Federal Free Printable 2016 Form 1094-C for 2017 Federal Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns

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Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns
2016 Form 1094-C

120117 1094-C Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns Form Department of the Treasury Internal Revenue Service Part I ▶ Information OMB No. 1545-2251 CORRECTED 2016 about Form 1094-C and its separate instructions is at www.irs.gov/form1094c Applicable Large Employer Member (ALE Member) 1 Name of ALE Member (Employer) 2 Employer identification number (EIN) 3 Street address (including room or suite no.) 4 City or town 5 State or province 6 Country and ZIP or foreign postal code 7 Name of person to contact 8 Contact telephone number 9 Name of Designated Government Entity (only if applicable) 10 Employer identification number (EIN) 11 Street address (including room or suite no.) For Official Use Only 12 City or town 13 State or province 14 Country and ZIP or foreign postal code 15 Name of person to contact 17 Reserved . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Total number of Forms 1095-C submitted with this transmittal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Is this the authoritative transmittal for this ALE Member? If “Yes,” check the box and continue. If “No,” see instructions . . . . . . . . . . . Part II . . . 16 Contact telephone number . . . . . . . . . . . . . . . . . . . . . . . . ▶ ALE Member Information 20 Total number of Forms 1095-C filed by and/or on behalf of ALE Member . . . . . . . . . . . . . . . . . . . . . . . . . . ▶ 21 Is ALE Member a member of an Aggregated ALE Group? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No If “No,” do not complete Part IV. 22 Certifications of Eligibility (select all that apply): A. Qualifying Offer Method B. Reserved C. Section 4980H Transition Relief D. 98% Offer Method Under 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. ▲ ▲ ▲ Signature For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Title Cat. No. 61571A Date Form 1094-C (2016) 120217 Page 2 Form 1094-C (2016) Part III ALE Member Information—Monthly (a) Minimum Essential Coverage Offer Indicator Yes 23 No (b) Section 4980H Full-Time Employee Count for ALE Member (c) Total Employee Count for ALE Member (d) Aggregated Group Indicator (e) Section 4980H Transition Relief Indicator All 12 Months 24 Jan 25 Feb 26 Mar 27 Apr 28 May 29 June 30 July 31 Aug 32 Sept 33 Oct 34 Nov 35 Dec Form 1094-C (2016) 120316 Page 3 Form 1094-C (2016) Part IV Other ALE Members of Aggregated ALE Group Enter the names and EINs of Other ALE Members of the Aggregated ALE Group (who were members at any time during the calendar year). Name EIN Name 36 51 37 52 38 53 39 54 40 55 41 56 42 57 43 58 44 59 45 60 46 61 47 62 48 63 49 64 50 65 EIN Form 1094-C (2016)
Extracted from PDF file 2016-federal-form-1094-c.pdf, last modified September 2016

More about the Federal Form 1094-C Corporate Income Tax TY 2016

We last updated the Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns in May 2017, so this is the latest version of Form 1094-C, fully updated for tax year 2016. You can download or print current or past-year PDFs of Form 1094-C directly from TaxFormFinder. You can print other Federal tax forms here.

Other Federal Corporate Income Tax Forms:

TaxFormFinder has an additional 774 Federal income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form 941 Employer's Quarterly Federal Tax Return
Form 9465 Installment Agreement Request
Form 990 or 990-EZ (Sch A) Public Charity Status and Public Support
Form 1125-A Cost of Goods Sold
Form 1120 U.S. Corporation Income Tax Return

Download all  tax forms View all 775 Federal Income Tax Forms


Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 1094-C from the Internal Revenue Service in May 2017.

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About the Corporate Income Tax

The IRS and most states require corporations to file an income tax return, with the exact filing requirements depending on the type of company.

Sole proprietorships or disregarded entities like LLCs are filed on Schedule C (or the state equivalent) of the owner's personal income tax return, flow-through entities like S Corporations or Partnerships are generally required to file an informational return equivilent to the IRS Form 1120S or Form 1065, and full corporations must file the equivalent of federal Form 1120 (and, unlike flow-through corporations, are often subject to a corporate tax liability).

Additional forms are available for a wide variety of specific entities and transactions including fiduciaries, nonprofits, and companies involved in other specific types of business.

Historical Past-Year Versions of Federal Form 1094-C

We have a total of two past-year versions of Form 1094-C in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2016 Form 1094-C

2016 Form 1094-C

Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns 2015 Form 1094-C

2015 Form 1094-C


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