ALE member information Form 1094-C

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Part III - ALE Member Information - Monthly


Line 23 to Line 25: ALE Member Information


Reminder: Part III (Lines 23-35) should only be completed on the Authoritative Transmittal for the employer.


In Column (a), if you offered Minimum Essential Covertage (MEC) to at least 95% of your full-time employees and their dependents, enter "X" in the "Yes" checkbox on line 23 for "All 12 Months," or for each of the 12 calendar months the coverage was offered.

Select "No" for each month MEC was not offered to at least 95% of your full-time employees. If you didn't offer this coverage but are eligible for Section 4980H Transition Relief for 2016, select "Yes" in the appropriate months.


In Column (b), enter the number of full-time employees you had each month, not including any employees in Limited Non-Assessment Periods.


In Column (c), enter the total number of all your employees (full-time, non-full-time, and employees in Limited Non-Assessment Periods). You'll need to choose one of the following days of the month to determine the number of employees per month. Use this same day for each month of the year:

  • The first day of each month
  • The last day of each month
  • The 12th day of each month
  • The first day the payroll period starts
  • The last day of the first payroll period that starts during the month

If you had the same total number of employees every month of the year, enter the total in Line 23 of Column (c).


If you checked "Yes" on Line 21, indicating that you're part of an Aggregated Group, indicate in Column (d) which months you were a member of an Aggregated ALE Group. If you enter an "X" in any box in Column (d), you must complete Part IV of Form 1094-C.


If you checked Box C on Line 22, indicating that you're eligible for Section 4980H Transition Relief, you'll need to complete
Column (e).

If you're eligible for Section 4980H Transition Relief, 50 to 99 Relief, enter code A in Column (e).
If you're eligible for the 100 or More Relief, enter Code B. No employers are eligible for both types of relief.