401k Plan data: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES plan

EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 401k Plan overview

Plan Name	EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES
Plan identification number	501

EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Severance pay

401k Sponsoring company profile

CURBELL, INC. has sponsored the creation of one or more 401k plans.

Company Name: CURBELL, INC.

Employer identification number (EIN): 160725141

NAIC Classification: 326100

Additional information about CURBELL, INC.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1947-12-30

Company Identification Number: 81253

Legal Registered Office Address: ATTENTION: president
7 COBHAM DRIVE
ORCHARD PARK
United States of America (USA)
14127

More information about CURBELL, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-04-01
501 2021-04-01
501 2020-04-01
501 2019-04-01
501 2018-04-01
501 2017-04-01 THOMAS LEONE
501 2016-04-01 THOMAS LEONE
501 2015-04-01 THOMAS LEONE
501 2014-04-01 THOMAS LEONE
501 2013-04-01 THOMAS LEONE
501 2012-04-01 THOMAS LEONE
501 2011-04-01 THOMAS LEONE
501 2010-04-01 THOMAS E. LEONE
501 2009-04-01 THOMAS E. LEONE

Plan Statistics for EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES

401k plan membership statisitcs for EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES

Measure Date Value
2022: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2022 401k membership
Total participants, beginning-of-year 2022-04-01 490
Total number of active participants reported on line 7a of the Form 5500 2022-04-01 491
Number of retired or separated participants receiving benefits 2022-04-01 3
Number of other retired or separated participants entitled to future benefits 2022-04-01 3
Total of all active and inactive participants 2022-04-01 497
2021: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2021 401k membership
Total participants, beginning-of-year 2021-04-01 505
Total number of active participants reported on line 7a of the Form 5500 2021-04-01 490
Number of retired or separated participants receiving benefits 2021-04-01 6
Number of other retired or separated participants entitled to future benefits 2021-04-01 3
Total of all active and inactive participants 2021-04-01 499
2020: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2020 401k membership
Total participants, beginning-of-year 2020-04-01 513
Total number of active participants reported on line 7a of the Form 5500 2020-04-01 505
Number of retired or separated participants receiving benefits 2020-04-01 4
Number of other retired or separated participants entitled to future benefits 2020-04-01 3
Total of all active and inactive participants 2020-04-01 512
2019: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2019 401k membership
Total participants, beginning-of-year 2019-04-01 456
Total number of active participants reported on line 7a of the Form 5500 2019-04-01 513
Number of retired or separated participants receiving benefits 2019-04-01 4
Number of other retired or separated participants entitled to future benefits 2019-04-01 3
Total of all active and inactive participants 2019-04-01 520
2018: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2018 401k membership
Total participants, beginning-of-year 2018-04-01 442
Total number of active participants reported on line 7a of the Form 5500 2018-04-01 456
Number of retired or separated participants receiving benefits 2018-04-01 4
Number of other retired or separated participants entitled to future benefits 2018-04-01 3
Total of all active and inactive participants 2018-04-01 463
2017: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2017 401k membership
Total participants, beginning-of-year 2017-04-01 454
Total number of active participants reported on line 7a of the Form 5500 2017-04-01 442
Number of retired or separated participants receiving benefits 2017-04-01 3
Number of other retired or separated participants entitled to future benefits 2017-04-01 4
Total of all active and inactive participants 2017-04-01 449
2016: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2016 401k membership
Total participants, beginning-of-year 2016-04-01 441
Total number of active participants reported on line 7a of the Form 5500 2016-04-01 454
Number of retired or separated participants receiving benefits 2016-04-01 3
Number of other retired or separated participants entitled to future benefits 2016-04-01 4
Total of all active and inactive participants 2016-04-01 461
2015: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2015 401k membership
Total participants, beginning-of-year 2015-04-01 447
Total number of active participants reported on line 7a of the Form 5500 2015-04-01 441
Number of retired or separated participants receiving benefits 2015-04-01 4
Number of other retired or separated participants entitled to future benefits 2015-04-01 4
Total of all active and inactive participants 2015-04-01 449
2014: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2014 401k membership
Total participants, beginning-of-year 2014-04-01 443
Total number of active participants reported on line 7a of the Form 5500 2014-04-01 432
Number of retired or separated participants receiving benefits 2014-04-01 11
Number of other retired or separated participants entitled to future benefits 2014-04-01 4
Total of all active and inactive participants 2014-04-01 447
2013: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2013 401k membership
Total participants, beginning-of-year 2013-04-01 431
Total number of active participants reported on line 7a of the Form 5500 2013-04-01 429
Number of retired or separated participants receiving benefits 2013-04-01 10
Number of other retired or separated participants entitled to future benefits 2013-04-01 4
Total of all active and inactive participants 2013-04-01 443
2012: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2012 401k membership
Total participants, beginning-of-year 2012-04-01 414
Total number of active participants reported on line 7a of the Form 5500 2012-04-01 418
Number of retired or separated participants receiving benefits 2012-04-01 9
Number of other retired or separated participants entitled to future benefits 2012-04-01 4
Total of all active and inactive participants 2012-04-01 431
2011: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2011 401k membership
Total participants, beginning-of-year 2011-04-01 412
Total number of active participants reported on line 7a of the Form 5500 2011-04-01 401
Number of retired or separated participants receiving benefits 2011-04-01 9
Number of other retired or separated participants entitled to future benefits 2011-04-01 4
Total of all active and inactive participants 2011-04-01 414
2010: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2010 401k membership
Total participants, beginning-of-year 2010-04-01 401
Total number of active participants reported on line 7a of the Form 5500 2010-04-01 394
Number of retired or separated participants receiving benefits 2010-04-01 12
Number of other retired or separated participants entitled to future benefits 2010-04-01 6
Total of all active and inactive participants 2010-04-01 412
2009: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2009 401k membership
Total participants, beginning-of-year 2009-04-01 390
Total number of active participants reported on line 7a of the Form 5500 2009-04-01 391
Number of retired or separated participants receiving benefits 2009-04-01 5
Number of other retired or separated participants entitled to future benefits 2009-04-01 5
Total of all active and inactive participants 2009-04-01 401

