Important Information Regarding Your Form 1095-C

David Douglas School District is providing notice regarding the availability of Form 1095-C (Employer-Provided Health Insurance Offer and Coverage) for the 2025 tax year.

Do I need this form to file my taxes? While you do not need to attach Form 1095-C to your tax return, you may use the information on the form to help you complete your filing.

How can I receive my Form 1095-C? In accordance with IRS regulations, David Douglas School District will provide a copy of your Form 1095-C upon request. You may request a copy using any of the following methods:

• Email: Send a request to Stefanie Edenburn, HR Benefits & Compensation Analyst at stefanie_edenburn@ddsd40.org with the subject line “1095-C Request.”
• Phone: Call Stefanie Edenburn, HR Benefits & Compensation Analyst at 503-261-8250.
• Mail: Send a written request to: David Douglas School District, Attn: Stefanie Edenburn, HR, 11300 NE Halsey St. Portland, OR 97220

Timeline for Delivery Once your request is received, we will furnish your Form 1095-C within 30 days.

This information only applies to employees (past and current) of David Douglas School District. If you are employed or have medical coverage outside of the District, then you will need to contact that employer or provider for information about additional Forms 1095-B and 1095-C.

Due to the complexities with navigating and understanding the Affordable Care Act (ACA) requirements, we want to simplify information about Forms 1095-B and 1095-C that you may receive. The ACA requires qualified medical carriers and employers to distribute Forms 1095-B and 1095-C to qualified individuals. Our district and medical carriers are required to distribute these Forms to qualified individuals. Depending on the requirements you meet under the ACA (Questions 3 & 4 talk about the requirements), you will receive both, one or neither of Forms 1095-B and 1095-C.  Forms 1095-B and 1095-C will be distributed to you around the same time you receive your W-2’s or shortly thereafter.

Information from Forms 1095-B and 1095-C may be referenced when filing your Federal tax return each year. The Forms can help determine if you’re eligible for a premium tax credit or whether you may have to pay a fine for failing to comply with the ACA.

FAQs

Helpful Links:

• https://www.irs.gov/uac/About-Form-1095-C
• https://www.irs.gov/Affordable-Care-Act/Questions-and-Answers-about-Health-Care-Information-Forms-for-Individuals

If you have any questions please contact Benefits and Compensation Analyst, Stefanie Edenburn (stefanie_edenburn@ddsd40.org)