PeakOne Administration 12/5/2023

© Peak One Administration 2016 23 ii.Client is responsible for completing the data request form and submitting it to PSP within the stated time period. Client is also responsible for performing any action required if the applicable plan becomes discriminatory. 3.Reporting under Code Section 6055 and 6056. (a)Responsibilities of PSP. i.For provider reporting forms required to be filed in each calendar year during the term of this Agreement, PSP will complete the applicable Form 1094-B or 1094-C and corresponding 1095-B or 1095-C, based solely on information provided by Client, for each Employee and non-employee identified by Client. ii.For each Employee who worked for more than one ALE Member of the same Aggregated ALE Group, PSP will complete a separate Form 1095-C from each employer. iii.PSP will provide to Client by the later of January 15th or ten (10) business days after receipt of an accurate and complete data spreadsheet, the completed Form 1094-B or 1094-C and Form 1095-B or 1095-C for Client to distribute to Employees and file with the IRS. (b)Responsibilities of Client. Client will: i.Determine who are/were full-time Employees during the relevant reporting period. ii.Determine if Client was an ALE during the relevant reporting period. iii.Determine if an offer of coverage for each Employee was “affordable” as that term is defined in Code § 36 B(c)(2)(c)(i). iv.Determine whether the coverage offered during the relevant reporting period provides minimum value as that term is defined in 26 C.F.R. § 54.4980H- 1(a)(12). v.Ensure that the spreadsheet data transmitted to PSP for its use in preparing the IRS mandated reporting is complete, accurate, timely and in the format designated by PSP. vi.Review and verify the accuracy of Form 1094-B or 1094-C and corresponding 1095-B or 1095-C for each Employee and non-employee identified by Client and notify PSP of any changes within five (5) business days. vii.Distribute the 1095-C or 1095-B, as applicable, to each Employee in a manner designated by the IRS by January 31 of the year following the year to which the form relates. viii.File the Form 1094-B or 1094-C, along with the applicable Form 1095-B or 1095- Cs with the IRS, on or before February 28 (or March 31 if filed electronically), or other date designated by the IRS, of the year following the year to which the forms relate. ix.Pay any penalties, including late filing penalties, for failure to file correct information returns and/or failure to furnish correct payee statements.