Annual Return/Report of Employee Benefit Plan

Transcription

1 Form5500 Department of the Treasuiy Internal Revenue Service Department of Labor Employee Benefits Security AdminlstraUon Pension Benefit Guaranty Corporation Part I I Annual Report Identification Information D Annual Return/Report of Employee Benefit Plan This form is required to be filed for employee benefit plans under sections 104 and 4065 of the Employee Retirement Income Security Act of 1974 (ERISA) and sections 6057(b) and 6058(a) of the Internal Revenue Code (the Code). > Complete all entries in accordance with the instructions to the Form For calendar plan year 2016 or fiscal plan year beginning 07/01/2016 and ending 06/30/2017 A This return/report is for: a multiemployer plan ~ a single-employer plan Da DFE (specify) 0MB Nos ~ This Form is Open to Public Inspection Da multiple-employer plan (Filers checking this box must attach a list of participating employer information in accordance with the form instructions.) B This return/report is: 0 the first return/report Dthe final return/report 0 an amended return/report Da short plan year return/report (less than 12 months) C If the plan is a collectively-bargained plan, check here,...,...,...,...,..- D D Check box if filing under: ~ Form automatic extension 0 the DFVC program n special extension (enter description) I Part II I Basic Plan lnformation--,mter all requested Information 1 a Name of plan COLUMBIA UNIVERSITY RETIREE MEDICAL AND LIFE INSURANCE BENEFITS PLAN 2a Plan sponsor's name (employer, if for a single-employer plan) Mailing address (include room, apt, suite no. and street, or P.O. Box) City or town, state or province, country, and ZIP or foreign postal (if foreign, see instructions) TRUSTEES OF COLUMBIA UNIVERSITY C/0 BENEFITS DEPARTMENT 615 WEST 131ST STREET STUDEBAKER, 4TH FLOOR NEW YORK NY b Three-digit plan I number IPNl, c Effective date of plan 07/01/1994 2b Employer Identification Number (EIN) c Plan Sponsor's telephone number d Business (see instructions) Caution: A penalty for the late or incomplete filing of this returnlreport will be assessed unless reasonable cause Is established. Under penalties of perjury and other penalties set forth in the instructions, I declare that l have examined this return/report, including accompanying schedules, statements and attachments, as well as the electronic version of this return/report, and to the best of my knowledge and belief, it is true, correct, and complete. SIGN HERE l)aaj/r,~ - j,// 04/11/2018 Daniel Driscoll Signature of plan administrator Date Enter name of individual siqnina as o!an administrator SIGN HERE Signature of employerfnlan snonsor Date Enter name of individual signing as emolover or Plan sponsor SIGN HERE Signature of DFE Date Enter name of individual slqnino as DFE Preparer's name (including firm name, if applicable) and address (include room or suite number) Preparer's telephone number For Paperwork Reduction Act Notice, see the Instructions for Form Form 5500 (2016)

2 Form 5500 (2016) Page 2 3a Plan administrator's name and address 0 Same as Plan Sponsor COLUMBIA UNIVERSITY VICE PRESIDENT OF HUMAN RESOURCES 615 w 131ST ST. 3b Administrator's E1N c Administrator's telephone number NEW YORK NY If t~e name and/or EIN of the plan sponsor has changed since the last return/report filed for this plan, enter the name, 4b EIN EIN and the plan number from the last return/report: a Sponsor's name 4c PN 5 Total number of participants at the beginning of the plan year 5 17,511 6 Number of participants as of the end of the plan year unless otherwise stated (welfare plans complete only lines 6a(1), 6a(2), Sb, Sc, and 6d). a(1) Total number of active participants at the beginning of the plan year '.. a(2) Total number of active participants at the end of the plan year a/1l a(2) b Retired or separated participants receiving benefits , C Other retired or separated participants entitled to future benefits c... d Subtotal. Add lines 6a(2), Sb, and Sc e Deceased participants whose beneficiaries are receiving or are entitled to receive benefits.... f Total. Add lines 6d and Se f b 6d 6e 15,708 16,394 1, ,194 g Number of participants with account balances as of the end of the plan year (only defined contribution plans complete this item) g h Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested h 7 Enter the total number of employers obligated to contribute to the plan (only multiemptoyer plans complete this item)... 7 Sa If the plan provides pension benefits, enter the applicable pension feature s from the List of Plan Characteristics Codes in the instructions: b If the plan provides welfare benefits, enter the applicable welfare feature s from the List of Plan Characteristics Codes in the instructions: 4A 4B Sa Plan funding arrangement (check all that apply) (1) Insurance 9b Plan benefit arrangement (check all that apply) (1) Insurance (2) Code section 412(e)(3) insurance contracts (2) 1- Code section 412(e)(3) insurance contracts (3) Trust (3) Trust (4) General assets of the sponsor (4) General assets of the sponsor 10 Check all applicable boxes in 10a and 10b to indicate which schedules are attached, and, where indicated, enter the number attached. (See instructions) a Pension Schedules (1) D R (Retirement Plan Information) b General Schedules (1) eg H (Financial Information) (2) 0 MB (Multiemployer Defined Benefit Plan and Certain Money (2) I D (Financial Information - Small Plan) Purchase Plan Actuarial Information) - signed by the plan 6 (3) A (Insurance Information) actuary ~ (4) C (Service Provider Information) (3) D SB (Single-Employer Defined Benefit Plan Actuarial (5) D (DFE/Participating Plan Information) Information) - signed by the plan actuary (6) D G (Financial Transaction Schedules)

