<n1:Form109495CTransmittalUpstream xmlns:n1="urn:us:gov:treasury:irs:msg:form1094-1095Ctransmitterupstreammessage" xmlns="urn:us:gov:treasury:irs:ext:aca:air:ty21" xmlns:irs="urn:us:gov:treasury:irs:common" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:us:gov:treasury:irs:msg:form1094-1095Ctransmitterupstreammessage IRS-Form1094-1095CTransmitterUpstreamMessage.xsd">
<Form1094CUpstreamDetail recordType="" lineNum="0">
<SubmissionId>1</SubmissionId>
<TaxYr>2021</TaxYr>
<CorrectedInd>0</CorrectedInd>
<EmployerInformationGrp>
<BusinessName>
<BusinessNameLine1Txt>First Employer Corp</BusinessNameLine1Txt>
</BusinessName>
<irs:TINRequestTypeCd>BUSINESS_TIN</irs:TINRequestTypeCd>
<irs:EmployerEIN>700000111</irs:EmployerEIN>
<MailingAddressGrp>
<USAddressGrp>
<AddressLine1Txt>1000 Main St</AddressLine1Txt>
<irs:CityNm>Trenton</irs:CityNm>
<USStateCd>NJ</USStateCd>
<irs:USZIPCd>08695</irs:USZIPCd>
</USAddressGrp>
</MailingAddressGrp>
<ContactNameGrp>
<PersonFirstNm>John</PersonFirstNm>
<PersonMiddleNm>H</PersonMiddleNm>
<PersonLastNm>Smith</PersonLastNm>
</ContactNameGrp>
<ContactPhoneNum>5551234567</ContactPhoneNum>
</EmployerInformationGrp>
<Form1095CAttachedCnt>4</Form1095CAttachedCnt>
<Form1095CUpstreamDetail recordType="" lineNum="0">
<RecordId>1</RecordId>
<CorrectedInd>0</CorrectedInd>
<TaxYr>2021</TaxYr>
<EmployeeInfoGrp>
<OtherCompletePersonName>
<PersonFirstNm>Allison</PersonFirstNm>
<PersonLastNm>Anderson</PersonLastNm>
</OtherCompletePersonName>
<irs:TINRequestTypeCd>INDIVIDUAL_TIN</irs:TINRequestTypeCd>
<irs:SSN>755000011</irs:SSN>
<MailingAddressGrp>
<USAddressGrp>
<AddressLine1Txt>1 Main St</AddressLine1Txt>
<irs:CityNm>Trenton</irs:CityNm>
<USStateCd>NJ</USStateCd>
<irs:USZIPCd>08695</irs:USZIPCd>
</USAddressGrp>
</MailingAddressGrp>
</EmployeeInfoGrp>
<CoveredIndividualInd>1</CoveredIndividualInd>
<CoveredIndividualGrp>
<CoveredIndividualName>
<PersonFirstNm>Allison</PersonFirstNm>
<PersonLastNm>Anderson</PersonLastNm>
</CoveredIndividualName>
<irs:TINRequestTypeCd>INDIVIDUAL_TIN</irs:TINRequestTypeCd>
<irs:SSN>755000011</irs:SSN>
<CoveredIndividualAnnualInd>1</CoveredIndividualAnnualInd>
</CoveredIndividualGrp>
</Form1095CUpstreamDetail>
<Form1095CUpstreamDetail recordType="" lineNum="0">
<RecordId>2</RecordId>
<CorrectedInd>0</CorrectedInd>
<TaxYr>2021</TaxYr>
<EmployeeInfoGrp>
<OtherCompletePersonName>
<PersonFirstNm>Brian</PersonFirstNm>
<PersonMiddleNm>B</PersonMiddleNm>
<PersonLastNm>Brown</PersonLastNm>
</OtherCompletePersonName>
<irs:TINRequestTypeCd>INDIVIDUAL_TIN</irs:TINRequestTypeCd>
<irs:SSN>755000021</irs:SSN>
<MailingAddressGrp>
<USAddressGrp>
<AddressLine1Txt>2 Main St</AddressLine1Txt>
<irs:CityNm>Trenton</irs:CityNm>
<USStateCd>NJ</USStateCd>
<irs:USZIPCd>08695</irs:USZIPCd>
</USAddressGrp>
</MailingAddressGrp>
</EmployeeInfoGrp>
<CoveredIndividualInd>1</CoveredIndividualInd>
<CoveredIndividualGrp>
<CoveredIndividualName>
<PersonFirstNm>Brian</PersonFirstNm>
<PersonMiddleNm>B</PersonMiddleNm>
