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473 <br />• File a complaint with the U.S. Department of Health and Human Services at: <br />U.S. Department of Health and Human Services <br />Hubert H. Humphrey Building <br />200 Independence Avenue, S.W. <br />Washington, D.C. 20201 <br />The City will not retaliate against you for filing a complaint. <br />As a self - funded entity, your health plan and the City are one and the same. However, the <br />City is prohibited from using or disclosing any protected health information for <br />employment - related activities, if the protected heath information was received or created <br />while the City was acting as your group health plan. <br />All requests related to privacy notices or protected health information should be made in <br />writing to the City's Privacy Officer: <br />City of Paris Health Plan <br />ATTN: Gene Anderson <br />P.O. Box 9037 <br />Paris, TX 75460 -9037 <br />EFFECTIVE DATE <br />This privacy notice has an effective date of April 14, 2004. <br />76 Revised 01 -25 -05 <br />