6bc3f3a21f
- tax/: 84 files across 2014-2025 with full .md transcriptions - immigration/: 734 files (H-1B, green card, visa stamping, travel visas, passport) with 26 summary.md files - Loose files sorted: SSN cards → id/, vaccines → medical/covid/, credit check + lease addendum → lease/, UChicago offer → employment/, wine archive → receipts/ - home.md: removed green card timeline (moved to immigration/greencard/greencard/summary.md)
47 lines
1.1 KiB
Markdown
47 lines
1.1 KiB
Markdown
---
|
|
type: 1095c
|
|
category: tax
|
|
person: Xuewei Jiang
|
|
date: 2018-12-31
|
|
source: jiang_1095c_2018.pdf
|
|
---
|
|
|
|
# Form 1095-C - Employer-Provided Health Insurance (2018)
|
|
|
|
## Part I - Employee
|
|
|
|
| Field | Value |
|
|
|---|---|
|
|
| 1. Name | Xuewei Jiang |
|
|
| 2. SSN | ***-**-3215 |
|
|
| 3. Address | 2110 Speedway Stop B6600, CBA 6.222 |
|
|
| 4. City/State/ZIP | Austin, TX 78712-1276 |
|
|
|
|
## Applicable Large Employer Member (Employer)
|
|
|
|
| Field | Value |
|
|
|---|---|
|
|
| 7. Name | The University of Texas at Austin |
|
|
| 8. EIN | 746000203 |
|
|
| 9. Address | 1616 Guadalupe St., Suite 1.408 |
|
|
| 10. Phone | (512) 471-4772 |
|
|
| 11. City/State/ZIP | Austin, TX 78701 |
|
|
|
|
## Part II - Employee Offer of Coverage
|
|
|
|
| Field | Value |
|
|
|---|---|
|
|
| 14. Offer of Coverage (All 12 Months) | 1G |
|
|
| 15. Employee Required Contribution | (blank for all months) |
|
|
| 16. Section 4980H Safe Harbor | (blank) |
|
|
|
|
Code 1G: Not a full-time employee for any month but enrolled in self-insured employer-sponsored coverage.
|
|
|
|
## Part III - Covered Individuals
|
|
|
|
Self-insured coverage: Yes (checked)
|
|
|
|
| Name | SSN | Covered All 12 Months |
|
|
|---|---|---|
|
|
| Xuewei Jiang | ***-**-3215 | X |
|