INFO YOU NEED TO PROVIDE US,
TO COMPLETE YOUR 2014 TAX RETURN
RE: AFFORDABLE CARE ACT (ACA)
ALSO KNOWN AS "OBAMACARE"
Did you have health insurance during 2014 for you and your dependents?
Yes _____ No _____
If yes, where did you obtain your insurance?
List Company Name: _________________________________
List Account Number: ________________________________
IMPORTANT NOTE: If you obtained your health insurance through Covered California, or HealthCare.gov, or any other state's "Marketplace", you will be receiving a tax form from the provider, called a form 1095-A. You must provide us with a copy of this, for us to complete your return!!!
Further, if you obtained your health insurance from a source other than Covered California, or HealthCare.gov, or another state Marketplace, we need to know if there were any months you were not covered.
Please provide a list of months not covered: