IMPORTANT TAX DOCUMENT – FORM 1095-C AVAILABLE UPON REQUEST

Our organization will provide Form 1095-C (Employer-Provided Health Insurance Offer and Coverage) to any employee who requests a copy.

To request your Form 1095-C, please contact:

Email: jeannie.schmidt@smphs.org
Phone: (701) 252-5660

Mail: Human Resources Director
SMP Health – Ave Maria
Attn: ACA/1095-C Requests
501 19th St NE
Jamestown, ND 58401

When requesting your form, please include your full name, last four digits of your SSN (or Employee ID), current mailing address, and a daytime phone number.

We will provide your Form 1095-C within 30 days of receiving your request.

If you have questions, please contact Jeannie Schmidt, Human Resources Director, using the information above.