Instructions For Forms 1094-C And 1095-C - 2017 Page 5

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eligible for and used the alternative method of furnishing under
Original Authoritative Transmittal Form 1094-C
the Qualifying Offer Method for that employee for that year’s
IF any of the following are
THEN ...
furnishing. For more information, see
Alternative Method of
incorrect ....
Furnishing Form 1095-C to Employees under the Qualifying
Offer
Method.
ALE Member or Designated
1. Prepare a new Authoritative
Forms 1095-C filed with incorrect dollar amounts on line 15,
Government Entity (Name and/or
Transmittal, Form 1094-C
Employee Required Contribution, may fall under a safe harbor
EIN)
for certain de minimis errors. The safe harbor generally applies if
2. Enter an “X” in the “CORRECTED”
no single amount in error differs from the correct amount by
box at the top of the form
more than $100. If the safe harbor applies, you will not have to
Total Number of Forms 1095-C filed
correct Form 1095-C to avoid penalties. However, if the recipient
by and/or on behalf of ALE Member
elects for the safe harbor not to apply, you may have to issue a
3. Submit the standalone corrected
Form 1094-C with the correct
corrected Form 1095-C to avoid penalties. For more information,
information present
see Notice 2017-9, 2017-4 I.R.B. 542 , at
IRS.gov/irb/2017-04
Aggregated ALE Group Membership
IRB/ar11.html.
Note. Enter an “X” in the CORRECTED checkbox only when
Certifications of Eligibility
correcting a Form 1095-C previously filed with the IRS. If you are
correcting a Form 1095-C that was previously furnished to a
Minimum Essential Coverage Offer
Indicator
recipient, but not filed with the IRS, write, type, or print
CORRECTED on the new Form 1095-C furnished to the
recipient.
Section 4980H Full-Time Employee
Count for ALE Member
Correcting information affecting statement furnished to
employee using an Alternative Furnishing Method under
Aggregated Group Indicator
the Qualifying Offer Method. If an ALE Member eligible to use
the Qualifying Offer Method had furnished the employee an
Other ALE Members of Aggregated
alternative statement, the ALE Member must furnish the
ALE Group (Name and/or EIN)
employee a corrected statement if it filed a corrected Form
1095-C correcting the ALE Member’s name, EIN, address or
contact name and telephone number. If the ALE Member is no
longer eligible to use an alternative furnishing method for the
Original Form 1095-C Submitted to IRS and Furnished to Employee
employee for whom it filed a corrected Form 1095-C, it must
IF any of the following are
THEN ...
furnish a Form 1095-C to the employee and advise the
incorrect ....
employee that Form 1095-C replaces the statement it had
previously furnished.
Name, SSN, ALE Member EIN
1. Prepare a new Form 1095-C
If you fail to file correct information returns or fail to
furnish a correct recipient statement, you may be subject
!
Offer of Coverage
2. Enter an “X” in the “CORRECTED”
to a penalty. However, you are not required to file
box at the top of the form
CAUTION
corrected returns for missing or incorrect TINs if you meet the
reasonable cause criteria. For additional information, see Pub.
Employee Required Contribution
3. Submit corrected Form 1095-Cs with
1586, Reasonable Cause Regulations and Requirements for
a non-authoritative Form 1094-C
Missing and Incorrect Name/TINs.
transmittal to the IRS
Section 4980H Safe Harbor and
See the charts for examples of errors and step by step
Other Relief Codes
instructions for filing corrected returns.
TIP
4. Furnish a corrected Form 1095-C to
the employee
Covered Individuals Information
-5-
Instructions for Forms 1094-C and 1095-C (2017)

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