3 Form 5500 (2016) Page 3 Part Ill I Form M-1 Compliance Information (to be completed by welfare benefit plans) 11 a If the plan provides welfare benefits, was the plan subject to the Form M-1 filing requirements during the plan year? (See instructions and 29 CFR )... 0 Yes Iii] No lf "Yes" is checked, complete lines 11b and 11c. 11 b Is the plan currently in compliance with the Form M-1 filing requirements? (See instructions and 29 CFR )... 0 Yes O No 11 c Enter the Receipt Confirmation Code for the 2016 Form M-1 annual report. If the plan was not required to file the 2016 Form M-1 annual report, enter the Receipt Confirmation Code for the most recent Form M-1 that was required to be filed under the Form M-1 filing requirements. (Failure to enter a valid Receipt Confirmation Code will subject the Form 5500 filing to rejection as incomplete.) Receipt Confirmation Code

4 SCHEDULE A (Form 5500) Department of the Treasury Internal Revenue Service Department of Labor Employee Benefits Security Administration Pension Benefit Guaranty Corporation Insurance Information This schedule is required to be filed under section 104 of the Employee Retirement Income Security Act of 1974 (ERISA). ~ File as an attachment to Form > Insurance companies are required to provide the information 0MB No This Form is Open to Public pursuant lo ERISA section 103(a)(2). Inspection For calendar plan year 2016 or fiscal plan year beginning 07/01/2016 and ending 06/30/2017 A Name of plan B Three-digit COLUMBIA UNIVERSITY RETIREE MEDICAL AND LIFE INSURANCE plan number (PN) I 517 BENEFITS PLAN C Plan sponsor's name as shown on line 2a of Form 5500 D Employer Identification Number (ElN) TRUSTEES OF COLUMBIA UNIVERSITY C/O BENEFITS DEPARTMENT Part I I Information Concerning Insurance Contract Coverage, Fees, and Commissions Provide infonnation for each contract on a separate Schedule A Individual contracts arouped as a unit in Parts II and Ill can be reported on a sinole Schedule A. 1 Coverage Information: (a) Name of insurance carrier OXFORD HEALTH PLANS (b) EIN (c) NAIC (NY), INC. (d} Contract or identification number (e) Approximate number of persons covered at end of policy or contract year (f) From Policv or contract vear (g) To H /01/ /30/ Insurance fee and commission information. Enter the total fees and total commissions paid. List in line 3 the agents, brokers, and other persons in descendi order of the amount aid. a Total amount of commissions aid b Total amount of fees aid 3 Persons receiving commissions and fees. (Complete as many entries as needed to report all persons). (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid (b) Amount ofsales and base commissions oaid {c) Amount Fees and other commissions oaid (di Purpose le) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid Fees and other commissions oaid commissions paid le) Amount (d) Purpose fe\ Oroanizatlon For Paperwork Reduction Act Notice, see the Instructions for Form Schedule A (Form 5500) 2016 v

5 Schedule A (Form 5500) 2016 Page2-c=J fa) Name and address of the agent, broker, or other person to whom commissions or fees were paid Fees and other commissions oaid commissions oaid (c) Amount (d) Purpose (e) Organization {a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions oaid (c) Amount Fees and other commissions paid (d) Purpose (e) Organization (a} Name and address of the agent, broker, or other person to whom commissions or fees were paid Fees and other commissions oaid commissions oaid (c) Amount (d) Purpose (e) Organization {a) Name and address of the agent, broker, or other person to whom commissions or fees were paid {b} Amount of sales and base commissions oaid {c} Amount Fees and other commissions oaid (d) Purpose (e) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid {b} Amount of sales and base commissions oaid (c) Amount Fees and other commissions paid (d) Purpose (e) Organization

