1094-C AGGREGATED GROUP FACTS
Year / reporting ALE member / secure EIN reference:
Determination reviewer / evidence:

ENTITY TIMELINE
Entity | Legal identity source | Relationship start | End | Decision reference

REPORTING MEMBER MONTHS
Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec
Exact date behind each changed month:
Line 21 answer and source:

PART IV WORKING REGISTER
Other member | EIN reference | Relevant period | Ranking basis | Reviewed average count | Rank | Included on form?
Reporting member excluded:
Any member using 98% Offer Method / count-basis review:
More than 30 other members / selection evidence:

FINAL REVIEW
Line 21 / monthly indicators / Part IV consistent:
Identity discrepancies resolved:
Prepared version / actual reviewer / date: