Skip to main content

Need a Form 1095-C or 1095-B?

Notice of Availability – Form 1095-C or 1095-B.

How to request your Affordable Care Act (ACA) form.
Important: You may obtain a copy of your Form 1095-C (and, if applicable, Form 1095-B)  upon request. We are not automatically mailing forms to all individuals.
How To Request Your Form
You can request your form using any of the methods below. Please include your full name, current mailing address, last 4 digits of your SSN (for identity verification), and the tax year.
  • Email: HRServices@Nussbaum.com
  • Mail: Nussbaum Transportation Services, 19936 N 1425 East Rd, Hudson, IL 61748 – Attn: Human Resources
  • Phone: (309) 268-1193 (Monday – Friday, 7:00 a.m. – 5:00 p.m. CST)
When you will receive your form:
  • We will furnish the requested form by the earlier of (1) January 31 of the year following the reporting year, or (2) 30 days after we receive your request.
Which Form Will You Receive?
  • Form 1095-C – Shows health coverage offered to you as a full-time eligible employee.
  • Form 1095-B (Nussbaum Technology) – Shows health coverage offered to you as a full-time eligible employee and shows minimum essential coverage.

Please fill out the form below and a Nussbaum Representative will be in touch soon!

Name
Employee Type(Required)
Current Mailing Address(Required)
Delivery Preference(Required)
Authorization(Required)

EMPLOYEE OWNED. PURPOSE DRIVEN.

Drive With Nussbaum