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: michelle.wobbema@smphs.org
Phone: (701) 845-8218

Mail: Payroll & Benefits Specialist
SMP Health – St. Raphael
Attn: ACA/1095-C Requests
979 Central Ave N
Valley City, ND 58072

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 Michelle Wobbema, Payroll & Benefits Specialist using the information above.