Document Wizard

Sponsoring Organization
Sponsoring Organization Legal Name
Sponsoring Organization Address
Street Address
City
State
Postal Code
Sponsoring Organization Telephone
Sponsoring Organization Federal EIN
Controlling Law
Except to the extent preempted by federal law, the laws of this State shall apply

The health and welfare benefits are for a:

plan sponsored by a single employer (or a group of related employers) under common control

plan sponsored by an employee organization or association

collectively bargained plan established by one or more employers and one or more employee organizations

plan established by two or more employers who are not under common control

Sponsor Information Text
Affiliated Participating Employers; Effective Date of Participation; Federal EIN.
Example: ABC Company, Inc.; 01/01/2019; 98-7654321. XYZ Corporation; 01/01/2018; 12-3456789.
Back < Instructions
Save & Resume Later

General Plan Information
Plan Name
Example: ABC Company, Inc. Welfare Benefit Plan
Plan Adoption Date
Month / Day / Year
Plan Effective Date
Month / Day / Year
Who is the ERISA Plan Administrator?

The Sponsoring Organization
Someone Else
The Plan is administered by:

a contract administrator
an insurer
the Plan Sponsor
Does the insurer provide only contract administration services?

Yes
No
Insurer contract administration only text
The Plan's financial records are maintained on the twelve-month period ending each:
Three Digit Plan Identification Number
Example: 501
Is the Plan subject to COBRA?

Yes
No
COBRA Text
Save & Resume Later

Service of Process Contact

Contact & Confirmation
Please navigate back to review your responses before submitting. After you submit the form, you will be taken to PayPal to complete your purchase. Please have your credit card or PayPal login credentials available. If you cancel the purchase, any information entered in the ERISA Wrap Document Wizard will be lost, and you will need to start over. If you are not ready to purchase, please feel free to use the Save & Resume Later option. By continuing, you acknowledge that you have reviewed your responses for accuracy and have read and agreed with Spectrum’s ERISA Wrap Document Terms of Use.
Agree
Contact First Name
Contact Last Name
Contact Telephone Number
Phone Number
Contact Email Address
PayPal Item Name
PayPal Item Amount
Referral ID
Save & Resume Later

Sponsoring Organization