Form 1095-C Request
About This Notice
Primary Companies has elected to use the Internal Revenue Service’s alternative method of furnishing Form 1095-C to employees, as permitted under applicable ACA regulations. Rather than mailing a paper copy of Form 1095-C, eligible employees may request a copy of their form at no cost.
Form 1095-C provides information about the health coverage offered to you during the applicable calendar year and may be needed when preparing your personal tax return.
How to Request Your Form 1095-C
Employees may request a copy of their Form 1095-C by contacting Human Resources using the information below or complete the form below. Once a request is received, a paper copy will be furnished to you within 30 days of the date the request is received.
Questions or Requests
Please contact Human Resources at:
920-756-2577 ext. 533
440 W Ryan St. Brillion, WI 54110
(mail written requests to: PO Box 163 Brillion, WI 54110)
to request your Form 1095-C or if you have any questions.