IRS 1094-C 2023 free printable template

Signature For Privacy Act and Paperwork Reduction Act Notice see separate instructions. Date Title Cat. No. 61571A Form 1094-C 2023 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. 120118 1094-C Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns Form Department of the Treasury Internal Revenue Service Part I OMB No* 1545-2251 CORRECTED Go 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. 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. 120118 1094-C Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns Form Department of the Treasury Internal Revenue Service Part I OMB No* 1545-2251 CORRECTED Go 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. 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. 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.

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How to fill out IRS 1094-C

Instructions and Help about IRS 1094-C

How to edit IRS 1094-C

Edit IRS 1094-C using a PDF editor like pdfFiller to make necessary changes. You can easily input data, resize fields, and ensure that all information is accurate before submission. Saving your progress allows you to return later if more data is needed.

How to fill out IRS 1094-C

To fill out IRS 1094-C, start by collecting required information about your business and employees. Follow these steps:

1. Gather employer details including your company's name, address, and Employer Identification Number (EIN).
2. List the total number of full-time employees for each month of the reporting year.
3. Record any offers of health coverage made to employees and related information on coverage.

Ensure that all data corresponds to the specific requirements of the form. Accuracy is crucial to avoid penalties and ensure compliance with IRS regulations.

About IRS 1094-C 2023 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

Due date

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 2023 previous version

What is IRS 1094-C?

IRS 1094-C is a tax form used by applicable large employers to report information about health insurance coverage offered to employees. This form is part of the Affordable Care Act (ACA) compliance and is essential for the IRS to assess the employer's responsibilities under the ACA.

What is the purpose of this form?

The purpose of IRS 1094-C is to provide the IRS with information regarding the health coverage provided to employees. It verifies compliance with the ACA's employer mandate and helps determine if an employer might face penalties for failing to provide adequate health coverage.

Who needs the form?

Employers with 50 or more full-time employees must complete IRS 1094-C. This includes both full-time employees as well as full-time equivalent employees and applies to employers regardless of their tax-exempt status.

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 employees or is not an applicable large employer under the ACA provisions. Additionally, certain types of employers, such as religious organizations, may also be exempt from some reporting requirements.

Components of the form

IRS 1094-C consists of several key components including employer information, the number of full-time employees, the number of months coverage was offered, and details about the coverage provided. You must accurately complete these sections to ensure compliance.

Due date

The due date for IRS 1094-C typically aligns with the deadline for filing the employer's tax return. Generally, forms related to ACA reporting must be submitted by February 28 if filed by paper, or by March 31 if filed electronically.

What are the penalties for not issuing the form?

Employers who fail to file IRS 1094-C may face significant penalties. The IRS may impose fines for each month that the form is not filed, with the amount increasing for repeated failures. Filing late or with inaccuracies can also result in additional fines.

What information do you need when you file the form?

When filing IRS 1094-C, you'll need the following information:

1. Your business name and EIN.
2. The total number of full-time employees for each month.
3. Details of health coverage offered to employees, including information about dependents.
4. Months coverage was offered and the type of healthcare coverage provided.

Is the form accompanied by other forms?

IRS 1094-C is typically accompanied by IRS 1095-C forms, which are used to provide individual employee information for health coverage offered. Employers must submit both forms in conjunction with each other to ensure compliance.

Where do I send the form?

To submit IRS 1094-C, send the completed forms to the appropriate IRS Service Center. The address depends on whether you are filing electronically or by mail. If submitting by mail, ensure that it is sent to the correct service center for timely processing.