Form 1095-C Disclosure and Request | Courtesy Motors Inc

IMPORTANT HEALTH COVERAGE TAX DOCUMENTS

Notice of Availability: Form 1095-C (Health Insurance Offer and Coverage)

In accordance with the Paperwork Burden Reduction Act, Courtesy Motors, Inc is no longer required to automatically furnish a paper copy of Form 1095-C to all employees.

What is Form 1095-C? This form provides information about the health insurance coverage offered to you by Courtesy Motors. While this information may be helpful for your records, you do not need this form to file your income tax return.

How to Request Your Copy: If you would like to receive a copy of your Form 1095-C for the current or prior tax year, you may request one at any time. We will provide the form to you within 30 days of your request.

Please submit your request using one of the following methods:

  • By Email: Use contact form below

  • By Phone: (616) 452-2143

  • By Mail: Courtesy Motors, Inc
    Attn: HR/Payroll - 1095-C Request
    440 28th St SE
    Grand Rapids, MI 49548

Contact form for 1095-C Request

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