| Plan Name | TAX DEFERRED ANNUITY |
| Plan identification number | 054 |
| 401k Plan Type | Defined Contribution Pension |
| Plan Features/Benefits |
|
| Company Name: | EPILEPSY FOUNDATION HEART OF WISCONSIN |
| Employer identification number (EIN): | 391370658 |
| NAIC Classification: | 813000 |
| NAIC Description: | Religious, Grantmaking, Civic, Professional, and Similar Organizations |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 054 | 2018-01-01 | MELISSA CLARK | 2019-05-28 | MELISSA CLARK | 2019-05-28 |