Instructions For Forms 1094-C And 1095-C - 2017 (Page 9 of 17) in pdf

Part IV—Other ALE Members of

offered health coverage to at least 95% of its full-time employees

and their dependents (even if it offered health coverage to less

Aggregated ALE Group (Lines 36–65)

than 95% of its full-time employees and their dependents, for

An ALE Member must complete this section if it checks “Yes” on

example to 75 of its 80 full-time employees and their

line 21. If the ALE Member was a member of an Aggregated ALE

dependents).

Group (with other ALE Members) for any month of the calendar

See Definitions, later, for more information on an offer of

year, enter the name(s) and EIN(s) of up to 30 of the other

health coverage.

Aggregated ALE Group members (not including the reporting

ALE Member). If there are more than 30 members of the

Column (b) Section 4980H Full-Time Employee Count for

Aggregated ALE Group (not including the reporting ALE

ALE Member. Enter the number of full-time employees for each

Member), enter the 30 with the highest monthly average number

month, but do not count any employee in a Limited

of full-time employees (using the number reported in Part III,

Non-Assessment Period. If the number of full-time employees

column (b), if a number was required to be reported) for the year

(excluding employees in a Limited Non-Assessment Period) for

or for the number of months during which the ALE Member was

a month is zero, enter “0.” An employee should be counted as a

a member of the Aggregated ALE Group. If any member of the

full-time employee for a month if the employee satisfied the

Aggregated ALE Group uses the 98% Offer Method and thus is

definition of full-time employee under the monthly measurement

not required to identify which employees are full-time

method or the look-back measurement method (as applicable)

employees, all ALE Members of the Aggregated ALE Group

on any day of the month. See

Full-time employee

and

Limited

should use the monthly average number of total employees

Non-Assessment Period

in the Definitions section. Be sure to

rather than the monthly average number of full-time employees

use the section 4980H definition and not any other definition of

for this purpose. Regardless of the number of members in the

the term full-time employee that you may use for other purposes.

Aggregated ALE Group, list only the 30 members in descending

Example. Employer uses the look-back measurement

order, listing first the member with the highest average monthly

method to determine the full-time status of its employees.

number of full-time employees (or highest average number of

Employee, who is not in a Limited Non-Assessment Period,

total employees, if any member of the Aggregated ALE Group

averaged over 130 hours of service per month during the

uses the 98% Offer Method), but do not include the reporting

measurement period that corresponds with the stability period

ALE Member. The reporting ALE Member must also complete

starting January 1, 2017, and ending December 31, 2017.

Part III, column (d), to indicate which months it was part of an

Employee terminates employment with Employer on February

Aggregated ALE Group.

15, 2017. Employer must include Employee in the number of

If you are filing Form 1094-C, a valid EIN is required at

full-time employees reported in column (b) for January and

the time it is filed. If a valid EIN is not provided, Form

February. See the description of code 2B in the instructions for

TIP

1094-C will not be processed. If you do not have an EIN,

line 16 of Form 1095-C, later, for rules for reporting an offer of

you may apply for one online. Go to IRS.gov and enter “EIN” in

coverage in an employee’s final month of employment.

the search box. You may also apply by faxing or mailing Form

SS-4 to the IRS. See the Instructions for Form SS-4 and Pub.

Note. If the ALE Member certified that it was eligible for the 98%

1635.

Offer Method by selecting box D, on line 22, it is not required to

complete column (b).

Specific Instructions for Form 1095-C

Column (c) Total Employee Count for ALE Member. Enter

the total number of all of the ALE Member’s employees,

including full-time employees and non-full-time employees, and

Part I—Employee

employees in a Limited Non-Assessment Period, for each

Line 1. Enter the name of the employee (first name, middle

calendar month. An ALE Member must choose to use one of the

initial, last name).

following days of the month to determine the number of

employees per month and must use that day for all months of the

Line 2. Enter the 9-digit SSN of the employee (including the

year: (1) the first day of each month; (2) the last day of each

dashes).

month; (3) the 12th day of each month; (4) the first day of the first

Lines 3–6. Enter the employee’s complete address, including

payroll period that starts during each month; or (5) the last day of

apartment no., if applicable. A country code is not required for

the first payroll period that starts during each month (provided

U.S. addresses.

that for each month that last day falls within the calendar month

in which the payroll period starts). If the total number of

Part I—Applicable Large Employer Member

employees was the same for every month of the entire calendar

(Employer)

year, enter that number in line 23, column (c) “All 12 Months” or

in the boxes for each month of the calendar year. If the number

Line 7. Enter the name of the ALE Member.

of employees for any month is zero, enter “0.”

Line 8. Enter the ALE Member’s EIN. Do not enter an SSN.

Column (d) Aggregated Group Indicator. An ALE Member

Enter the 9-digit EIN including the dash. The ALE Member’s

must complete this column if it checked “Yes” on line 21,

name and EIN should match the name and EIN of the ALE

indicating that, during any month of the calendar year, it was a

Member reported on lines 1 and 2 of Form 1094-C.

member of an Aggregated ALE Group. If the ALE Member was a

member of an Aggregated ALE Group during each month of the

If you are filing Form 1095-C, a valid EIN is required at

calendar year, enter “X” in the “All 12 Months” box or in the

the time it is filed. If a valid EIN is not provided, Form

boxes for each of the 12 calendar months. If the ALE Member

1095-C will not be processed. If you do not have an EIN,

CAUTION

was not a member of an Aggregated ALE Group for all 12

you may apply for one online. Go to IRS.gov and enter “EIN” in

months but was a member of an Aggregated ALE Group for one

the search box. You may also apply by faxing or mailing Form

or more month(s), enter “X” in each month for which it was a

SS-4 to the IRS. See the Instructions for Form SS-4 and Pub.

member of an Aggregated ALE Group. If an ALE Member enters

1635.

“X” in one or more months in this column, it must also complete

Part IV.

-9-

Instructions for Forms 1094-C and 1095-C (2017)

Instructions For Forms 1094-C And 1095-C - 2017 Page 9

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