6 Part II Schedule A (Form 5500) 2016 Page 3 Investment and Annuity Contract Information Where individual contracts are provided, the entire group of such individual contracts with each carrier may be treated as a unit for purposes of this report. 4 Current value of plan's interest under this contract In the general account at year end... 4 I 5 Current value of plan's interest under this contract in separate accounts at year end. s I 6 Contracts With Allocated Funds: a State the basis of premium rates._ b Premiums paid to carrier.... C Premiums due but unpaid at the end of the year... d If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amount. Specify nature of costs ~ e Type of contract: (1) 0 individual policies (2) D group deferred annuity (3) 0 other (specify) ~ f If contract purchased, in whole or in part, to distribute benefits from a terminating plan, check here 7 Contracts With Unallocated Funds (Do not include portions of these contracts maintained in separate accounts) a Type of contract (1) Ddeposit administration (2) 0 immediate participation guarantee (3) Dguaranteed investment (4) 0 other ~ b Balance at the end of the previous year b 0 c Additions: (1) Contributions deposited during the year... 7c{1l (2) Dividends and credits... 7c(2) (3) Interest credited during the year... 7c(3l (4) Transferred from separate account c(4) (5) Other (specify below).... 7c(5) ~ (6)Total additions c(6l 0 d Total of balance and additions (add lines 7b and 7c(6)) d 0 e Deductions: (1) Disbursed from fund to pay benefits or purchase annuities during year 7e(1 l (2) Administration charge made by carrier... 7el2) (3) Transferred to separate account... 7el3l (4) Other (specify below) 7e(4l ~ (5) Total deductions.... ;- _7~e~(5~i)'-+ o f Balance at the end of the current vear (subtract line 7e(5) from line 7d) f 0

7 Schedule A (Form 5500) 2016 Page4 Part Ill Welfare Benefit Contract Information If more than one contract covers the same group of employees of the same employer(s) or members of the same employee organizations(s), the information may be combined for reporting purposes if such contracts are experience-rated as a unit. Where contracts cover individual employees, the entire group of such Individual contracts with each carrier may be treated as a unit for purposes of this report. 8 Benefit and contract type (check all applicable boxes) a ~ Health (other than dental or vision) b DDental co Vision d DLife insurance e DTemporary disability (accident and sickness) f OLong-term disability g DSupplemental unemployment h DPrescription drug i OStop loss (large deductible) j OHMO contract k DPPO contract I OIndemnity contract m DOther (specify) ~ 9 Experience-rated contracts: a Premiums: (1) Amount received , al1) (2) Increase (decrease) in amount due but unpaid a(21 (3) Increase (decrease) in unearned premium reserve a(3) (4) Earned ((1) + (2) - (3)) b Benefit charges (1) Claims paid , bl11 9a(4) (2) Increase (decrease) in claim reserves b/2) I (3) Incurred claims (add (1) and (2)) ,... 9b(3) (4) Claims charged b(41 C Remainder of premium: (1) Retention charges (on an accrual basis)~- (A) Commissions , cl1l/AI (B) Administrative service or other fees , cl1 l(b) (C) Other specific acquisition costs......, c(1 )(C) (D} Other expenses ,... 9c(1 )(D) (E) Taxes......, c(1)(E) (F) Charges for risks or other contingencies c(1 )(F) (G) Other retention charges c(1)(G) (H) Total retention , ' ' ' c(1l!HI (2) Dividends or retroactive rate refunds. (These amounts were 0 paid in cash, or Dcredited.)... 9c(2) d Status of policyholder reserves at end of year: (1) Amount held to provide benefits after retirement... 9d/1l (2) Claim reserves d/2) (3) Other reserves , d(3) e Dividends or retroactive rate refunds due. (Do not include amount entered in Hne 9c(2).) e 10 Nonexperience-rated contracts: a Total premiums or subscription charges paid to carrier a 194,327 b If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, other than reported in Part I, line 2 above, report amount...., b Specify nature of costs Part IV Provision of Information 11 Did the insurance company fail to provide any information necessary to complete Schedule A?.. OYes!xi No 12 If the answer to line 11 is "Yes," specify the information not provided. ~

