Wiki source code of IRS FORM 1095-C
Version 2.2 by steveny on 2023/05/04 15:16
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| author | version | line-number | content |
|---|---|---|---|
| 1 | == FORM 1095-C == | ||
| 2 | |||
| 3 | ===== //Click on the individual boxes below for specific IRS Instructions// ===== | ||
| 4 | |||
| 5 | [[image:/xwiki/bin/download/Windows/U.S./Affordable%20Care%20Act%20%28ACA%29%20%C2%BB/IRL%20Forms/IRS%20FORM%201095-C/WebHome/1.png?rev=1.1||alt="1.png"]]//[[image:attach:1.png]]// | ||
| 6 | |||
| 7 | |**Part I: Employee Applicable Large Employer Member (ALE Member/Employer)** | ||
| 8 | |((( | ||
| 9 | |**Employee** | ||
| 10 | |[[Line 1, Employee's Name>>url:https://www.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1069]] | ||
| 11 | |[[Line 2, Employee's Social Security Number (including dashes)>>url:https://www.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1074]] | ||
| 12 | |[[Lines 3-6, Employee's Complete Address>>url:https://www.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1079]] | ||
| 13 | |||
| 14 | |**Employer (Should match information on 1094-C)** | ||
| 15 | |[[Line 7, Employer's Name>>url:https://www.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1087]] | ||
| 16 | |[[Line 8, Employer's EIN>>url:https://www.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1092]] | ||
| 17 | |[[Lines 9 and 11-13, Employer's Complete Address>>url:https://www.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1106]] | ||
| 18 | |[[Line 10, Contact Person's Telephone Number>>url:https://www.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1111]] | ||
| 19 | ))) | ||
| 20 | |||
| 21 | |**Part II: Employee Offer and Coverage** | ||
| 22 | |[[Employee Offer and Coverage - Plan Start Month>>url:https://www.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1119]] | ||
| 23 | |[[Line 14, Offer of Coverage (Code)>>url:https://www.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1127]] | ||
| 24 | |[[Line 15, Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage>>url:https://www.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1290]] | ||
| 25 | |[[Line 16, Applicable Section 4980H safe Harbor (Code, if applicable)>>url:https://www.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1319]] | ||
| 26 | |||
| 27 | |**Part III: Covered Individuals** | ||
| 28 | |((( | ||
| 29 | [[Part III Lines 17-22, Covered Individuals>>url:https://www.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1434]] | ||
| 30 | ))) | ||
| 31 | |||
| 32 | [[image:attach:2.png]] | ||
| 33 | |||
| 34 | |||
| 35 | |**Part III: Covered Individuals** | ||
| 36 | |[[Column (a), Covered Individual's Name>>url:https://www.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1492]] | ||
| 37 | |[[Column (b), Covered Individual's Social Security Number (SSN)>>url:https://www.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1497]] | ||
| 38 | |[[Column (c), Covered Individual's Birthdate (MM/DD/YYY) if Social Security Number (SSN) is not available>>url:https://www.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1502]] | ||
| 39 | |[[Column (d), Covered all 12 months>>url:https://www.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1507]] | ||
| 40 | |[[Column (e), Months of Coverage>>url:https://www.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1515]] | ||
| 41 | |||
| 42 | [[// // Back To Top>>url:https://www.aatrix.com/support/knowledgebase/windows/us/affordable-care-act/irs-forms/1095c/#]] | ||
| 43 | |||
| 44 |