Form 1095-C Request Information
IMPORTANT HEALTH COVERAGE TAX DOCUMENTS
The Affordable Care Act (ACA) requires certain employers, such as the City and County of Honolulu, to offer health insurance coverage to all full-time employees and their dependents. Form 1095-C includes information about the health insurance coverage offered to employees by the City.
Changes to Reporting Requirements
Recently, the Paperwork Burden Reduction Act (HR 3797) modified requirements of the Affordable Care Act (ACA) to reduce the administrative burden of ACA reporting requirements on employers. As a result, employers are no longer required to send the Form 1095-C to all employees.
The 1095-C Tax Form is NOT required to complete your tax return!
The Form 1095-C is not required to complete your tax return. Your tax preparer may request a copy of your Form 1095-C, but if you inform your tax preparer regarding the months you had coverage during the calendar year, they do not need to receive a copy of this form.
Request a 1095-C Statement
If you want to receive a copy of your most recent tax year Form 1095-C or if you have any questions regarding this matter, please contact your department personnel office noted below.
Please allow up to 30 days for processing and delivery.
Department of Budget and Fiscal Services
Contact Person: Department of Budget and Fiscal Services Personnel Office
Physical Address: 530 S King Street, Room 208, Honolulu, HI 96813
Email Address: BFSPersonnel@honolulu.gov
Telephone Number: 808-768-3773 or 808-768-3907
City Clerks Office
Contact Person: Chadd Kadota
Physical Address: 530 S King Street, Room 100, Honolulu, HI 96813
Email Address: clerks@honolulu.gov
Telephone Number: 808-768-3810
City Auditor’s Office
Contact Person: Jordan Alonzo
Physical Address: 1001 Kamokila Blvd, Suite 216, Kapolei, HI 96707
Email Address: Jordan.alonzo@honolulu.gov
Telephone Number: 808-768-3134
City Council
Contact Person: Nanette Saito
Physical Address: 530 S King Street, Room 202, Honolulu, HI 96813
Email Address: nsaito@honolulu.gov
Telephone Number: 808-768-5085
Customer Services Department
Contact Person: Nilda Ocreto
Physical Address: 925 Dillingham Blvd, Room 257, Honolulu, HI 96817
Email Address: nocreto@honolulu.gov
Telephone Number: 808-768-3739
Department of the Corporation Council
Contact Person: Jennifer Wong
Physical Address: 1001 Bishop Street, Suite 2020, Honolulu, HI 96813
Email Address: cor@honolulu.gov
Telephone Number: 808-768-5193
Department of Community Services
Contact Persons: Angela Niuelua or Lisa Williams
Physical Address: 222 N School Street, Honolulu, HI 96817
Email Address: angela.niuelua@honolulu.gov or lisa.williams@honolulu.gov
Telephone Number: 808-768-7765 or 808-768-7766
Department of Design and Construction
Contact Person: Pat Higa
Physical Address: 650 S King Street, 11th floor, Honolulu, HI 96813
Email Address: phiga@honolulu.gov
Telephone Number: 808-768-8487
Department of Emergency Management
Contact Person: Mari Masuoka
Physical Address: 650 S King Street, Basement, Honolulu, HI 96813
Email Address: mmasuoka@honolulu.gov
Telephone Number: 808-723-8959
Department of Enterprise Services
Contact Person: Amber Haleamau
Physical Address: 777 Ward Avenue, Honolulu, HI 96814
Email Address: desadminservices@honolulu.gov
Telephone Number: 808-768-5402
Department of Environmental Services
Contact Person: Rachel Brady
Physical Address: 91-2060 Franklin D Roosevelt Ave., Kapolei, HI 96707
Email Address: rachel.brady@honolulu.gov
