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Get IRS 1094-C 2016

Signature For Privacy Act and Paperwork Reduction Act Notice see separate instructions. Title Cat. No. 61571A Date Form 1094-C 2016 Page 2 a Minimum Essential Coverage Offer Indicator b Section 4980H Full-Time Employee Count for ALE Member c Total Employee Count for ALE Member d Aggregated Group Indicator Transition Relief Indicator All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 120316 Page 3 Other ALE Members of Aggregated ALE Group Enter the names and EINs of Other ALE Member.

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