Measure	Date	Value
2022: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2022 401k membership
Total participants, beginning-of-year	2022-04-01	490
Total number of active participants reported on line 7a of the Form 5500	2022-04-01	491
Number of retired or separated participants receiving benefits	2022-04-01	3
Number of other retired or separated participants entitled to future benefits	2022-04-01	3
Total of all active and inactive participants	2022-04-01	497
2021: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2021 401k membership
Total participants, beginning-of-year	2021-04-01	505
Total number of active participants reported on line 7a of the Form 5500	2021-04-01	490
Number of retired or separated participants receiving benefits	2021-04-01	6
Number of other retired or separated participants entitled to future benefits	2021-04-01	3
Total of all active and inactive participants	2021-04-01	499
2020: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2020 401k membership
Total participants, beginning-of-year	2020-04-01	513
Total number of active participants reported on line 7a of the Form 5500	2020-04-01	505
Number of retired or separated participants receiving benefits	2020-04-01	4
Number of other retired or separated participants entitled to future benefits	2020-04-01	3
Total of all active and inactive participants	2020-04-01	512
2019: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2019 401k membership
Total participants, beginning-of-year	2019-04-01	456
Total number of active participants reported on line 7a of the Form 5500	2019-04-01	513
Number of retired or separated participants receiving benefits	2019-04-01	4
Number of other retired or separated participants entitled to future benefits	2019-04-01	3
Total of all active and inactive participants	2019-04-01	520
2018: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2018 401k membership
Total participants, beginning-of-year	2018-04-01	442
Total number of active participants reported on line 7a of the Form 5500	2018-04-01	456
Number of retired or separated participants receiving benefits	2018-04-01	4
Number of other retired or separated participants entitled to future benefits	2018-04-01	3
Total of all active and inactive participants	2018-04-01	463
2017: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2017 401k membership
Total participants, beginning-of-year	2017-04-01	454
Total number of active participants reported on line 7a of the Form 5500	2017-04-01	442
Number of retired or separated participants receiving benefits	2017-04-01	3
Number of other retired or separated participants entitled to future benefits	2017-04-01	4
Total of all active and inactive participants	2017-04-01	449
2016: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2016 401k membership
Total participants, beginning-of-year	2016-04-01	441
Total number of active participants reported on line 7a of the Form 5500	2016-04-01	454
Number of retired or separated participants receiving benefits	2016-04-01	3
Number of other retired or separated participants entitled to future benefits	2016-04-01	4
Total of all active and inactive participants	2016-04-01	461
2015: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2015 401k membership
Total participants, beginning-of-year	2015-04-01	447
Total number of active participants reported on line 7a of the Form 5500	2015-04-01	441
Number of retired or separated participants receiving benefits	2015-04-01	4
Number of other retired or separated participants entitled to future benefits	2015-04-01	4
Total of all active and inactive participants	2015-04-01	449
2014: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2014 401k membership
Total participants, beginning-of-year	2014-04-01	443
Total number of active participants reported on line 7a of the Form 5500	2014-04-01	432
Number of retired or separated participants receiving benefits	2014-04-01	11
Number of other retired or separated participants entitled to future benefits	2014-04-01	4
Total of all active and inactive participants	2014-04-01	447
2013: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2013 401k membership
Total participants, beginning-of-year	2013-04-01	431
Total number of active participants reported on line 7a of the Form 5500	2013-04-01	429
Number of retired or separated participants receiving benefits	2013-04-01	10
Number of other retired or separated participants entitled to future benefits	2013-04-01	4
Total of all active and inactive participants	2013-04-01	443
2012: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2012 401k membership
Total participants, beginning-of-year	2012-04-01	414
Total number of active participants reported on line 7a of the Form 5500	2012-04-01	418
Number of retired or separated participants receiving benefits	2012-04-01	9
Number of other retired or separated participants entitled to future benefits	2012-04-01	4
Total of all active and inactive participants	2012-04-01	431
2011: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2011 401k membership
Total participants, beginning-of-year	2011-04-01	412
Total number of active participants reported on line 7a of the Form 5500	2011-04-01	401
Number of retired or separated participants receiving benefits	2011-04-01	9
Number of other retired or separated participants entitled to future benefits	2011-04-01	4
Total of all active and inactive participants	2011-04-01	414
2010: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2010 401k membership
Total participants, beginning-of-year	2010-04-01	401
Total number of active participants reported on line 7a of the Form 5500	2010-04-01	394
Number of retired or separated participants receiving benefits	2010-04-01	12
Number of other retired or separated participants entitled to future benefits	2010-04-01	6
Total of all active and inactive participants	2010-04-01	412
2009: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2009 401k membership
Total participants, beginning-of-year	2009-04-01	390
Total number of active participants reported on line 7a of the Form 5500	2009-04-01	391
Number of retired or separated participants receiving benefits	2009-04-01	5
Number of other retired or separated participants entitled to future benefits	2009-04-01	5
Total of all active and inactive participants	2009-04-01	401

