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: theresa.kadrie@smphs.org
Phone: (701) 277-7954
Mail: Payroll/Benefits Specialist
SMP Health – St. Catherine North
Attn: ACA/1095-C Requests
1351 Broadway N.
Fargo, ND 58102
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 Theresa Kadrie, Payroll/Benefits Specialist, using the information above.