Qualification Termination WCB Number Organization Name …

1 Group Self Insurer carrier code Numbers(Board Assigned W Numbers)as of 10/01/20 WCB NumberOrganization NameQualification DateTermination DateW333256 Associated Builders & Contractors Compensation Trust5/1/19971/1/2013W334882 Automotive Service and Repair Self Insurance Trust1/1/2005 1/31/2010W335251 Automobile Dealers Workers' Compensation Self Insurance Trust12/29/1995 12/31/2010W342752 Beer Wholesalers Compensation Trust of New York2/1/2000 12/31/2010W361687 Business Council Workers' Compensation Manufacturers Group Self Insurance Trust1/1/19961/1/2009W371504 Community Residence Insurance Saving Plan Self Insurance Trust12/15/19951/1/2011W375265 Contractors Self Insurance Trust Fund8/15/19971/1/2012W375331 Contractors Compensation Trust11/1/19991/1/2009W375943 Cooperative Association of Food Enterprises Workers' Compensation Trust6/13/19951/1/2009W397756 ELEC CON

2 Trust7/1/20011/1/2009W398002 Electrical Employers Self Insurance Safety Plan1/1/1967W398325 ElderWood Senior Care Self Insurance Trust11/1/20051/1/2009W398390 Elite Contractors Trust of New York8/27/1999 7/16/2008W398770 Empire State Agricultural Compensation Trust12/31/1997 12/31/2008W398788 Empire State Hospitality Workers' Compensation Trust3/1/19961/1/2009W399505 Empire State Transportation Workers' Compensation Trust1/1/19951/1/2009W399752 Empire State Education Trust6/30/20001/1/2009W400501 Team Transportation Workers' Comp Trust10/15/19951/1/2011W410880 Empire State Towing and Recovery (ESTRA)5/15/19951/1/2012W417448 First Automotive Services Trust1/1/20051/1/2009W435507 Gioia Insurance Trust Fund10/1/19911/1/2001W445506 Wholesale and Retail Workers' Compensation Trust of New York9/27/1999 4/29/2008W450258 Healthcare Industry Trust of New York9/12/1999 12/31/2007W450506 Health Care Providers Self Insurance Trust4/19/19937/1/2009W450753 Healthcare Underwriters Mutual Risk Management Group4/1/1996 12/31/2011W450886 Healthcare of New York Workers' Compensation Trust (HONY)

3 9/1/20011/1/2012W468508 Hudson Health Care Workers' Compensation Group1/1/2002 12/31/2010W472880 Independent Grocers Workers' Compensation Self Insurance Trust4/26/19967/1/2009W512503 Long Term Care Risk Management Group10/1/19921/1/2010W517544 New York Manufacturing Self Insurance Trust12/1/1997 8/31/2006W520571 McGuire Group Trust1/1/1994 9/30/2011W520720 Preferred Manufacturers Insurance Trust Fund1/1/19939/1/2009W521256 Metropolitan New York College & University Workers' Compensation Group7/1/1996 12/31/1999W521504 Special Trades Contracting and Construction Trust10/1/19951/1/2012W535942 Selective Safety Trust10/1/19951/1/2009W537757 NYAHSA Services Inc Self Insurance Trust10/2/19951/1/2012W537823NY Transportation Workers Compensation Trust12/1/20001/1/2009W548507 New York McDonald's Operators Workers' Compensation Trust1/1/19991/1/2009W549943 New York Bus Operators Compensation Trust1/1/19931/1/2012W550503 New York Operators Self Insurance Trust12/31/1995 12/31/2011W551006 New York Lumbermen's Insurance Trust Fund4/1/1981W551501 New York State Cemeteries Trust2/1/2002 3/31/2008W552632 New York State Motor Truck Association Compensation Trust7/1/19941/1/2012W552756 New York State Health Providers Workers' Compensation Trust4/1/1992 12/31/2010W552889 Building Exterior Services Trust of New York3/30/1994 5/12/2003W553507 New York State Agricultural Compensation Trust1/1/19951/1/2004W554190 New York Healthcare Facilities Workers' Compensation Trust7/1/1997 7/31/2006W554299 New York Choice Self Insurance Trust9/1/19971/1/2012W554828 New York Petroleum Associations Compensation Trust7/1/20011/1/2009W554943 Builders Self Insurance

4 Trust10/1/1998 9/30/2007W555064 Niagara Business Trust2/1/1998 12/31/2011W558381 NYSARC Workers' Compensation Trust5/1/1999 12/31/2010W558555 OHI Workers' Compensation Trust1/1/19981/1/2010W565386 Unity Health fka Park Ridge Health System WC Trust11/1/1995 11/1/1997W570758 Manufacturing Industry WC Self Insurance Trust1/1/1998 3/31/2006W572978 PIA Manufacturers Self Insurance Trust Fund4/1/19961/1/2011W573752 Provider Agency Trust For Human Services (PATH)1/1/19973/1/2006W573885 Public Entity Trust of New York1/1/20028/2/2007W576888 Real Estate Management Trust of New York1/1/2001 1/31/2008W580005 Rest Inn Safety Plan1/1/19714/1/1985W580252 Retail and Wholesale Industry WC Self Insurance Trust7/16/1998 7/31/2006W580500 Retailers of New York Workers' Compensation Trust9/1/19971/1/2009W585509 Road & Bridge Construction WC Trust8/20/1996 4/30/1998W591382 Roman Catholic Diocese of Brooklyn NY10/1/1977 8/31/2008W591408 Roman Catholic Diocese of Rochester6/1/1977 6/30/2009W591432 Roman Catholic Diocese of Rockville Centre NY1/7/1977 12/31/2011W600381 Northeast Health Workers' Compensation Plan1/1/1995 12/31/2010W616635 Sisters of St Francis Healthcare Group1/1/1994 7/25/1997W634505 Mercantile Self Insurance Trust10/1/1994 2/29/2008W647614 Trade Industry Workers'

5 Compensation Trust for Manufacturers12/27/2001 1/31/2008W648885 Transportation Industry Workers Compensation Trust12/27/2000 1/31/2008W662035 Human Services Self Insurance Trust Fund12/29/19951/1/2012W662092 New York College & University Risk Management Group6/30/1994W662191 Western New York Hospital Risk Management Group7/1/19941/1/2012W817977 Erie # 2 Area Schools Self Funded Workers' Compensation Consortium7/1/1996W820724 Fulmont Workers' Compensation Plan7/1/1991W833883 Madison Oneida Herkimer Workers' Compensation Consortium7/1/1994W848139 New York State Municipal Workers' Compensation Alliance2/18/1994W861223 Public Employers Risk Management Association6/1/1985W865695 Schoharie Area Workers' Compensation Plan7/1/2004