2017-10-30T09:35:37-05:00 2016-12-31 131578842 BUCHBINDER TUNICK & COMPANY LLP 6720-A ROCKLEDGE DRIVE SUITE 510 BETHESDA MD 20817 990 2016-01-01 477358956 TRUSTEES OF CATASTROPHE MAJOR MEDICAL PLAN NEWY 5182136000 800 TROY-SCHENECTADY ROAD LATHAM NY 121102455 J PHILIPPE ABRAHAM TRUSTEE 5182136000 2017-10-27 1 JOHN ZIMMERMAN P01049106 2402001400 2017-10-27 71.4.209.130 2017-10-27 15:03:18 ED P 12A467B009B37059C69C0FF69FF72A1B294E1161 FDEEBAEF04A3276C03B5530B834748A26B57546D 2016 2021-01-29 14:40:06Z J PHILIPPE ABRAHAM 800 TROY-SCHENECTADY ROAD LATHAM NY 121102455 55659829 0 X N/A X 2015 NY THE SOLE PLAN SPONSOR AND PLAN ADMINISTRATOR OF THE NYSUT CATASTROPHE MAJOR MEDICAL PLAN ("CMM PLAN"), WHICH IS DESIGNED TO ACT AS SUPPLEMENTAL (EXCESS MAJOR MEDICAL BENEFITS) HEALTH INSURANCE TO THE NYSUT MEMBERSHIP. 7 7 0 0 0 0 0 0 11329100 32714988 109409 363420 0 0 11438509 33078408 0 0 1525924 10506959 0 0 0 0 0 1887828 5633073 3413752 16140032 8024757 16938376 61781471 80563966 2055452 2391097 59726019 78172869 THE SOLE PLAN SPONSOR AND PLAN ADMINISTRATOR OF THE NYSUT CATASTROPHE MAJOR MEDICAL PLAN ("CMM PLAN"), WHICH IS DESIGNED TO ACT AS SUPPLEMENTAL (EXCESS MAJOR MEDICAL BENEFITS) HEALTH INSURANCE TO THE NYSUT MEMBERSHIP. 0 0 SUPPLEMENTED BASIC HOSPITALIZATION AND MAJOR MEDICAL INSURANCE AND LONG TERM CARE. FOR THE YEAR ENDING 12/31/16, THERE WERE, ON AVERAGE, 82,506 PARTICIPANTS, AND 50,351 POLICIES. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 5 0 1 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X JACLYN FERRUCCI 5182136000 800 TROY-SCHENECTADY ROAD LATHAM NY 121102455 X JOHN BURNS TRUSTEE 1.00 X 0 0 0 BARBARA HAFNER TRUSTEE 1.00 X 0 0 0 DEBORAH PAULIN TRUSTEE 1.00 X 0 0 0 ARTHUR PEPPER TRUSTEE 1.00 X 0 0 0 RODERICK SHERMAN CHAIRPERSON 1.00 X X 0 0 0 JEFFREY HARTNETT TRUSTEE 1.00 X 0 0 0 EMILY SAMUELS SECRETARY 1.00 X X 0 0 0 SANDRA CARNER-SHAFRAN TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 MERCER CONSUMER 12421 MEREDITH DRIVE URBANDALE IA 50398 CLAIMS PROCESSOR; RECORDKEEPER & INFORMA 3059739 STACEY BRAUN ASSOCIATES INC 377 BROADWAY STREET NEW YORK NY 10013 INVESTMENT MANAGEMENT 292463 AMERICAN GENERAL LIFE INSURANCE CO 3600 ROUTE 66 NEPTUNE NJ 07754 CONSULTING 272000 MEYER SUOZZI ENGLISH & KLEIN PC 1350 BROADWAY STREET SUITE 501 NEW YORK NY 10018 LEGAL 153852 SEGAL CONSULTING 333 WEST 34TH STREET NEW YORK NY 10001 ACTUARIAL/BENEFITS CONSULTING 131871 5 PARTICIPANT CONTRIBUTIONS 524292 32491988 32491988 DIVIDENDS FROM PRIOR INSURED PROG 525100 223000 223000 32714988 1144583 1144583 21800258 22581421 -781163 -781163 -781163 33078408 32714988 0 363420 X 10506959 180859 34431 312739 3706993 103673 46272 ADMINISTRATIVE SERVICE 1060753 PCORI FEE 187353 16140032 15867 1898999 61781471 4841045 16000 73792055 61781471 80563966 1044895 1328471 1010557 1062626 2055452 2391097 X 0 0 0 0 59726019 78172869 59726019 78172869 61781471 80563966 16938376 1508474 0 X 0 1 X 0 0 0 X 34274143 1508474 1508474 32765669 312739 312739 33078408 15827293 0 15827293 312739 312739 16140032 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN ADMINISTRATOR HAS CONCLUDED THAT AS OF DECEMBER 31, 2016, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. EMPLOYEE BENEFIT PLANS ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER THERE IS CURRENTLY NO AUDIT FOR THE INITIAL TAX PERIOD IN PROGRESS FOR THE PLAN. FORM 990, PART VI, SECTION B, LINE 11B THE FINAL DRAFT OF THE FORM 990 IS PROVIDED TO THE BOARD OF TRUSTEES PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY APPOINTS A CONFLICT OF INTEREST OFFICER. THE CONFLICT OF INTEREST OFFICER'S RESPONSIBILITIES ARE TO MONITOR THE IMPLEMENTATION OF THE CONFLICT OF INTEREST POLICY AND, RECOMMEND TO THE OVERSIGHT COMMITTEE, SUCH MODIFICATIONS IN THE POLICY AS HE OR SHE MAY FROM TIME TO TIME DEEM APPROPRIATE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. THE FORM 5500 FILED WITH THE EMPLOYEE BENEFIT SECURITY ADMINISTRATION (US DEPARTMENT OF LABOR) IS MADE AVAILABLE TO PLAN PARTICIPANTS. FORM 990, PART IX, LINE 11G ADMINISTRATIVE FEES 1,777,282. CLAIMS FEES 1,816,483. CONSULTING 111,094. OTHER FEES 2,134.