Documents & Forms Annuity Documents & Forms ANU - Annuity Beneficiary Form 10.2019 ANU - Determination Letter from IRS 021116 ANU - Notice of Military Service Credit (USERRA) ANU - Plan Document effective 013015 and Amendments updated 06292021 ANU - Summary Annual Report 2017 (published 2018) ANU - Summary Annual Report 2018 (published 2019) ANU - Summary Annual Report 2019 (published 2020) ANU - Summary Annual Report 2020 (published 2021) ANU - Summary Annual Report 2021 (published 2022) ANU - Summary Plan Description (effective 07012019) and Plan changes thru 12012021 ANU - Trust Agreement Restated 2023 Employers Documents & Forms EC - 10 - Frequently Asked Questions in Payroll Audit Revised 20230105 EC - 14 - Contribution Due Date Notice (Published 201402) EC - 3 - ACH Holding Account Information 202301 EC - 4 - Employer Information Request Form 20230105 EC - 7 - Alumni Agreement Important Information Notice (Published 201709) EC - 8 - BNF Alumni Agreement final 1.2023 - rev 7.18.23 EC - 9 - BNF Alumni Election Change Form final 1.2023 - revised 3.3.23 - fillable EC - ANU - Summary Annual Report 2019 (published 2020) EC - ANU - Summary Annual Report 2020 (published 2021) EC - ANU - Summary Annual Report 2021 (published 2022) EC - ANU - Summary Plan Description (effective 07012019) and Plan changes thru 07012020 EC - ANU - Trust Agreement Restated 2023 EC - HW - Trust Agreement Restated 2022 EC - HW - Trust Agreement Restated 2022 Amendment #1 EC - PEN - 14th Pension Plan Restatement effective 06012022 and Amendments 06142022 EC - PEN - 2018 FASB Disclosures 201911 EC - PEN - 2019 FASB Disclosures 202011 EC - PEN - 2019 Rehabilitation Plan EC - PEN - 2020 FASB Disclosures 202111 EC - PEN - 2020 Funding Improvement Plan EC - PEN - 2021 FASB Disclosures 202211 EC - PEN - 2023 Rehabilitation Plan EC - PEN - 5500 Summary Notice 104(d) 2019 (published November 2020) EC - PEN - 5500 Summary Notice 104(d) 2020 (published November 2021) EC - PEN - 5500 Summary Notice 104(d) 2021 (published November 2022) EC - PEN - Notice of Annual Funding 2018 (published April 2019) EC - PEN - Notice of Annual Funding 2019 (published April 2020) EC - PEN - Notice of Annual Funding 2020 (published April 2021) EC - PEN - Notice of Annual Funding 2021 (published April 2022) EC - PEN - Notice of Annual Funding 2022 (published April 2023) EC - PEN - Notice of Plan Status 2019 EC - PEN - Notice of Plan Status 2020 EC - PEN - Notice of Plan Status 2021 EC - PEN - Notice of Plan Status 2023 EC - PEN - Summary Plan Description effective 6.1.2022 EC - PEN - Trust Agreement Restated 2023 EC - PEN - Withdrawal Liability Valuation as of 123120 EC - PEN - Withdrawal Liability Valuation as of 123121 Health & Welfare Documents & Forms HW - 2023 Annual Care Checklist HW - 2023 National Preferred Formulary Drug List HW - 2023 Summary Plan Description (SPD) with Plan Amendments HW - 2023 United Healthcare Benefits Summary HW - 2023 United Healthcare Plan Guide HW - Appointment of Authorized Representative Form (Jan 2023) HW - Authorization to Release Protected Health Information (Jan 2023) HW - BNF Vision Claim Form (Jan 2023) HW - COB and Information Verification Form July 2023 HW - COBRA Continuation Coverage Election or Rejection Form (Jan 2023) HW - Children's Health Insurance Program 2022 HW - Dependent Child Enrollment Form (Jan 2023) HW - Designation of Beneficiary Card (Jan 2023) HW - Disclaimer of Benefits Form (Jan 2023) HW - Disclosure Notice No Surprise Billing HW - Express Scripts Prescription Drug Claim Form HW - M Coverage Enrollment Form (Jan 2024) HW - M Coverage Open Enrollment Packet for 2024 HW - New York Life Long-Term Disability Information HW - Notice of Creditable Prescription Drug Coverage 2022 HW - Privacy Practices 2022 HW - Summary Annual Report 2021 (published 2022) HW - Summary of Benefits and Coverage Active 2023 HW - Summary of Benefits and Coverage Retiree 2023 HW - Summary of Benefits and Coverage Uniform Glossary HW - Trust Agreement Restated 2022 HW - Trust Agreement Restated 2022 Amendment #1 HW - Womens Health and Cancer Rights Act 2022 Pension Documents & Forms PEN - 14th Pension Plan Restatement effective 06012022 and Amendments 07212023 PEN - 2018 Pension Funding Improvement Plan PEN - 2019 Rehabilitation Plan PEN - 2020 Funding Improvement Plan PEN - 2023 Rehabilitation Plan PEN - 20th SRWR Local Labor Shortage List 09082022 PEN - 21st SRWR Local Labor Shortage List 09132023 PEN - Application Instructions revised (Jan 2023) PEN - Application Timeline (Jan 2023) PEN - Determination Letter from IRS 110615 PEN - Notice of Annual Funding 2018 (published April 2019) PEN - Notice of Annual Funding 2019 (published April 2020) PEN - Notice of Annual Funding 2020 (published April 2021) PEN - Notice of Annual Funding 2021 (published April 2022) PEN - Notice of Annual Funding 2022 (published April 2023) PEN - Notice of Plan Status 2019 PEN - Notice of Plan Status 2020 PEN - Notice of Plan Status 2021 PEN - Notice of Plan Status 2023 PEN - Pension Benefit Factor Chart Effective 100117 for Grandfathered Status Final PEN - Pension Benefit Factor Chart Effective 5.1.2019 for Non grandfathered PEN - Special Retiree Work Rule Request Form PEN - Summary Plan Description effective 6.1.2022 PEN - Trust Agreement Restated 2023 PEN - W-4P Tax Form (US only) (2023) BNF - Authorization Form to Release Personal Information (Jan 2023) BNF - Change of Personal Information Form (Jan 2023) BNF - EBSA Online Security Tips