8 SCHEDULE A (Form 5500) Department of the Treasury Internal Revenue Service Department of Labor Employee Benefits Security Administration Insurance Information This schedule is required to be filed under section 104 of the Employee Retirement Income Security Act of 1974 (ERISA). ~ File as an attachment to Form MB No Pension Benefit Guaranty Corporation ~ Insurance companies are required to provide the information This Form Is Open to Public pursuant to ERISA section 103(a)(2). lnsoection For calendar plan year 2016 or fiscal plan year beginning 07/01/2016 and ending 06/30/2017 A Name of plan B Three-digit COLUMBIA UNIVERSITY RETIREE MEDICAL AND LIFE INSURANCE plan number (PN) ~ I 517 BENEFITS PLAN C Plan sponsor's name as shown on line 2a of Form 5500 D Employer Identification Number (EIN) TRUSTEES OF COLUMBIA UNIVERSITY C/O BENEFITS DEPARTMENT Part I l Information Concerning Insurance Contract Coverage, Fees, and Commissions Provide information for each contract on a senarate Schedule A. Individual contracts arouoed as a unit in Parts 11 and Ill can be reoorted on a sinole Schedule A. 1 Coverage Information: {a) Name of insurance carrier UNITED HEALTHCARE INSURANCE COMPANY (b) EIN (c) NAIC (d) Contract or identification number {e) Approximate number of persons covered at end of nolicy or contract year Policv or contract vear (!) From (g) To H /01/ /30/ Insurance fee and commission information. Enter the total fees and total commissions paid. List in line 3 the agents, brokers, and other persons in descendin order of the amount aid. a Total amount of commissions aid b Total amount of fees aid 3 Persons receiving commissions and fees. (Complete as many entries as needed to report all persons). (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid Fees and other commissions naid commissions naid (c) Amount (d) Purpose (e\ Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid Fees and other commissions 1Jaid commissions naid (c) Amount Id) Purpose /el Oraanization For Paperwork Reduction Act Notice, see the Instructions for Form Schedule A (Form 5500) 2016 V

9 Schedule A (Form 5500) 2016 Page2-CJ (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions oaid (c) Amount Fees and other commissions paid (d) Purpose (e) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions paid (c) Amount Fees and other commissions oaid (d) Purpose (e) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid (b} Amount of sales and base commissions paid (c) Amount Fees and other commissions paid (d) Purpose (e) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions paid (c) Amount Fees and other commissions oaid (d) Purpose (e) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions aaid (c) Amount Fees and other commissions oaid (d) Purpose (e) Organization

10 Schedule A (Form 5500) 2016 Page 3 Part II Investment and Annuity Contract Information Where individual contracts are provided, the entire group of such individual contracts with each carrier may be treated as a unit for purposes of this reoort. 4 Current value of plan's interest under this contract in the general account at year end I 4 I 5 Current value of plan's interest under this contract in separate accounts at year end.....i 5 I 6 Contracts With Allocated Funds: a State the basis of premium rates ~ b Premiums paid to carrier... C Premiums due but unpaid at the end of the year... d 1f the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amount.. Specify nature of costs e Type of contract: (1) 0 individual policies (2) 0 group deferred annuity f (3) 0 other (specify) If contract purchased, in whole or in part, to distribute benefits from a terminating plan, check here 7 Contracts With Unallocated Funds (Do not include portions of these contracts maintained in separate accounts) a Type of contract: (1) 0 deposit administration (2) 0 immediate participation guarantee (3) 0 guaranteed investment (4) 0 other b Balance at the end of the previous year I 7b C Additions: (1) Contributions deposited during the year c(1) (2) Dividends and credits c(2) (3) Interest credited during the year c(3) (4) Transferred from separate account ct4l (5) Other (specify below) c(5l 0 (6)Total additions c(6l I 7d d Total of balance and additions (add lines 7b and 7c(6)). e Deductions: (1) Disbursed from fund to pay benefits or purchase annuities during year (2) Administration charge made by carrier (3) Transferred to separate account (4) other (specify below) e/1) 7e(2) 7e/3) 7e(4) (5) Total deductions......, e(5) f Balance at the end of the current year (subtract line 7e(5) from line 7d) I 7f 0 0

