Tax1095C_V100

OFX / Types / Tax1095C_V100
#TagType
1 SRVRTID ServerIdType
2 TAXYEAR YearType
3 VOID BooleanType
4 CORRECTED BooleanType
5 ALECONTACTPHONE PhoneType
6 EMPLOYER Employer
7 EMPLOYEEINFO EmployeeInfo
8 EMPLOYEEAGE AgeType
9 PLANSTARTMONTH anonymous simple type
10 ANNUALCOVERAGE anonymous complex type
11 MONTHLYCOVERAGE PartIIGrpType
12 SELFINSURED BooleanType
13 COVEREDINDIVIDUAL CoveredIndivGrpType
Usages:
XSD
	<xsd:complexType name="Tax1095C_V100">
		<xsd:annotation>
			<xsd:documentation>The OFX element "TAX1095C_V100" is of type "Tax1095C_V100"</xsd:documentation>
		</xsd:annotation>
		<xsd:complexContent>
			<xsd:extension base="ofx:AbstractTaxForm1095">
				<xsd:sequence>
					<xsd:element name="ALECONTACTPHONE" type="ofx:PhoneType" minOccurs="0">
						<xsd:annotation>
							<xsd:documentation>Contact telphone number</xsd:documentation>
						</xsd:annotation>
					</xsd:element>
					<xsd:element name="EMPLOYER" type="ofx:Employer" minOccurs="0"/>
					<xsd:element name="EMPLOYEEINFO" type="ofx:EmployeeInfo" minOccurs="0"/>
					<xsd:element name="EMPLOYEEAGE" type="ofx:AgeType" minOccurs="0">
						<xsd:annotation>
							<xsd:documentation>Employee's Age on January 1. New TY20</xsd:documentation>
						</xsd:annotation>
					</xsd:element>
					<xsd:element name="PLANSTARTMONTH" minOccurs="0">
						<xsd:annotation>
							<xsd:documentation>Optional for TY15. Enter the 2 digit month 01-12</xsd:documentation>
						</xsd:annotation>
						<xsd:simpleType>
							<xsd:restriction base="xsd:string">
								<xsd:enumeration value="01"/>
								<xsd:enumeration value="02"/>
								<xsd:enumeration value="03"/>
								<xsd:enumeration value="04"/>
								<xsd:enumeration value="05"/>
								<xsd:enumeration value="06"/>
								<xsd:enumeration value="07"/>
								<xsd:enumeration value="08"/>
								<xsd:enumeration value="09"/>
								<xsd:enumeration value="10"/>
								<xsd:enumeration value="11"/>
								<xsd:enumeration value="12"/>
							</xsd:restriction>
						</xsd:simpleType>
					</xsd:element>
					<xsd:choice>
						<xsd:element name="ANNUALCOVERAGE" minOccurs="0">
							<xsd:annotation>
								<xsd:documentation>Use if Covered for ALL 12 Months</xsd:documentation>
							</xsd:annotation>
							<xsd:complexType>
								<xsd:sequence>
									<xsd:element name="COVERAGEOFFERCD">
										<xsd:simpleType>
											<xsd:restriction base="xsd:string">
												<xsd:maxLength value="2"/>
												<xsd:minLength value="2"/>
											</xsd:restriction>
										</xsd:simpleType>
									</xsd:element>
									<xsd:element name="MONTHLYPREMIUMAMT" type="ofx:AmountType" minOccurs="0">
										<xsd:annotation>
											<xsd:documentation>If COVERAGEOFFERCD is 1B,1C,1D, 1E</xsd:documentation>
										</xsd:annotation>
									</xsd:element>
									<xsd:element name="SEC4980HCODE" minOccurs="0">
										<xsd:simpleType>
											<xsd:restriction base="xsd:string">
												<xsd:maxLength value="2"/>
											</xsd:restriction>
										</xsd:simpleType>
									</xsd:element>
									<xsd:element name="POSTALCODE" type="ofx:ZipType" minOccurs="0">
										<xsd:annotation>
											<xsd:documentation>ZIP Code. New TY20</xsd:documentation>
										</xsd:annotation>
									</xsd:element>
								</xsd:sequence>
							</xsd:complexType>
						</xsd:element>
						<xsd:element name="MONTHLYCOVERAGE" type="ofx:PartIIGrpType" minOccurs="0" maxOccurs="unbounded">
							<xsd:annotation>
								<xsd:documentation>Use if NOT covered for ALL 12 months</xsd:documentation>
							</xsd:annotation>
						</xsd:element>
					</xsd:choice>
					<xsd:element name="SELFINSURED" type="ofx:BooleanType" minOccurs="0">
						<xsd:annotation>
							<xsd:documentation>Checked if employer provided self-insured coverage</xsd:documentation>
						</xsd:annotation>
					</xsd:element>
					<xsd:element name="COVEREDINDIVIDUAL" type="ofx:CoveredIndivGrpType" minOccurs="0" maxOccurs="unbounded"/>
				</xsd:sequence>
			</xsd:extension>
		</xsd:complexContent>
	</xsd:complexType>

