Self-service ACA Form 1095-C & Form 1094-C PDF batch generator for ALEs (50–500 employees)

ACA Form 1095-C & 1094-C Bulk Generator from Excel or CSV for ALE Employers

Built for HR Directors, Payroll Managers, and Benefits Administrators at Applicable Large Employers (ALEs with 50–500 full-time and FTE employees). Generate recipient-ready IRS Form 1095-C statements (Part I Employee & ALE Member details, Part II Lines 14, 15, and 16 Offer of Coverage / Employee Required Contribution / Section 4980H Safe Harbor Codes, and Part III Covered Individuals for self-insured plans) plus the Form 1094-C transmittal cover directly from your ADP, Gusto, Paychex, Rippling, Workday, or BambooHR Excel (.xlsx) and CSV exports.

Try the sample batchUpload your 1095-C PDF

Try five spreadsheet rows free with a watermark and free AI column matching. Clean ZIP exports are unlocked by the $7 7-Day Pass (up to 25 rows) or included in Starter ($19/month for up to 25 rows), Pro ($49/month for 100 rows), and Business ($99/month for 500 rows).

Your data lives in Google Sheets? Fill the PDF directly from Sheets with the JustFill add-on.

22-second walkthrough

One PDF. Five spreadsheet rows. One ZIP.

A real production workflow with a synthetic vendor form and a five-row Excel workbook: match all nine fields, review every PDF, and export one ZIP.

  1. 1Review nine PDF fields once
  2. 2Match 9/9 Excel headers
  3. 3Approve five and export ZIP

PDF mail merge, without Word

How to fill multiple PDF forms from Excel

Keep the original PDF layout. Put column names in the first spreadsheet row and one customer, employee, vendor, or case in each row below it. JustFill creates a separate PDF for every selected row.

  1. 1

    Upload the original PDF

    Use an AcroForm, a flat PDF, or a scan. JustFill detects the fields before the merge.

  2. 2

    Import XLSX or CSV

    Dates, leading zeros, percentages, booleans, and spreadsheet headers are preserved for mapping.

  3. 3

    Check the column mapping

    Matching headers map directly. Ambiguous columns can use AI-assisted mapping.

  4. 4

    Review and export

    Approve the records you want and download individual filled PDFs in one ZIP.

Sample input

One employee ACA census row becomes one populated IRS Form 1095-C PDF

Employee & ALE Member (Part I)Part II Lines 14 / 15 / 16 CodesPlan Start Month & Coverage
Elena M. Vance (***-**-4821) · Northstar Manufacturing LLCLine 14: 1E · Line 15: $142.50 · Line 16: 2C (All 12 Mos)Plan Start: 01 · Fully Insured Medical
Marcus T. Holloway (***-**-9104) · Northstar Manufacturing LLCLine 14: 1A · Line 15: $0.00 · Line 16: 2G (All 12 Mos)Plan Start: 01 · Qualifying Offer
Priya K. Patel (***-**-6375) · Northstar Manufacturing LLCLine 14: 1H/1E · Line 15: $142.50 · Line 16: 2D/2C (Mid-Year Hire)Plan Start: 01 · Waiting Period → Enrolled
Live PDF Field Preview (Row 1 of 3)

Employee & ALE Member (Part I)

Elena M. Vance (***-**-4821) · Northstar Manufacturing LLC

Part II Lines 14 / 15 / 16 Codes

Line 14: 1E · Line 15: $142.50 · Line 16: 2C (All 12 Mos)

Plan Start Month & Coverage

Plan Start: 01 · Fully Insured Medical

Click any spreadsheet row above to preview its generated PDF. All 3/3 columns auto-matched by AI.

Upload IRS Form 1095-C (and Form 1094-C transmittal)

Start with the official fillable or flat IRS Form 1095-C PDF and Form 1094-C transmittal cover, or open our verified Form 1095-C template directly.

