401k Plan data: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN plan

MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 401k Plan overview

Plan Name	MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN
Plan identification number	501

MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Dental Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

MEDAILLE UNIVERSITY has sponsored the creation of one or more 401k plans.

Company Name: MEDAILLE UNIVERSITY

Employer identification number (EIN): 160805158

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 BARBARA J. BILOTTA 2023-07-17
501 2021-01-01 BARBARA J. BILOTTA 2022-07-22
501 2020-01-01 BARBARA J. BILOTTA 2021-07-27
501 2019-01-01 BARBARA J. BILOTTA 2020-07-27
501 2018-01-01 BARBARA J. BILOTTA 2019-07-29
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 BARBARA J. BILOTTA
501 2011-01-01 BARBARA J. BILOTTA
501 2010-01-01 BARBARA J. BILOTTA
501 2009-01-01 BARBARA BILOTTA
501 2009-01-01 BARBARA BILOTTA

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	BARBARA J. BILOTTA	2023-07-17
501	2021-01-01	BARBARA J. BILOTTA	2022-07-22
501	2020-01-01	BARBARA J. BILOTTA	2021-07-27
501	2019-01-01	BARBARA J. BILOTTA	2020-07-27
501	2018-01-01	BARBARA J. BILOTTA	2019-07-29
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2014-01-01
501	2013-01-01
501	2012-01-01	BARBARA J. BILOTTA
501	2011-01-01	BARBARA J. BILOTTA
501	2010-01-01	BARBARA J. BILOTTA
501	2009-01-01	BARBARA BILOTTA
501	2009-01-01	BARBARA BILOTTA

Plan Statistics for MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN

401k plan membership statisitcs for MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN

Measure Date Value
2022: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 225
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 171
Total of all active and inactive participants 2022-01-01 171
2021: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 260
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 225
Total of all active and inactive participants 2021-01-01 225
2020: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 260
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 388
Total of all active and inactive participants 2020-01-01 388
2019: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 369
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 260
Total of all active and inactive participants 2019-01-01 260
2018: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 373
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 369
Total of all active and inactive participants 2018-01-01 369
2017: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 363
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 373
Total of all active and inactive participants 2017-01-01 373
2016: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 224
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 363
Total of all active and inactive participants 2016-01-01 363
2015: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 222
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 224
Total of all active and inactive participants 2015-01-01 224
2014: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 248
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 222
Total of all active and inactive participants 2014-01-01 222
2013: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 251
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 248
Total of all active and inactive participants 2013-01-01 248
2012: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 247
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 251
Total of all active and inactive participants 2012-01-01 251
2011: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 235
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 247
Total of all active and inactive participants 2011-01-01 247
2010: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 243
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 235
Total of all active and inactive participants 2010-01-01 235
2009: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 284
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 243
Total of all active and inactive participants 2009-01-01 243

Measure	Date	Value
2022: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	225
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	171
Total of all active and inactive participants	2022-01-01	171
2021: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	260
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	225
Total of all active and inactive participants	2021-01-01	225
2020: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	260
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	388
Total of all active and inactive participants	2020-01-01	388
2019: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	369
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	260
Total of all active and inactive participants	2019-01-01	260
2018: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	373
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	369
Total of all active and inactive participants	2018-01-01	369
2017: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	363
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	373
Total of all active and inactive participants	2017-01-01	373
2016: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	224
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	363
Total of all active and inactive participants	2016-01-01	363
2015: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	222
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	224
Total of all active and inactive participants	2015-01-01	224
2014: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	248
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	222
Total of all active and inactive participants	2014-01-01	222
2013: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	251
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	248
Total of all active and inactive participants	2013-01-01	248
2012: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	247
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	251
Total of all active and inactive participants	2012-01-01	251
2011: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	235
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	247
Total of all active and inactive participants	2011-01-01	247
2010: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	243
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	235
Total of all active and inactive participants	2010-01-01	235
2009: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	284
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	243
Total of all active and inactive participants	2009-01-01	243

Form 5500 Responses for MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN

2022: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: MEDAILLE COLLEGE LONG TERM DISABILITY INCOME PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

000010239309

Policy instance

Insurance contract or identification number	000010239309
Number of Individuals Covered	171
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,026
Total amount of fees paid to insurance company	USD $550
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,026
Amount paid for insurance broker fees	550
Insurance broker organization code?	3

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

Policy contract number

000010239308

Policy instance

Insurance contract or identification number	000010239308
Number of Individuals Covered	171
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,575
Total amount of fees paid to insurance company	USD $1,361
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $33,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,575
Amount paid for insurance broker fees	1361
Insurance broker organization code?	3

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

Policy contract number

ABY960215

Policy instance

Insurance contract or identification number	ABY960215
Number of Individuals Covered	171
Insurance policy start date	2021-04-01
Insurance policy end date	2022-04-01
Total amount of commissions paid to insurance broker	USD $75
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $75
Insurance broker organization code?	3

