IRS Test Scenario 7

The IRS web site lists the following detail of what is in the IRS Test Scenario 7.  

Instructions: Prepare a submission for Carrtestseven who is reporting health coverage information for one employee. The information to be included in this submission is provided in the following narrative.

Submission Narrative

Part I ALE Information

ALE Name: Carrtestseven
Employer Identification Number (EIN): 00-0000710
Address: 109 Cypress Cove, Wimberley, TX 78676
ALE Point of Contact: Carla Hayes
ALE Point of Contact Phone Number: 5551552899
There is a total of 1 1095-C included with this transmittal.

Part II ALE Member Information

Carrtestseven will have a total of 103 Form 1095-Cs filed by and/or on its behalf.
Carrtestseven was not an ALE member of an Aggregated ALE Group.
While it is not required to check any boxes on line 22, and more than one method may be applicable for an ALE, Carrtestseven qualifies for and is only choosing to use the 98% Offer Method.
Signature, title and date can be left blank, as there is no requirement for these elements within TY2018.

Part III ALE Member Information – All 12 Months

Carrtestseven offered minimum essential coverage (column a) to at least 95% of their Full-Time Employees and dependents from January 1st through December 31st (inclusive).
Since Carrtestseven qualifies for the 98% Offer Method (line 22D), they are not required to include a Full-Time Employee Count (column b).
The Total Employee Count (column c) was 103 for all 12 months.
There are two correct ways to complete this form: entries on the All 12 Months line (line 23), or within each of the individual month lines (lines 24-35). In this 1094-C submission, these entries should be completed within the All 12 Months line 23.

Scenario 7-1 Employee #1

Part I Employee
Employee: Scarlett Camen
SSN: 000-00-0701
Address: 420 Falcon Lane, San Juan Capistrano, CA 92693
Part II Employee Offer of Coverage
Carrtestseven chooses to enter a Plan Start Month of January ("01") showing the month in which the plan year begins.
Carrtestseven offered minimum essential coverage providing minimum value for their employee, Scarlett Camen, and at least minimum essential coverage to her dependent(s)(not spouse) from January 1st to December 31st (inclusive).
Scarlett's Employee Required Contribution, for Self-Only Minimum Coverage was $115.00 per month. She enrolled in the coverage that was offered to her for all 12 months.
Carrtestseven entered the Applicable Section 4980H Safe Harbor Code for the months Scarlett was enrolled in the coverage her employer offered for all 12 months of the 2018 tax year.

Note : There are two correct ways to complete this form. In this scenario, entries for the Offer of Coverage, Employee Required Contribution and Safe Harbor Codes should be entered in the All 12 Months column.