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| Plan Name | FORT WAYNE MEDICAL EDUCATION PROGRAM EMPLOYEE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | FORT WAYNE MEDICAL EDUCATION PROGRAM |
| Employer identification number (EIN): | 356049685 |
| NAIC Classification: | 621498 |
| NAIC Description: | All Other Outpatient Care Centers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2019-04-01 |
| Measure | Date | Value |
|---|---|---|
| 2019: FORT WAYNE MEDICAL EDUCATION PROGRAM EMPLOYEE BENEFIT PLAN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-04-01 | 101 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 110 |
| Number of retired or separated participants receiving benefits | 2019-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-04-01 | 0 |
| Total of all active and inactive participants | 2019-04-01 | 110 |
| 2019: FORT WAYNE MEDICAL EDUCATION PROGRAM EMPLOYEE BENEFIT PLAN 2019 form 5500 responses | ||
|---|---|---|
| 2019-04-01 | Type of plan entity | Single employer plan |
| 2019-04-01 | First time form 5500 has been submitted | Yes |
| 2019-04-01 | Plan funding arrangement – Insurance | Yes |
| 2019-04-01 | Plan benefit arrangement – Insurance | Yes |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) | |
| Policy contract number | 00499155 |
| Policy instance | 1 |
| PHYSICIANS HEALTH PLAN OF NORTHERN INDIANA (National Association of Insurance Commissioners NAIC id number: 95436 ) | |
| Policy contract number | H_190069_L |
| Policy instance | 2 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |
| Policy contract number | 10166041001 |
| Policy instance | 3 |