<PersonLastNm>Brown</PersonLastNm>
</CoveredIndividualName>
<irs:TINRequestTypeCd>INDIVIDUAL_TIN</irs:TINRequestTypeCd>
<irs:SSN>755000021</irs:SSN>
<CoveredIndividualMonthlyIndGrp>
<SeptemberInd>1</SeptemberInd>
<OctoberInd>1</OctoberInd>
<NovemberInd>1</NovemberInd>
<DecemberInd>1</DecemberInd>
</CoveredIndividualMonthlyIndGrp>
</CoveredIndividualGrp>
</Form1095CUpstreamDetail>
<Form1095CUpstreamDetail recordType="" lineNum="0">
<RecordId>3</RecordId>
<CorrectedInd>0</CorrectedInd>
<TaxYr>2021</TaxYr>
<EmployeeInfoGrp>
<OtherCompletePersonName>
<PersonFirstNm>Candace</PersonFirstNm>
<PersonLastNm>Clark</PersonLastNm>
</OtherCompletePersonName>
<irs:TINRequestTypeCd>INDIVIDUAL_TIN</irs:TINRequestTypeCd>
<irs:SSN>755000031</irs:SSN>
<MailingAddressGrp>
<USAddressGrp>
<AddressLine1Txt>3 Main St</AddressLine1Txt>
<irs:CityNm>Trenton</irs:CityNm>
<USStateCd>NJ</USStateCd>
<irs:USZIPCd>08695</irs:USZIPCd>
</USAddressGrp>
</MailingAddressGrp>
</EmployeeInfoGrp>
<CoveredIndividualInd>1</CoveredIndividualInd>
<CoveredIndividualGrp>
<CoveredIndividualName>
<PersonFirstNm>Candace</PersonFirstNm>
<PersonLastNm>Clark</PersonLastNm>
</CoveredIndividualName>
<irs:TINRequestTypeCd>INDIVIDUAL_TIN</irs:TINRequestTypeCd>
<irs:SSN>755000031</irs:SSN>
<CoveredIndividualAnnualInd>1</CoveredIndividualAnnualInd>
</CoveredIndividualGrp>
<CoveredIndividualGrp>
<CoveredIndividualName>
<PersonFirstNm>Carter</PersonFirstNm>
<PersonLastNm>Clark</PersonLastNm>
</CoveredIndividualName>
<irs:TINRequestTypeCd>INDIVIDUAL_TIN</irs:TINRequestTypeCd>
<irs:SSN>755000032</irs:SSN>
<CoveredIndividualAnnualInd>1</CoveredIndividualAnnualInd>
</CoveredIndividualGrp>
</Form1095CUpstreamDetail>
<Form1095CUpstreamDetail recordType="" lineNum="0">
<RecordId>4</RecordId>
<CorrectedInd>0</CorrectedInd>
<TaxYr>2021</TaxYr>
<EmployeeInfoGrp>
<OtherCompletePersonName>
<PersonFirstNm>Diana</PersonFirstNm>
<PersonLastNm>Davis</PersonLastNm>
</OtherCompletePersonName>
<irs:TINRequestTypeCd>INDIVIDUAL_TIN</irs:TINRequestTypeCd>
<irs:SSN>755000041</irs:SSN>
<MailingAddressGrp>
<USAddressGrp>
<AddressLine1Txt>4 Main St</AddressLine1Txt>
<irs:CityNm>Trenton</irs:CityNm>
<USStateCd>NJ</USStateCd>
<irs:USZIPCd>08695</irs:USZIPCd>
</USAddressGrp>
</MailingAddressGrp>
</EmployeeInfoGrp>
<CoveredIndividualInd>1</CoveredIndividualInd>
<CoveredIndividualGrp>
<CoveredIndividualName>
<PersonFirstNm>Diana</PersonFirstNm>
<PersonLastNm>Davis</PersonLastNm>
</CoveredIndividualName>
<irs:TINRequestTypeCd>INDIVIDUAL_TIN</irs:TINRequestTypeCd>
<irs:SSN>755000041</irs:SSN>
<CoveredIndividualAnnualInd>1</CoveredIndividualAnnualInd>
</CoveredIndividualGrp>
<CoveredIndividualGrp>
<CoveredIndividualName>
<PersonFirstNm>Donald</PersonFirstNm>
<PersonMiddleNm>D</PersonMiddleNm>
<PersonLastNm>Davis</PersonLastNm>
</CoveredIndividualName>
<BirthDt>2019-03-21</BirthDt>
<CoveredIndividualMonthlyIndGrp>
<MarchInd>1</MarchInd>
<AprilInd>1</AprilInd>
<MayInd>1</MayInd>
<JuneInd>1</JuneInd>
