Health Plans
Plan Year January 1st - December 31st

January 2025 -October 2025
HR 3797 NOTICE
(Employer Notice For 1095 forms)
IMPORTANT HEALTH COVERAGE TAX DOCUMENTS
THIS NOTICE is required under congressional act H.R. 3797 – “Paperwork Burden Reduction Act”: You may receive a copy of your form 1095-B “Health Coverage” or form 1095-C “Employer-Provided Health Insurance Offer and Coverage” for 2024 by sending your request to:
By Email: Finance@stambrosefinancial.com
By Mail:
Your Employer’s Name
C/O St Ambrose Financial Services, Inc. Accounting Dept
P.O. Box 4004
La Crosse, WI 54602-4004
By Phone: 608-791-2669 ext. 9894
Contact Name: Cheryl Cummings, Accounting Manager – St. Ambrose Financial Services, Inc.
Please include the following information in your request:
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Your Employer’s Name and City
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Your Name: First Name MI Last Name
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What you are requesting: Specify Email or Paper copy of your 2024 1095 Form