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

Policy contract number

00422170

Policy instance

Insurance contract or identification number	00422170
Number of Individuals Covered	295
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,422,235
Welfare Benefit Premiums Paid to Carrier	USD $145,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2422235
Insurance broker organization code?	3

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

Policy contract number

00001D023354

Policy instance

Insurance contract or identification number	00001D023354
Number of Individuals Covered	124
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,060
Total amount of fees paid to insurance company	USD $2,121
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $89,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,060
Amount paid for insurance broker fees	2121
Insurance broker organization code?	3

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

Policy contract number

00001D023354

Policy instance

Insurance contract or identification number	00001D023354
Number of Individuals Covered	174
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,426
Total amount of fees paid to insurance company	USD $1,983
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $130,548
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,426
Amount paid for insurance broker fees	1983
Insurance broker organization code?	3

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

Policy contract number

00422170

Policy instance

Insurance contract or identification number	00422170
Number of Individuals Covered	399
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $151,407
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

ABY960215

Policy instance

Insurance contract or identification number	ABY960215
Number of Individuals Covered	225
Insurance policy start date	2020-04-01
Insurance policy end date	2021-04-01
Total amount of commissions paid to insurance broker	USD $75
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $75
Insurance broker organization code?	3

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

Policy contract number

000010239308

Policy instance

Insurance contract or identification number	000010239308
Number of Individuals Covered	225
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,747
Total amount of fees paid to insurance company	USD $1,266
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $41,872
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,747
Amount paid for insurance broker fees	1266
Insurance broker organization code?	3

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

Policy contract number

000010239309

Policy instance

Insurance contract or identification number	000010239309
Number of Individuals Covered	223
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,441
Total amount of fees paid to insurance company	USD $513
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,441
Amount paid for insurance broker fees	513
Insurance broker organization code?	3

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

Policy contract number

00001D023354

Policy instance

Insurance contract or identification number	00001D023354
Number of Individuals Covered	175
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,405
Total amount of fees paid to insurance company	USD $5,124
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $122,023
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,405
Amount paid for insurance broker fees	5124
Insurance broker organization code?	3

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

Policy contract number

00422170

Policy instance

Insurance contract or identification number	00422170
Number of Individuals Covered	388
Insurance policy start date	2019-06-01
Insurance policy end date	2020-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $278,591
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

ABY960215

Policy instance

Insurance contract or identification number	ABY960215
Number of Individuals Covered	260
Insurance policy start date	2019-04-01
Insurance policy end date	2020-04-01
Total amount of commissions paid to insurance broker	USD $75
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $75
Insurance broker organization code?	3

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

Policy contract number

000010239308

Policy instance

Insurance contract or identification number	000010239308
Number of Individuals Covered	213
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,689
Total amount of fees paid to insurance company	USD $1,615
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $38,962
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,689
Amount paid for insurance broker fees	1615
Insurance broker organization code?	3

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

Policy contract number

000010239309

Policy instance

Insurance contract or identification number	000010239309
Number of Individuals Covered	212
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $2,327
Total amount of fees paid to insurance company	USD $662
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,327
Amount paid for insurance broker fees	662
Insurance broker organization code?	3

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

Policy contract number

000010239309

Policy instance

Insurance contract or identification number	000010239309
Number of Individuals Covered	250
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,640
Total amount of fees paid to insurance company	USD $78
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,640
Amount paid for insurance broker fees	78
Insurance broker organization code?	3

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

Policy contract number

000010239308

Policy instance

Insurance contract or identification number	000010239308
Number of Individuals Covered	251
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,833
Total amount of fees paid to insurance company	USD $200
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $46,141
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,833
Amount paid for insurance broker fees	200
Insurance broker organization code?	3

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

Policy contract number

ABY960215

Policy instance

Insurance contract or identification number	ABY960215
Number of Individuals Covered	260
Insurance policy start date	2018-04-01
Insurance policy end date	2019-04-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $75
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	75

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

Policy contract number

00412601

Policy instance

Insurance contract or identification number	00412601
Number of Individuals Covered	374
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $37,591
Total amount of fees paid to insurance company	USD $0
Health 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 $37,591
Insurance broker organization code?	3

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

Policy contract number

00001D023354

Policy instance

Insurance contract or identification number	00001D023354
Number of Individuals Covered	192
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,219
Total amount of fees paid to insurance company	USD $617
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $146,404
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,219
Amount paid for insurance broker fees	617
Insurance broker organization code?	3

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

Policy contract number

00001D023354

Policy instance

Insurance contract or identification number	00001D023354
Number of Individuals Covered	177
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,424
Total amount of fees paid to insurance company	USD $1,884
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $129,560
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,424
Insurance broker organization code?	3
Amount paid for insurance broker fees	1884
Insurance broker name	BROWN & BROWN OF FL

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

Policy contract number

ABY960215

Policy instance

Insurance contract or identification number	ABY960215
Number of Individuals Covered	213
Insurance policy start date	2016-04-01
Insurance policy end date	2017-04-01
Total amount of commissions paid to insurance broker	USD $75
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $75
Insurance broker name	WALSH DUFFIELD CO INC.

