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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Instructions and Help about IRS 1094-C
How to edit IRS 1094-C
How to fill out IRS 1094-C
Instructions and Help about IRS 1094-C
How to edit IRS 1094-C
To edit IRS 1094-C, utilize pdfFiller's editing tools. This allows for the modification of information, addition of data, or correction of errors. Ensure that any adjustments retain compliance with IRS standards.
How to fill out IRS 1094-C
Filling out the IRS 1094-C requires understanding its components and ensuring accurate information regarding your health insurance offerings. Follow these steps:
01
Collect necessary employee data including names, addresses, and months of coverage.
02
Enter employer information and applicable reporting year at the top of the form.
03
Complete lines related to the number of full-time employees and specific coverage details for each month.
04
Check all entries for accuracy before submission.
About IRS 1094-C 2019 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 2019 previous version
What is IRS 1094-C?
IRS 1094-C is a transmittal form used by applicable large employers (ALEs) to report health insurance information to the IRS. It acts as a summary of the information included in forms 1095-C that report each employee's insurance coverage data.
What is the purpose of this form?
The purpose of IRS 1094-C is to demonstrate compliance with the Affordable Care Act's employer mandate. It helps the IRS track whether employers are providing adequate health coverage to their full-time employees.
Who needs the form?
Applicable large employers, defined as those with 50 or more full-time equivalent employees, must file IRS 1094-C. Small employers are not required to file this form but can do so to report health coverage offered.
When am I exempt from filling out this form?
You may be exempt from filing IRS 1094-C if your organization has fewer than 50 full-time equivalent employees or if you are not offering health coverage. Certain types of employers, like religious or tribal organizations, may also have specific exemptions.
Components of the form
The IRS 1094-C consists of a cover sheet with employer details, a series of sections summarizing the number of full-time employees, and specific monthly details about the healthcare coverage provided. It includes various codes related to the type of health coverage offered.
What are the penalties for not issuing the form?
Failing to issue IRS 1094-C can result in significant penalties, typically starting at $250 per form. If the failure to file is considered intentional, the penalties can increase dramatically. Employers must ensure they comply to avoid these financial repercussions.
What information do you need when you file the form?
When filing IRS 1094-C, you will need the following information: employer identification number (EIN), total number of full-time employees, health coverage data for each month, and information from Form 1095-C for each employee. Ensuring all data is accurate is essential.
Is the form accompanied by other forms?
Yes, IRS 1094-C is typically accompanied by Forms 1095-C, which provide detailed information about the health coverage for each individual employee. These forms must be filed together to complete your reporting obligations.
Where do I send the form?
The IRS 1094-C should be submitted to the IRS at the address specified in the IRS instructions for the form. If you're filing the form electronically, ensure to adhere to the guidelines provided by the IRS for e-filing.
Use this catalog to find any type of IRS forms. We've gathered all of them under this section uncategorized to help you to find a proper form faster. Once you spot it on this list, have a look at the versions and schedules you might need as attachments. All returns are available for 2016 and for previous fiscal years.
