Transcription of 2015 Form 1095-C - irs.gov
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2015 Form 1095-C - irs.gov
600116 VOIDCORRECTEDForm 1095-CDepartment of the Treasury Internal Revenue ServiceEmployer-Provided Health Insurance Offer and Coverage Information about Form 1095-C and its separate instructions is at No. 1545-22512015 Part IEmployee 1 Name of employee 2 Social security number (SSN) 3 Street address (including apartment no.) 4 City or town5 State or province 6 Country and ZIP or foreign postal codeApplicable Large Employer Member (Employer) 7 Name of employer 8 Employer identification number (EIN) 9 Street address (including room or suite no.)
You are receiving this Form 1095-C because your employer is an Applicable Large Employer subject to the employer shared responsibility provision in the Affordable Care Act.
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