Finance and tax forms and useful links

Find all the finance and tax forms and useful links you need for ExxonMobil Family

Affordable Care Act

Under the Affordable Care Act, you may receive one or more Forms 1095.

Form 1095-C from ExxonMobil

  • Full-time employee (during any time of the year) - Yes
  • Non-full-time employees - Only if enrolled in any of the following plans options:
  • POS II
  • Aetna Select
  • Cigna OAPIN
  • OE students - No

Form 1095-B from insurance carrier

  • Full-time employee (during any time of the year) - n/a
  • Non-full-time employees - Only if enrolled in any of the following plans options:
  • HMO Illinois, Blue Cross/Blue Shield - Chicago
  • HMO Kaiser Permanent Mid-Atlantic
  • HMO Kaiser Permanente S. CA
  • HMO Harvard Pilgrim HealthCare
  • OE students - No

By March 31, a Form 1095 will be mailed to your address on record. It will contain information about the offer of health coverage, who was covered, and when, for the previous calendar year. While the information on this form may assist in preparing a federal tax return, it is not required. Form 1095 can be kept with your tax records. 

For more information about Forms 1095, review the sample of Form 1095-C and Frequently Asked Questions.

Payroll

Pay In Lieu Authorization Form

Payroll Distribution - For SeaRiver Maritime Only

Loan Request Forms (Promissory Note and Payroll Deduction Authorization)

W-4 Federal Tax (also see Payroll Calculators)

Verification of Service, Pay and Allowances (Military Duty)

Verification of Service, Pay and Allowances - OEF (Military Duty - Operation Enduring Freedom)

Pension Payroll Forms (PIN is required)

Pre-tax spending plan (Flexible Spending Account)

Employee Affidavit - Flexible Spending Account Dependent Care Reimbursement Account

Employee Health Care Affidavit - Flexible Spending Account Health Care Reimbursement Account

Pre-Tax Direct Deposit Form

Dependent Care Flexible Spending Account Claim Form

Health Care Flexible Spending Account Claim Form

Pre-Tax Claim Instructions

IRS Publication 502 - Medical and Dental Expenses

IRS Publication 503 - Child and Dependent Care Expenses

IRS Publication 2441 - Instructions for Child and Dependent Care Expenses

IRS Form 2441 - Child and Dependent Care Expenses

Useful links

ExxonMobil Benefits Service Center (for post-employment activities, including Pension Estimates)

ExxonMobil Savings Plan Site 

EY Financial Planning Center® (The EY Financial Planner Line® at 1-866-XOM-1-FFP requires Employee ID)