Get Application - Form M100 - In.gov - In

This guide provides clear instructions on how to complete the Application - Form M100 for registration of a multiple employer welfare arrangement (MEWA). Designed for users with various levels of experience, this guide helps ensure you accurately fill out the form online.

Follow the steps to effectively complete the application form.

1. Click the ‘Get Form’ button to access the application form in your preferred online editor.
2. Begin by entering the full name of the MEWA and the Federal Employer Identification Number (FEIN#).
3. Provide the MEWA statutory home address, including street, city, state, and ZIP code. Repeat this for the MEWA mailing address.
4. Fill in the MEWA service of process details, including the company name and address.
5. Enter the MEWA telephone number and email address.
6. Input the contact person's name and title, followed by their telephone number and email.
7. Complete the application contact information similarly, ensuring all contact details are accurate.
8. Respond to the questions regarding the association or group of employers. Indicate if members belong to the same trade or industry and provide any necessary explanations.
9. If applicable, provide detail about the association’s activities, duration, and whether it is a not-for-profit organization.
10. State whether the MEWA has a contract with a third-party administrator and provide the details required.
11. Indicate whether any trustees are owners, officers, or employees of the administrator.
12. Confirm if the MEWA’s trust balance meets or exceeds $500,000.
13. Certify the statements provided by signing and dating the application. Print the name and title of the signer.
14. Once all fields are complete, review the information for accuracy. Save your changes, and you may choose to download, print, or share the completed form.

Complete your Application - Form M100 online today and ensure all necessary documentation is submitted correctly.