IRS Forms 1094-C

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FORM 1094-C

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IRS.gov: Affordable Care Act 1094-C, Page 1 IRS.gov: Affordable Care Act 1094-C, Part I  Line 1, Name of ALE Member (Employer) IRS.gov: Affordable Care Act 1094-C, Part I  Line 2, Employer Identification Number (EIN) IRS.gov: Affordable Care Act 1094-C, Part I  Lines 3-6, Employer's Complete Address IRS.gov: Affordable Care Act 1094-C, Part I  Lines 7 and 8, Contact Person's Name and Telephone Number IRS.gov: Affordable Care Act 1094-C, Part I  Line 9, Name of Designated Government Entity (DGE) IRS.gov: Affordable Care Act 1094-C, Part I  Line 10, Employer Identification Number (EIN) of Designated Government Entity (DGE) IRS.gov: Affordable Care Act 1094-C, Part I  Lines 11-14, Designated Government Entity's (DGE) Complete Address IRS.gov: Affordable Care Act 1094-C, Part I  Lines 15 and 16, Contact Person's Name and Telephone Number IRS.gov: Affordable Care Act 1094-C, Part I  Line 17, Line reserved for future use IRS.gov: Affordable Care Act 1094-C, Part I  Line 18, Total number of Forms 1094-C submitted with this transmittal IRS.gov: Affordable Care Act 1094-C, Part I  Line 19, Authoritative Transmittal IRS.gov: Affordable Care Act 1094-C, Part II  Line 20, Total Number of Forms filed by and/or on behalf of the employer. IRS.gov: Affordable Care Act 1094-C, Part II  Line 21, ALE Member is part of Aggregated ALE Group IRS.gov: Affordable Care Act 1094-C, Part II  Line 22, Certifications of Eligibility




IRS.gov: Affordable Care Act 1095-C, Part III Column (a), Minimum Essential Coverage IRS.gov: Affordable Care Act 1095-C, Part III Column (b), Full-Time Employee Count for ALE Member IRS.gov: Affordable Care Act 1095-C, Part III Column (c), Total Employee Count for ALE Member IRS.gov: Affordable Care Act 1095-C, Part III Column (d), Aggregated Group Indicator IRS.gov: Affordable Care Act 1095-C, Part III Column (e), Aggregated Group Indicator




IRS.gov: Affordable Care Act 1094-C, Part IV  Lines 36-65, Other ALE Members of Aggregated ALE Group

Part IV: Other ALE Members of Aggregated ALE Group
Lines 36-65, Other ALE Members of Aggregated ALE Group



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