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What is the MEWA s fund balance Comments Signature of Chair of Board Form M400 Date Printed Name of Signature Title Ver. RENEWAL APPLICATION FOR REGISTRATION OF MULTIPLE EMPLOYER WELFARE ARRANGEMENT MEWA -IC 27-1-34-1 NOTE Multiple Employer Welfare Arrangement means an entity other than a duly admitted insurer that establishes an employee benefit plan for the purpose of offering or providing accident and sickness or death benefits to the employees of at least two 2 employers including self-employed individuals and their dependents. 1. Applicants Certification A. I certify that there have been no changes to the application information and documentation submitted during the last year attached the revised documentation* 2. Full name of MEWA 3. Statutory home address of MEWA street city state ZIP code 4. Mailing address of MEWA street city state ZIP code 5. Contact person of MEWA 5a* Title 5b. Telephone number 6. Are the employers in the MEWA members of an association or group of two 2 or ....

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How to fill out the M400 Form online

Filling out the M400 Form online is a straightforward process that ensures your renewal application for the multiple employer welfare arrangement is submitted efficiently. This guide will walk you through each section of the form, providing clarity and assistance as you complete it.

Follow the steps to complete the M400 Form online.

  1. Press the ‘Get Form’ button to obtain the M400 Form and open it in your selected online editing platform.
  2. Begin by checking the 'Applicants Certification' section. Choose either option (A) if there have been no changes to your application information, or (B) if changes have occurred and ensure to attach the revised documentation.
  3. In the next fields, provide the full name of the multiple employer welfare arrangement (MEWA) as well as the statutory home address, which should include the street, city, state, and ZIP code.
  4. Fill in the mailing address of the MEWA, again including street, city, state, and ZIP code, if it differs from the statutory home address.
  5. Identify the contact person for the MEWA, including their title and telephone number to ensure they can be reached for any queries.
  6. Answer whether the employers in the MEWA are members of an association or group of two or more businesses within the same trade or industry by selecting 'yes' or 'no.' If 'yes,' list the relevant trade or industry.
  7. Indicate if the association is substantially involved in activities for its members beyond sponsorship. If the answer is 'no,' provide a brief explanation.
  8. State if the MEWA’s fiscal year has changed. If applicable, provide the new details.
  9. Confirm whether the MEWA operates as a non-for-profit organization by selecting 'yes' or 'no.'
  10. Clarify if the MEWA has a contract with a third-party administrator and specify the administrator's name if applicable.
  11. State if any of the trustees are an owner, officer, or employee of the administrator, and if yes, offer a brief explanation.
  12. Provide the MEWA’s fund balance in the designated field. Ensure all statements are truthful as required.
  13. After completing all sections, review the form for accuracy, then save your changes. You can download, print, or share the completed form as needed.

Begin completing your documents online today for a seamless and efficient experience.

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