Fillable Indiana M400 Form Create Your Indiana M400

Fillable Indiana M400 Form

The Indiana M400 form is a renewal application specifically designed for the registration of Multiple Employer Welfare Arrangements (MEWAs). These arrangements provide employee benefits, such as accident and sickness or death benefits, to employees from at least two different employers. Completing this form is essential for MEWAs to maintain compliance and continue offering benefits to their members.

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Documents used along the form

The Indiana M400 form serves as a renewal application for the registration of Multiple Employer Welfare Arrangements (MEWAs). While this form is essential for maintaining compliance, several other documents often accompany it to ensure a complete application process. Below is a list of relevant forms and documents that may be needed alongside the M400.

  • Articles of Incorporation: This document outlines the establishment of the MEWA as a legal entity. It includes essential information such as the organization’s name, purpose, and structure.
  • Bylaws: Bylaws govern the internal management of the MEWA. They detail the rules and procedures for the organization, including the roles of trustees and members.
  • Financial Statements: These documents provide a clear picture of the MEWA’s financial health. They typically include balance sheets, income statements, and cash flow statements for the previous fiscal year.
  • Trustee Information Form: This form lists the individuals who serve as trustees for the MEWA. It often includes their names, titles, and roles within the organization.
  • Third Party Administrator (TPA) Agreement: If the MEWA engages a TPA, this agreement outlines the responsibilities and obligations of the TPA in managing the employee benefit plan.
  • Certificate of Good Standing: This document confirms that the MEWA is compliant with state regulations and is authorized to conduct business in Indiana.
  • Texas Motor Vehicle Bill of Sale: This form, available at legalpdf.org, is crucial for documenting the sale of a vehicle in Texas, providing essential details about the transaction and ensuring a legally binding transfer of ownership.
  • Member Employer Agreements: These agreements detail the terms under which employers join the MEWA, including their rights and responsibilities.
  • Compliance Documentation: This may include various certificates and reports that demonstrate adherence to state and federal regulations governing employee benefit plans.
  • Annual Report: An annual report provides an overview of the MEWA’s activities, financial performance, and any significant changes that occurred during the year.
  • Insurance Policies: Copies of any insurance policies held by the MEWA, including health, liability, and other relevant coverage, may be required to ensure adequate protection for members.

Submitting the Indiana M400 form along with these supporting documents helps ensure that the MEWA remains compliant with state regulations and continues to provide valuable benefits to its members. Careful preparation and attention to detail in these submissions can facilitate a smoother renewal process.

Common mistakes

  1. Omitting Required Information: One common mistake is failing to provide all necessary details, such as the full name of the Multiple Employer Welfare Arrangement (MEWA) or its statutory home address. Each piece of information is crucial for processing the application.

  2. Incorrect Certification: Applicants often misinterpret the certification section. It's essential to clearly indicate whether there have been changes to the previously submitted application information. Failing to do so can lead to delays.

  3. Neglecting the Contact Information: Providing incomplete or incorrect contact information can hinder communication. This includes the contact person's name, title, and telephone number, which should be accurate to facilitate any necessary follow-ups.

  4. Misunderstanding Association Membership: Some applicants mistakenly answer the question about whether employers in the MEWA are members of an association. This question requires careful consideration, as it can affect eligibility.

  5. Overlooking the Fiscal Year Change: If there has been a change in the MEWA’s fiscal year, this must be reported. Ignoring this detail can lead to complications in compliance and reporting.

  6. Failing to Provide Third-Party Administrator Information: If the MEWA has a contract with a third-party administrator, applicants must include this information. Omitting it can raise questions about the MEWA’s operations.

  7. Inaccurate Fund Balance Reporting: When asked about the MEWA’s fund balance, providing inaccurate figures can mislead reviewers. It is vital to report this information truthfully and accurately.

  8. Not Signing the Application: Lastly, forgetting to sign the application can result in immediate rejection. The signature of the Chair of the Board is a crucial element that validates the application.

