, with a maximum penalty reaching up to $3 million. It is crucial for employers to adhere to filing requirements to avoid these financial implications.

What information do you need when you file the form?

When filing the IRS 1094-C form, employers need specific information such as the Employer Identification Number (EIN), details of full-time employees, and specifics about the health coverage offered. Additionally, you'll need to provide information about any health plans provided during the previous calendar year, including coverage type and duration. Collecting this information ahead of time is vital to streamline the filing process.

Is the form accompanied by other forms?

The IRS 1094-C form is usually submitted alongside the IRS 1095-C forms, which provide detailed information about the health coverage offered to each employee. While the 1094-C serves as a summary transmittal form, the 1095-C provides individualized health coverage data for employees. Together, these forms fulfill the reporting requirements imposed by the ACA.

Where do I send the form?

Employers must send the IRS 1094-C form to the IRS by mail. The specific mailing address depends on whether the employer is submitting Form 1094-C with or without a payment. Typically, organizations will send it to the following address: Department of the Treasury, Internal Revenue Service Center, Kansas City, MO 64999. Check the IRS website for any updates on mailing addresses and procedures to ensure compliance.

FAQ about 1094 c 2017 form

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What is IRS 1094-C?

IRS 1094-C is a transmittal form used by applicable large employers to report information about their health insurance offerings to the IRS as part of the Affordable Care Act (ACA) requirements.

Who is required to file IRS 1094-C?

Applicable large employers, defined as those with 50 or more full-time equivalent employees, are required to file IRS 1094-C. This includes those who offer health insurance coverage to their employees.

How to fill out IRS 1094-C?

To fill out IRS 1094-C, you need to provide basic information about your business, including your name, Employer Identification Number (EIN), and the number of full-time employees. You also need to report information regarding the health coverage provided to employees.

What is the purpose of IRS 1094-C?

The purpose of IRS 1094-C is to provide the IRS with a summary of the health insurance coverage offered by an applicable large employer. This helps the IRS determine compliance with the ACA mandates.

What information must be reported on IRS 1094-C?

The information that must be reported includes the employer's identification information, a count of full-time employees, details about the health coverage offered, and any other relevant data that indicates compliance with ACA requirements.