FDX JSON

{
  "tax1095C" : {
    "taxYear" : 2020,
    "taxFormId" : "e5d4ee73bd1-9295-480f-a426-1095-C",
    "taxFormDate" : "2021-03-30",
    "additionalInformation" : "FDX v4.6",
    "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",
      "coveredAll12Months" : true,
      "coveredMonths" : [ "NOV", "DEC" ]
    }, {
      "name" : {
        "first" : "Tracy",
        "middle" : "R",
        "last" : "Public"
      },
      "tin" : "xxx-xx-4321",
      "dateOfBirth" : "1995-08-11",
      "coveredAll12Months" : true,
      "coveredMonths" : [ "NOV", "DEC" ]
    } ]
  }
}

OFX XML

<?xml version="1.0" encoding="UTF-8" standalone="no"?>
<?OFX OFXHEADER="200" VERSION="202" SECURITY="NONE" OLDFILEUID="NONE" NEWFILEUID="NONE"?>

<OFX>
    <SIGNONMSGSRSV1>
        <SONRS>
            <STATUS>
                <CODE>0</CODE>
                <SEVERITY>INFO</SEVERITY>
                <MESSAGE>Successful Login</MESSAGE>
            </STATUS>
            <DTSERVER>39210131000000</DTSERVER>
            <LANGUAGE>ENG</LANGUAGE>
            <FI>
                <ORG>fiName</ORG>
                <FID>fiId</FID>
            </FI>
        </SONRS>
    </SIGNONMSGSRSV1>
    <TAX1095MSGSRSV1>
        <TAX1095TRNRS>
            <TRNUID>_GUID_</TRNUID>
            <STATUS>
                <CODE>0</CODE>
                <SEVERITY>INFO</SEVERITY>
                <MESSAGE>SUCCESS</MESSAGE>
            </STATUS>
            <TAX1095RS>
                <TAX1095C_V100>
                    <SRVRTID>e5d4ee73bd1-9295-480f-a426-1095-C</SRVRTID>
                    <TAXYEAR>2020</TAXYEAR>
                    <ALECONTACTPHONE>888-555-1212</ALECONTACTPHONE>
                    <EMPLOYER>
                        <FEDIDNUMBER>12-3456789</FEDIDNUMBER>
                        <NAME1>Financial Data Exchange</NAME1>
                        <ADDR1>12020 Sunrise Valley Dr</ADDR1>
                        <ADDR2>Suite 230</ADDR2>
                        <CITY>Reston</CITY>
                        <STATE>VA</STATE>
                        <POSTALCODE>20191</POSTALCODE>
                    </EMPLOYER>
                    <EMPLOYEEINFO>
                        <SSN>xxx-xx-1234</SSN>
                        <NAME>Kris Q Public</NAME>
                        <ADDR1>1 Main St</ADDR1>
                        <CITY>Melrose</CITY>
                        <STATE>NY</STATE>
                        <POSTALCODE>12121</POSTALCODE>
                        <COUNTRYSTRING>US</COUNTRYSTRING>
                    </EMPLOYEEINFO>
                    <EMPLOYEEAGE>25</EMPLOYEEAGE>
                    <PLANSTARTMONTH>11</PLANSTARTMONTH>
                    <ANNUALCOVERAGE>
                        <COVERAGEOFFERCD>1E</COVERAGEOFFERCD>
                        <MONTHLYPREMIUMAMT>30.18</MONTHLYPREMIUMAMT>
                        <SEC4980HCODE>2C</SEC4980HCODE>
                        <POSTALCODE>12121</POSTALCODE>
                    </ANNUALCOVERAGE>
                    <MONTHLYCOVERAGE>
                        <MONTHNAME>NOV</MONTHNAME>
                        <COVERAGEOFFERCD>1E</COVERAGEOFFERCD>
                        <MONTHLYPREMIUMAMT>15.09</MONTHLYPREMIUMAMT>
                        <SEC4980HCODE>2C</SEC4980HCODE>
                        <POSTALCODE>12121</POSTALCODE>
                    </MONTHLYCOVERAGE>
                    <MONTHLYCOVERAGE>
                        <MONTHNAME>DEC</MONTHNAME>
                        <COVERAGEOFFERCD>1E</COVERAGEOFFERCD>
                        <MONTHLYPREMIUMAMT>15.09</MONTHLYPREMIUMAMT>
                        <SEC4980HCODE>2C</SEC4980HCODE>
                        <POSTALCODE>12121</POSTALCODE>
                    </MONTHLYCOVERAGE>
                    <SELFINSURED>N</SELFINSURED>
                    <COVEREDINDIVIDUAL>
                        <PERSONNM>Kris Q Public</PERSONNM>
                        <SSN>xxx-xx-1234</SSN>
                        <PERSONBIRTHDT>19950711</PERSONBIRTHDT>
                        <ALLYEARIND>Y</ALLYEARIND>
                        <NOVEMBERIND>Y</NOVEMBERIND>
                        <DECEMBERIND>Y</DECEMBERIND>
                    </COVEREDINDIVIDUAL>
                    <COVEREDINDIVIDUAL>
                        <PERSONNM>Tracy R Public</PERSONNM>
                        <SSN>xxx-xx-4321</SSN>
                        <PERSONBIRTHDT>19950811</PERSONBIRTHDT>
                        <ALLYEARIND>Y</ALLYEARIND>
                        <NOVEMBERIND>Y</NOVEMBERIND>
                        <DECEMBERIND>Y</DECEMBERIND>
                    </COVEREDINDIVIDUAL>
                </TAX1095C_V100>
            </TAX1095RS>
        </TAX1095TRNRS>
    </TAX1095MSGSRSV1>
</OFX>

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