IRS · United States

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

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For Applicable Large Employers (ALEs), HR Directors, Payroll Managers & CPAs

ALE HR Director, Payroll Manager, or Benefits Administrator preparing the Form 1094-C Authoritative Transmittal (Parts I–IV: ALE Member EIN, Line 18–20 1095-C counts, Part III monthly MEC Offer Indicator & Section 4980H full-time headcounts) alongside employee Forms 1095-C? Generate your entire 1095-C & 1094-C filing packet from Excel or CSV.

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JustFill prepares completed Form 1094-C and Form 1095-C PDFs for review, signing, paper filing, and compliance archives; it does not transmit ACA AIR XML submissions to the IRS (employers filing 10 or more information returns in aggregate must e-file through the IRS ACA Information Returns system).JustFill is not affiliated with IRS. This is an independent third-party tool to help you complete Form 1094-C. Always download the current blank form from the official source and verify your completed copy before signing or submitting. Official Form 1094-C from IRS

Quick answer

IRS Form 1094-C, Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns, is the mandatory 3-page Affordable Care Act (ACA) summary cover sheet that every Applicable Large Employer (ALE with 50+ full-time and full-time-equivalent employees) files with the IRS to transmit its employee Forms 1095-C. It reports ALE Member employer and contact details (Part I, Lines 1–18), the Authoritative Transmittal designation (Line 19), total employee Form 1095-C counts, Aggregated ALE Group status, and Section 4980H Certifications of Eligibility (Part II, Lines 20–22), monthly Minimum Essential Coverage (MEC) indicators and full-time/total headcounts (Part III, Lines 23–35, Columns a–e), and other Aggregated ALE Group members (Part IV, Lines 36–65). Open the official Form 1094-C PDF in JustFill to complete it online or pair it with batch-generated Forms 1095-C from Excel/CSV.

Form
Form 1094-C
Issued by
IRS
Country
United States
Free allowance
Watermarked preview (hand-filled PDFs up to 1 page)
Official edition
2026 Form 1094-C (OMB No. 1545-2251; 3 pages)
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IRS Form W-4 + USCIS Form I-9

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IRS Form 2848 (POA) + Form 8821 + Form 4506-T Transcript

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What is Form 1094-C?

Filing annual ACA employer health coverage returns under Internal Revenue Code Section 6056? Every Applicable Large Employer (ALE) Member must file at least one Form 1094-C transmittal cover alongside the individual Forms 1095-C prepared for its full-time employees. While Form 1095-C reports employee-level offer, contribution, and safe harbor codes (Lines 14–16), Form 1094-C is the employer-level summary return the IRS uses to evaluate Section 4980H Employer Shared Responsibility compliance: verifying whether the ALE Member offered Minimum Essential Coverage (MEC) to at least 95% of its full-time employees and their dependents each month (Part III, Column a), reconciling monthly Section 4980H full-time employee headcounts (Column b) against total employee headcounts (Column c), and linking Controlled Group or Affiliated Service Group entities (Part IV). JustFill lets HR directors, payroll managers, and CPA firms complete all 3 pages of Form 1094-C in the browser or generate the transmittal alongside 25 to 500 employee Form 1095-C PDFs from an HRIS/payroll Excel or CSV export.

Pairing Form 1094-C (Authoritative Transmittal) with Bulk Form 1095-C Employee Runs

IRS Form 1094-C never travels alone: it is the mandatory employer-level transmittal cover sheet that summarizes and accompanies every batch of employee Forms 1095-C filed under IRC Section 6056. The IRS Automated Underreporter and ACA compliance systems cross-check your Form 1094-C Part II Line 20 total against the actual count of Forms 1095-C submitted, and evaluate Part III Column (a) (Minimum Essential Coverage Offer Indicator) and Column (b) (Section 4980H Full-Time Employee Count) before issuing any Letter 226-J proposed Employer Shared Responsibility Payment.

HR Directors, Payroll Managers, and CPA firms use JustFill to complete the 3-page Form 1094-C Authoritative Transmittal and batch-generate 25 to 500 accompanying employee Form 1095-C PDFs directly from their HRIS or payroll Excel/CSV workbook.

