Standard Report - 1094-C

Report Description

Form 1094-C and Form 1095-C are forms used to report required information about healthcare to the IRS. Following the Affordable Care Act (ACA), all applicable large employers (ALEs) need to report whether they’ve offered health coverage to each employee and whether those employees are enrolled in health coverage. Form 1094-C is the summary of this information for all employees. 



Parameter Name



Form Batch ID

Employer & ACA Form Year

Select the Employer and ACA form year from the dropdown menu


Report Fields

Field Name


Name of ALE Member

Enter employer's name. The employer is the ALE Member.

Employer Identification Number

Enter the ALE Member’s EIN. Do not enter an SSN. Enter the 9-digit EIN, including the dash.

Street Address

Employer's Street Address

City or Town

Employer's City or Town

State or Province

Employer's State or Province

Country & Zip or Foreign Postal Code

Employer's Country & Zip or Foreign Postal Code

Name of Person to Contact

Name of Contact Person

Contact Telephone Number

Contact's Telephone Number

Total Number of Forms 1095-C Filed by ALE Member

The total number of Forms 1095-C submitted with this Form 1094-C transmittal.

Is ALE Member a member of an Aggregated ALE Group?


Certifications of Eligibility

 If the ALE Member meets the eligibility requirements and is using one of the Offer Methods, it must check the applicable box.

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