Form 5500 Responses for EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES

2022: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2022 form 5500 responses
2022-04-01	Type of plan entity	Single employer plan
2022-04-01	Plan funding arrangement – Insurance	Yes
2022-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-04-01	Plan benefit arrangement – Insurance	Yes
2022-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2021 form 5500 responses
2021-04-01	Type of plan entity	Single employer plan
2021-04-01	Plan funding arrangement – Insurance	Yes
2021-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-04-01	Plan benefit arrangement – Insurance	Yes
2021-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2020 form 5500 responses
2020-04-01	Type of plan entity	Single employer plan
2020-04-01	Plan funding arrangement – Insurance	Yes
2020-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-04-01	Plan benefit arrangement – Insurance	Yes
2020-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2019 form 5500 responses
2019-04-01	Type of plan entity	Single employer plan
2019-04-01	Plan funding arrangement – Insurance	Yes
2019-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-04-01	Plan benefit arrangement – Insurance	Yes
2019-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2018 form 5500 responses
2018-04-01	Type of plan entity	Single employer plan
2018-04-01	Plan funding arrangement – Insurance	Yes
2018-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-04-01	Plan benefit arrangement – Insurance	Yes
2018-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2017 form 5500 responses
2017-04-01	Type of plan entity	Single employer plan
2017-04-01	Plan funding arrangement – Insurance	Yes
2017-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-04-01	Plan benefit arrangement – Insurance	Yes
2017-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2016 form 5500 responses
2016-04-01	Type of plan entity	Single employer plan
2016-04-01	Plan funding arrangement – Insurance	Yes
2016-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-04-01	Plan benefit arrangement – Insurance	Yes
2016-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2015 form 5500 responses
2015-04-01	Type of plan entity	Single employer plan
2015-04-01	Plan funding arrangement – Insurance	Yes
2015-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-04-01	Plan benefit arrangement – Insurance	Yes
2015-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2014 form 5500 responses
2014-04-01	Type of plan entity	Single employer plan
2014-04-01	Plan funding arrangement – Insurance	Yes
2014-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-04-01	Plan benefit arrangement – Insurance	Yes
2014-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2013 form 5500 responses
2013-04-01	Type of plan entity	Single employer plan
2013-04-01	Plan funding arrangement – Insurance	Yes
2013-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-04-01	Plan benefit arrangement – Insurance	Yes
2013-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2012 form 5500 responses
2012-04-01	Type of plan entity	Single employer plan
2012-04-01	Plan funding arrangement – Insurance	Yes
2012-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-04-01	Plan benefit arrangement – Insurance	Yes
2012-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2011 form 5500 responses
2011-04-01	Type of plan entity	Single employer plan
2011-04-01	Submission has been amended	Yes
2011-04-01	Plan funding arrangement – Insurance	Yes
2011-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-04-01	Plan benefit arrangement – Insurance	Yes
2011-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2010 form 5500 responses
2010-04-01	Type of plan entity	Single employer plan
2010-04-01	Plan funding arrangement – Insurance	Yes
2010-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-04-01	Plan benefit arrangement – Insurance	Yes
2010-04-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: EMPLOYEE BENEFITS PLAN FOR EMPLOYEES OF CURBELL, INC. AND SUBSIDIARIES 2009 form 5500 responses
2009-04-01	Type of plan entity	Single employer plan
2009-04-01	This submission is the final filing	No
2009-04-01	Plan funding arrangement – Insurance	Yes
2009-04-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-04-01	Plan benefit arrangement – Insurance	Yes
2009-04-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3340702

Policy instance

Insurance contract or identification number	3340702
Number of Individuals Covered	301
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $9,152
Total amount of fees paid to insurance company	USD $6,880
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $231,151
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,152
Insurance broker organization code?	3
Amount paid for insurance broker fees	6880
Additional information about fees paid to insurance broker	GENERAL AGENT PAYMENTS

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYK600147

Policy instance

Insurance contract or identification number	NYK600147
Number of Individuals Covered	452
Insurance policy start date	2022-04-01
Insurance policy end date	2023-04-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2528
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLY960387

Policy instance

Insurance contract or identification number	FLY960387
Number of Individuals Covered	491
Insurance policy start date	2022-04-01
Insurance policy end date	2023-04-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $3,932
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	3932
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYD075328

Policy instance

Insurance contract or identification number	NYD075328
Number of Individuals Covered	263
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $4,026
Total amount of fees paid to insurance company	USD $5,765
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $106,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5765
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $4,026

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYK600147

Policy instance

Insurance contract or identification number	NYK600147
Number of Individuals Covered	452
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $4,080
Total amount of fees paid to insurance company	USD $6,302
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $116,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	6302
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $4,080

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYK960259

Policy instance

Insurance contract or identification number	NYK960259
Number of Individuals Covered	491
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $4,865
Total amount of fees paid to insurance company	USD $4,326
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $80,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,865
Insurance broker organization code?	3
Amount paid for insurance broker fees	4326
Additional information about fees paid to insurance broker	SALES & SERVICE

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

YOK960388

Policy instance

Insurance contract or identification number	YOK960388
Number of Individuals Covered	491
Insurance policy start date	2022-04-01
Insurance policy end date	2023-04-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $121
Other welfare benefits provided	AD&D
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	121
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SDJ960778

Policy instance

Insurance contract or identification number	SDJ960778
Number of Individuals Covered	10
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $367
Total amount of fees paid to insurance company	USD $183
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $367
Insurance broker organization code?	3
Amount paid for insurance broker fees	183
Additional information about fees paid to insurance broker	SALES & SERVICE

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLY960387

Policy instance

Insurance contract or identification number	FLY960387
Number of Individuals Covered	491
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $4,431
Total amount of fees paid to insurance company	USD $9,308
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $171,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	9308
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $4,431