Related IRS & B2B Compliance Forms

IRS Form 1095-C (ACA Employee Health Coverage Statement)IRS Form 941 (Employer Quarterly Federal Tax Return)IRS Form W-2 (Wage and Tax Statement)IRS Form SS-4 (Employer Identification Number)Fillable Form 2848 (IRS Power of Attorney)IRS Form 843 (Employer Penalty Abatement)

Download the Form 1094-C form PDF — free

The official 3-page IRS Form 1094-C PDF (OMB No. 1545-2251) is a free fillable PDF published by the IRS at irs.gov/pub/irs-pdf/f1094c.pdf. Click "Fill the blank Form 1094-C now" above to open the blank Form 1094-C directly in JustFill, or pair it with our ACA Form 1095-C & 1094-C Excel/CSV batch workflow to generate your employee statements and transmittal cover together.

Get the official Form 1094-C PDF from IRS

Who fills out Form 1094-C?

  • Applicable Large Employers (ALEs averaging 50+ full-time and full-time-equivalent employees in the prior calendar year) transmitting annual Forms 1095-C to the IRS
  • HR Directors, Payroll Managers, and Benefits Administrators completing the Authoritative Transmittal (Part I Line 19, Parts II–IV) for their company EIN
  • Parent companies, subsidiaries, and sister entities in an Aggregated ALE Group (IRC § 414(b), (c), (m), or (o)) reporting separate EIN transmittals and cross-listing top group members in Part IV
  • CPA firms, PEOs, and benefits compliance teams preparing archival and paper/electronic ACA Section 6056 packets alongside employee Forms 1095-C

Field-by-field breakdown

What each section of Form 1094-C asks for. JustFill’s AI will detect these fields automatically when you upload the PDF — review the breakdown below so you know what to enter.

Part I — Applicable Large Employer Member (ALE Member) (Page 1, Lines 1–19)

ALE Member legal name (Line 1), 9-digit Employer Identification Number / EIN (Line 2), street address, city, state, and ZIP code (Lines 3–6), ACA contact person name and telephone number (Lines 7–8), Designated Government Entity (DGE) name, EIN, address, and contact if applicable (Lines 9–16), total number of Forms 1095-C submitted with this specific transmittal (Line 18), and the checkbox on Line 19 certifying whether this Form 1094-C is the Authoritative Transmittal for the ALE Member.

Part II — ALE Member Information (Page 1, Lines 20–22)

Completed only on the Authoritative Transmittal (when Line 19 is checked): Line 20 enters the total number of Forms 1095-C that will be filed by or on behalf of this ALE Member across all batches; Line 21 checks Yes or No to indicate whether the ALE Member was a member of an Aggregated ALE Group during any month of the calendar year; and Line 22 selects applicable Certifications of Eligibility (Box A Qualifying Offer Method, Box D 98% Offer Method).

Part III, Column (a) — Minimum Essential Coverage Offer Indicator (Page 2, Lines 23–35)

For "All 12 Months" (Line 23) or individually for January through December (Lines 24–35), check "Yes" if the ALE Member offered Minimum Essential Coverage (MEC) to at least 95% of its full-time employees and their dependents (or all but 5 full-time employees, if greater) for that calendar month; otherwise check "No".

Part III, Columns (b) & (c) — Section 4980H Full-Time & Total Employee Counts (Page 2, Lines 23–35)

Column (b) reports the number of Section 4980H full-time employees (averaging 30+ hours of service per week or 130+ hours per month, excluding employees in a Limited Non-Assessment Period) for each calendar month (not required if Line 22 Box D 98% Offer Method is checked). Column (c) reports the Total Employee Count (full-time, part-time, seasonal, and employees in a waiting period) on the 1st day, 12th day, first/last day of the first payroll period, or last day of each month.

Part III, Columns (d) & (e) — Aggregated Group Indicator & Reserved (Page 2, Lines 23–35)

Column (d) is checked for each month (or All 12 Months on Line 23) in which the employer was a member of an Aggregated ALE Group (completed only if Line 21 is marked "Yes"). Column (e) was previously used for Section 4980H Transition Relief and is reserved on current IRS revisions.

