Notice of Availability of Form 1095-C

The Paperwork Burden Reduction Act and the Employer Reporting Improvement Act recently introduced changes to the Affordable Care Act (ACA) reporting requirements. As a result, we will now provide Form 1095-C only upon request.

You have access to your Form 1095-C in UKG under My Info → My HR → Forms → Government Forms.

Otherwise, if you would like to receive a copy of your Form 1095-C, please contact the Human Resources Department using one of the following methods:

• Email: Send your request via email to hr@avalonmemorycare.com
• Phone: 469-778-4551
• Mail: Send a request to:
  Avalon Memory Care
  1625 N Stemmons Frwy
  Dallas, Texas 75207

Requests can be made at any time, and the form will be provided to you by January 31 or within 30 days of your request, whichever is later.