Wiki source code of Resources: Supported Forms

Last modified by christie w on 2023/01/30 00:57
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1 == Is Aatrix supporting the ACA reporting? ==
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4 Yes, Aatrix will be supporting the 6055 & 6056 reporting requirements. The information will be reported on the 1095/94-B or the 1095/94-C form sets.
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7 ----
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11 == FORM 1095-C ==
12
13 ===== //Click on the individual boxes below for specific IRS Instructions// =====
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17 [[image:https://partner.aatrix.com/files/5615/1337/7117/download.png||alt="IRS.gov: Affordable Care Act 1095-C, Page 1" height="680" width="900"]]
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20 |**Part I: Employee Applicable Large Employer Member (ALE Member/Employer)**
21 |(((
22 |**Employee**
23 |[[Line 1, Employee's Name>>url:https://partner.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1069]]
24 |[[Line 2, Employee's Social Security Number (including dashes)>>url:https://partner.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1074]]
25 |[[Lines 3-6, Employee's Complete Address>>url:https://partner.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1079]]
26
27 |**Employer (Should match information on 1094-C)**
28 |[[Line 7, Employer's Name>>url:https://partner.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1087]]
29 |[[Line 8, Employer's EIN>>url:https://partner.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1092]]
30 |[[Lines 9 and 11-13, Employer's Complete Address>>url:https://partner.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1106]]
31 |[[Line 10, Contact Person's Telephone Number>>url:https://partner.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1111]]
32 )))
33
34 |**Part II: Employee Offer and Coverage**
35 |[[Employee Offer and Coverage - Plan Start Month>>url:https://partner.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1119]]
36 |[[Line 14, Offer of Coverage (Code)>>url:https://partner.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1127]]
37 |[[Line 15, Employee Share of Lowest Cost Monthly Premium, for Self-Only Minimum Value Coverage>>url:https://partner.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1290]]
38 |[[Line 16, Applicable Section 4980H safe Harbor (Code, if applicable)>>url:https://partner.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1319]]
39
40 |**Part III: Covered Individuals**
41 |[[Part III Lines 17-22, Covered Individuals>>url:https://partner.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1434]]
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46 [[image:https://partner.aatrix.com/index.php/download_file/3717/||alt="IRS.gov: Affordable Care Act 1095-C, Page 2" height="680" width="900"]]
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49 |**Part III: Covered Individuals**
50 |[[Column (a), Covered Individual's Name>>url:https://partner.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1492]]
51 |[[Column (b), Covered Individual's Social Security Number (SSN)>>url:https://partner.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1497]]
52 |[[Column (c), Covered Individual's Birthdate (MM/DD/YYY) if Social Security Number (SSN) is not available>>url:https://partner.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1502]]
53 |[[Column (d), Covered all 12 months>>url:https://partner.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1507]]
54 |[[Column (e), Months of Coverage>>url:https://partner.aatrix.com/aca/supported-forms/1095-1094-c-instructions#d0e1515]]
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58 ----
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60
61
62 == FORM 1094-C ==
63
64 ===== //Click on the individual boxes below for specific IRS Instructions// =====
65
66 [[image:https://www.aatrix.com/download_file/view_inline/3681/]]
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68
69 |**Part I: Applicable Large Employer Member (ALE Member)**
70 |(((
71 |[[Line 1, Name of ALE Member (Employer)>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e630]]
72 |[[Line 2, Employer Identification Number (EIN)>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e635]]
73 |[[Lines 3-6, Employer's Complete Address>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e646]]
74 |[[Lines 7 and 8, Contact Person's Name and Telephone Number>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e651]]
75 |[[Line 9, Name of Designated Government Entity (DGE)>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e668]]
76 |[[Line 10, Employer Identification Number (EIN) of Designated Government Entity (DGE)>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e673]]
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78 |[[Lines 11-14, Designated Government Entity's (DGE) Complete Address>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e684]]
79 |[[Lines 15 and 16, Contact Person's Name and Telephone Number>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e689]]
80 |[[Line 17, Line reserved for future use>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e694]]
81 |[[Line 18, Total number of Forms 1094-C submitted with this transmittal>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e699]]
82 |[[Line 19, Authoritative Transmittal>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e704]]
83 )))
84
85 |**Part II: ALE Member Information**
