If you are a previous City employee and have a Health Care Saving Plan account with a balance, you may request a 1095 – B Health Coverage form for the previous tax year. Please contact Lori Winsemius, Payroll and Benefits Clerk, at 616-355-1376 or by email at email@example.com. The request may also be mailed to the following mailing address:
City of Holland Attn: Lori Winsemius 270 S. River Ave. Holland, MI 49423
You will receive the 1095 – B form within 30 days of your request.