MEWA-ECE Form
This Form is Open to Public Inspection
OMB No. 1210-0116
Department of Labor
Employee Benefits Security Administration
Complete as applicable:
01/01/2020
Began Operating
04/21/2021
Kansas Independent College Foundation Pooled Employee Health Plan
700 S. Kansas Avenue, Suite 622
Topeka, KS 66603
(785) 235-9877
48-0636041
501
KICF Employee Benefits Advisory Committee
Attn: Matthew Lindsey
700 S. Kansas, Suite 622
Topeka, KS 66603
(785) 235-9877
48-0636041
matt@kscolleges.org
Kansas Independent College Foundation
700 S. Kansas, Suite 622
Topeka, KS 66603
(785) 235-9877
48-0636041
Kansas Independent College Foundation
Attn: Matthew Lindsey
700 S. Kansas, Suite 622
Topeka, KS 66603
(785) 235-9877
matt@kscolleges.org
Dr. Elizabeth Mauch
335 E. Swensson Street
Lindsborg, KS 67456
Dr. Jon Gering
300 E. 27th Street
Newton, KS 67117
Dr. Matt Thompson
100 E. Claflin
Salina, KS 67401
Mr. Kevin Ingram
1415 Anderson Avenue
Manhattan, KS 66502
Dr. Michael Schneider
1600 E. Euclid
McPherson, KS 67460
Dr. Kathleen Jagger
3100 W. McCormick
Wichita, KS 67213
Dr. Reggies Wenyika
1001 S. Cedar
Ottawa, KS 66067
Dr. Scott Rich
125 West Cooper Street
Sterling, KS 67579
Dr. Jules Glazner
400 S. Jefferson
Hillsboro, KS 67063
Dr. Diane Steele
4100 S. 4th Street
Leavenworth, KS 66048
n/a
n/a
n/a, KS n/a
n/a - All benefits are fully insured
n/a
n/a, KS n/a
n/a - All benefits are fully insured
n/a
n/a, KS n/a
n/a - All benefits are fully insured
n/a
n/a, KS n/a
n/a - All benefits are fully insured
n/a
n/a, KS n/a
KICF Employee Benefits Advisory Committee
Attn: Matthew Lindsey
700 S. Kansas, Suite 622
Topeka, KS 66603
(785) 235-9877
matt@kscolleges.org
48-0636041
n/a
n/a
n/a, KS n/a
No
Yes
Carrier: QBE (Arrowhead)
Policy Holder: Kansas Independent College Foundation
Coverage Limit: $50,000
No
Yes
If no, please explain.
Neither the MEWA nor its sponsoring organization holds any plan assets. As of January 1, 2020, all benefits under the program are fully insured and all contributions are transmitted directly to the insurance carrier by the participating employers.
No
If yes, please identify each litigation or enforcement proceeding to include (if applicable): (1) the case number, (2) the date, (3) the nature of the proceedings, (4) the court, (5) all parties (for example, plaintiffs and defendants or petitioners and respondents), and (6) the disposition.
No
If yes, please explain.
No
Entity | Year |
---|
17a | 17b | 17c | 17d | 17e | 17f | 17g | 17h | 17i | 17j |
---|---|---|---|---|---|---|---|---|---|
Enter all States where the MEWA or ECE is operating. | Is coverage provided? | State registration number. | Name of state agent or entity for service of process. | Is the entity a licensed health insurer in this State? | If yes to 17e, enter NAIC number. | If no to 17e, is the entity fully insured? | If yes to 17g, enter name and NAIC number of insurer. | Does the entity purchase stop loss coverage? | If yes to 17i, enter the name and NAIC number of insurer. |
KS
Is new? |
Yes | No | Yes | Blue Cross and Blue Shield of Kansas - 70729 | No |
KS
920
N/A
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Under penalty of perjury and other penalties set forth in the instructions, I declare that I have examined this report, including any accompanying attachments, and to the best of my knowledge and belief, it is true and correct. Under penalty of perjury and other penalties set forth in the instructions, I also declare that, unless this is an extension request, this report is complete.