IRS Form 1094-C Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns

IRS Form 1094-C Instructions

Instructions for Form 1094-C are as follows:

1. Part I - ALE Member. Enter the employer's name, the employer identification number (EIN), the complete address, the name and telephone number of the person for the IRS to contact. If a Designated Governmental Entity (DGE) files on behalf of an ALE member, it is necessary to state their name, the EIN, the complete address, and the name and telephone number of the person for the IRS to contact. Write down the total number of form 1095-C submitted;
2. Part II - ALE Member Information. State the total number of Forms 1095-C filed. Indicate if the employer is a member of an aggregated ALE group. Choose a certification of eligibility, if applicable. Sign and date the form;
3. Part III - ALE Member Information - Monthly. Check the appropriate boxes if the ALE member offered minimum essential coverage to at least 95% of its employees for the entire year/certain months. Provide the full-time employee count and total employee count;
4. Part IV - Other ALE Members of Aggregated ALE Group. If the ALE member is a member of an aggregated ALE group, it is necessary to submit the names and the EINs of the other group members (not more than 30).

When Is Form 1094-C Due?

The due date for Form 1094-C is the last day of February if you file it on paper and the last day of March if you file it electronically (the year that follows the calendar year of coverage). There is a penalty if you fail to provide an accurate information return - $270 for each return for which the failure has occurred.

Where to Mail Form 1094-C?

Mailing addresses for the form:

• Department of the Treasury Internal Revenue Service Center Austin, TX 73301 - for Alabama, Arizona, Arkansas, Connecticut, Delaware, Florida, Georgia, Kentucky, Louisiana, Maine, Massachusetts, Mississippi, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Texas, Vermont, Virginia, West Virginia, and foreign countries;
• Department of the Treasury Internal Revenue Service Center PO Box 219256 Kansas City, MO 64121-9256 - for Alaska, California, Colorado, District of Columbia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Maryland, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, North Dakota, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Utah, Washington, Wisconsin, Wyoming.