dc66e42ec4
Categories now match folder names (15 canonical values). Types normalized to 25 canonical values per VAULT_MAP.md spec. Context-aware mapping: W-2s→tax-form, lease files→lease, vet records→vet, etc.
47 lines
1.1 KiB
Markdown
47 lines
1.1 KiB
Markdown
---
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type: tax-form
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category: tax
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person: Xuewei Jiang
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date: 2018-12-31
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source: jiang_1095c_2018.pdf
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---
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# Form 1095-C - Employer-Provided Health Insurance (2018)
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## Part I - Employee
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| Field | Value |
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|---|---|
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| 1. Name | Xuewei Jiang |
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| 2. SSN | ***-**-3215 |
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| 3. Address | 2110 Speedway Stop B6600, CBA 6.222 |
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| 4. City/State/ZIP | Austin, TX 78712-1276 |
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## Applicable Large Employer Member (Employer)
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| Field | Value |
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|---|---|
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| 7. Name | The University of Texas at Austin |
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| 8. EIN | 746000203 |
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| 9. Address | 1616 Guadalupe St., Suite 1.408 |
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| 10. Phone | (512) 471-4772 |
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| 11. City/State/ZIP | Austin, TX 78701 |
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## Part II - Employee Offer of Coverage
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| Field | Value |
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| 14. Offer of Coverage (All 12 Months) | 1G |
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| 15. Employee Required Contribution | (blank for all months) |
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| 16. Section 4980H Safe Harbor | (blank) |
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Code 1G: Not a full-time employee for any month but enrolled in self-insured employer-sponsored coverage.
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## Part III - Covered Individuals
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Self-insured coverage: Yes (checked)
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| Name | SSN | Covered All 12 Months |
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|---|---|---|
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| Xuewei Jiang | ***-**-3215 | X |
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