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Santa Ana California Form 1094-C: What You Should Know

The information in these letters is accurate as of March 12, 2016. If there was an error or correction made to the information in any of these letters, please contact the following: Eileen M. Alvarado 948.979.5090 / Eileen M. Pardon 948.955.6058 / Maria H. Cervantes 925.844.8590 / mcervandssacd.edu Eileen M. Alvarado School District of Santa Ana C/O School Board Policy Advisor Dear Parents and Guardians, We will send letters to the children, parents and caregivers of all current and prospective employees and their families. We encourage you to carefully review the information, if applicable, included in these two forms to make sure you receive all the information necessary to properly prepare an accurate Form 1095-C for your employee. We recommend that your employees be listed on your EZ-Check and Employee ID Number on the employer's website. Sincerely, Elisa A. Moll Assistant Superintendent, Employee Benefits and Compliance Dear Employees and Potential Employees, If you do not receive the form with any information you need, you should contact the information coordinator, Eileen M. Alvarado If an employee is not covered by an approved plan (see “What is an approved plan?” on the 1094-C or the 1095-C) or is not properly registered, Please contact the information coordinator at Employees with a new or newly installed device are not eligible for a tax credit Your information was processed incorrectly. Please contact the Department of Motor Vehicles to report your information. The Santa Ana Unified School District has been asked to provide an estimated tax liability of 8,946.81 on Form 1095-C and 22,543.94 on Form 1095-B due to the Affordable Care Act, Part II of the Patient Protection and Affordable Care Act (ACA) of 2010, Public Law 111-148.

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