Part I - Applicable Large Employer Member (ALE Member)
Line 1: name of ALE member (Employer)
Enter the full name of the ALE reporting the Form 1094-C with their 1095-C Forms.
Line 2: Employer identification number (EIN)
Enter the ALE's 9-digit employer identification number (EIN). SSN may not be used instead of an EIN. If you do not have an EIN, you can apply for one online at www.irs.gov, or by faxing or mailing Form SS-4 to the IRS.
Line 3: Street address (including room or suite no.)
Line 4: City or town
Line 5: State or province
Line 6: Country and ZIP or foreign postal code
In Lines 3-6, enter the complete address of the ALE where all correspondence regarding the filing may be sent. A P.O. Box may be entered in lieu of a street address if that's how mail is received by the filer. This address should match the ALE's address on the accompanying 1095-C forms.
Line 7: Name of person to contact
Line 8: Contact telephone number
In Lines 7-8, enter the name and contact information of the person responsible for answering any questions about the filing of Form 1095-C.