Key takeaways

When filling out the Indiana M400 form, there are several important points to keep in mind. Here are five key takeaways to ensure a smooth application process:

  • Accurate Certification: Applicants must certify whether there have been changes to the information submitted in the previous year. This is crucial as it determines if revised documentation is needed.
  • Complete Information: Ensure that all required fields are filled out completely, including the full name, statutory home address, and mailing address of the Multiple Employer Welfare Arrangement (MEWA).
  • Contact Details: Provide a contact person along with their title and telephone number. This information is essential for any follow-up or clarifications needed by the reviewing authority.
  • Association Membership: Clearly indicate if the employers in the MEWA are part of an association or group in the same trade or industry. This helps establish the legitimacy of the arrangement.
  • Fiscal Year and Non-Profit Status: Be prepared to answer questions regarding the MEWA’s fiscal year and its non-profit status. This information is vital for compliance and regulatory purposes.

By paying attention to these details, you can enhance the chances of a successful application and ensure compliance with Indiana regulations.

Form Breakdown

Fact Name Details
Form Purpose The Indiana M400 form is a renewal application for the registration of Multiple Employer Welfare Arrangements (MEWAs).
Governing Law This form is governed by Indiana Code IC 27-1-34-1.
Definition of MEWA A MEWA is an entity that provides employee benefit plans for at least two employers, including self-employed individuals.
Applicant Certification Applicants must certify whether there have been changes to the previously submitted application information.
Contact Information The form requires the full name, statutory home address, and mailing address of the MEWA.
Association Membership Applicants must indicate if employers in the MEWA are members of an association or group in the same trade or industry.
Non-Profit Status The form asks whether the MEWA is a non-profit organization.
Fiscal Year Changes Applicants must disclose if there has been a change in the MEWA's fiscal year.

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Form Example

RENEWAL APPLICATION FOR REGISTRATION OF MULTIPLE

EMPLOYER WELFARE ARRANGEMENT (MEWA)-IC 27-1-34-1

NOTE: “Multiple Employer Welfare Arrangement” means an entity other than a duly admitted insurer that establishes an employee benefit plan for the purpose of offering or providing accident and sickness or death benefits to the employees of at least two (2) employers, including self-employed individuals and their dependents.

(1.)

Applicants Certification:

 

 

 

 

 

 

 

 

 

 

(A.)

I certify that

there have been no changes to the application information and documentation submitted during the last year

 

 

 

 

 

 

 

 

 

(B.)

I certify that

there have been changes to the previously submitted application information and documentation and have

 

attached the revised documentation.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2.)

Full name of MEWA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(3.)

Statutory home address of MEWA (street, city, state, ZIP code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(4.)

Mailing address of MEWA (street, city, state, ZIP code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(5.)

Contact person of MEWA

(5a.) Title

 

 

 

 

 

(5b.) Telephone number

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

(6.)

Are the employers in the MEWA members of an association or

(6a.) List trade or industry:

 

 

 

 

 

group of two (2) or more businesses in the same trade or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

industry ?

yes

 

no

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(7.)

Is the association substantially involved in the activity for its members other than sponsorship?

yes

no

 

If answer is no please explain:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(8.)

Has the MEWA’s fiscal year changed?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(9.)

Is the MEWA a non-for-profit organization?

yes

no

 

 

 

 

 

 

 

 

 

 

 

 

(10.) Does the MEWA have a contract with a third party

 

 

(10a.) If answer is yes list or attached the name of the third party

 

administrator?

yes

no

 

 

 

 

administrator(s):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(11.)

Are any of the trustees an owner, officer, or employee if the administrator? yes

no

 

 

 

 

 

If yes, please explain:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(12.)

What is the MEWA’s fund balance?

 

 

 

 

 

 

 

 

 

 

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I certify that the above statements are true.

 

 

 

 

 

 

 

 

 

 

Signature of Chair of Board

 

 

 

Date

 

Printed Name of Signature

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form M400

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