PLAN INFORMATION Plan Name DEPAUW UNIVERSITY GROUP HEALTH BENEFIT PLAN Name And Address Of Employer DEPAUW UNIVERSITY 313 LOCUST ST GREENCASTLE IN 46135 Name, Address, And Phone Number DEPAUW UNIVERSITY Of Plan Administrator 313 LOCUST ST GREENCASTLE IN 46135 765-658-4181 Named Fiduciary DEPAUW UNIVERSITY Claims Appeal Fiduciary For Medical UMR Claims Employer Identification Number 35-0869045 Assigned By The IRS Plan Number Assigned By The Plan 501 Type Of Benefit Plan Provided Self-funded Health and Welfare Plan providing group health benefits. Type Of Administration The administration of the Plan is under the supervision of the Plan Administrator. The Plan is not financed by an insurance company and benefits are not guaranteed by a contract of insurance. UMR provides administrative services such as claim payments for medical claims. Name And Address Of Agent For DEPAUW UNIVERSITY Service Of Legal Process 313 LOCUST ST GREENCASTLE IN 46135 Service of legal process may also be made upon the Plan Administrator. Funding Of The Plan Employer and Employee Contributions Benefits are provided by a benefit Plan maintained on a self-insured basis by Your employer. Benefit Plan Year Benefits begin on January 1 and end on the following December 31. For new Employees and Dependents, a Benefit Plan Year begins on the individual's Effective Date and runs through December 31 of the same Benefit Plan Year. ERISA Plan Year July 1 through June 30 -2- 7670-00-413597