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:

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>

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