Import your HRIS / payroll ACA Excel or CSV export

Map Employee_First_Name, Employee_Last_Name, Employee_SSN, Street_Address, City, State, ZIP, Employer_Name, Employer_EIN, Line14_All_12_Months, Line15_All_12_Months, Line16_All_12_Months, Plan_Start_Month, or Jan–Dec monthly columns.

Inspect every employee statement & export one ZIP

Verify Part II codes (1A–1U, lowest-cost self-only monthly contribution, and 2A–2I safe harbor codes) on the visual PDF canvas, edit mid-year hires inline, and download a clean ZIP.

Where it fits

Purpose-built for HR Directors, Payroll Managers, and Benefits Administrators at 50–500 Employee ALEs.

When your HRIS, payroll platform, or benefits broker spreadsheet already holds your annual ACA census, you should not have to pay per-EIN enterprise ACA software minimums or manually key 100+ employee statements. JustFill maps your Excel/CSV columns directly onto official IRS Form 1095-C (Part I Employee & ALE Member, Part II Lines 14–16 monthly or All-12-Months grids, and Part III Covered Individuals) plus the Form 1094-C transmittal cover.

Annual IRS Form 1095-C employee furnishing runs for ALEs with 50–500 employees
Part II All-12-Months & Jan–Dec monthly grid mapping (Line 14 Offer of Coverage, Line 15 Employee Required Contribution, Line 16 Section 4980H Safe Harbor)
Part III Covered Individuals population for self-insured & level-funded health plans
Form 1094-C Authoritative Transmittal cover sheet & Part III monthly ALE Member headcount grids
Multi-EIN / Aggregated ALE Group batches for PEOs, CPA firms, and fractional HR directors
Corrected Form 1095-C statements and state individual-mandate furnishing copies (CA, NJ, MA, RI, DC)

32-second video walkthrough

Watch: Batch Fill Form 1095-C from Excel in 32 seconds

See the live browser workflow: upload one PDF template, import your Excel (.xlsx) or CSV spreadsheet, auto-match columns to detected PDF fields, preview every record, and download one filled PDF per row in a clean ZIP.

Fill Multiple PDF Forms from Excel — PDF Mail Merge DemoWatch on YouTube

Simple pricing

Validate five synthetic employee rows before importing your annual ACA census.

Download the ready-to-use Form 1095-C CSV template (with Employee_First_Name through Plan_Start_Month columns) or run the 5-row guided sample free in your browser. Starter ($19/mo), Pro ($49/mo), and Business ($99/mo) support 25, 100, and 500 employee statements per batch.

$7 7-Day Pass — One-off batch up to 25 rows (25 clean PDFs in a batch ZIP + 25 AI credits, no subscription, $7 credited toward Starter)

Need recurring monthly runs, saved templates, and 150 clean flat pages/month with AI column mapping? Choose $19/month Starter above.

Get $7 7-Day Pass (up to 25 rows)

Running larger spreadsheet batches? Get Pro — $49/month for up to 100 rows per batch (or Business at $99/month for up to 500 rows).

Prefer annual corporate billing? Get 2 months free (17% off) with 12× annual page & AI allowances on a single corporate invoice: Starter $190/yr, Pro $490/yr, or Business $990/yr.

Starter

Recommended first workflow

$19
/ month
  • AI field detection for 250 new pages per month
  • Reusable templates — refills use no detection pages
  • Up to 25 PDFs per batch
  • 150 clean flat pages per month
  • Clean, watermark-free ZIP exports
  • CSV and XLSX spreadsheet imports
  • Review every record before export
Starter: 25 records for $19/month. Pro: 100 for $49/month. Business: 500 for $99/month. Each plan also enforces its monthly clean-output allowance.

Paid workflow

Keep your ALE Member block (Lines 7–13) locked across every employee row.

Save one calibrated Form 1095-C layout with your employer name, EIN, address, and benefits contact telephone number pre-mapped, then run full-year employees and mid-year variable-hour hires from the same workbook.

