Quote Questionnaire see all our services here Contact Field Contact Name First Name Last Name Entity Name or Names Address Contact Email Contact Phone (###) ### #### Questions for Quote Which of our services are you interested in? Check all that apply ACA Risk Assessment - Penalty Exposure Analysis ALE Determination and Monitoring - Calculation of Applicable Large Employer Status per Tax Year Complete Service - Standalone 1094/1095-C Production, Furnishing, and Electronic Filing with Monthly Compliance Reports Form Fulfillment + Expertise - Standalone 1094/1095-C Production, Furnishing, and Electronic Filing Form Fulfillment Only - Electronic IRS Transmission Services Individual State Mandate Reporting - State Form Production, Furnishing, and Electronic Filing Service ACA Compliance Strategy Consultation IRS 5699 Letter Response IRS 226-J Letter Response Prior Year ACA Reporting Other Which year or years are you looking for service? Is the Applicable Large Employer needing ACA Compliance and Reporting comprised of more than one EIN? Yes No Unsure If Yes, provide the number of EINs and any relevant information. Which measurement method or methods are being used to determine the ACA status of employees? Look-back measurement method (LBMM) Monthly measurement method (MMM) Multiple measurement methods No measurement method has been established Unsure Approximately how many W-2 forms were issued by the Applicable Large Employer last year? Approximately how many 1095-Cs (if any) were issued by the Applicable Large Employer last year? What type of health insurance plans are offered to employees? Check all that apply Fully-Funded Health Plan Self-Insured or Level Funded Health Plan Health Reimbursement Account (HRA) Individual Coverage HRA Health Insurance through a Union No Health Insurance Are all health insurance eligible employees offered the same plan or plans? Yes No Unsure How is Affordability of Health Plans Determined? Check all that apply Federal Poverty Line Safe Harbor (2G) Rate of Pay Safe Harbor (2H) Form W-2 Box 1 Safe Harbor (2F) Unsure Additional Comments? Thank you for your submission. Expect to receive a quote within two business days.
