EMPLOYEE SITE

Below are several downloadable forms and other various information to assist in keeping your benefits package up-to-date. All forms are in Adobe PDF format. If you do not have Adobe Reader, you can download it for free by clicking on the icon at the bottom of the page.

Questions or concerns? Contact Diana in the office at (616) 877-0008 or by email at dburgess@burgessconcrete.com.

General

• Change of Address
  Use this form to notify BCC of a change of address or contact information

Health / Dental / Life / Prescription Insurance

• For claims: contact Patti Webster at PBS
  (616) 285-2480 / (800) 732-3412
• Status Change Form
  Use this form for change of address or adding/deleting dependants
• Short Term Disabilty Benefits Application
• Life Insurance Beneficiary Change Form
• Prescription Insurance: www.expressscripts.com
• PPOM: www.cofinity.net

Basic Flex

• Reimbursement Form

401K / Profit Sharing

• Employee Data Change Form
  Use this form for changes in name, beneficiary, and contribution amounts
• 401K Investment Change Form
  Use this form to transfer assets between investment options in your retirement account portfolio and/or change your allocation instructions for future contributions
• 401K Questions?: contact Hank Bouman at Raymond James Financial
  (616) 531-4186

Payroll

• W4
• Direct Deposit Enrollment & Changes