Telephone Number: 808-768-3473
Department of Facility Maintenance
Contact Person: Jazmin Hoffman
Physical Address: 1000 Ulu’ohi’a St, Suite 215, Kapolei, HI 96707
Email Address: jazzmin.hoffman@honolulu.gov
Telephone Number: 808-768-3354
Department of Human Resources
Contact Person: Gary Chan
Physical Address: 650 S King Street, 10th Floor, Honolulu, HI 96813
Email Address: gary.chan@honolulu.gov
Telephone Number: 808-768-2308
Department of Information Technology
Contact Person: Department of Information Technology Administrative Office
Physical Address: 650 S King Street, 5th Floor, Honolulu, HI 96813
Email Address: Danielle.kirk@honolulu.gov
Telephone Number: 808-768-7619
Department of Housing and Land Management
Contact Person: Ty Tomimoto
Physical Address: 650 S King Street, 3rd Floor, Honolulu, HI 96813
Email Address: ty.tomimoto@honolulu.gov
Telephone Number: 808-768-4270
Liquor Commission
Contact Person: Gerald (Jerry) DeGuzman
Physical Address: 711 Kapiolani Blvd, Suite 600, Honolulu, HI 96813
Email Address: Gerald.deguzman@honolulu.gov
Telephone Number: 808-768-7360
Department of Planning and Permitting
Contact Person: Catherine Fernandez
Physical Address: 650 S. King Street, 7th Floor, Honolulu, HI 96813
Email Address: c.fernandez@honolulu.gov
Telephone Number: 808-768-8002
Department of Parks and Recreation
Contact Person: Kimberly Ribellia-Collins
Physical Address: 1000 Ulu’ohi’a St, Suite 309, Kapolei, HI 96707
Email Address: kribellia@honolulu.gov
Telephone Number: 808-768-3036
Department of the Prosecuting Attorney
Contact Person: Jason Tamanaha
Physical Address: 1060 Richards Street, Honolulu, HI 96813
Email Address: Jason.tamanaha@honolulu.gov
Telephone Number: 808-768-7525
Department of Transportation Services
Contact Person: Chris Ovitt
Physical Address: 711 Kapiolani Blvd, Suite 1600, Honolulu, HI 96813
Email Address: covitt@honolulu.gov
Telephone Number: 808-768-8307
Honolulu Authority for Rapid Transportation
Contact Person: Sandy Aguilar
Physical Address: 1099 Alakea Street, Suite 1700, Honolulu, HI 96813
Email Address: sandy.aguilar@honolulu.gov
Telephone Number: 808-768-6124
Honolulu Emergency Services Department
Contact Person: Liane Kaneko
Physical Address: 3375 Koapaka Street, H450, Honolulu, HI 96819
Email Address: lkaneko@honolulu.gov
Telephone Number: 808-723-7812
Honolulu Ocean Safety Department
Contact Person: Jonna Justiniano
Physical Address: 3823 Le’ahi Avenue, Honolulu, HI 96815
Email Address: Jonna.justiniano@honolulu.gov
Telephone Number: 808-768-7874
Honolulu Fire Department
Contact Person: Doris Watts
Physical Address: 636 South Street, Honolulu, HI 96813-5007
Email Address: doris.watts@honolulu.gov
Telephone Number: 808-723-7140
Honolulu Police Department
Contact Person: Finance Division – Payroll Section
Physical Address: 801 S Beretania Street, Honolulu, HI 96813
Email Address: hpdpayroll@honolulu.gov
Telephone Number: 808-723-3219
Medical Examiner Department
Contact Person: LaShayna Thomas
Physical Address: 835 Iwilei Road, Honolulu, HI 96817
Email Address: Lashayna.thomas@honolulu.gov
Telephone Number: 808-768-9714
Office of Council Services
Contact Person: Marisa Yoshioka
Physical Address: 530
S King Street, Room 207, Honolulu, HI 96813
Email Address: myoshioka@honolulu.gov
Telephone Number: 808-768-5196
Royal Hawaiian Band
Contact Person: Julie Yamamoto
Physical Address: 2241 Kapiolani Blvd, Floor 9, Honolulu, HI 96826
Email Address: jyamamoto@honolulu.gov
Telephone Number: 808-768-6677