Former Employees – Form 1095-C Availability Notice
Important Tax Information
If you were employed with Brockton Neighborhood Health Center during the 2025 calendar year, your Form 1095-C (Employer-Provided Health Insurance Offer and Coverage) is available upon request.
Form 1095-C contains important information about the health coverage offered to you and may be needed for your tax records.
Request a Copy of Your Form 1095-C
To receive a copy of your Form 1095-C please contact Michelle Rocheleau. Mail a letter to me at:
103 Commercial St.
4th Floor
Brockton, MA 02302
When requesting your form, please provide:
- Your full name (as it appeared during employment)
- Last four digits of your Social Security Number. Important: do not include your complete SSN.
- Current mailing address
- Approximate dates of employment
Requests will be processed promptly.
Thank you,
Michelle Rocheleau
Payroll & Benefits Manager