401k Plan data: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN plan

TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN
Plan identification number	502

TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Long-term disability cover Other welfare benefit cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

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

Company Name: TIOGA OPPORTUNITIES, INC.

Employer identification number (EIN): 160907793

NAIC Classification: 624200

Additional information about TIOGA OPPORTUNITIES, INC.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1965-08-02

Company Identification Number: 189660

Legal Registered Office Address: 9 SHELDON GUILE BLVD.
Tioga
OWEGO
United States of America (USA)
13827

More information about TIOGA OPPORTUNITIES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2015-01-01 MAUREEN ABBOTT
502 2014-01-01 MAUREEN ABBOTT
502 2013-01-01 KATHLEEN L. HORNER
502 2012-01-01 KATHLEEN L. HORNER
502 2011-01-01 KATHLEEN HORNER
502 2010-01-01 KATHLEEN HORNER
502 2009-01-01 KATHLEEN HORNER

Plan id#	Filing Submission Date	Name of Administrator
502	2015-01-01	MAUREEN ABBOTT
502	2014-01-01	MAUREEN ABBOTT
502	2013-01-01	KATHLEEN L. HORNER
502	2012-01-01	KATHLEEN L. HORNER
502	2011-01-01	KATHLEEN HORNER
502	2010-01-01	KATHLEEN HORNER
502	2009-01-01	KATHLEEN HORNER

Plan Statistics for TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN

Measure Date Value
2015: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 72
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 80
Total of all active and inactive participants 2015-01-01 80
2014: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 72
Total of all active and inactive participants 2014-01-01 72
2013: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 107
Total of all active and inactive participants 2013-01-01 107
Total participants 2013-01-01 0
2012: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 118
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 116
Total of all active and inactive participants 2012-01-01 116
Total participants 2012-01-01 0
2011: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 173
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 118
Total of all active and inactive participants 2011-01-01 118
Total participants 2011-01-01 118
2010: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 160
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 173
Total of all active and inactive participants 2010-01-01 173
Total participants 2010-01-01 173
2009: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 160
Total of all active and inactive participants 2009-01-01 160
Total participants 2009-01-01 160

Measure	Date	Value
2015: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	72
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	80
Total of all active and inactive participants	2015-01-01	80
2014: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	72
Total of all active and inactive participants	2014-01-01	72
2013: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	107
Total of all active and inactive participants	2013-01-01	107
Total participants	2013-01-01	0
2012: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	118
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	116
Total of all active and inactive participants	2012-01-01	116
Total participants	2012-01-01	0
2011: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	173
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	118
Total of all active and inactive participants	2011-01-01	118
Total participants	2011-01-01	118
2010: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	160
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	173
Total of all active and inactive participants	2010-01-01	173
Total participants	2010-01-01	173
2009: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	160
Total of all active and inactive participants	2009-01-01	160
Total participants	2009-01-01	160

Financial Data on TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN

Measure	Date	Value
2011 : TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 2011 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Did the plan have assets held for investment	2011-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
2010 : TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 2010 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Did the plan have assets held for investment	2010-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No

Form 5500 Responses for TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN

2015: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT 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: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT 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: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT 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: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT 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: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT 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: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT 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: TIOGA OPPORTUNITIES, INC. WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
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

000010075586 00

Policy instance

Insurance contract or identification number	000010075586 00
Number of Individuals Covered	68
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,429
Total amount of fees paid to insurance company	USD $191
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,527
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,429
Amount paid for insurance broker fees	191
Additional information about fees paid to insurance broker	ENROLLMENT
Insurance broker organization code?	3
Insurance broker name	KAFL INC

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )

Policy contract number

508298

Policy instance

Insurance contract or identification number	508298
Number of Individuals Covered	42
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,850
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,461
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,850
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN EMPIRE STATE

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )

Policy contract number

00008543

Policy instance

Insurance contract or identification number	00008543
Number of Individuals Covered	36
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $26,187
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $591,371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,187
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN EMPIRE STATE

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

Policy contract number

000010075585 00

Policy instance

Insurance contract or identification number	000010075585 00
Number of Individuals Covered	68
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $278
Total amount of fees paid to insurance company	USD $37
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH/DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $278
Amount paid for insurance broker fees	37
Additional information about fees paid to insurance broker	ENROLLMENT
Insurance broker organization code?	3
Insurance broker name	KAFL INC

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )

Policy contract number

00008543

Policy instance

Insurance contract or identification number	00008543
Number of Individuals Covered	38
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $30,378
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
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $685,561
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,378
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN EMPIRE STATE

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

Policy contract number

000010075585 00

Policy instance

Insurance contract or identification number	000010075585 00
Number of Individuals Covered	72
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $397
Total amount of fees paid to insurance company	USD $56
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/DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $2,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $397
Amount paid for insurance broker fees	56
Additional information about fees paid to insurance broker	ENROLLMENT
Insurance broker organization code?	3
Insurance broker name	KAFL INC

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

Policy contract number

000010075586 00

Policy instance

Insurance contract or identification number	000010075586 00
Number of Individuals Covered	72
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,896
Total amount of fees paid to insurance company	USD $253
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 $12,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,896
Amount paid for insurance broker fees	253
Additional information about fees paid to insurance broker	ENROLLMENT
Insurance broker organization code?	3
Insurance broker name	KAFL INC

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )

Policy contract number

508298

Policy instance

Insurance contract or identification number	508298
Number of Individuals Covered	43
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,300
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 $18,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,300
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN EMPIRE STATE

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )

Policy contract number

508298

Policy instance

Insurance contract or identification number	508298
Number of Individuals Covered	61
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,713
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,713
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN EMPIRE STATE

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

Policy contract number

000010075585 00

Policy instance

Insurance contract or identification number	000010075585 00
Number of Individuals Covered	107
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $384
Total amount of fees paid to insurance company	USD $55
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH/DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $2,727
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $384
Amount paid for insurance broker fees	55
Additional information about fees paid to insurance broker	ENROLLMENT
Insurance broker organization code?	3
Insurance broker name	KAFL INC

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

Policy contract number

000010075586 00

Policy instance

Insurance contract or identification number	000010075586 00
Number of Individuals Covered	104
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,132
Total amount of fees paid to insurance company	USD $284
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,132
Amount paid for insurance broker fees	284
Additional information about fees paid to insurance broker	ENROLLMENT
Insurance broker organization code?	3
Insurance broker name	KAFL INC

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )

Policy contract number

00008543

Policy instance

Insurance contract or identification number	00008543
Number of Individuals Covered	51
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $33,996
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $730,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,996
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN EMPIRE STATE

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )

Policy contract number

508298

Policy instance

Insurance contract or identification number	508298
Number of Individuals Covered	70
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,101
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,101
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN EMPIRE STATE

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

Policy contract number

000010075586 00

Policy instance

Insurance contract or identification number	000010075586 00
Number of Individuals Covered	116
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,388
Total amount of fees paid to insurance company	USD $328
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,388
Amount paid for insurance broker fees	328
Additional information about fees paid to insurance broker	ENROLLMENT
Insurance broker organization code?	3
Insurance broker name	KAFL INC

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

Policy contract number

000010075585 00

Policy instance

Insurance contract or identification number	000010075585 00
Number of Individuals Covered	116
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $441
Total amount of fees paid to insurance company	USD $63
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH/DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $441
Amount paid for insurance broker fees	63
Additional information about fees paid to insurance broker	ENROLLMENT
Insurance broker organization code?	3
Insurance broker name	KAFL INC

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )

Policy contract number

00008543

Policy instance

Insurance contract or identification number	00008543
Number of Individuals Covered	61
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $36,309
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $753,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,309
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN EMPIRE STATE

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

Policy contract number

000010075586

Policy instance

Insurance contract or identification number	000010075586
Number of Individuals Covered	118
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,406
Total amount of fees paid to insurance company	USD $331
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,558
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )

Policy contract number

508298

Policy instance

Insurance contract or identification number	508298
Number of Individuals Covered	66
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $35,497
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $715,266
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )

Policy contract number

508298

Policy instance

Insurance contract or identification number	508298
Number of Individuals Covered	76
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,153
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,099
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

000010075585 00

Policy instance

Insurance contract or identification number	000010075585 00
Number of Individuals Covered	118
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $567
Total amount of fees paid to insurance company	USD $85
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH/DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $4,227
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

000010075585 00

Policy instance

Insurance contract or identification number	000010075585 00
Number of Individuals Covered	137
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $555
Total amount of fees paid to insurance company	USD $84
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH/DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $4,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )

Policy contract number

508298

Policy instance

Insurance contract or identification number	508298
Number of Individuals Covered	138
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $42,710
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )

Policy contract number

508298

Policy instance

Insurance contract or identification number	508298
Number of Individuals Covered	173
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,482
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,482
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

000010075586

Policy instance

Insurance contract or identification number	000010075586
Number of Individuals Covered	137
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,222
Total amount of fees paid to insurance company	USD $296
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	TIOGA OPPORTUNITIES, INC.
Employer identification number (EIN):	160907793
NAIC Classification:	624200

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1965-08-02
Company Identification Number:	189660
Legal Registered Office Address:	9 SHELDON GUILE BLVD. Tioga OWEGO United States of America (USA) 13827