Right to Request Form 1095-C

Notice of availability and right to request Form 1095-C

This notice informs Employees of changes to the Affordable Care Act (ACA) reporting requirements.

Effective immediately, Copper Canyon Fire and Medical District will no longer automatically provide employees with Form 1095-C. This form reports information about health insurance coverage offered through an employer-sponsored plan.

If you require a copy of Form 1095-C for tax filing purposes, you must submit a written request through the Administration Office. We encourage you to make your request as soon as possible to ensure you receive the necessary documentation for your records and tax filing.

Please submit your request in writing via email CCFMD Admin or in person or by mail at 26 W Salt Mine Road Unit B, Camp Verde, AZ 86322.

If requested, Form 1095-C must be provided by January 31, or 30 days after the request, whichever is later.