MEWA-ECE Form
This Form is Open to Public Inspection
OMB No. 1210-0116
Department of Labor
Employee Benefits Security Administration
Complete as applicable:
03/17/2021
THE EMPLOYER GROUP, INC.
1000 SOLAR COURT
VERONA, WI 53593
(608) 845-3377
39-1825035
502
ANGELA HEIM
THE EMPLOYER GROUP, INC.
VERONA, WI 53593
(800) 406-9675
39-1825035
AMH@THEEMPLOYERGROUP.COM
THE EMPLOYER GROUP, INC.
1000 SOLAR COURT
VERONA, WI 53593
(800) 406-9675
39-1825035
ANGELA HEIM
THE EMPLOYER GROUP, INC.
1000 SOLAR COURT
VERONA, WI 53593
(608) 845-3377
AMH@THEEMPLOYERGROUP.COM
ERIC LOWRY
THE EMPLOYER GROUP, INC.
1000 SOLAR COURT
VERONA, WI 53593
(608) 497-4573
EAL@THEEMPLOYERGROUP.COM
No
Yes
CHUBB INSURANCE CO
Yes
No
If no, please explain.
EXCEPTIONS (B)(2)
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. |
CT
Is new? |
Yes | WI OCI 16479 | CT CORP SYST. ONE CORP CENTER FL 11 HARTFORD CT 06103-3320 | No | Yes | DEAN60067 | No | ||
FL
Is new? |
Yes | WI OCI 16479 | CT CORP SYST 1200 S PINE ISLAND RD PLANTATION FL 33324 | No | Yes | DEAN60067 | No | ||
IA
Is new? |
Yes | WI OCI 16479 | CT CORP SYST 500 E COURT AVE STE 200 DES MOINES IA 50309 | No | Yes | DEAN60067 | No | ||
ID
Is new? |
Yes | WI OCI 16479 | CT CORP SYST 921 S ORCHARD ST STE G BOISE ID 83705 | No | Yes | DEAN60067 | No | ||
IL
Is new? |
Yes | WI OCI 16479 | CT CORP SYST 208 S LASALLE ST STE 814 CHICAGO IL 60604 | No | Yes | DEAN60067 | No | ||
IN
Is new? |
Yes | WI OCI 16479 | CT CORP SYST 150 W MARKET ST STE 800 INDIANAPOLIS IN 46204 | No | Yes | DEAN60067 | No | ||
MI
Is new? |
Yes | WI OCI 16479 | THE CORPORATION CO. 30600 TELEGRAPH RD STE 2345 BINGHAM FARMS MI 48205-4530 | No | Yes | DEAN60067 | No | ||
NV
Is new? |
Yes | WI OCI 16479 | CT CORP TRUST OF NV 311 S DIVISION ST CARSON CITY NV 89703 | No | Yes | DEAN60067 | No | ||
OH
Is new? |
Yes | WI OCI 16479 | CT CORP 1300 E 9TH ST CLEVELAND OH 44114 | No | Yes | DEAN60067 | No | ||
TX
Is new? |
Yes | WI OCI 16479 | CT CORP SYST 1999 BRYAN ST STE 900 DALLAS TX 75201 | No | Yes | DEAN60067 | No | ||
WI
Is new? |
Yes | WI OCI 16479 | THE EMPLOYER GROUP INC PO BOX 930127 VERONA WI 53593 | No | Yes | DEAN60067 | No | ||
MN
Is new? |
Yes | WI OCI 16479 | CT CORP SYST 1010 DALE ST N ST PAUL MN 55117 | No | Yes | DEAN60067 | No | ||
ND
Is new? |
Yes | WI OCI 16479 | CT CORP SYST 314 E THAYER AVE BISMARCK ND 58501 | No | Yes | DEAN60067 | No | ||
CO
Is new? |
Yes | WI OCI 16479 | THE CORPORATION CO. 1675 BROADWAY STE 1200 DENVER CO 80202 | No | Yes | DEAN60067 | No |
WI
675
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.