86 |[[Line 20, Total Number of Forms filed by and/or on behalf of the employer.>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e722]]
87 |[[Line 21, ALE Member is part of Aggregated ALE Group>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e727]]
88 |[[Line 22, Certifications of Eligibility>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e741]]
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93 [[image:https://partner.aatrix.com/files/2915/1337/7526/2015_1094-C_p2.png||height="680" width="900"]]
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96 |**Part III: ALE Member Information — Monthly (Lines 23–35)**
97 |[[Column (a), Minimum Essential Coverage>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e883]]
98 |[[Column (b), Full-Time Employee Count for ALE Member>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e966]]
99 |[[Column (c), Total Employee Count for ALE Member>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e980]]
100 |[[Column (d), Aggregated Group Indicator>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e988]]
101 |[[Column (e), Aggregated Group Indicator>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e996]]
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106 [[image:https://partner.aatrix.com/files/7215/1337/7594/2015_1094-C_p3.png||height="575" width="900"]]
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109 |**Part IV: Other ALE Members of Aggregated ALE Group**
110 |[[Lines 36-65, Other ALE Members of Aggregated ALE Group>>url:https://www.irs.gov/instructions/i109495c/ar01.html#d0e1001]]
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113 ----
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115
116
117 == FORM 1095-B ==
118
119 ===== //Click on the individual boxes below for specific IRS Instructions// =====
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122 [[image:https://partner.aatrix.com/files/4715/1337/7659/2015_1095-B_p1.png||height="680" width="900"]]
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125 |**Part I: Responsible Individual**
126 |(((
127 |[[Line 1, Name of Responsible Individual>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e619]]
128 |[[Line 2, Social Security Number of Responsible Individual>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e630]]
129 |[[Line 3, Birthdate (MM/DD/YYYY) of Responsible Individual if SSN is blank.>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e638]]
130
131 |[[Lines 4-7, Complete Mailing Address of the Responsible Individual>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e643]]
132 |[[Line 8, Letter Code of Origin of Policy (Policy Origin Code)>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e648]]
133 |[[Line 9, SHOP Identifier (Leave blank for 2015 filing)>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e677]]
134 )))
135
136 |**Part II: Employer-Sponsored Coverage**
137 |[[Lines 10-15, Name, EIN, and Complete Mailing Address for the Employer Sponsoring the Coverage>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e693]]
138
139 |**Part III: Issuer or Other Coverage Provider**
140 |[[Lines 16-22, Name, EIN, and Complete Mailing Address of Issuer/ Other Coverage>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e704]]
141
142 |**Part IV: Covered Individuals**
143 |[[Column (a), Covered Individual's Name>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e712]]
144 |[[Column (b), Covered Individual's Social Security Number (SSN)>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e717]]
145 |[[Column (c), Covered Individual's Birthdate (MM/DD/YYY) if Social Security Number (SSN) is not available>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e725]]
146 |[[Column (d), Covered all 12 months>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e730]]
147 |[[Column (e), Months of Coverage>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e738]]
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152 |**Part IV: Covered Individuals (Continuation)**
153 |[[Column (a), Name of each Covered Individual>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e712]]
154 |[[Column (b), Social Security Number (SSN) of each Covered Individual>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e717]]
155 |[[Column (c), Birthdate (MM/DD/YYY) of each Covered Individual if SSN is not available>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e725]]
156 |[[Column (d), Individual Covered for 12 months>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e730]]
157 |[[Column (e), Coverage each month if individual wasn't covered for all 12 months>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e738]]
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162 ----
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165
166 == FORM 1094-B ==
167
168 ===== //Click on the individual boxes below for specific IRS Instructions// =====
169
170 [[image:__fileCreatedFromDataURI__.png]]
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172
173 |**Part IV: Covered Individuals (Continuation)**
174 |[[Line 1, Filer's Complete Name>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e585]]
175 |[[Line 2, Filer's EIN>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e590]]
176 |[[Lines 3 and 4, Contact Person's Name and Telephone Number>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e598]]
177 |[[Lines 5-8, Filer's Complete Address>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e603]]
178 |[[Line 9, Total number of 1095-B forms transmitted with 1094-B>>url:https://www.irs.gov/instructions/i109495b/ar01.html#d0e608]]