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYD075328

Policy instance

Insurance contract or identification number	NYD075328
Number of Individuals Covered	263
Insurance policy start date	2022-04-01
Insurance policy end date	2023-04-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,500
Temporary Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1500
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYK960259

Policy instance

Insurance contract or identification number	NYK960259
Number of Individuals Covered	452
Insurance policy start date	2022-04-01
Insurance policy end date	2023-04-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1802
Additional information about fees paid to insurance broker	SALES & SERVICE
Insurance broker organization code?	3

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

YOK960388

Policy instance

Insurance contract or identification number	YOK960388
Number of Individuals Covered	487
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $495
Total amount of fees paid to insurance company	USD $-43
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $-1,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $495
Insurance broker organization code?	3
Amount paid for insurance broker fees	-43
Additional information about fees paid to insurance broker	SALES & SERVICE

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLY960387

Policy instance

Insurance contract or identification number	FLY960387
Number of Individuals Covered	490
Insurance policy start date	2021-04-01
Insurance policy end date	2022-04-01
Total amount of commissions paid to insurance broker	USD $2,056
Total amount of fees paid to insurance company	USD $7,754
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $171,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	7754
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $2,056

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYD075328

Policy instance

Insurance contract or identification number	NYD075328
Number of Individuals Covered	262
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $3,080
Total amount of fees paid to insurance company	USD $4,334
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $97,349
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	4334
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $3,080

HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

11444574

Policy instance

Insurance contract or identification number	11444574
Number of Individuals Covered	663
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	POS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

YOK960388

Policy instance

Insurance contract or identification number	YOK960388
Number of Individuals Covered	490
Insurance policy start date	2021-04-01
Insurance policy end date	2022-04-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $111
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	111
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYK600147

Policy instance

Insurance contract or identification number	NYK600147
Number of Individuals Covered	442
Insurance policy start date	2021-04-01
Insurance policy end date	2022-04-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2133
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYK600147

Policy instance

Insurance contract or identification number	NYK600147
Number of Individuals Covered	442
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $2,952
Total amount of fees paid to insurance company	USD $4,919
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $111,064
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	4919
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $2,952

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYK960259

Policy instance

Insurance contract or identification number	NYK960259
Number of Individuals Covered	490
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $3,390
Total amount of fees paid to insurance company	USD $3,549
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $78,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	3549
Additional information about fees paid to insurance broker	SERVICE FEES
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $3,390

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

YOK960388

Policy instance

Insurance contract or identification number	YOK960388
Number of Individuals Covered	490
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $2,977
Total amount of fees paid to insurance company	USD $1,372
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,987
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,977
Insurance broker organization code?	3
Amount paid for insurance broker fees	1372
Additional information about fees paid to insurance broker	SERVICE FEES

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3340702

Policy instance

Insurance contract or identification number	3340702
Number of Individuals Covered	269
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $8,994
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $227,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,994
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SDJ960778

Policy instance

Insurance contract or identification number	SDJ960778
Number of Individuals Covered	11
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $479
Total amount of fees paid to insurance company	USD $240
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $479
Insurance broker organization code?	3
Amount paid for insurance broker fees	240
Additional information about fees paid to insurance broker	SERVICE FEES

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLY960387

Policy instance

Insurance contract or identification number	FLY960387
Number of Individuals Covered	490
Insurance policy start date	2021-04-01
Insurance policy end date	2022-04-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $3,386
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $875
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	3386
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYD075328

Policy instance

Insurance contract or identification number	NYD075328
Number of Individuals Covered	262
Insurance policy start date	2021-04-01
Insurance policy end date	2022-04-01
Total amount of commissions paid to insurance broker	USD $82
Total amount of fees paid to insurance company	USD $1,109
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $82
Amount paid for insurance broker fees	1027
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYD075328

Policy instance

Insurance contract or identification number	NYD075328
Number of Individuals Covered	261
Insurance policy start date	2020-04-01
Insurance policy end date	2021-04-01
Total amount of commissions paid to insurance broker	USD $3,307
Total amount of fees paid to insurance company	USD $3,270
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,307
Insurance broker organization code?	3
Amount paid for insurance broker fees	3270
Additional information about fees paid to insurance broker	SERVICE FEE

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLY960387

Policy instance

Insurance contract or identification number	FLY960387
Number of Individuals Covered	505
Insurance policy start date	2020-04-01
Insurance policy end date	2021-04-01
Total amount of commissions paid to insurance broker	USD $4,196
Total amount of fees paid to insurance company	USD $9,920
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $139,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	9920
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $4,196

HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

11444574

Policy instance

Insurance contract or identification number	11444574
Number of Individuals Covered	723
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	POS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYK600147

Policy instance

Insurance contract or identification number	NYK600147
Number of Individuals Covered	441
Insurance policy start date	2020-04-01
Insurance policy end date	2021-04-01
Total amount of commissions paid to insurance broker	USD $3,779
Total amount of fees paid to insurance company	USD $5,786
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $82,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5786
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $3,779

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYK960259

Policy instance

Insurance contract or identification number	NYK960259
Number of Individuals Covered	505
Insurance policy start date	2020-04-01
Insurance policy end date	2021-04-01
Total amount of commissions paid to insurance broker	USD $4,459
Total amount of fees paid to insurance company	USD $4,584
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $63,123
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	4584
Additional information about fees paid to insurance broker	SERVICE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $4,459

