[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-303980-105":3,"detail-sidebar-cat-1-en-105":80,"doc-detail-303980-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","form-1094-c-2025-transmittal-of-employer-provided-health-insurance-offer-and-coverage-information-returns","Form 1094-C (2025) - Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns","","Form 1094-C (2025) is the transmittal used by an Applicable Large Employer Member (ALE Member) to submit Employer-Provided Health Insurance Offer and Coverage Information Returns. The form captures key ALE Member details including name, employer identification numbers (EINs), addresses, contact information, and whether the transmittal is authoritative. It also includes counts for submitted and filed Forms 1095-C and eligibility certifications, along with monthly indicators for minimum essential coverage and employee counts by month.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/form-1094-c-2025-transmittal-of-employer-provided-health-insurance-offer-and-coverage-information-returns/303980/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/form-1094-c-2025-transmittal-of-employer-provided-health-insurance-offer-and-coverage-information-returns/303980.png","ImageObject",442,249,{"name":42,"@type":43},"Aldword","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-01","2026-09-19",true,{"@type":52,"interactionType":53,"userInteractionCount":30},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"What is Form 1094-C used for?","Question",{"text":62,"@type":63},"Form 1094-C is a transmittal that an ALE Member uses to submit Employer-Provided Health Insurance Offer and Coverage Information Returns.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"What information is collected in Part I about the ALE Member?",{"text":67,"@type":63},"Part I requests the ALE Member’s name, EIN, street address, city/town, state/province, country and ZIP/foreign postal code, and a contact person and telephone number.",{"name":69,"@type":60,"acceptedAnswer":70},"How does the form report monthly information?",{"text":71,"@type":63},"Part II provides monthly indicators, including minimum essential coverage offer status and counts related to full-time employees and total employee counts for the ALE Member across the 12 months.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},303980,1790187145,{"code":4,"msg":81,"data":82},"success",[83,88,93,98,103,108,112,117,122],{"id":84,"doc_module":22,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},11,"Presentations",90,"presentations",{"id":89,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},12,"Resumes",80,"resumes",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},14,"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":110,"slug":111},17,40,"forms",{"id":113,"doc_module":22,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},18,"Letters",30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":81,"data":127},{"doc_id":78,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":109,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":33,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":139,"read_time":22},2336478940917,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","OMB No.1545-2251  \n1094-C  \n# Transmittal of Employer-Provided Health Insurance Offer andCoverage Information Returns\n\nCORRECTED  \n2025  \nDepartment of the Treasuy  \nGo to www.irs.gov/Form1094C for instructions and the latest information.  \nPartl  \nApplicable Large Employer Member(ALE Member)  \n\n| 1 Name of ALE Member(Employer)   |  |  | 2 Employer identification number(EIN)   | For Official Use Only   |\n| --- | --- | --- | --- | --- |\n| 3 Street address(including room or suite no.)   |  |  |  |  |\n| 4 City or town   | 5 State or province   | 6 Country and ZIP or foreign postal code   |  |  |\n| 7 Name of person to contact   |  |  | 8 Contact telephone number   |  |\n| 9 Name of Designated Government Entity(only if applicable)   |  |  | 10 Employer identification number(EIN)   |  |\n| 11 Street address(ncluding room or suite no.)   |  |  |  |  |\n| 12 City or town   | 13 State or province   | 14 Country and ZIPor foreign postalcode   |  |  |\n| 15 Name of person to contact   |  |  | 16 Contact telephone number   |  |\n| 17 Reserved ....  \u003Cbr>.........   |  |  |  |  |\n\n18 Total number of Forms 1095-C submitted with this transmittal                                          \n19 Is this the authoritative transmitalfor this ALE Member?If“Yes,\"check the box and continue.If“\"No,\"see instructions.PartII ALE Member Information                                                    \n20 Total number of Forms 1095-C filed by and/or on behalf of ALE Member.                               If\"No,\"do not complete Part IV.                                                  \n22 Certifications of Eligibility (select all that apply):  \n□A.Qualifying Offer MethodB.ReservedC.Reserved□D.98%Offer MethodUnder penalties of perjury,I declare that I have examined this return and accompanying documents,and to the best of my knowledge and belief,they are true,correct,and complete.  \nPage2  \nFom 1094-C (2025)  \nALE Member Information-Monthly  \n## Part II\n\n\n|  | (a)Minimum Essential Coverage  \u003Cbr>Offer Indicator   |  | (b)Section 4980H Full-Time  \u003Cbr>Employee Count for ALE Member   | (c)Total Employee Count  \u003Cbr>for ALE Member   | (d)Aggregated  \u003Cbr>Group Indicator   | (e)Reserved   |\n| --- | --- | --- | --- | --- | --- | --- |\n|  | Yes   | No   |  |  |  |  |\n| 23  \u003Cbr>All 12 Months   |  |  |  |  |  |  |\n| 24  \u003Cbr>Jan   |  |  |  |  |  |  |\n| Feb  \u003Cbr>25   |  |  |  |  |  |  |\n| 26  \u003Cbr>Mar   |  |  |  |  |  |  |\n| Apr  \u003Cbr>27   |  |  |  |  |  |  |\n| 28  \u003Cbr>May   |  |  |  |  |  |  |\n| 29  \u003Cbr>June   |  |  |  |  |  |  |\n| 30  \u003Cbr>July   |  |  |  |  |  |  |\n| 31  \u003Cbr>Aug   |  |  |  |  |  |  |\n| 32  \u003Cbr>Sept   |  | □   |  |  |  |  |\n| 33  \u003Cbr>Oct   |  |  |  |  |  |  |\n| 34  \u003Cbr>Nov   |  | □   |  |  |  |  |\n| Dec  \u003Cbr>35   |  | □   |  |  |  |  |\n\nPart IVOther ALE Members of Aggregated ALE Group                                         \nEnter the names and EINs of Other ALE Members of the Aggregated ALE Group (who were members at any time during the calendar year)  \n\n| Name   | EIN   | Name   | EIN   |\n| --- | --- | --- | --- |\n| 36   |  | 51   |  |\n| 37   |  | 52   |  |\n| 38   |  | 53   |  |\n| 39   |  | 54   |  |\n| 40   |  | 55   |  |\n| 41   |  | 56   |  |\n| 42   |  | 57   |  |\n| 43   |  | 58   |  |\n| 44   |  | 59   |  |\n| 45   |  | 60   |  |\n| 46   |  | 61   |  |\n| 47   |  | 62   |  |\n| 48   |  | 63   |  |\n| 49   |  | 64   |  |\n| 50-   |  | 65   |  |\n\nForm 1094-C(2025)","cbCaihmLAO2sniM3","https://ap.wps.com/l/cbCaihmLAO2sniM3","pdf",159619,"English","# Transmittal overview\n## Part I - Applicable Large Employer Member (ALE Member)\n## Part II - ALE Member Information (Monthly)\n## Part IV - Other ALE Members of Aggregated ALE Group","[{\"question\":\"What is Form 1094-C used for?\",\"answer\":\"Form 1094-C is a transmittal that an ALE Member uses to submit Employer-Provided Health Insurance Offer and Coverage Information Returns.\"},{\"question\":\"What information is collected in Part I about the ALE Member?\",\"answer\":\"Part I requests the ALE Member’s name, EIN, street address, city/town, state/province, country and ZIP/foreign postal code, and a contact person and telephone number.\"},{\"question\":\"How does the form report monthly information?\",\"answer\":\"Part II provides monthly indicators, including minimum essential coverage offer status and counts related to full-time employees and total employee counts for the ALE Member across the 12 months.\"}]","Form 1094-C (2025) - Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns | PDF",1789808745]