Tax1095C_V100
OFX / Types / Tax1095C_V100
| # | Tag | Type |
|---|---|---|
| 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:
- Tax1095Response TAX1095C_V100
FDX 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" ]
} ]
}
}
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>
<NOVEMBERIND>Y</NOVEMBERIND>
<DECEMBERIND>Y</DECEMBERIND>
</COVEREDINDIVIDUAL>
<COVEREDINDIVIDUAL>
<PERSONNM>Tracy R Public</PERSONNM>
<SSN>xxx-xx-4321</SSN>
<PERSONBIRTHDT>19950811</PERSONBIRTHDT>
<NOVEMBERIND>Y</NOVEMBERIND>
<DECEMBERIND>Y</DECEMBERIND>
</COVEREDINDIVIDUAL>
</TAX1095C_V100>
</TAX1095RS>
</TAX1095TRNRS>
</TAX1095MSGSRSV1>
</OFX>