MEWA-ECE Form
This Form is Open to Public Inspection
OMB No. 1210-0116
Department of Labor
Employee Benefits Security Administration
Complete as applicable:
02/23/2021
Commerce Lexington, Inc. Wholesale & Retail Trade Sub-Association, LTD Group Health Benefit Plan
330 East Main Street Ste 100
Lexington, KY 40507
(859) 254-4447
82-5389061
501
Commerce Lexington, Inc. Wholesale & Retail Trade Sub-Association, LTD Board of Directors
Charles Hoben
101 Innovation Way
Georgetown, KY 40324
(502) 418-0217
82-5389061
cj@countryboybrewing.com
Commerce Lexington, Inc. Wholesale & Retail Trade Sub-Association, LTD
330 East Main Street Ste 100
Lexington, KY 40507
(859) 254-4447
82-5389061
Charles Hoben
Country Boy Brewing
101 Innovation Way
Georgetown, KY 40324
(502) 418-0217
cj@countryboybrewing.com
Charles Hoben
Country Boy Brewing
101 Innovation Way
Georgetown, KY 40324
(502) 418-0217
cj@countryboybrewing.com
Dottie Gibbs
Another Man's Treasure, Inc.
2550 Regency Road
Lexington, KY 40503
(859) 296-5991
dottie@anothermanstreasurefurniture.com
Not applicable
Not applicable-MEWA is fully insured and has no assets
Not applicable
Not applicable
Not applicable-If the Plan ever has assets, the Board of Directors (2a.) would control the assets.
Commerce Lexington, Inc. Wholesale & Retail Trade Sub-Association, LTD Group Health Benefit Plan
Board of Directors
330 East Main Street Ste 100
Lexington, KY 40507
(859) 254-4447
82-5389061
Not applicable
No
No
No
No
If no, please explain.
No assets
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. |
KY
Is new? |
Yes | NA | Charles Hoben 101 Innovation Way Georgetown, KY 40324 | No | Yes | Humana Health Plan, Inc 95885 | No |
KY
412
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.