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Get IRS 1094-C 2015

Signature For Privacy Act and Paperwork Reduction Act Notice see separate instructions. Title Cat. No. 61571A Date Form 1094-C 2015 Page 2 a Minimum Essential Coverage Offer Indicator b Full-Time Employee Count for ALE Member c Total Employee Count d Aggregated Group Indicator Transition Relief Indicator All 12 Months Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 120315 Page 3 Other ALE Members of Aggregated ALE Group Enter the names and EINs of Other ALE Members of the Aggregated ALE Group.

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