Availability of IRS Form 1095-C

The Internal Revenue Service (IRS) requires employers to provide certain employees with Form 1095-C, which reports information about health coverage offered to employees.

Our company will provide Form 1095-C to any full-time employee who requests a copy.

How to Request a Copy of Your Form 1095-C

Employees may request a copy of their Form 1095-C at no cost by contacting us any time using one of the methods below:

1. Email:
   AskHR@claybourneco.com

2. In-Person:
   CI Distribution, LLC
   1320 W. Oleander Ave.
   Perris, CA 92571

When making a request, please include your full name, current mailing address, and a brief statement that you are requesting a copy of your Form 1095-C.

Copies will be provided within a reasonable timeframe after the request is received.

This notice is provided in accordance with IRS regulations regarding employer-provided health coverage reporting.