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1094-c form 278016-1094 c tax form

 Form 1094C is a requirement for Applicable Large Employers (ALE), or those with 50 or more fulltime equivalent employees Who is responsible Form 1094B will be completed by the carrier or plan sponsor Form 1094C is completed by the employer or members of the Applicable Large Employer (ALE) Form 1095Inst 1094C and 1095C Instructions for Forms 1094C and 1095C 14 Form 1094C Transmittal of EmployerProvided Health Insurance Offer and Coverage Information Returns Form 1094C Transmittal of EmployerProvided Health Insurance Offer andForm 1094C Department of the Treasury Internal Revenue Service Transmittal of EmployerProvided Health Insurance Offer and Coverage Information Returns Go to wwwirsgov/Form1094C for instructions and the latest information OMB No Part I Applicable Large Employer Member (ALE Member) 1 Name of ALE Member (Employer) 2

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