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

YOK960388

Policy instance

Insurance contract or identification number	YOK960388
Number of Individuals Covered	505
Insurance policy start date	2020-04-01
Insurance policy end date	2021-04-01
Total amount of commissions paid to insurance broker	USD $669
Total amount of fees paid to insurance company	USD $231
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $669
Insurance broker organization code?	3
Amount paid for insurance broker fees	231
Additional information about fees paid to insurance broker	SERVICE FEE

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SDJ960778

Policy instance

Insurance contract or identification number	SDJ960778
Number of Individuals Covered	183
Insurance policy start date	2020-07-01
Insurance policy end date	2021-07-01
Total amount of commissions paid to insurance broker	USD $211
Total amount of fees paid to insurance company	USD $163
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,111
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $211
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Amount paid for insurance broker fees	163

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SDJ960778

Policy instance

Insurance contract or identification number	SDJ960778
Number of Individuals Covered	10
Insurance policy start date	2020-11-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $257
Total amount of fees paid to insurance company	USD $129
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $257
Insurance broker organization code?	3
Amount paid for insurance broker fees	129
Additional information about fees paid to insurance broker	SERVICE FEES

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3340702

Policy instance

Insurance contract or identification number	3340702
Number of Individuals Covered	283
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $9,232
Total amount of fees paid to insurance company	USD $850
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $233,038
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,232
Amount paid for insurance broker fees	850
Additional information about fees paid to insurance broker	GENERAL AGENT PAYMENTS
Insurance broker organization code?	3

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYK600147

Policy instance

Insurance contract or identification number	NYK600147
Number of Individuals Covered	438
Insurance policy start date	2019-04-01
Insurance policy end date	2020-04-01
Total amount of commissions paid to insurance broker	USD $3,648
Total amount of fees paid to insurance company	USD $2,903
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $69,763
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,648
Insurance broker organization code?	3
Amount paid for insurance broker fees	2903
Additional information about fees paid to insurance broker	SERVICE FEE

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3340702

Policy instance

Insurance contract or identification number	3340702
Number of Individuals Covered	290
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $7,937
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $200,059
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,937
Insurance broker organization code?	3

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

YOK960388

Policy instance

Insurance contract or identification number	YOK960388
Number of Individuals Covered	513
Insurance policy start date	2019-04-01
Insurance policy end date	2020-04-01
Total amount of commissions paid to insurance broker	USD $723
Total amount of fees paid to insurance company	USD $199
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $723
Insurance broker organization code?	3
Amount paid for insurance broker fees	199
Additional information about fees paid to insurance broker	SERVICE FEE

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYK960259

Policy instance

Insurance contract or identification number	NYK960259
Number of Individuals Covered	513
Insurance policy start date	2019-04-01
Insurance policy end date	2020-04-01
Total amount of commissions paid to insurance broker	USD $4,670
Total amount of fees paid to insurance company	USD $2,984
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,670
Insurance broker organization code?	3
Amount paid for insurance broker fees	2984
Additional information about fees paid to insurance broker	SERVICE FEE

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYD075328

Policy instance

Insurance contract or identification number	NYD075328
Number of Individuals Covered	269
Insurance policy start date	2019-04-01
Insurance policy end date	2020-04-01
Total amount of commissions paid to insurance broker	USD $2,967
Total amount of fees paid to insurance company	USD $2,017
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,967
Insurance broker organization code?	3
Amount paid for insurance broker fees	2017
Additional information about fees paid to insurance broker	SERVICE FEE

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLY960387

Policy instance

Insurance contract or identification number	FLY960387
Number of Individuals Covered	513
Insurance policy start date	2019-04-01
Insurance policy end date	2020-04-01
Total amount of commissions paid to insurance broker	USD $4,218
Total amount of fees paid to insurance company	USD $5,924
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $143,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	5924
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $4,218

HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

11444574

Policy instance

Insurance contract or identification number	11444574
Number of Individuals Covered	750
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	POS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SDJ960778

Policy instance

Insurance contract or identification number	SDJ960778
Number of Individuals Covered	182
Insurance policy start date	2019-07-01
Insurance policy end date	2020-07-01
Total amount of commissions paid to insurance broker	USD $284
Total amount of fees paid to insurance company	USD $142
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $284
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Amount paid for insurance broker fees	142

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

P75338A1

Policy instance

Insurance contract or identification number	P75338A1
Number of Individuals Covered	9
Insurance policy start date	2018-01-01
Insurance policy end date	2018-08-16
Total amount of commissions paid to insurance broker	USD $948
Total amount of fees paid to insurance company	USD $213
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,181
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $948
Amount paid for insurance broker fees	159
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BONUS

HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

11444574

Policy instance

Insurance contract or identification number	11444574
Number of Individuals Covered	737
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	POS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SDJ960778

Policy instance

Insurance contract or identification number	SDJ960778
Number of Individuals Covered	188
Insurance policy start date	2018-07-01
Insurance policy end date	2019-07-01
Total amount of commissions paid to insurance broker	USD $209
Total amount of fees paid to insurance company	USD $105
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $209
Insurance broker organization code?	3
Amount paid for insurance broker fees	105
Additional information about fees paid to insurance broker	SERVICE FEE

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3340702

Policy instance

Insurance contract or identification number	3340702
Number of Individuals Covered	252
Insurance policy start date	2018-04-01
Insurance policy end date	2019-03-31
Total amount of commissions paid to insurance broker	USD $6,723
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $169,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,723
Insurance broker organization code?	3

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

YOK960388

Policy instance

Insurance contract or identification number	YOK960388
Number of Individuals Covered	456
Insurance policy start date	2018-04-01
Insurance policy end date	2019-04-01
Total amount of commissions paid to insurance broker	USD $1,509
Total amount of fees paid to insurance company	USD $247
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,509
Insurance broker organization code?	3
Amount paid for insurance broker fees	247
Additional information about fees paid to insurance broker	SERVICE FEE

