1094-C Form Transmittal Of Employer-Provided Health Insurance Offer And Coverage Information Returns Page 2

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Form 1094-C (2015)
Page
Part III
ALE Member Information—Monthly
(a) Minimum Essential Coverage
(b) Full-Time Employee Count
(c) Total Employee Count
(d) Aggregated
(e) Section 4980H
Offer Indicator
for ALE Member
for ALE Member
Group Indicator
Transition Relief Indicator
Yes
No
23
All 12 Months
24
Jan
25
Feb
26
Mar
27
Apr
28
May
29
June
30
July
31
Aug
32
Sept
33
Oct
34
Nov
35
Dec
1094-C
Form
(2015)

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