11 Schedule A (Form 5500) 2016 Page4 Part Ill Welfare Benefit Contract Information If more than one contract covers the same group of employees of the same employer(s) or members of the same employee organizations(s), the information may be combined for reporting purposes if such contracts are experience-rated as a unit Where contracts cover individual employees, the entire group of such individual contracts with each carrier may be treated as a unit for purposes of this report. 8 Benefit and contract type (check all applicable boxes) a ~ Health (other than dental or vision) b DDental c DVision d Ollfe insurance e OTemporary disability (accident and sickness} f OLong-term disability g OSupplemental unemployment h OPrescription drug i OStop loss (large deductible) j DHMO contract k OPPO contract I OIndemnity contract mdother (specify) ~ 9 Experience-rated contracts: a Premiums: (1) Amount received a/1 (2) Increase (decrease) in amount due but unpaid a/2 (3) Increase (decrease) in unearned premium reserve a(3 (4) Earned ((1) + (2) - (3)) al41 b Benefit charges (1) Claims paid b(1) (2) Increase (decrease) in claim reserves b(2) (3) Incurred claims (add (1) and (2)) bl3\ (4) Claims charged b(41 C Remainder of premium: (1) Retention charges (on an accrual basis) - (A) Commissions c(1)(A) (B) Administrative service or other fees c(1 )(B) (C) Other specific acquisition costs c(1 )(C) (D) other expenses c(1)(D) (E) Taxes c(1)(E) (F) Charges for risks or other contingencies c(1 )(F) (G) other retention charges c(1)(G) (H) T ota1 retention cC1l(Hl (2) Dividends or retroactive rate refunds. (These amounts were Dpaid in cash, or 0 credited.) c(21 d Status of policyholder reserves at end of year: (1) Amount held to provide benefits after retirement d/11 (2) Claim reserves d/2\ (3) other reserves dl3\ e Dividends or retroactive rate refunds due. (Do not include amount entered in line 9c(2).) e 10 Nonexperience-rated contracts: a Total premiums or subscription charges paid to carrier a 61,563 b If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, other than reported in Part I, line 2 above, report amount.... Specify nature of costs. 10b Part IV Provision of Information 11 Did the insurance company fail to provide any information necessa'y to complete Schedule A?... D Yes fxl No 12 If the answerto line 11 is "Yes," specify the information not provided. ~

12 SCHEDULE A (Form 5500) Department Of the Treasury Internal Revenue Service Department of Labor Employee Benefits Security Admlnistrat!on Pension Benefit Guaranty Corporation Insurance Information This schedule is required to be filed under section 104 of the Employee Retirement Income Security Act of 1974 (ERtSA).., File as an attachment to Form f Insurance companies are required to provide the Information pursuant to ERISA section 103(a)(2). For calendar plan year 2016 or fiscal nlan year beginning 07/01/2016 and ending 06/30/2017 A Name of plan B Three-digit COLUMBIA UNIVERSITY RETIREE MEDICAL AND LIFE INSURANCE plan number (PN) ~ I BENEFITS PLAN 0MB No This Form is Open to Public lnsnection 517 C Plan sponsor's name as shown on line 2a of Form 5500 D Employer Identification Number (EIN) TRUSTEES OF COLUMBIA UNIVERSITY C/O BENEFITS DEPARTMENT Information Concerning Insurance Contract Coverage, Fees, and Commissions Provide information for each contract on a senarate Schedule A. Individual contracts nrouned as a unit in Parts II and Ill can be renorted on a sinnle Schedule A. 1 Coverage Information: I Part I I (a) Name of insurance carrier AETNA LIFE INSURANCE COMPANY (b) EIN (c) NAIC (d) Contract or identification number (e) Approximate number of persons covered at end of policy or contract vear (I) From Policv or contract vear (g) To AE /01/ /31/ Insurance fee and commission information. Enter the total fees and total commissions paid. List in line 3 the agents, brokers, and other persons in descendin order of the amount aid. b Total amount of fees aid 3 Persons receiving commissions and fees. (Complete as many entries as needed to report all persons). (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid Fees and other commissions oaid commissions l"laid (cl Amount Id) Purpose (el Oraanization {a) Name and address of the agent, broker, or other person to whom commissions or fees were paid Fees and other commissions oaid commissions "-aid (c) Amount (d) Purpose le\ Oraanization For Paperwork Reduction Act Notice, see the Instructions for Form Schedule A (Form 5500) 2016 v

13 Schedule A (Form 5500) 2016 Page2-0 (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions oaid (c) Amount Fees and other commissions oaid (d) Purpose (e) Organization (a} Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions oaid (c) Amount Fees and other commissions oaid (d) Purpose (e) Organization (a} Name and address of the agent, broker, or other person to whom commissions or fees were paid Fees and other commissions paid commissions oaid (c) Amount (d) Purpose (e) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions oaid (c) Amount Fees and other commissions oaid (d) Purpose (e) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions oaid (c)amount Fees and other commissions oaid (d) Purpose (e) Organization