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYK600147

Policy instance

Insurance contract or identification number	NYK600147
Number of Individuals Covered	409
Insurance policy start date	2018-04-01
Insurance policy end date	2019-04-01
Total amount of commissions paid to insurance broker	USD $3,207
Total amount of fees paid to insurance company	USD $3,834
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $76,671
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	3834
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $3,207

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYK960259

Policy instance

Insurance contract or identification number	NYK960259
Number of Individuals Covered	456
Insurance policy start date	2018-04-01
Insurance policy end date	2019-04-01
Total amount of commissions paid to insurance broker	USD $4,583
Total amount of fees paid to insurance company	USD $3,209
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $64,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,583
Insurance broker organization code?	3
Amount paid for insurance broker fees	3209
Additional information about fees paid to insurance broker	SERVICE FEE

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYD075328

Policy instance

Insurance contract or identification number	NYD075328
Number of Individuals Covered	279
Insurance policy start date	2018-04-01
Insurance policy end date	2019-04-01
Total amount of commissions paid to insurance broker	USD $3,123
Total amount of fees paid to insurance company	USD $1,953
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $39,069
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,123
Insurance broker organization code?	3
Amount paid for insurance broker fees	1953
Additional information about fees paid to insurance broker	SERVICE FEE

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLY960387

Policy instance

Insurance contract or identification number	FLY960387
Number of Individuals Covered	456
Insurance policy start date	2018-04-01
Insurance policy end date	2019-04-01
Total amount of commissions paid to insurance broker	USD $4,057
Total amount of fees paid to insurance company	USD $7,573
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $151,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	7573
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $4,057

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3340702

Policy instance

Insurance contract or identification number	3340702
Number of Individuals Covered	231
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $6,926
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $174,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,926
Insurance broker organization code?	3
Insurance broker name	HART AND KEENAN CO, INC.

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYK960259

Policy instance

Insurance contract or identification number	NYK960259
Number of Individuals Covered	442
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,711
Total amount of fees paid to insurance company	USD $3,225
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $64,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,711
Insurance broker organization code?	3
Amount paid for insurance broker fees	3225
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker name	EMERSON REID LLC

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

YOK960388

Policy instance

Insurance contract or identification number	YOK960388
Number of Individuals Covered	442
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $714
Total amount of fees paid to insurance company	USD $239
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $714
Insurance broker organization code?	3
Amount paid for insurance broker fees	239
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker name	EMERSON REID LLC

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYK600147

Policy instance

Insurance contract or identification number	NYK600147
Number of Individuals Covered	392
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,660
Total amount of fees paid to insurance company	USD $3,549
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $70,978
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,660
Insurance broker organization code?	3
Amount paid for insurance broker fees	3549
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker name	EMERSON REID LLC

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYD075328

Policy instance

Insurance contract or identification number	NYD075328
Number of Individuals Covered	273
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,656
Total amount of fees paid to insurance company	USD $880
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,656
Insurance broker organization code?	3
Amount paid for insurance broker fees	880
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker name	EMERSON REID LLC

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLY960387

Policy instance

Insurance contract or identification number	FLY960387
Number of Individuals Covered	442
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,211
Total amount of fees paid to insurance company	USD $7,109
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $142,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	7109
Additional information about fees paid to insurance broker	SERVICE FEE
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $4,211
Insurance broker name	HART AND KEENAN

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

P75338A1

Policy instance

Insurance contract or identification number	P75338A1
Number of Individuals Covered	9
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $269
Total amount of fees paid to insurance company	USD $189
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,704
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $269
Amount paid for insurance broker fees	135
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	BONUS
Insurance broker name	USI INS SERVICES LLC

HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

00997629

Policy instance

Insurance contract or identification number	00997629
Number of Individuals Covered	720
Insurance policy start date	2017-04-01
Insurance policy end date	2018-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	POS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYK600147

Policy instance

Insurance contract or identification number	NYK600147
Number of Individuals Covered	392
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $3,137
Total amount of fees paid to insurance company	USD $2,187
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,747
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,137
Amount paid for insurance broker fees	550
Insurance broker organization code?	3
Insurance broker name	EMERSON REID LLC

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYD075328

Policy instance

Insurance contract or identification number	NYD075328
Number of Individuals Covered	282
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $1,270
Total amount of fees paid to insurance company	USD $635
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,270
Amount paid for insurance broker fees	60
Insurance broker organization code?	3
Insurance broker name	EMERSON REID LLC

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

FLY960387

Policy instance

Insurance contract or identification number	FLY960387
Number of Individuals Covered	441
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $3,873
Total amount of fees paid to insurance company	USD $4,364
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $87,279
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,873
Amount paid for insurance broker fees	1100
Insurance broker organization code?	3
Insurance broker name	EMERSON REID LLC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

20100

Policy instance

Insurance contract or identification number	20100
Number of Individuals Covered	280
Insurance policy start date	2015-01-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $492
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $492
Insurance broker organization code?	3
Insurance broker name	EMERSON REID & CO INC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010161784

Policy instance

Insurance contract or identification number	000010161784
Number of Individuals Covered	383
Insurance policy start date	2015-01-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $320
Total amount of fees paid to insurance company	USD $799
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $320
Amount paid for insurance broker fees	799
Additional information about fees paid to insurance broker	OVERRIDES
Insurance broker organization code?	3
Insurance broker name	EMERSON REID & CO INC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010161782