Part IV — Other ALE Members of Aggregated ALE Group (Page 3, Lines 36–65)

Completed only if the employer checked "Yes" on Part II, Line 21: enters the legal name and 9-digit EIN of up to 30 other ALE Members in the same Aggregated ALE Group, listed in descending order from highest to lowest average monthly full-time employee count.

Common mistakes to avoid

  • 1Filing Form 1094-C without checking Line 19 ("Is this the authoritative transmittal for this ALE Member?") — every ALE Member EIN must designate exactly one Form 1094-C as its Authoritative Transmittal and complete Parts II, III, and (if applicable) IV on that return.
  • 2Checking "Yes" in Part III Column (a) when Minimum Essential Coverage was offered to fewer than 95% of full-time employees (or leaving out dependent child coverage) — an inaccurate "No" or unverified headcount in Column (a) is the primary trigger for IRS Letter 226-J Section 4980H penalty assessments.
  • 3Entering the same number in Part III Column (b) (Full-Time Employee Count) and Column (c) (Total Employee Count) when the company also employs part-time, variable-hour, or waiting-period workers — Column (c) must include all employees on the chosen monthly snapshot date.
  • 4Mismatching Line 18 / Line 20 on Form 1094-C with the actual number of employee Forms 1095-C generated from your payroll or HRIS export — always reconcile your Excel/CSV row count before exporting.

Form 1094-C example — what a filled-out form looks like

A fictional standalone 75-employee Texas manufacturer, Sample Horizon Manufacturing Inc. (not part of an Aggregated ALE Group), files its single Authoritative Transmittal Form 1094-C accompanying 75 employee Forms 1095-C after offering Minimum Essential Coverage to 100% of full-time employees for all 12 months.

Part I, Lines 1–8 — ALE Member Employer & Contact Information

Sample Horizon Manufacturing Inc. · EIN 74-•••••82 · 900 Industrial Sample Blvd, Austin, TX 78744 · Contact: Dana M. Sample · (512) 555-01••

Matches the ALE Member employer name, EIN, and contact telephone printed in Part I (Lines 7–13) of every accompanying Form 1095-C.

Part I, Lines 18–19 & Part II, Lines 20–22 — Authoritative Transmittal & Totals

Line 18 Forms 1095-C submitted with this transmittal: 75 · Line 19 Authoritative Transmittal: ☑ Checked · Line 20 Total Forms 1095-C: 75 · Line 21 Aggregated ALE Group: ☑ No · Line 22 Certifications: left blank (standard monthly reporting)

Designates this return as the sole Authoritative Transmittal for the EIN and reconciles all 75 employee Forms 1095-C.

Part III, Line 23–35 — Monthly MEC Offer Indicator & Employee Counts (Cols. a–c)

Line 23 Col. (a) MEC Offer Indicator (All 12 Months): ☑ Yes · Lines 24–35 Col. (b) Full-Time Employee Count: 72–75 per month · Lines 24–35 Col. (c) Total Employee Count: 84–88 per month (includes 12–13 part-time staff)

Certifies that Minimum Essential Coverage was offered to at least 95% of full-time employees and dependents all year and reports monthly full-time vs. total headcounts.

Page 1 Signature Block & Part IV

Signed by Dana M. Sample, VP of Human Resources, on 02/24/2026 · Part IV left blank (Line 21 is No)

Part IV is completed only when the ALE Member belongs to a multi-EIN Aggregated ALE Group.

These values are made up. They are here to show what belongs on each line, not to be copied — every name, number, and address on your own Form 1094-C has to be your own.

Where to send Form 1094-C — fax numbers and mailing addresses

Applicable Large Employers file Form 1094-C together with the employer copies of Form 1095-C with the IRS. Employers filing 10 or more information returns in aggregate across the calendar year must file electronically through the IRS ACA Information Returns (AIR) system; eligible small paper filers mail Form 1094-C and Forms 1095-C in a flat envelope to the IRS Service Center for their principal place of business.

Austin IRS Service Center (Eastern & Southern States)

Use this if the address is in: Alabama, Arizona, Arkansas, Connecticut, Delaware, Florida, Georgia, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Mississippi, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Texas, Vermont, Virginia, West Virginia

Mail to
Department of the Treasury, Internal Revenue Service Center, Austin, TX 73301

Kansas City IRS Service Center (Midwest, Western States & D.C.)

