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: cassey.lene@smpsh.org
Phone: (701) 293-7750
Mail: Payroll/Purchasing Coordinator
SMP Health – St. Catherine South
Attn: ACA/1095-C Requests
3102 University Drive South
Fargo, ND 58103

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 Cassey Lene, Payroll/Purchasing Coordinator, using the information above.