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1094-c instructions PDF Form: What You Should Know

Enter the employee's date of birth (MM/DD/YYY). Line 4. Enter the information for the insurance coverage obtained through the employer (including the health insurance premium, any tax credits and any out-of-pocket expenses). Line 5. Enter the type of coverage obtained through the employer (Medicare, Medicaid, Trocar, Trocar Prime, a military or other benefit, TRI CARE Prime, Veterans Administration, VA Prescription drug program, Medicare Advantage, or COBRA plan). Line 6. Enter the name of the plan and whether it is a group plan (such as a family membership plan, a group coverage or a health maintenance organization). Line 7. Enter the number of individuals enrolled in the plan. Line 8. Enter the total number of individuals (excluding dependents under age 19 and those in the immediate family of the employee). Line 9. Enter the number of dependent children under age 19 (including one or more adopted children) and how many are covered under the plan. Line 10. Enter the cost for the employer-provided coverage obtained by the employee. Line 11. Enter any additional information about the employee (such as marital status, employer, marital status for the spouse of the employee and other information). Line 12. Enter the employee's taxpayer identification number (PIN). Line 13. Enter employer information. Line 14. Enter the tax year of employment. Line 15. Add the employer's filing status. If it's a partnership, enter “2.” The tax year is the calendar year. Line 16. Enter the total wages for the year and how much was paid in wages for self-only coverage and how much was paid in wages for family coverage. Line 17. Enter the total number of persons covered and how many were in each of the following categories: self-only and family coverage. Line 18. Enter the number of employees eligible for self-only coverage and how many were in the group. Line 19. Add the employee's premium (X). Line 20. Add the cost for self-only coverage obtained by the employee and the employer's cost for the same coverage. Line 21. Add the employee's co-pay (X). Line 22. Add the employee's cost for family coverage obtained by the employee. Line 23. Add the employee's co-pay (X). Line 24. Add the employee's additional payments (X). Line 25.

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Video instructions and help with filling out and completing Form 1094-c instructions PDF

Instructions and Help about Form 1094-c instructions PDF

Thank you for attending the 1095 see 2016 data gathering spreadsheet webinar hosted by me, Benjamin Davis. Diversified Administration is pleased to announce the release of our data gathering spreadsheets for the 2016 calendar year's ACA reporting. Thanks to some IRS guidance, which clarified certain things, as well as invaluable experience we've gained preparing the 1094 and 1095 see forms for the 2015 filings, we've been able to greatly simplify the data gathering spreadsheets. This will make it much easier for you to enter the information and much easier for us to review it for accuracy to ensure we're able to process your data in an efficient manner. Please be sure to complete the employer information at the top. Please be sure to list two contacts, so even if someone's out of the office on a particular day, we're still able to get in touch with someone who will be able to assist us and answer any questions we may have. In this example, I've listed myself, Benjamin Davis, as well as my assistant, Sandro Vives, as the contacts for questions related to the Diversified Administration spreadsheet. I've listed data for a number of people, each representing different situations your employees are likely to face. A vast majority of your employees are likely to fit into a scenario similar to the first four or five examples. However, we've included examples of some less common situations, so you know how to enter data for those employees as well. The first column, labeled "notes," gives you a place to provide us with additional information you think may be important for us to know as we go through the scenarios. For various sample employees, you'll see a number of ways this field can be used. Columns B through K are for your basic...