Finance

Director: Janet L. Smith.

Jan Smith jansmith@dioscg.org
Nancy McNamara nmcnamara@dioscg.org
Anne Buckley abuckley@dioscg.org
Betty Carleton bcarleton@dioscg.org
Finance Office
The Catholic Center
601 S. Jefferson Ave. Springfield, MO  65806
Phone:  (417) 866-0841 Fax: (417) 866-1140

Forms

Health Coverage Forms

These forms are provided in Adobe Acrobat Portable Document Format (.PDF) for online viewing.

Request for Group Enrollment

Open Enrollment Form

Statement of Change of Active Employment

Special Enrollment Form

Change of Dependent Coverage

Request for Waiver of Medical Benefits

Late Entrant/Prior Waiver Form

Return From Leave of Absence

Request for Change of Beneficiary

Request for Change of Name

Dependent Eligibility Form

Divorce Decree Update

Full Time Student Dependent Eligibility

HIPAA Privacy Authorization Form

Pension Plan

These forms are provided in Adobe Acrobat Portable Document Format (.PDF) for online viewing.  To view the available forms, you will need the Adobe Acrobat Reader, which you can get free of charge from Adobe here:

Notice of Change/New Participant Enrollment 

Employee Beneficiary Designation Form

Compensation for Participating Employees

 

403B Forms

These forms are provided in Adobe Acrobat Portable Document Format (.PDF) for online viewing.  To view the available forms, you will need the Adobe Acrobat Reader, which you can get free of charge from Adobe here:

C.B. Retirement Savings Plan (403B) Enrollment Form

C.B. Retirement Savings Plan (403B) Deferral Change Form.

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