IMPORTANT HEALTH COVERAGE TAX DOCUMENTS

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: nancy.maasjo@smphs.org
Phone: (701) 491-7695 direct line

Mail: Business Office/HR Coordinator
SMP Health – Maryhill
Attn: ACA/1095-C Requests
110 Hillcrest Drive
Enderlin, ND 58027

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 Nancy Maasjo, Business Office/HR Coordinator, using the information above.