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| Plan Name | MIDWEST FUEL BENEFITS PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | MIDWEST FUEL INJECTION SERVICE |
| Employer identification number (EIN): | 363148869 |
| NAIC Classification: | 811110 |
| NAIC Description: | Automotive Mechanical and Electrical Repair and Maintenance |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-03-01 | SCOT F. BROWNLIE | 2023-09-14 | ||
| 501 | 2021-03-01 | SARAH EIGEL | 2022-08-10 |
| 2022: MIDWEST FUEL BENEFITS PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-03-01 | Type of plan entity | Single employer plan |
| 2022-03-01 | Plan funding arrangement – Insurance | Yes |
| 2022-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: MIDWEST FUEL BENEFITS PLAN 2021 form 5500 responses | ||
| 2021-03-01 | Type of plan entity | Single employer plan |
| 2021-03-01 | First time form 5500 has been submitted | Yes |
| 2021-03-01 | Plan funding arrangement – Insurance | Yes |
| 2021-03-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||
| Policy contract number | 9S4965 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
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| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |||||||||||||||||||||
| Policy contract number | 99537951001 | ||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||
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| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |||||||||||||||||||||
| Policy contract number | 1077317 | ||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||
| Policy contract number | 9S4965 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |||||||||||||||||||||
| Policy contract number | 99537951001 | ||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |||||||||||||||||||||
| Policy contract number | 1077317 | ||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||
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