As part of our compliance with the Affordable Care Act (ACA), we are informing you that Form 1095-C, which provides information about your health coverage, is available upon request. This form is important for your tax filings and provides details about the health insurance coverage offered to you by Houlton Regional Hospital.

How to Request Your Form 1095-C:
To request a copy of your Form 1095-C for the 2025 tax year, please contact us at:

• Email: rnickerson@hrhospital.org
• Mailing Address: 20 Hartford Street, Houlton, Maine 04730
• Phone Number:  207-521-2144

We will provide the requested form within 30 days of your request.
Thank you for your attention to this matter.
If you have any questions, feel free to reach out to our HR department.