Information Needed for Compliance with Federal Mandates Question Title * 1. Please provide the following information about your company and plan. Company name Group number(i.e. SM11111E) Contact name Contact email Question Title * 2. Please enter the required employee and employer contributions for your plan in 2022 as a percentage of total plan costs. Please round your answers so that they total 100%. Required employee contribution for plan as a percentage of total plan costs. Required employer contribution for plan as a percentage of total plan costs. Question Title * 3. Please provide the following information. Employer Identification Number (EIN) 3-digit health plan number reported on IRS Form 5500 (Enter N/A if not applicable.) Done