14 Schedule A (Form 5500) 2016 Page3 Part II Investment and Annuity Contract Information Where individual contracts are provided, the entire group of such individual contracts with each carrier may be treated as a unit for purposes of this reoort. 4 Current value of plan's interest under this contract in the general account at year end......) 4 I 5 Current value of plan's interest under this contract in separate accounts at year end...! 5 I 6 Contracts With Allocated Funds: a State the basis of premium rates ~ b Premiums paid to carrier Sb I C Premiums due but unpaid at the end of the year Ge d If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or >----d----< retention of the contract or policy, enter amount.... ~--~ Specify nature of costs >- e Type of contract: (1) Dindividual policies (2) D group deferred annuity (3) D other (specify) ~ f If contract purchased, in whole or in part, to distribute benefits from a terminating plan, check here ~ D 7 Contracts With Unallocated Funds (Do not include portions of these contracts maintained in separate accounts) a Type of contract: (1) 0 deposit administration (2) 0 immediate participation guarantee (3) 0 guaranteed investment (4) 0 other >- b Balance at the end of the previous year b c Additions: (1) Contributions deposited during the year... (2) DiVidends and credits c(1) 7c(2l (3) Interest credited during the year... 7cl3) (4) Transferred from separate account cl4l (5) Other (specify below) 7c(5l ~ 0 (6)Total additions c(6) d Total of balance and additions (add lines 7b and 7c(6}).....I 7d e Deductions: (1) Disbursed from fund to pay benefits or purchase annuities during year (2) Administration charge made by carrier (3) Transferred to separate account..... (4) Other (specify below)... ~ 7e(1) 7e(2) 7e(3) 7e(4) 0 0 (5) Total deductions.... ;- -'-7e"c!l'='5,_) ,-o f Balance at the end of the current vear {subtract line 7e(5) from line 7d)... J n o

15 Schedule A (Form 5500) 2016 Page4 Part Ill Welfare Benefit Contract Information If more than one contract covers the same group of employees of the same employer(s) or members of the same employee organizations(s), the information may be combined for reporting purposes if such contracts are experience-rated as a unit. Where contracts cover individual employees, the entire group of such individual contracts with each carrier may be treated as a unit for purposes of this report. 8 Benefit and contract type (check all applicable boxes) 9 a OHealth (other than dental or vision) b ODental co Vision d OUfe insurance e OTemporary disability (accident and sickness) f OLong-term disability g DSupplemental unemployment h OPrescription drug i OStop loss (large deductible) j OHMO contract k ~ PPO contract IO Indemnity contract m OOther (specify) ~ Experience-rated contracts: a Premiums: (1) Amount received a11l (2) Increase (decrease) in amount due but unpaid a(2) (3) Increase (decrease) in unearned premium reseive a(3) (4) Earned ((1) + (2) - (3)) a(4) b Benefit charges (1) Claims paid b(1) (2) Increase (decrease) in claim reserves b(2l (3) Incurred claims (add (1) and (2)) b/3l (4) Claims charged b(4l C Remainder of premium: (1) Retention charges (on an accrual basis) -- (A) Commissions c(1 )(Al (B) Administrative service or other fees... 9c(1)(B) (C) other specific acquisition costs c(1 )(C) (D) other expenses c(1 )(D) (E) Taxes c(1 )(E) (F) Charges for risks or other contingencies c(1 )(F) (G) Other retention charges c(1 )(G) (H) Total retention cl1l/Hl (2) Dividends or retroactive rate refunds. (These amounts were 0 paid in cash, or 0 credited.)... 9c(2l d Status of policyholder reserves at end of year: (1) Amount held to provide benefits after retirement d/1l (2) Claim reserves d/2l (3) other reserves d/3} e Dividends or retroactive rate refunds due. (Do not include amount entered in line 9c(2).) e 10 Nonexperience-rated contracts: a Total premiums or subscription charges paid to carrier a 559,529 b If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, other than reported in Part I, line 2 above, report amount b Specffy nature of costs Part IV Provision of Information 11 Did the insurance company fail to provide any information necessary to complete Schedule A?.. 0 Yes [x/ No 12 If the answer to line 11 is "Yes," specify the Information not provided. ~