<JulyInd>1</JulyInd>
<AugustInd>1</AugustInd>
<SeptemberInd>1</SeptemberInd>
<OctoberInd>1</OctoberInd>
<NovemberInd>1</NovemberInd>
<DecemberInd>1</DecemberInd>
</CoveredIndividualMonthlyIndGrp>
</CoveredIndividualGrp>
</Form1095CUpstreamDetail>
</Form1094CUpstreamDetail>
<Form1094CUpstreamDetail recordType="" lineNum="0">
<SubmissionId>2</SubmissionId>
<TaxYr>2021</TaxYr>
<CorrectedInd>0</CorrectedInd>
<EmployerInformationGrp>
<BusinessName>
<BusinessNameLine1Txt>second Employer Corp</BusinessNameLine1Txt>
</BusinessName>
<irs:TINRequestTypeCd>BUSINESS_TIN</irs:TINRequestTypeCd>
<irs:EmployerEIN>700000222</irs:EmployerEIN>
<MailingAddressGrp>
<USAddressGrp>
<AddressLine1Txt>2000 Main St</AddressLine1Txt>
<irs:CityNm>Trenton</irs:CityNm>
<USStateCd>NJ</USStateCd>
<irs:USZIPCd>08695</irs:USZIPCd>
</USAddressGrp>
</MailingAddressGrp>
<ContactNameGrp>
<PersonFirstNm>John</PersonFirstNm>
<PersonMiddleNm>H</PersonMiddleNm>
<PersonLastNm>Smith</PersonLastNm>
</ContactNameGrp>
<ContactPhoneNum>5551234567</ContactPhoneNum>
</EmployerInformationGrp>
<Form1095CAttachedCnt>1</Form1095CAttachedCnt>
<Form1095CUpstreamDetail recordType="" lineNum="0">
<RecordId>5</RecordId>
<CorrectedInd>0</CorrectedInd>
<TaxYr>2021</TaxYr>
<EmployeeInfoGrp>
<OtherCompletePersonName>
<PersonFirstNm>Erik</PersonFirstNm>
<PersonLastNm>Edwards</PersonLastNm>
</OtherCompletePersonName>
<irs:TINRequestTypeCd>INDIVIDUAL_TIN</irs:TINRequestTypeCd>
<irs:SSN>755000051</irs:SSN>
<MailingAddressGrp>
<USAddressGrp>
<AddressLine1Txt>5 Main St</AddressLine1Txt>
<irs:CityNm>Trenton</irs:CityNm>
<USStateCd>NJ</USStateCd>
<irs:USZIPCd>08695</irs:USZIPCd>
</USAddressGrp>
</MailingAddressGrp>
</EmployeeInfoGrp>
<CoveredIndividualInd>1</CoveredIndividualInd>
<CoveredIndividualGrp>
<CoveredIndividualName>
<PersonFirstNm>Erik</PersonFirstNm>
<PersonLastNm>Edwards</PersonLastNm>
</CoveredIndividualName>
<irs:TINRequestTypeCd>INDIVIDUAL_TIN</irs:TINRequestTypeCd>
<irs:SSN>755000051</irs:SSN>
<CoveredIndividualMonthlyIndGrp>
<JanuaryInd>1</JanuaryInd>
<FebruaryInd>1</FebruaryInd>
</CoveredIndividualMonthlyIndGrp>
</CoveredIndividualGrp>
<CoveredIndividualGrp>
<CoveredIndividualName>
<PersonFirstNm>Erin</PersonFirstNm>
<PersonLastNm>Edwards</PersonLastNm>
</CoveredIndividualName>
<irs:TINRequestTypeCd>INDIVIDUAL_TIN</irs:TINRequestTypeCd>
<irs:SSN>755000052</irs:SSN>
<CoveredIndividualMonthlyIndGrp>
<JanuaryInd>1</JanuaryInd>
<FebruaryInd>1</FebruaryInd>
</CoveredIndividualMonthlyIndGrp>
</CoveredIndividualGrp>
<CoveredIndividualGrp>
<CoveredIndividualName>
<PersonFirstNm>Eleanor</PersonFirstNm>
<PersonLastNm>Edwards</PersonLastNm>
</CoveredIndividualName>
<irs:TINRequestTypeCd>INDIVIDUAL_TIN</irs:TINRequestTypeCd>
<irs:SSN>755000053</irs:SSN>
<CoveredIndividualMonthlyIndGrp>
<JanuaryInd>1</JanuaryInd>
<FebruaryInd>1</FebruaryInd>
</CoveredIndividualMonthlyIndGrp>
</CoveredIndividualGrp>
</Form1095CUpstreamDetail>
</Form1094CUpstreamDetail>
</n1:Form109495CTransmittalUpstream>