Identification Number Group Number
Effective Date
123456789*  
 01/01/2000
Members Name
Sally Smith*
 Members  
* 00 Member first name * 02 Member first name  
* 01 Member first name * 03 Member first name  
   
 
*This is the Plan Identification number.  
*This is the Employee's name.
*This is information about the Members listed on the   employee's plan, and it includes the Member names   and their Member number.