16 SCHEDULE A (Form 5500) Department of the Treasury Internal Revenue Service Deparlmen\ of Labor Employee Benefits Security Admlnis\ralion Pension Benefit Guaranty Corporation Insurance Information This schedule is required to be filed under section 104 of the Employee Retirement Income Security Act of 1974 (ERISA). ~ File as an attachment to Form ~ Insurance companies are required to provide the information pursuant to ERISA section 103(a)(2). For calendar plan year 2016 or fiscal plan year beginning 07/01/2016 and ending 06/30/2017 A Name of plan B Three-digit COLUMBIA UNIVERSITY RETIREE MEDICAL AND LIFE INSURANCE olan number (PN) ~ I BENEFITS PLAN 0MB No This Form is Open to Public Inspection 517 C Plan sponsor's name as shown on line 2a of Form 5500 D Employer Identification Number (EIN) I TRUSTEES OF COLUMBIA UNIVERSITY C/O BENEFITS DEPARTMENT Part I j Information Concerning Insurance Contract Coverage, Fees, and Commissions Provide information for each contract on a seoarate Schedule A Individual contracts orouned as a unit in Parts 11 and Ill can be reported on a sinqle Schedule A 1 Coverage Information: (a) Name of insurance carrier THE STANDARD LIFE INSURANCE COMPANY OF NEW YORK (b) EIN (c) NAIC (d) Contract or identification number (e) Approximate number of persons covered at end of policy or contract year (I) From Policv or contract vear (g) To ,095 07/01/ /31/ Insurance fee and commission information. Enter the total fees and total commissions paid. List in line 3 the agents, brokers, and other persons in descendin order of the amount aid. 5,364 b Total amount offees aid 0 3 Persons receiving commissions and fees. (Complete as many entries as needed to report all persons). (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid WILLIS OF MASSACHUSETTS INC. PO BOX BOSTON MA Fees and other commissions oald commissions paid (c) Amount fd) Puroose (e) Organization 5,364 3 (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions oaid Fees and other commissions vaid (c} Amount (d) Puroose tel Oraanization For Paperwork Reduction Act Notice, see the Instructions for Form Schedule A (Form 5500) 2016 v

17 Schedule A (Form 5500) 2016 Page2-c=J (a) Name and address of the agent, broker, or other person to whom commlssfons or fees were paid commissions oafd (c) Amount Fees and other commissions paid (d) Purpose (e) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions oaid (c) Amount Fees and other commissions oaid (d) Purpose (e) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions Dald (c) Amount Fees and other commissions paid (d) Purpose (e) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions oaid (c) Amount Fees and other commissions oaid (d) Purpose (e) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions oald (c) Amount Fees and other commissions oaid (d) Purpose (e) Organization

18 Schedule A (Form 5500) 2016 Page 3 Part II Investment and Annuity Contract Information Where Individual contracts are provided, the entire group of such individual contracts with each carrier may be treated as a unit for purposes of this renort. 4 Current value of plan's interest under this contract in the general account at year end...i 4 I 5 Current value of plan's interest under this contract In separate accounts at vear end...i 5 I 6 Contracts With Allocated Funds: a State the basis of premium rates ~ b Premiums paid to carrier.... C Premiums due but unpaid at the end of the year. d lf the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amount.. Specify nature of costs ~ J:~ I e Type of contract: (1) 0 individual policies (2) 0 group deferred annuity f (3) 0 other (specify) If contract purchased, in whole or in part, to distribute benefits from a terminating plan, check here 7 Contracts With Unallocated Funds (Do not include portions of these contracts maintained in separate accounts) a Type of contract: (1) 0 deposit administration (2) 0 immediate participation guarantee (3) 0 guaranteed investment (4) 0 other ~ b Balance at the end of the previous year b 0 c Additions: (1) Contributions deposited during the year... 7c(1) (2) Dividends and credits... 7c(2) (3) Interest credited during the year 7c(3) (4) Transferred from separate account c(4) (5) Other (specify below) 7c(5) (6)Total additions.... 7c(61 0 d Total of balance and additions (add lines 7b and 7c(6}) , 7d 0 e Deductions: (1) Disbursed from fund to pay benefits or purchase annuities during year 7e(1l (2) Administration charge made by carrier... 7e(2) (3) Transferred to separate account.. 7e(31 (4) Other (specify below)... 7e(41 (5) Total deductions.....r._7_e~(5~)-+- o f Balance at the end of the current year (subtract line 7e(5) from line 7d)... J TI o

