Use the form variables to create a form layout for printing Form 1094 and 1095.
Alignment
Returns printer marks.
1099 Dividend Limit
Returns 1099 dividend limit.
1099 Government Payments Limit
Returns 1099 government payments limit.
1099 Interest Limit
Returns 1099 interest limit.
1099 Miscellaneous Limit
Returns 1099 miscellaneous limit.
1099 Real Estate Limit
Returns 1099 real estate limit.
1099 Retirement Limit
Returns 1099 retirement limit.
3rd Party
Returns 3rd party amount.
98% Offer Method
Returns 98% offer method.
ACA Employee Age (use Employee's Age)
Use the Employee's Age variable to return the employee's age during the tax year.
ACA Contact Name
Returns ACA contact name.
ACA Contact Telephone
Returns ACA contact telephone number.
ACA Employee City
Returns ACA employee city.
ACA Employee Country
Returns ACA employee country.
ACA Employee Date of Birth
Returns ACA employee date of birth.
ACA Employee First Name
Returns ACA employee first name.
ACA Employee First Name & Middle Initial
Returns ACA employee first name and middle name. [First Name] [Middle Name]
ACA Employee Last Name
Returns ACA employee last name. [Last Name]
ACA Employee Last Name and Suffix
Returns ACA employee last name and suffix. [Last Name] [Suffix]
ACA Employee Mailing Address 1
Returns ACA employee mailing address 1.
ACA Employee Mailing Address 2
Returns ACA employee mailing address 2.
ACA Employee Mailing City, ST, Zip Code
Returns ACA employee mailing city, 2-character state code, and zip code. [City] [##] [#####]
ACA Employee Mailing Line 1
Returns ACA employee mailing line 1. If line is blank, print the ACA employee mailing line 2.
ACA Employee Mailing Line 2
Returns ACA employee mailing line 2. If line is blank, print the ACA employee mailing line 3.
ACA Employee Mailing Line 3
Returns ACA employee mailing line 3. If line is blank, print the ACA employee city, state, zip code.
ACA Employee Middle Initial
Returns ACA employee middle initial. [#]
ACA Employee Middle Name
Returns ACA employee middle name. [Middle Name]
ACA Employee Name
Returns ACA employee name. [Employee Name]
ACA Employee Name Suffix
Returns ACA employee name suffix. [Suffix]
ACA Employee Number
Returns ACA employee number.
ACA Employee Self Insured
Returns ACA employee self insured status.
ACA Employee Social Security Number
Returns ACA employee Social Security number.
ACA Employee State
Returns ACA employee 2-character state code.
ACA Employee Status
Returns ACA employee status based on the last month of the tax year.
ACA Employee Zip Code
Returns the ACA employee zip code.
ACA Employee Zip Code with Checksum
Returns the ACA employee zip code and checksum, hyphen removed.
Aggregated ALE Group Member - No
Returns the ALE group member status.
Aggregated ALE Group Member - Yes
Returns the ALE group member status.
Aggregated group indicator all 12 months
Returns the aggregated group indicator for all 12 months.
Aggregated group by month
Returns the aggregated group by month.
ALE Full Time emp count all 12 months
Returns the ALE full time employee count for all 12 months.
ALE Full Time employee county by month
Returns the ALE full time employee count by month.
ALE Member EIN
Returns the ALE member EIN (Employer Identification Number).
ALE Member Name
Returns the ALE member name.
ALE Total employee count all 12 months
Returns the ALE total employee count for all 12 months.
ALE Total employee count by month
Returns the ALE total employee count for by month.
Authoritative Transmittal
Returns a checkmark when the report is the authoritative transmittal.
Calculated Variable
Returns a user-defined calculated variable.
Conditional Variable
Returns a value based on conditional statement.
Corrected
Returns a checkmark for a corrected ACA form.
Count of 1095 C forms filed
Prints page number of each form.
Dependent covered all 12 months
Returns status for dependent coverage for all 12 months. Used on Form 1095, Covered Individuals.
Dependent covered by month
Returns status for dependent coverage by month. Used on Form 1095, Covered Individuals.
Dependent Date of Birth
Returns dependent date of birth. Used on Form 1095, Covered Individuals.
Dependent First Name
Returns dependent first name. Used on Form 1095, Covered Individuals.
Dependent Last Name
Returns dependent last name. Used on Form 1095, Covered Individuals.
Dependent Middle Initial
Returns dependent middle initial. Used on Form 1095, Covered Individuals.
Dependent Middle Name
Returns dependent middle name. Used on Form 1095, Covered Individuals.
