IRS 1094-C 2021 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 IRS 1094-C, use a PDF editor like pdfFiller that allows you to make necessary changes to the form efficiently. Open the document in pdfFiller, and utilize the editing tools to modify any incorrect or outdated information. After editing, you can save your changes or download the updated form for submission.

How to fill out IRS 1094-C

To fill out IRS 1094-C, follow these steps:

1. Obtain the latest version of IRS 1094-C.
2. Gather all relevant information about your company and its employee health coverage.
3. Fill in the required fields, including employer information, and metrics on health coverage provided.
4. Ensure to report accurate employee counts in the form's designated sections.
5. Review all entries for accuracy before submission.

About IRS 1094-C 2021 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 2021 previous version

What is IRS 1094-C?

IRS 1094-C is a transmittal form used by applicable large employers (ALEs) to report health coverage provided to their employees. This form serves as a summary of information reported on Forms 1095-C, which detail the individual health insurance coverage offered to employees. Proper filing of 1094-C is crucial for compliance with the Affordable Care Act (ACA).

What is the purpose of this form?

The purpose of IRS 1094-C is to communicate necessary information regarding health insurance coverage to the IRS. It ensures compliance with ACA reporting requirements and helps verify whether an employer offers suitable health coverage to full-time employees. By submitting the form, employers can avoid potential penalties associated with non-compliance.

Who needs the form?

Applicable large employers (ALEs)—defined as those with 50 or more full-time equivalent employees—must file IRS 1094-C. Employers who offer self-insured health plans also need to file, regardless of the number of employees. Additionally, small employers may need to file if they choose to offer health insurance under the ACA provisions.

When am I exempt from filling out this form?

Exemptions from filing IRS 1094-C typically apply to employers with fewer than 50 full-time equivalent employees. Employers who do not offer health coverage, aren’t considered ALEs, or are not reporting health coverage can also be exempt from filing this form. Historical exemptions may vary, so it is essential to confirm current IRS guidelines.

Components of the form

The IRS 1094-C form consists of several key components, including:

1. Part I: Basic information about the reporting employer.
2. Part II: Information regarding the employer’s health coverage offers to employees.
3. Part III: Information on employees receiving the health insurance coverage.

Each section must be accurately filled out to comply with reporting requirements.

What are the penalties for not issuing the form?

Employers who fail to issue or file IRS 1094-C face penalties, which can be significant. The failure-to-file penalty includes fines for each month a form is not filed or for incorrect information reported. Consistent non-compliance may lead to stricter penalties and audits from the IRS.

What information do you need when you file the form?

When filing IRS 1094-C, collect essential information including:

1. Employer identification number (EIN).
2. Contact details and address of the employer.
3. Information related to employee count and health coverage offered.
4. Details of any self-insured coverage provided.

This information ensures compliance and accurate reporting to the IRS.

Is the form accompanied by other forms?

IRS 1094-C is generally accompanied by Forms 1095-C for each full-time employee. These forms provide detailed information about the health coverage offered to and accepted by employees. It is crucial to submit both forms together to ensure comprehensive reporting.

Where do I send the form?

IRS 1094-C should be submitted to the IRS at the address specified in the form's instructions. Employers must also retain copies for their records. Electronic filing is encouraged, as it may streamline the process and provide confirmation of receipt.

FAQ about IRS 1094-C

How can I correct mistakes on my IRS 1094-C after submission?

To correct errors on your IRS 1094-C, you need to prepare and file an amended return. Clearly indicate which corrections are being made, and submit it as soon as the mistake is discovered to avoid penalties. This submission can be paper filed or electronically e-filed if you use approved software.

What should I do if I receive a notice regarding my filed IRS 1094-C?

If you receive a notice regarding your IRS 1094-C, carefully read the notice to understand the issue. Gather any requested documentation and respond promptly, addressing the specific concerns outlined in the notice to ensure compliance and avoid further complications.

What e-filing issues should I watch for when submitting my IRS 1094-C?

When e-filing your IRS 1094-C, be aware of common rejection codes such as issues with TINs or incorrect formatting. Regularly check the status of your submission through the e-filing portal and be prepared to make any necessary corrections based on feedback or rejections.

How long should I retain records related to my IRS 1094-C?

You should retain records related to your IRS 1094-C for at least three years from the due date of the form or the date it was filed, whichever is later. This retention is important for compliance and in case of audits or requests for documentation.