All-12-Months & Jan–Dec monthly code support

Populate `Line14_All_12_Months`, `Line15_All_12_Months`, and `Line16_All_12_Months` for full-year employees, or map individual Jan–Dec columns (`1H` waiting period to `1E` enrolled) for mid-year hires.

Part III Covered Individuals & Form 1094-C cover

For self-insured or level-funded plans, map covered spouse/dependent rows in Part III (Lines 18–30) and prepare your companion Form 1094-C transmittal cover.

Truncated SSN (TTIN) & inline grid edits

Use IRS-permitted truncated SSNs (`***-**-1234`) on employee furnishing copies and fix any employee address or monthly contribution cell inline before ZIP export.

Guardrails

Draft preparation with human review.

Clear boundaries

JustFill populates IRS Form 1095-C and Form 1094-C PDF drafts from HR, payroll, and benefits data your organization provides. It does not determine Applicable Large Employer (ALE) status, calculate Section 4980H affordability safe harbors, e-file ACA returns through the IRS AIR system, or provide legal or tax advice.

Frequently asked questions

Which Excel or CSV columns should we include for a Form 1095-C batch run?

Click "Download Ready-to-Use CSV/Excel Template" above to get a starter sheet pre-configured with `Employee_First_Name`, `Employee_Last_Name`, `Employee_SSN`, `Street_Address`, `City`, `State`, `ZIP`, `Employer_Name`, `Employer_EIN`, `Line14_All_12_Months`, `Line15_All_12_Months`, `Line16_All_12_Months`, and `Plan_Start_Month`. If you have mid-year hires or terminations, you can also include separate January through December columns for Lines 14, 15, and 16.

How does JustFill handle Part II Lines 14, 15, and 16 codes (1A, 1E, 1H, 2C, 2D, 2F, 2G, 2H)?

JustFill prints the exact ACA code and dollar string from your spreadsheet into the matching PDF boxes on Form 1095-C Part II—whether you use the "All 12 Months" column for full-year employees (e.g., Line 14 `1E`, Line 15 `142.50`, Line 16 `2C`) or month-by-month columns for waiting periods (`1H` / `2D`) and partial-year employment (`1H` / `2A`).

Can we generate both employee Form 1095-C statements and the Form 1094-C transmittal cover?

Yes. HR Directors and Payroll Managers use the batch workflow to generate 50 to 500 individual employee Form 1095-C PDFs from their census CSV, and also fill the companion Form 1094-C (Transmittal of Employer-Provided Health Insurance Offer and Coverage Information Returns) cover sheet for their filing archive.

Does this support Part III Covered Individuals for self-insured or level-funded health plans?

Yes. If your ALE sponsors a self-insured or level-funded plan, you can check the Part III box on Form 1095-C and map covered employee, spouse, and dependent names, SSNs/DOBs, and monthly coverage checkboxes across Lines 18–30.

Can we mask or truncate Employee SSNs on furnished copies?

Yes. IRS regulations permit employers to furnish employee copies of Form 1095-C showing a truncated taxpayer identification number (TTIN) such as `***-**-4821`. Format your `Employee_SSN` column in Excel however you want it printed on the PDF.

Does it work with scanned or flat PDFs?

Yes. JustFill detects field locations in fillable, flat, and scanned PDFs before mapping spreadsheet columns.

Does each spreadsheet row create a separate PDF?

Yes. The first row contains the Excel or CSV column names. Every selected data row becomes one reviewable PDF in the exported ZIP.

Is this the same as Word mail merge?

It uses the same one-row-per-document idea, but fills your existing PDF directly. You do not need to recreate the form in Word or convert the PDF first.

Can I review results before downloading?

Yes. Each spreadsheet row becomes a reviewable record. Approve the records you want before creating the ZIP.

Does JustFill email the generated PDFs?

Not in the current self-service batch. It creates individual PDFs and packages the approved files in a ZIP for download.

What happens to uploaded documents?

Transfers use TLS. Rendered page images are deleted within 7 days and source documents within 30 days unless you save the PDF as a reusable template.