Edit Form 1094-C screen Field Reference

This screen reference describes the following:

Part I & Part II

FieldDescription
Part I - Applicable Large Employer Member (ALE Member)
ALE Member NameDisplays the name of the company selected in the header from the Company screen. If you want to override this value for the active tax year, enter a different name.
Employer Identification Number (EIN)Displays the employer identification number for the company from the Company screen. If you want to override this value for the active tax year, enter a different number.
Note: You cannot use an SSN in place of an EIN on this form.
Street 1Displays the first line of the street address for the company from the Company screen. If you want to override these values for the active tax year, enter a new street address.
Note: The address entered here is also printed on all Forms 1095-C created for the company.
Street 2Displays the second line of the street address for the company from the Company screen. If you want to override these values for the active tax year, enter a new street address.
City / State / ZipDisplays the city, state, and ZIP code for the company from the Company screen. If you want to override these values for the active tax year, enter a new city, state, and ZIP code.
ContactEnter the name of the contact at the company who can answer questions about Forms 1094-C and 1095-C.
PhoneEnter the phone number for the contact, including area code, phone number, and extension.
Total Number of Forms 1095-C submitted with transmittalDisplays the total number of Forms 1095-C that will be submitted with Form 1094-C.
Is Member of Aggregated ALE GroupSelect the checkbox to indicate that the employer was a member of an Aggregated ALE Group during any month of the year. You can specify which months the employer was a member of an Aggregated ALE Group on the Part III tab.
Part II - ALE Member Information
Is Member of Aggregated ALE Group

Select the checkbox to indicate that the employer was a member of an Aggregated ALE Group during any month of the year.

You can specify which months the employer was a member of an Aggregated ALE Group on the Part III tab.

Certifications of Eligibility (select all that apply) - Selecting one or more of these checkboxes affects how Forms 1095-C should be completed for employees. Refer to the IRS website (www.irs.gov/instructions/i109495c/ar01.html) for the most up-to-date information.
Qualifying Offer MethodSelect the checkbox to indicate that the employer is eligible to use and is using the Qualifying Offer Method to report the information on Form 1095–C for one or more full-time employees.
Note: If the employer reports using this method, it must not complete line 15 of Form 1095-C Part II for any month for which a Qualifying Offer is made. Instead it must enter the Qualifying Offer code 1A on line 14 of Form 1095-C to indicate that the employee received a Qualifying Offer for all 12 months (in which case the employer must not, for any month, report the dollar amount on line 15). An employer is not required to use the Qualifying Offer Method, even if it is eligible and instead may enter on line 14 the applicable offer code and on line 15 the dollar amount required as an employee contribution for the lowest-cost employee-only coverage providing minimum value for that month.
ReservedThis checkbox is currently not in use on Form 1094 - C and is disabled.
ReservedThis checkbox is currently not in use on Form 1094 - C and is disabled.
98% Offer MethodSelect the checkbox to indicate that the employer is eligible for and is using the 98% Offer Method.
Note: To be eligible to use the 98% Offer Method, an employer must certify that it offered, for all months of the calendar year, affordable health coverage providing minimum value to at least 98% of its employees for whom it is filing a Form 1095-C employee statement, and offered minimum essential coverage to those employees' dependents. The employer is not required to identify which of the employees for whom it is filing were full-time employees, but the employer is still required to file Forms 1095-C on behalf of all of its full-time employees. (For this purpose, the health coverage is affordable if the employer meets one of the section 4980H affordability safe harbors.) Note: if an employer uses this method, it is not required to complete the "Full-Time Employee Count" in Part III, column (b).

Part III

FieldDescription
ALE Member Information - Monthly - Each row in the grid is a box number for Part III of Form 1094-C.
Box No.

Displays the box numbers from Part III of Form 1094-C.

Complete either the row for Box 23 - All 12 Months or the rows for Boxes 24-35, but do not complete both.

Box DescDisplays the box description from Part III of Form 1094-C.
MEC Offer IndicatorSelect the checkbox in a row to indicate that the employer offered minimum essential coverage under an eligible employer-sponsored plan to at least 95% of its full-time employees and their dependents.
Full Time Employee CountEnter the number of full-time employees for each month.
Note: If you selected the 98% Offer Method checkbox on the Part I & Part II tab, you are not required to complete this field.
Total Employee CountEnter the total number of employees including full-time employees and non-full-time employees and employees in a Limited Non-Assessment Period for each month.
Note: An employer must use one of the following days to determine the number of employees per month and must use the same day for all months of the year:
  • The first day of each month.
  • The last day of each month.
  • The first day of the first payroll period that starts during each month.
  • The last day of the first payroll period that starts during each month (provided that, for each month, that last day falls within the calendar month in which the payroll period starts).
If the total number of employees was the same for every month of the entire year, enter that number in the row for Box 23 - All 12 Months.
Aggregated Group Indicator

Select this checkbox to indicate that the employer was a member of an Aggregated ALE Group in the rows for the months in which the employer was a member. If the employer was a member of an Aggregated ALE Group for the entire year, select this checkbox in the row for Box 23 - All 12 Months.

You should only select this checkbox if you selected the Is Member of Aggregated ALE Group checkbox on the Part I & Part II tab.

If you select this checkbox in any row, you must also complete the information on the Part IV tab.

ReservedThis column is currently not used on Form 1094 - C.

Part IV

FieldDescription
Other ALE Members of Aggregated ALE Group - Each row in the grid can be used to enter a member of the Aggregated ALE Group. You cannot add or delete rows. You can enter up to 30 members.
Sequence No.Displays the row number.
Member NameIf you selected the Is Member of Aggregated ALE Group checkbox on the Part I & Part II tab, enter the name of a member of the Aggregated ALE Group.
Note: If there are more than 30 members of the Aggregated ALE Group, enter the 30 with the highest monthly average number of full-time employees (using the number reported in Part III, column (b), if a number was required to be reported) for the year or for the number of months during which the ALE Member was a member of the Aggregated ALE Group. Regardless of the number of members in the Aggregated ALE Group, list only the 30 members in descending order, listing first the member with the highest average monthly number of full-time employees. The employer must also complete the Aggregated Group Indicator field on the Part III tab to indicate which months it was part of an Aggregated ALE Group.
Employer Identification NumberEnter the Employer Identification Number for the member of the Aggregated ALE Group whose name you entered in the Member Name field in the row.