Policy instance

Insurance contract or identification number	000010161782
Number of Individuals Covered	432
Insurance policy start date	2015-01-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $499
Total amount of fees paid to insurance company	USD $341
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $6,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $499
Amount paid for insurance broker fees	341
Additional information about fees paid to insurance broker	OVERRIDES
Insurance broker organization code?	3
Insurance broker name	EMERSON REID & CO INC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010161783

Policy instance

Insurance contract or identification number	000010161783
Number of Individuals Covered	432
Insurance policy start date	2015-01-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $756
Total amount of fees paid to insurance company	USD $610
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $756
Amount paid for insurance broker fees	610
Additional information about fees paid to insurance broker	OVERRIDES
Insurance broker organization code?	3
Insurance broker name	EMERSON REID & CO INC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000400161785

Policy instance

Insurance contract or identification number	000400161785
Number of Individuals Covered	394
Insurance policy start date	2015-01-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $3,679
Total amount of fees paid to insurance company	USD $1,226
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,679
Amount paid for insurance broker fees	1226
Additional information about fees paid to insurance broker	OVERRIDES
Insurance broker organization code?	3
Insurance broker name	EMERSON REID & CO INC

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

1 P75338A1AA

Policy instance

Insurance contract or identification number	1 P75338A1AA
Number of Individuals Covered	9
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $447
Total amount of fees paid to insurance company	USD $84
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $447
Amount paid for insurance broker fees	84
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	EMERSON REID LLC

SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 )

Policy contract number

1156

Policy instance

Insurance contract or identification number	1156
Number of Individuals Covered	223
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $7,462
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,462
Insurance broker organization code?	3
Insurance broker name	HART AND KEENAN CO, INC.

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

NYK960259

Policy instance

Insurance contract or identification number	NYK960259
Number of Individuals Covered	441
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $3,494
Total amount of fees paid to insurance company	USD $1,494
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,876
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,494
Amount paid for insurance broker fees	301
Insurance broker organization code?	3
Insurance broker name	EMERSON REID LLC

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

YOK960388

Policy instance

Insurance contract or identification number	YOK960388
Number of Individuals Covered	441
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $447
Total amount of fees paid to insurance company	USD $149
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $2,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $447
Amount paid for insurance broker fees	37
Insurance broker organization code?	3
Insurance broker name	EMERSON REID & CO INC

HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

00997629

Policy instance

Insurance contract or identification number	00997629
Number of Individuals Covered	764
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	POS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010161783

Policy instance

Insurance contract or identification number	000010161783
Number of Individuals Covered	425
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,532
Total amount of fees paid to insurance company	USD $2,373
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,733
Insurance broker organization code?	3
Amount paid for insurance broker fees	2373
Additional information about fees paid to insurance broker	OVERRIDES
Insurance broker name	EMERSON REID & CO INC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010161782

Policy instance

Insurance contract or identification number	000010161782
Number of Individuals Covered	425
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,401
Total amount of fees paid to insurance company	USD $1,339
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $26,784
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,980
Insurance broker organization code?	3
Amount paid for insurance broker fees	1339
Additional information about fees paid to insurance broker	OVERRIDES
Insurance broker name	EMERSON REID & CO INC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010161784

Policy instance

Insurance contract or identification number	000010161784
Number of Individuals Covered	376
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,273
Total amount of fees paid to insurance company	USD $3,169
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $63,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $582
Amount paid for insurance broker fees	3169
Additional information about fees paid to insurance broker	OVERRIDES
Insurance broker organization code?	3
Insurance broker name	HART AND KEENAN CO, INC.

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

20100

Policy instance

Insurance contract or identification number	20100
Number of Individuals Covered	278
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,530
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,783
Insurance broker organization code?	3
Insurance broker name	EMERSON REID & CO INC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

1 P75338A1AA

Policy instance

Insurance contract or identification number	1 P75338A1AA
Number of Individuals Covered	9
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $399
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $399
Insurance broker organization code?	3
Insurance broker name	EMERSON REID LLC

AMERICAN MEDICAL AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 81418 )

Policy contract number

1156

Policy instance

Insurance contract or identification number	1156
Number of Individuals Covered	228
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $7,364
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,364
Insurance broker organization code?	3
Insurance broker name	HART AND KEENAN CO, INC.

HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

00997629

Policy instance

Insurance contract or identification number	00997629
Number of Individuals Covered	779
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	POS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000400161785

Policy instance

Insurance contract or identification number	000400161785
Number of Individuals Covered	393
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $14,795
Total amount of fees paid to insurance company	USD $4,932
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $98,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,298
Insurance broker organization code?	3
Amount paid for insurance broker fees	4932
Additional information about fees paid to insurance broker	OVERRIDES
Insurance broker name	EMERSON REID & CO INC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000400161785

Policy instance

Insurance contract or identification number	000400161785
Number of Individuals Covered	395
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $13,767
Total amount of fees paid to insurance company	USD $7,162
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $91,779
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,767
Amount paid for insurance broker fees	2573
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	EMERSON REID LLC

HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

00997629

Policy instance

Insurance contract or identification number	00997629
Number of Individuals Covered	795
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	POS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN MEDICAL AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 81418 )

Policy contract number

1156

Policy instance

Insurance contract or identification number	1156
Number of Individuals Covered	237
Insurance policy start date	2013-04-01
Insurance policy end date	2014-03-31
Total amount of commissions paid to insurance broker	USD $6,611
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,611
Insurance broker organization code?	3
Insurance broker name	HART AND KEENAN CO, INC.

