Notice of Availability of Form 1095-B

IMPORTANT TAX INFORMATION

Our organization sponsors a partially self-funded group health plan that provides minimum essential health coverage. Form 1095-B, Health Coverage, is available upon request.

Form 1095-B reports information about individuals enrolled in our partially self-funded health plan during the prior calendar year. You do not need Form 1095-B to file your federal income tax return, but you may request a copy for your records.

How to Request Form 1095-B

You may request a copy of your Form 1095-B using one of the following methods:

Delivery and Timing

Requests may be made at any time. A copy of Form 1095-B will be furnished within 30 days of the request. The form is available in either electronic or paper format, upon request.

Plan Administration Disclosure

Coverage under this plan is partially self-funded by the employer and may be administered by a third-party administrator. The employer is responsible for furnishing Form 1095-B upon request.

This notice is provided in accordance with IRS guidance under Internal Revenue Code Sections 6055 and 6056.