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Forms & Documents

The forms and documents on this page are generally Adobe® Acrobat® files. To view or print these forms, you need to have the Adobe Acrobat Reader installed on your computer.

Follow the directions on the form and submit to the appropriate party and address.

Benefit Plan/Program Forms Documents
General 2015 New Hire Orientation  
  2015 New Hire Benefits Enrollment



  2015 Insurance Rates for Medical, Dental and Vision  
  Partner Agreement Benefit Summary for Lewiston Campus
  Payroll Direct Deposit Choice Time & Extended Sick Bank Accruals (Salaried)
  2015 Pay Check Dates Choice Time & Extended Sick Bank Accruals (Hourly)
  2015 Holiday Schedule CMMC Parking Map & Violation Notice
  Qualifying Event Form

Voluntary Benefits:

  W4- -Federal and State - 2015 PPACA Notice, August 2012
  Change of Name/Address Change

 

  Check Request Form  
  Ability Assist (EAP)  
 
Medical Plan   Medical Summary Plan Description
   

About Creditable Prescription Drug Coverage and Medicare:

    Summary Annual Report Medical and Dental 10.14
   
Summary Benefits & Coverage $500
    Summary Benefits & Coverage $1,500
    Understanding Health Care Reform
    Health Insurance HIPPA Privacy Notice
    Summary Annual Report 2012
    SBC-1.1.14-Medical-Plan-$500-deductible
   

SBC-1.1.14-Medical-Plan-$1500-deductible

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Dental Plan   Dental Summary Plan Description
    Dental SPD Amendment
 
Spending Accounts Health Care Benny Card Receipt Claim Spending Account Summary Plan Description
  Health Care Claim FSA Expense List
  Dependent Care Claim  
  Direct Deposit Authorization  
  Doctor's Statement of Medical Necessity  
 
Life and Disability Insurance Beneficiary Change Form Life/LTD Summary Plan Description (non-MD)
  Ability Assist (EAP) Life Insurance Summary Plan Description (MD)
  STD Premium Rate Sheet LTD Summary Plan Description (MD)
    STD Summary Plan Description
 

Retirement: Defined Benefit Pension Plan (Frozen 04/01/2011)


Notice of Withdrawal


Special Tax Notice January 2015

    Frequently Asked Questions (FAQs)
    Summary Plan Description, Restated April 1, 2011
    Summary of Material Modification - July 2015
    2014 Annual Funding Notice
 
Retirement: 403(b) & 401(k) Plan Address Change Online Access Instructions
  Beneficiary 403(b)Fund Performance Notice 10.14
  Deduction Change 403(b) Fee Disclosure 10.14
  Enrollment Form 403(b) Fund Change Disclosure 10.14
  403(b) Auto Enrollment notice 457(b) Fee Disclosure 10.14
  401(k) Auto Enrollment notice 2015 Enrollment Form
 

403(b) Hardship Distribution Form

401(k) Hardship Distribution Form

2015 Insurance Rates
  Withdrawal/Transfer Request Form
2014-401k-EACA-Notice-of-Auto-Enroll
  403(b) and 401(k) Loan Application with Instructions 2014-401k-Investment-Profile-11.14
  Waiver 2014-403b-EACA-Notice-of-Auto-Enroll-11.14
    2014-403b-Investment-Profile-11.14
 
Retirement: 457 Plan Beneficiary Designation  
  Distribution Request  
  Distribution/Rollover Request  
  Hardship Distribution Request  
 

 

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