Tax Documents

 

Tax1095C

 

FDX Data Structure as JSON
{
  "tax1095C" : {
    "taxYear" : 0,
    "corrected" : true,
    "accountId" : "",
    "taxFormId" : "",
    "taxFormDate" : "2020-07-01",
    "description" : "string",
    "additionalInformation" : "string",
    "taxFormType" : "BusinessIncomeStatement",
    "attributes" : [ {
      "name" : "string",
      "value" : "string",
      "boxNumber" : "string",
      "code" : "string"
    } ],
    "error" : {
      "code" : "string",
      "message" : "string"
    },
    "employeeName" : {
      "first" : "string",
      "middle" : "string",
      "last" : "string",
      "suffix" : "string"
    },
    "tin" : "string",
    "employeeAddress" : {
      "line1" : "String64",
      "line2" : "String64",
      "line3" : "String64",
      "city" : "String64",
      "state" : "String64",
      "postalCode" : "string",
      "country" : "AD"
    },
    "employerNameAddressPhone" : {
      "line1" : "String64",
      "line2" : "String64",
      "line3" : "String64",
      "city" : "String64",
      "state" : "String64",
      "postalCode" : "string",
      "country" : "AD",
      "name1" : "String64",
      "name2" : "String64",
      "phone" : {
        "type" : "HOME",
        "country" : "string",
        "number" : "string",
        "extension" : "string"
      }
    },
    "employerNameAddress" : {
      "line1" : "String64",
      "line2" : "String64",
      "line3" : "String64",
      "city" : "String64",
      "state" : "String64",
      "postalCode" : "string",
      "country" : "AD",
      "name1" : "String64",
      "name2" : "String64",
      "phone" : {
        "type" : "HOME",
        "country" : "string",
        "number" : "string",
        "extension" : "string"
      }
    },
    "employerId" : "string",
    "employerTin" : "string",
    "selfInsuredCoverage" : true,
    "offersOfCoverage" : [ {
      "coverageCode" : "string",
      "requiredContribution" : 0.0,
      "section4980HCode" : "string",
      "postalCode" : "string",
      "month" : "ANNUAL"
    } ],
    "employeeAge" : 0,
    "planStartMonth" : 0,
    "coveredIndividuals" : [ {
      "name" : {
        "first" : "string",
        "middle" : "string",
        "last" : "string",
        "suffix" : "string"
      },
      "tin" : "string",
      "dateOfBirth" : "2020-07-01",
      "coveredAt12Months" : true,
      "coveredMonths" : [ "JAN" ]
    } ]
  }
}
FDX / Data Structures / Tax1095C
Form 1095-C, Employer-Provided Health Insurance Offer and Coverage
Extends and inherits all fields from Tax  
Tax1095C Properties
#IdTypeDescription
1employeeNameIndividualNameBox 1, Employee name
2tinstringBox 2, Social security number (SSN)
3employeeAddressAddressBoxes 3-6, Employee address
4employerNameAddressPhoneNameAddressPhoneBoxes 7, 9-13, Employer name, address and phone (deprecated for rename to employerNameAddress, removing in FDX v5.0)
5employerNameAddressNameAddressPhoneBoxes 7, 9-13, Employer name, address and phone
6employerIdstringBox 8, Employer identification number (EIN) (deprecated for rename to employerTin, removing in FDX v5.0)
7employerTinstringBox 8, Employer identification number (EIN)
8selfInsuredCoveragebooleanSelf Insured Coverage
9offersOfCoverageArray of OfferOfHealthInsuranceCoverageBoxes 14-16, Employee Offer of Coverage
10employeeAgeintegerEmployee's Age on January 1
11planStartMonthintegerPlan Start Month
12coveredIndividualsArray of HealthInsuranceCoveredIndividualBoxes 17+, Covered Individuals
Tax1095C Usage:
Example Form JSON
{
  "tax1095C" : {
    "taxYear" : 2020,
    "taxFormId" : "e5d4ee73bd1-9295-480f-a426-1095-C",
    "taxFormDate" : "2021-02-01",
    "taxFormType" : "Tax1095C",
    "employeeName" : {
      "first" : "Kris",
      "middle" : "Q",
      "last" : "Public"
    },
    "tin" : "xxx-xx-1234",
    "employeeAddress" : {
      "line1" : "1 Main St",
      "city" : "Melrose",
      "state" : "NY",
      "postalCode" : "12121",
      "country" : "US"
    },
    "employerNameAddress" : {
      "line1" : "12020 Sunrise Valley Dr",
      "line2" : "Suite 230",
      "city" : "Reston",
      "state" : "VA",
      "postalCode" : "20191",
      "country" : "US",
      "name1" : "Financial Data Exchange",
      "phone" : {
        "number" : "8885551212"
      }
    },
    "employerTin" : "12-3456789",
    "selfInsuredCoverage" : false,
    "offersOfCoverage" : [ {
      "coverageCode" : "1E",
      "requiredContribution" : 15.09,
      "section4980HCode" : "2C",
      "postalCode" : "12121",
      "month" : "NOVEMBER"
    }, {
      "coverageCode" : "1E",
      "requiredContribution" : 15.09,
      "section4980HCode" : "2C",
      "postalCode" : "12121",
      "month" : "DECEMBER"
    }, {
      "coverageCode" : "1E",
      "requiredContribution" : 30.18,
      "section4980HCode" : "2C",
      "postalCode" : "12121",
      "month" : "ANNUAL"
    } ],
    "employeeAge" : 25,
    "planStartMonth" : 11,
    "coveredIndividuals" : [ {
      "name" : {
        "first" : "Kris",
        "middle" : "Q",
        "last" : "Public"
      },
      "tin" : "xxx-xx-1234",
      "dateOfBirth" : "1995-07-11",
      "coveredAt12Months" : false,
      "coveredMonths" : [ "NOV", "DEC" ]
    }, {
      "name" : {
        "first" : "Tracy",
        "middle" : "R",
        "last" : "Public"
      },
      "tin" : "xxx-xx-4321",
      "dateOfBirth" : "1995-08-11",
      "coveredAt12Months" : false,
      "coveredMonths" : [ "NOV", "DEC" ]
    } ]
  }
}
Example Form JSON as QR Code

 

 

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