Page 2 - Tax Forms Catalog

1095-C Employer-Provided Health Insurance Oer and Coverage

You must report information to the IRS about the healthcare coverage oered to your full-time employees
using Form 1095-C.

Employee Copies
Our 1095-C prints one page for each qualied employee and folds into a compatible double-window envelope
for easy distribution.

IRS Copies
Payroll now selects your ling method based on the number
of 1095-C forms you are required to le with the IRS. Please
identify your ling requirement in Payroll* then select the
ling method below:
* LESS THAN 250 forms, paper IRS ling is required
If you have less than 250 1095-Cs per Tax Reporting Group (TRG)
paper ling with the IRS is required. Purchase your W-2 and
1095-C forms from Xenial and we will provide extra 1095-C
forms for your IRS ling at no additional charge!

* MORE THAN 250 forms, online IRS ling is required
If you have more than 250 1095-Cs per Tax Reporting Group
(TRG), the IRS requires online ling. IRS Copy for paper lers only

Employer Copies (optional)
For your employer records, we suggest you print the 1095-C
Proof on plain paper. Or if you prefer an actual 1095-C for
your company records, you can order more 1095-C forms
and print them separately.

Item No. Description

1095-C Portrait version of 1095-C for Employee Copies

1095-C IRS IRS version of 1095-C for paper ling (250 or less)
7777-1 Gummed 1095-C Envelopes

7777-2 Self-Seal 1095-C Envelopes
1094-C FREE - Included with every 1095-C order!
Employee Copy

*Know How Many W-2 / 1095-C Forms to Order

For both W-2 and 1095-C forms, use the Count Employees for W-2 order option in Payroll Utilities, Year End Functions.
The report provides a suggested count for both W-2 and 1095-C forms.
Add 10% to cover your needs through the end of the year.

PO Box 7789, Santa Rosa, CA 95407 2
866.412.5623 orders@xenialforms.com