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Wiki source code of IRS FORM 1095-C

Last modified by Andrew K on 2025/12/31 20:51
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1 == FORM 1095-C ==
2
3 ===== //Click on the individual boxes below for specific IRS Instructions// =====
4
5 //[[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 ----
43
44 == Related Pages: ==
45
46
47 === [[IRS Forms 1095-B>>doc:Windows.U\.S\..Affordable Care Act (ACA) ».IRL Forms.IRS FORM 1095-B.WebHome]] ===
48
49 ====== Learn more about the IRS Form 1095-B. ======
50
51
52 === [[IRS Forms 1094-B>>doc:Windows.U\.S\..Affordable Care Act (ACA) ».IRL Forms.IRS FORM 1094-B.WebHome]] ===
53
54 ====== Learn more about the IRS Form 1094-B. ======
55
56
57 === [[IRS Forms 1094-C>>doc:Windows.U\.S\..Affordable Care Act (ACA) ».IRL Forms.IRS FORM 1094-C.WebHome]] ===
58
59 ====== Learn more about the IRS Form 1094-C. ======