Dependent Name
Returns dependent name. Used on Form 1095, Covered Individuals.
Dependent Social Security Number
Returns dependent Social Security number. Used on Form 1095, Covered Individuals.
Dependent Suffix
Returns dependent suffix. Used on Form 1095, Covered Individuals.
Employee coverage all 12 months
Returns employee coverage for all 12 months. Used on Form 1095, Covered Individuals, first line.
Employee coverage by month
Returns employee coverage by month. Used on Form 1095, Covered Individuals, first line.
Employee Date of Birth
Returns employee date of birth. Used on Form 1095, Covered Individuals, first line.
Employee First Name
Returns employee first name. Used on Form 1095, Covered Individuals, first line.
Employee Last Name
Returns employee last name. Used on Form 1095, Covered Individuals, first line.
Employee Middle Initial
Returns employee middle initial. Used on Form 1095, Covered Individuals, first line.
Employee Name
Returns employee name as it is saved in the Employee Name box. Used on Form 1095, Covered Individuals, first line.
Employee Share all 12 Months
Returns employee share all 12 months.
Employee Share by Month
Returns employee share by month.
Employee Social Security Number
Returns employee Social Security number.
Employee Status all 12 months
Returns employee employment status for all 12 months.
Employee Status by Month
Return employee employment status by month.
Employee's Age (2021.05 or later)
Return the employee's age during the tax year. The employee's age displays if the employee has an offer of coverage of 1L, 1M, 1O, 1P, 1Q, 1R, or 1S during the reporting year.
Employee Age = 1/1/[Tax Year] - Employee Birth Date
Employer Sponsored Address Line 1
Returns the employer sponsored coverage address line 1.
Employer Sponsored Address Line 2
Returns the employer sponsored coverage address line 2.
Employer Sponsored City, State, Zip
Returns the employer sponsored coverage city, state, and zip.
Employer Sponsored Federal ID Number
Returns the employer sponsored coverage federal ID number.
Employer Sponsored Mailing Line 1
Returns the employer sponsored coverage mailing line 1.
Employer Sponsored Mailing Line 2
Returns the employer sponsored coverage mailing line 2.
Employer Sponsored Mailing Line 3
Returns the employer sponsored coverage mailing line 3.
Employer Sponsored Zip Code w/Checksum
Returns the employer sponsored coverage zip code with checksum, without hyphen.
Employer Sponsored City
Returns the employer sponsored coverage city.
Employer Sponsored Country
Returns the employer sponsored coverage country.
Employer Sponsored Name 1
Returns the employer sponsored coverage name 1.
Employer Sponsored Name 2
Returns the employer sponsored coverage name 2.
Employer Sponsored State
Returns the employer sponsored coverage state.
Employer Sponsored Telephone 1
Returns the employer sponsored coverage telephone 1.
Employer Sponsored Telephone 2
Returns the employer sponsored coverage telephone 1.
Employer Sponsored Zip Code
Returns the employer sponsored coverage zip code.
Employer/Payer City
Returns the employer/payer sponsored coverage city.
Employer/Payer Country
Returns the employer/payer sponsored coverage country.
Employer/Payer Federal ID Number
Returns the employer/payer sponsored coverage federal ID number.
Employer/Payer Mailing Address 1
Returns the employer/payer sponsored coverage mailing address 1. If mailing address 1 is blank, print mailing address 2.
Employer/Payer Mailing Address 2
Returns the employer/payer sponsored coverage mailing address 2. If mailing address 2 is blank, print mailing city, state, and zip.
Employer/Payer Mailing City, State, Zip
Returns the employer/payer sponsored coverage mailing city, state, and zip.
Employer/Payer Mailing Line 1
Returns the employer/payer sponsored coverage mailing address, line 1. If line is blank, print mailing line 2.
Employer/Payer Mailing Line 2
Returns the employer/payer sponsored coverage mailing address, line 2. If line is blank, print mailing line 3.
Employer/Payer Mailing Line 3
Returns the employer/payer sponsored coverage mailing address, line 3. If line is blank, print mailing city, state, and zip.
Employer/Payer Name 1
Returns employer/payer sponsored coverage name 1.
Employer/Payer Name 2
Returns employer/payer sponsored coverage name 2.
Employer/Payer SSA/RTN
Returns employer/payer sponsored coverage Social Security account (SSA) and routing transit number (RTN).
Employer/Payer State
Returns employer/payer sponsored state.
Employer/Payer Telephone 1
Returns employer/payer sponsored telephone 1.
Employer/Payer Telephone 2
Returns employer/payer sponsored telephone 2.