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010161783

Policy instance

Insurance contract or identification number	000010161783
Number of Individuals Covered	429
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,498
Total amount of fees paid to insurance company	USD $3,649
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,498
Amount paid for insurance broker fees	1313
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	EMERSON REID LLC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010161782

Policy instance

Insurance contract or identification number	000010161782
Number of Individuals Covered	429
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,423
Total amount of fees paid to insurance company	USD $2,085
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $26,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,423
Amount paid for insurance broker fees	756
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	EMERSON REID LLC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010161784

Policy instance

Insurance contract or identification number	000010161784
Number of Individuals Covered	384
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,365
Total amount of fees paid to insurance company	USD $4,830
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,365
Amount paid for insurance broker fees	1735
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	EMERSON REID LLC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

20100

Policy instance

Insurance contract or identification number	20100
Number of Individuals Covered	844
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,578
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,578
Insurance broker name	HART & KEENAN AND CO INC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

1 P75338A1AA

Policy instance

Insurance contract or identification number	1 P75338A1AA
Number of Individuals Covered	10
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $381
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $381
Insurance broker organization code?	3
Insurance broker name	EMERSON REID LLC

HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

00997629

Policy instance

Insurance contract or identification number	00997629
Number of Individuals Covered	822
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	POS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010161784

Policy instance

Insurance contract or identification number	000010161784
Number of Individuals Covered	369
Insurance policy start date	2012-07-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,935
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,493
Insurance broker organization code?	3
Insurance broker name	EMERSON REID LLC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010161782

Policy instance

Insurance contract or identification number	000010161782
Number of Individuals Covered	418
Insurance policy start date	2012-07-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,062
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $12,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,434
Insurance broker organization code?	3
Insurance broker name	EMERSON REID LLC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000400161785

Policy instance

Insurance contract or identification number	000400161785
Number of Individuals Covered	385
Insurance policy start date	2012-07-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $8,400
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,998
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,300
Insurance broker organization code?	3
Insurance broker name	EMERSON REID LLC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

18052 NY DBL

Policy instance

Insurance contract or identification number	18052 NY DBL
Number of Individuals Covered	0
Insurance policy start date	2012-01-01
Insurance policy end date	2012-07-12
Total amount of commissions paid to insurance broker	USD $1,104
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,379
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,082
Insurance broker organization code?	3
Insurance broker name	ALLIANCE ADVISORY GROUP

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

1 P75338A1AA

Policy instance

Insurance contract or identification number	1 P75338A1AA
Number of Individuals Covered	11
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $545
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,178
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $545
Insurance broker organization code?	3
Insurance broker name	EMERSON REID LLC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00281351

Policy instance

Insurance contract or identification number	00281351
Number of Individuals Covered	398
Insurance policy start date	2012-01-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $11,645
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $103,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,449
Insurance broker organization code?	3
Insurance broker name	ALLIANCE ADVISORY GROUP

AMERICAN MEDICAL AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 81418 )

Policy contract number

1156

Policy instance

Insurance contract or identification number	1156
Number of Individuals Covered	231
Insurance policy start date	2012-04-01
Insurance policy end date	2013-03-31
Total amount of commissions paid to insurance broker	USD $8,603
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,603
Insurance broker organization code?	3
Insurance broker name	HART AND KEENAN CO, INC.

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

20100

Policy instance

Insurance contract or identification number	20100
Number of Individuals Covered	407
Insurance policy start date	2012-07-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,581
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,641
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,581
Insurance broker name	HART & KEENAN AND CO INC

LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 )

Policy contract number

000010161783

Policy instance

Insurance contract or identification number	000010161783
Number of Individuals Covered	418
Insurance policy start date	2012-07-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,053
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,863
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,960
Insurance broker organization code?	3
Insurance broker name	EMERSON REID LLC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

1 P75338A1AA

Policy instance

Insurance contract or identification number	1 P75338A1AA
Number of Individuals Covered	10
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $758
Total amount of fees paid to insurance company	USD $139
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,406
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

18052 NY DBL

Policy instance

Insurance contract or identification number	18052 NY DBL
Number of Individuals Covered	405
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,747
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00281351

Policy instance

Insurance contract or identification number	00281351
Number of Individuals Covered	405
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $19,924
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $205,018
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

00997629

Policy instance

Insurance contract or identification number	00997629
Number of Individuals Covered	800
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	POS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN MEDICAL AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 81418 )

Policy contract number

1156

Policy instance

Insurance contract or identification number	1156
Number of Individuals Covered	235
Insurance policy start date	2011-04-01
Insurance policy end date	2012-03-31
Total amount of commissions paid to insurance broker	USD $7,651
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

18052 NY DBL

Policy instance

Insurance contract or identification number	18052 NY DBL
Number of Individuals Covered	408
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,390
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00281351

Policy instance

Insurance contract or identification number	00281351
Number of Individuals Covered	400
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $15,461
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $140,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN MEDICAL AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 81418 )

Policy contract number

1156

Policy instance

Insurance contract or identification number	1156
Number of Individuals Covered	237
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $7,496
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

00997629

Policy instance

Insurance contract or identification number	00997629
Number of Individuals Covered	1596
Insurance policy start date	2010-04-01
Insurance policy end date	2011-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	POS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

1 P75338A1AA

Policy instance

Insurance contract or identification number	1 P75338A1AA
Number of Individuals Covered	10
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $660
Total amount of fees paid to insurance company	USD $120
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	STATUTORY DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $4,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	CURBELL, INC.
Employer identification number (EIN):	160725141
NAIC Classification:	326100

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1947-12-30
Company Identification Number:	81253
Legal Registered Office Address:	ATTENTION: president 7 COBHAM DRIVE ORCHARD PARK United States of America (USA) 14127