Form 1094-C - Transmittal Of Employer-Provided Health Insurance Offer And Coverage Information Returns - 2017 Page 2

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2
Form 1094-C (2017)
Page
Part III
ALE Member Information—Monthly
(a) Minimum Essential Coverage
(b) Section 4980H Full-Time
(c) Total Employee Count
(d) Aggregated
(e) Reserved
Offer Indicator
Employee Count for ALE Member
for ALE Member
Group Indicator
Yes
No
23
All 12 Months
Jan
24
Feb
25
Mar
26
Apr
27
May
28
June
29
July
30
Aug
31
Sept
32
Oct
33
Nov
34
Dec
35
1094-C
Form
(2017)

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