Use this if the address is in: Alaska, California, Colorado, District of Columbia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, North Dakota, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Utah, Washington, Wisconsin, Wyoming

Mail to
Department of the Treasury, Internal Revenue Service Center, Kansas City, MO 64999

Do not furnish Form 1094-C to employees — employees receive only their individual Form 1095-C statement, while Form 1094-C goes exclusively to the IRS and your employer ACA compliance archive.

Checked against the official IRS instructions on 2026-11-03. Destinations change — confirm on the IRS page before you send anything.

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For Applicable Large Employers (ALEs), HR Directors, Payroll Managers & CPAs

Transmitting 50–500 employee Forms 1095-C with IRS Form 1094-C? Batch-fill from Excel or CSV.

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Related forms

IRS

Form 1095-C

Form 1095-C: Employer-Provided Health Insurance Offer and Coverage

Internal Revenue Service (IRS)

Form 941

Form 941, Employer's Quarterly Federal Tax Return

Internal Revenue Service (IRS) / Social Security Administration (SSA)

Form W-2

Form W-2, Wage and Tax Statement

Internal Revenue Service (IRS)

Form SS-4

Form SS-4, Application for Employer Identification Number (EIN)

IRS

W-9

Form W-9: Request for Taxpayer Identification Number and Certification

IRS

Form 2848

Form 2848: Power of Attorney and Declaration of Representative

IRS

Form 8821

Form 8821: Tax Information Authorization

IRS

Form 843

Form 843: Claim for Refund and Request for Abatement

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Frequently asked questions

Every Applicable Large Employer (ALE) Member with its own EIN must file one (and only one) Form 1094-C marked as the "Authoritative Transmittal" by checking the box on Part I, Line 19. Even if an employer submits Forms 1095-C in multiple separate batches, only the single Authoritative Transmittal Form 1094-C reports the employer's aggregate summary data in Part II (Lines 20–22), Part III (Lines 23–35 monthly MEC indicator and headcounts), and Part IV (Lines 36–65 Aggregated ALE Group members).
In Part III, Column (a) (Lines 23–35), check "Yes" if your ALE Member offered Minimum Essential Coverage (MEC) under an eligible employer-sponsored plan to at least 95% of its full-time employees and their dependents (or to all but 5 full-time employees, if 5 is greater than 5%) for every month of the year (Line 23 "All 12 Months") or for the specific calendar month (Lines 24–35). Checking "No" without applicable relief indicates potential exposure to an IRC Section 4980H(a) assessment if at least one full-time employee receives a Premium Tax Credit.
Part III, Column (b) reports only Section 4980H full-time employees (those averaging 30+ hours of service per week or 130+ hours per calendar month under the monthly measurement or look-back measurement method), excluding employees in a Limited Non-Assessment Period (such as a new-hire waiting period). Part III, Column (c) reports the Total Employee Count — including full-time employees, part-time employees, seasonal workers, and employees in a waiting period — measured on a consistent monthly snapshot date (such as the 1st day or 12th day of each month, or the first or last day of the first payroll period each month).
You complete Part IV (Lines 36–65) on Page 3 only if your company was part of an Aggregated ALE Group (parent-subsidiary, brother-sister, or affiliated service group under IRC Section 414(b), (c), (m), or (o)) during any month of the year and therefore checked "Yes" on Part II, Line 21. In Part IV, you list the legal name and EIN of up to 30 other ALE Members of the group in descending order of their average monthly full-time employee counts, and check Part III, Column (d) for the months your entity belonged to the group.
In JustFill, HR Directors and Payroll Managers first batch-generate their employee Forms 1095-C from an HRIS or payroll CSV export (one row per full-time employee), then open Form 1094-C to enter the matching ALE Member EIN block (Part I, Lines 1–8), set Line 18 and Line 20 to the exact count of employee Forms 1095-C in the batch, and record the 12-month Part III MEC indicator and full-time/total headcounts.

Official source: Form 1094-C on IRS’s website

Edition checked: 2026 Form 1094-C (OMB No. 1545-2251; 3 pages). Verified against the official source on · Verified in our Government Forms Fillability Study.

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Form 1094-C

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