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1095-C, Employer-Provided Health Insurance, Employer/Employee Continuation Copy

Item 92636.5096C, 1095-C, Employer-Provided Health Insurance, Employer/Employee Continuation Copy

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Please Note:  The 2019 ACA forms (1094/1095) are not yet available but should be by mid-to-late-October.  As soon as they are available, we will update this description and the forms will be eligible for purchase.  Thank you.

Used by large employers with more than 50 full-time employees to report Affordable Care Act (ACA) information to employees/recipients and to the IRS as proof of healthcare coverage.  For laser or inkjet printers.

  • This form is an addendum to the 92636.5096 form and is used as the Recipient copy and the Employer copy for recipients with more than 6 dependents
  • The form used for the Recipient copy and as the Employer copy is 92636.5906, which can be found in Compatible Products (see blelow)
  • The Continuation form used to file with the IRS is 92636.5096N, which can be found in Compatible Products (see below)
  • One recipient per sheet
  • Filing Deadlines: to Recipients by January 31 - to IRS by February 28
  • Compatible with Laser Link Tax Preparation Software (Product 95412)
Please contact us if you need quantities other than those listed.  We'd be happy to give you a very competitive quote.  And please also give us the opportunity to meet or beat any other legitimate quotes.

You may also want to review our FAQs for frequently-asked questions about tax forms.

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