Employer/Payer Zip Code
Returns employer/payer sponsored zip code.
Employer/Payer Zip Code with Checksum
Returns employer/payer sponsored zip code with checksum, hyphen removed.
General Message
Returns general message.
Gov Entity City
Returns government entity city.
Gov Entity Contact Name
Returns government entity contact name.
Gov Entity Contact Telephone 1
Returns government entity telephone 1.
Gov Entity Country
Returns government entity country.
Gov Entity EIN
Returns government entity employer identification number (EIN).
Gov Entity Mailing Address 1
Returns government entity mailing address 1.
Gov Entity Mailing Address 2
Returns government entity mailing address 2.
Gov Entity Mailing City, State, Zip
Returns government entity mailing city, state, and zip.
Gov Entity Mailing Line 1
Returns government entity mailing line 1.
Gov Entity Mailing Line 2
Returns government entity mailing line 2.
Gov Entity Mailing Line 3
Returns government entity mailing line 3.
Gov Entity Name
Returns government entity name.
Gov Entity State
Returns government entity state.
Gov Entity Telephone 1
Returns government entity telephone 1.
Gov Entity Telephone 2
Returns government entity telephone 2.
Gov Entity Zip Code
Returns government entity zip code.
Gov Entity Provider City
Returns government entity city.
Gov Entity Provider Country
Returns government entity country.
Gov Entity Provider EIN
Returns government entity employer identification number (EIN).
Gov Entity Provider Mailing Address 1
Returns government entity mailing address 1.
Gov Entity Provider Mailing Address 2
Returns government entity mailing address 2.
Gov Entity Provider Mailing City, ST, Zip
Returns government entity mailing city, 2-character state code, and zip code.
Gov Entity Provider Mailing Line 1
Returns government entity mailing line 1. If mailing line 1 is blank, print mailing line 2.
Gov Entity Provider Mailing Line 2
Returns government entity mailing line 2. If mailing line 2 is blank, print mailing line 3.
Gov Entity Provider Mailing Line 3
Returns government entity mailing line 3. If mailing line 3 is blank, print mailing city, state, and zip code.
Gov Entity Provider Name
Returns government entity provider name.
Gov Entity Provider State
Returns government entity provider state.
Gov Entity Provider Telephone 1
Returns government entity provider telephone 1.
Gov Entity Provider Telephone 2
Returns government entity provider telephone 2.
Gov Entity Provider Zip Code
Returns government entity provider zip code.
Minimum Offer Coverage all 12 Months No
Returns checkmark with no minimum essential offer of coverage for all 12 months.
Minimum Offer Coverage all 12 Months Yes
Returns checkmark with minimum essential offer of coverage for all 12 months.
Minimum Offer Coverage by month - No
Returns checkmark with no minimum essential offer of coverage for by month.
Minimum Offer Coverage by month - Yes
Returns checkmark with minimum essential offer of coverage for by month.
Number of 1095 B Forms Submitted
Print page number on Form 1095-B.
Number of 1095 C Forms Submitted
Print page number of Form 1095-C.
Offer of Coverage all 12 months
Returns offer of coverage for all 12 months.
Offer of Coverage by Month
Returns offer of coverage by month.
Origin of Policy
Returns origin of policy.
Plan Start Month (2021.05 or later)
Returns 2-digit plan start month (01-12). This is the calendar month during which the plan year begins for the health plan for which the employee had an offer of coverage. If more than one plan year could apply, the earliest month is used. If there is no health plan under which coverage is offered to the employee, returns "00" when offer of coverage is 1H.
Qualifying Offer Method
Returns qualifying offer method.
Qualifying Offer Method Trans Relief
Returns a checkmark if employee reported a qualifying offer method transaction relief.
Safe Harbor Code all 12 months
Returns safe harbor code for 12 months.
Section 4980H Transition Relief
Returns 4980H transition relief.
Section 4980H indicator for all 12 months
Returns 4980H indicatory for 12 months.
Section 4980H indicator by month
Returns 4980H indicator by month.
SHOP Identifier
Returns SHOP (Small Business Health Options Program) identifier.
System Date
Returns system date.
Void
Returns checkmark if the Void checkbox is selected on the ACA employee.
Zip Code all 12 Months (2021.05 or later)
Returns the zip code for all 12 months. If the offer of coverage for the selected month is 1L, 1M, 1N, 1O, 1P, 1Q, returns a zip code for all 12 months.
Zip Code by Month (2021.05 or later)
Returns the zip code by month. If the offer of coverage for all 12 months is 1L, 1M, 1N, 1O, 1P, or 1Q, returns a zip code for each month.
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