Instructions For Forms 1094-C And 1095-C - 2017 Page 7

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Lines 7 and 8. Enter the name and telephone number of the
Line 21. If during any month of the calendar year the ALE
person to contact who is responsible for answering any
Member was a member of an Aggregated ALE Group, check
questions from the IRS regarding the filing of or information
“Yes.” If you check “Yes,” also complete the “Aggregated Group
reported on Forms 1094-C or 1095-C. This may be different than
Indicator” in Part III, column (d), and then complete Part IV to list
the contact information on line 10 of Form 1095-C.
the other members of the Aggregated ALE Group. If, for all 12
months of the calendar year, the employer was not a member of
Note. If you are a Designated Governmental Entity (DGE) filing
an Aggregated ALE Group, check “No,” and do not complete
on behalf of an ALE Member, complete lines 9–16. If you are not
Part III, column (d), or Part IV.
a DGE filing on behalf of an ALE Member do not complete lines
Line 22. If the ALE Member meets the eligibility requirements
9–16. Instead, skip to line 18. See
Designated Governmental
and is using one of the Offer Methods, it must check the
Entity (DGE)
in the Definitions section of these instructions.
applicable box. See the descriptions of Qualifying Offer Method
Line 9. If a DGE is filing on behalf of the ALE Member, enter the
and 98% Offer Method, below.
name of the DGE.
A. Qualifying Offer Method. Check this box if the ALE
Member is eligible to use and is using the Qualifying Offer
Line 10. Enter the DGE’s EIN (including the dash). Do not enter
Method to report the information on Form 1095-C for one or
an SSN.
more full-time employees. Under the Qualifying Offer Method
If you are a DGE that is filing Form 1094-C, a valid EIN is
there is an alternative method of completing Form 1095-C and
required at the time the return is filed. If a valid EIN is not
!
an alternative method for furnishing Form 1095-C to certain
provided, the return will not be processed. If the DGE
employees. If the ALE Member is using either of these
CAUTION
does not have an EIN when filing Form 1094-C it can get an EIN
alternative rules, check this box. To be eligible to use the
by applying online at IRS.gov or by faxing or mailing a completed
Qualifying Offer Method, the ALE Member must certify that it
Form SS-4. See the Instructions for Form SS-4 and Pub. 1635.
made a Qualifying Offer to one or more of its full-time employees
for all months during the year in which the employee was a
Lines 11–14. Enter the DGE’s complete address (including
full-time employee for whom an employer shared responsibility
room or suite no.).
payment could apply. Additional requirements described below
must be met to be eligible to use the alternative method for
Lines 15 and 16. Enter the name and telephone number of the
furnishing Form 1095-C to employees under the Qualifying Offer
person to contact who is responsible for answering any
Method.
questions from the IRS regarding the filing of or information
reported on Form 1094-C.
Alternative Method of Completing Form 1095-C under
the Qualifying Offer Method. If the ALE Member reports using
Line 17. Reserved.
this method, it must not complete Form 1095-C, Part II, line 15,
Line 18. Enter the total number of Forms 1095-C (not counting
for any month for which a Qualifying Offer is made. Instead it
continuation sheets) submitted with this Form 1094-C
must enter the Qualifying Offer code 1A on Form 1095-C,
transmittal.
line 14, for any month for which the employee received a
Qualifying Offer (or in the all 12 months box if the employee
Line 19. If this Form 1094-C transmittal is the Authoritative
received a Qualifying Offer for all 12 months), and must leave
Transmittal that reports aggregate employer-level data for the
line 15 blank for any month for which code 1A is entered on
ALE Member, check the box on line 19 and complete Parts II, III,
line 14. The ALE Member may, but is not required, to enter an
and IV, to the extent applicable. Otherwise, complete the
applicable code on line 16 for any month for which code 1A is
signature portion of Form 1094-C and leave the remainder of
entered on line 14; a Qualifying Offer is, by definition, treated as
Parts II, III, and IV blank.
an offer that falls within an affordability safe harbor even if no
There must be only one Authoritative Transmittal filed for
code is entered on line 16.
each ALE Member. If this is the only Form 1094-C being filed for
An ALE Member is not required to use the Qualifying Offer
the ALE Member, this Form 1094-C must report aggregate
Method, even if it is eligible and instead may enter on line 14 the
employer-level data for the ALE Member and be identified on
applicable offer code and then enter on line 15 the Employee
line 19 as the Authoritative Transmittal. If multiple Forms 1094-C
Required Contribution.
are being filed for an ALE Member so that Forms 1095-C for all
full-time employees of the ALE Member are not attached to a
If the ALE Member is eligible to use the Qualifying Offer
single Form 1094-C transmittal (because Forms 1095-C for
Method, it may report on Form 1095-C by entering the
TIP
some full-time employees of the ALE Member are being
Qualifying Offer code 1A on Form 1095-C, line 14, for
transmitted separately), one (and only one) of the Forms 1094-C
any month for which it made a Qualifying Offer to an employee,
must report aggregate employer-level data for the ALE Member
even if the employee did not receive a Qualifying Offer for all 12
and be identified on line 19 as the Authoritative Transmittal. For
calendar months. However, if an employee receives a Qualifying
more information, see
Authoritative Transmittal for ALE
Offer for less than all 12 months, the ALE Member must furnish a
Members Filing Multiple Forms
1094-C, earlier.
copy of Form 1095-C to the employee (rather than using the
alternative method of furnishing Form 1095-C described below).
Part II—ALE Member Information
Example. Employee’s employment with Employer begins on
Reminder. Lines 20–22 should be completed only on the
January 1. Employee is in a health coverage waiting period (and
Authoritative Transmittal for the ALE Member. For more
an employer shared responsibility payment could not apply with
information, see
Authoritative Transmittal for ALE Members
respect to Employee, because Employee is in a Limited
Filing Multiple Forms
1094-C, earlier.
Non-Assessment Period) until April 1 and is a full-time employee
for the remainder of the calendar year. Employer makes a
Line 20. Enter the total number of Forms 1095-C (not counting
Qualifying Offer to Employee for coverage beginning on April 1
continuation sheets) that will be filed by and/or on behalf of the
and for the remainder of the calendar year. Employer is eligible
ALE Member. This includes all Forms 1095-C that are filed with
to use the Qualifying Offer method because it has made a
this transmittal including those filed for individuals who enrolled
Qualifying Offer to at least one full-time employee for all months
in the employer-sponsored self-insured plan, if any, and for any
in which both (1) the employee was a full-time employee and (2)
Forms 1095-C filed with a separate transmittal filed by or on
an employer shared responsibility payment could apply with
behalf of the ALE Member.
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Instructions for Forms 1094-C and 1095-C (2017)

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