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

Policy contract number

00412601

Policy instance

Insurance contract or identification number	00412601
Number of Individuals Covered	373
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $35,211
Total amount of fees paid to insurance company	USD $0
Health 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 $35,211
Insurance broker organization code?	3
Insurance broker name	M&T INSURANCE AGENCY, INC.

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

Policy contract number

SYK600226

Policy instance

Insurance contract or identification number	SYK600226
Number of Individuals Covered	213
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $449
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $3,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $449
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF NEW YORK

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

Policy contract number

SGN600547

Policy instance

Insurance contract or identification number	SGN600547
Number of Individuals Covered	213
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,682
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,644
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,682
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF NEW YORK INC.

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

Policy contract number

SGE600301

Policy instance

Insurance contract or identification number	SGE600301
Number of Individuals Covered	213
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,494
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,494
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF NEW YORK

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

Policy contract number

00001D023354

Policy instance

Insurance contract or identification number	00001D023354
Number of Individuals Covered	171
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,428
Total amount of fees paid to insurance company	USD $531
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $131,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,428
Insurance broker organization code?	3
Amount paid for insurance broker fees	531
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	BROWN & BROWN OF FL

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

Policy contract number

SGN600547

Policy instance

Insurance contract or identification number	SGN600547
Number of Individuals Covered	224
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $2,665
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,665
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF NEW YORK

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

Policy contract number

SYK600226

Policy instance

Insurance contract or identification number	SYK600226
Number of Individuals Covered	224
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $444
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $3,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $444
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF NEW YORK

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

Policy contract number

SGE600301

Policy instance

Insurance contract or identification number	SGE600301
Number of Individuals Covered	224
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $2,487
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,487
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF NEW YORK

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

Policy contract number

000010153713

Policy instance

Insurance contract or identification number	000010153713
Number of Individuals Covered	222
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,355
Total amount of fees paid to insurance company	USD $1,197
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 $26,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,355
Insurance broker organization code?	3
Amount paid for insurance broker fees	1197
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	BROWN & BROWN OF FL

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

Policy contract number

00001D023354

Policy instance

Insurance contract or identification number	00001D023354
Number of Individuals Covered	171
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,454
Total amount of fees paid to insurance company	USD $1,455
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
Welfare Benefit Premiums Paid to Carrier	USD $141,588
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,454
Insurance broker organization code?	3
Amount paid for insurance broker fees	1455
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	BROWN & BROWN OF FL

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

Policy contract number

000010153714

Policy instance

Insurance contract or identification number	000010153714
Number of Individuals Covered	222
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,722
Total amount of fees paid to insurance company	USD $868
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 $19,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,722
Insurance broker organization code?	3
Amount paid for insurance broker fees	868
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	BROWN & BROWN OF FL

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

Policy contract number

000010153714

Policy instance

Insurance contract or identification number	000010153714
Number of Individuals Covered	248
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,792
Total amount of fees paid to insurance company	USD $1,165
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 $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 $2,792
Insurance broker organization code?	3
Amount paid for insurance broker fees	1165
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	BROWN & BROWN OF FL

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

Policy contract number

000010153713

Policy instance

Insurance contract or identification number	000010153713
Number of Individuals Covered	248
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,418
Total amount of fees paid to insurance company	USD $1,612
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 $28,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,418
Insurance broker organization code?	3
Amount paid for insurance broker fees	1612
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	BROWN & BROWN OF FL

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

Policy contract number

0001D023354

Policy instance

Insurance contract or identification number	0001D023354
Number of Individuals Covered	187
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,442
Total amount of fees paid to insurance company	USD $1,834
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
Welfare Benefit Premiums Paid to Carrier	USD $136,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,442
Insurance broker organization code?	3
Amount paid for insurance broker fees	1834
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker name	BROWN & BROWN OF FL

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

Policy contract number

000010153714

Policy instance

Insurance contract or identification number	000010153714
Number of Individuals Covered	251
Insurance policy start date	2012-02-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,702
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 $19,516
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,702
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF NY

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

Policy contract number

0001D023354

Policy instance

Insurance contract or identification number	0001D023354
Number of Individuals Covered	197
Insurance policy start date	2012-02-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,408
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
Welfare Benefit Premiums Paid to Carrier	USD $123,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,408
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF NY

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

Policy contract number

000010153713

Policy instance

Insurance contract or identification number	000010153713
Number of Individuals Covered	251
Insurance policy start date	2012-02-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,359
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 $26,978
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,359
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF NY

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

FNY1000024

Policy instance

Insurance contract or identification number	FNY1000024
Number of Individuals Covered	247
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $9,057
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 $74,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

FNY1000024

Policy instance

Insurance contract or identification number	FNY1000024
Number of Individuals Covered	235
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $8,600
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 $65,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,600
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN OF NEW YORK - BUFFALO

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Company Name:	MEDAILLE UNIVERSITY
Employer identification number (EIN):	160805158
NAIC Classification:	611000