19 Part Ill Schedule A (Form 5500) 2016 Page 4 Welfare Benefit Contract Information If more than one contract covers the same group of employees of the same employer(s) or members of the same employee organizations(s), the information may be combined for reporting purposes if such contracts are experience-rated as a unit. Where contracts cover indivldual employees, the entire group of such individual contracts with each carrier may be treated as a unit for purposes of this report. 8 Benefit and contract type (check all applicable boxes) a OHealth (other than dental or vision) b ODental co Vision d ~ Life insurance e OTemporary disability (accident and sickness) f OLong-term disability 9 0 Supplemental unemployment h OPrescription drug i OStop loss (large deductible) j OHMO contract k OPPO contract IOIndemnity contract m Oother (specify) ~ 9 Experience-rated contracts: a Premiums: (1) Amount received ' al11 90, 105 (2) Increase (decrease) in amount due but unpaid '... 9al21 (3) Increase (decrease) in unearned premium reserve a(3\ (4) Earned ((1) + (2) - (3)) ' al4I 90,105 b Benefit charges (1) Claims paid b/11 179,750 (2) Increase (decrease) in claim reserves b(2I 66,208 (3) Incurred claims (add (1) and (2)) ' b(3) 245,958 (4) Claims charged " bl4) 245,958 C Remainder of premium: (1) Retention charges (on an accrual basis) -- (A) Commissions , c/11fA\ 5,364 (B) Administrative service or other fees c(1 l(b) (C) Other specific acquisition costs c(1)(C) (D} Other expenses c(1 )(D) 6,820 (E) Taxes c(1 )(E) 2,253 (F) Charges for risks or other contingencies c(1 )(F) 8,663 (G) Other retention charges c(1)(G) (H) Total retention... " ' '... 9cf1IIHI 23,100 (2) Dividends or retroactive rate refunds. (These amounts were 0 paid in cash, or 0 credited.)... 9c(21 d Status of policyholder reserves at end of year: (1) Amount held to provide benefits after retirement dl1) (2) Claim reserves dl2) 91,219 (3) Other reserves '... ' dl3) e Dividends or retroactive rate refunds due. (Do not include amount entered in line 9c(2).).... ".... 9e 10 Nonexperience-rated contracts: a Total premiums or subscription charges paid to carrier ' a b If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, other than reported in Part l, line 2 above, report amount Specify nature of costs. 10b Part IV Provision of Information 11 Did the insurance company fail to provide any information necessary to complete Schedule A?.. 0 Yes /xj No 12 If the answer to line 11 is "Yes," specify the information not provided. ~

20 SCHEDULE A (Form 5500) Department of the Treasury Internal Revenue Service Department of Labor Employee Benefits Secun1Y Administration Pension Benefit Guaranty Corporation Insurance Information This schedule is required to be filed under section 104 of the Employee Retirement Income Security Act of 1974 (ERISA). ~ File as an attachment to Form ~ Insurance companies are required to provide the information pursuant to ERISA section 103(a)(2). For calendar plan year 2016 or fiscal plan year beginning 07/01/2016 and ending 06/30/2017 A Name of plan COLUMBIA UNIVERSITY RETIREE MEDICAL AND LIFE INSURANCE BENEFITS PLAN plan number (PN) 0MB No This Form is Open to Public Inspection I 517 C Plan sponsor's name as shown on line 2a of Form 5500 D Employer Identification Number (ElN) TRUSTEES OF COLUMBIA UNIVERSITY C/O BENEFITS DEPARTMENT I! Part I Information Concerning Insurance Contract Coverage, Fees, and Commissions Provide information for each contract on a separate Schedule A. Individual contracts orouoed as a unit in Parts II and 111 can be reoorted on a sinale Schedule A 1 Coverage Information: (a) Name of insurance carrier AETNA LIFE INSURANCE COMPANY (b) EIN (c) NAIC {d) Contract or identification number (e) Approximate number of persons covered at end of policy or contract year (I) From Policv or contract vear (g) To AE /01/ /31/ Insurance fee and commission information. Enter the total fees and total commissions paid. List in line 3 the agents, brokers, and other persons in descendin order of the amount aid. a Total amount of commissions aid b Total amount of fees aid 3 Persons receiving commissions and fees. (Complete as many entries as needed to report all persons). (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid (b} Amount of sales and base Fees and other commissions paid commissions oaid (c) Amount (d) Puroose (e) On::ianization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid Fees and other commissions oaid commissions paid (c\ Amount (d) Purpose (e} Qrqanization For Paperwork Reduction Act Notice, see the Instructions for Form Schedule A (Form 5500) 2016 v

21 Schedule A (Form 5500) 2016 Page2-c:::J (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid {b) Amount of sales and base commissions oaid (c) Amount Fees and other commissions oaid (d) Purpose (e) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions paid (c) Amount Fees and other commissions paid (d) Purpose (e) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions oaid (c) Amount Fees and other commissions oaid (d) Purpose (e) Organization {a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions oaid (c) Amount Fees and other commissions oaid (d) Purpose (e) Organization (a} Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions paid (c) Amount Fees and other commissions paid (d) Purpose (e) Organization

22 Schedule A (Form 5500) 2016 Page 3 Part II Investment and Annuity Contract Information Where individual contracts are provided, the entire group of such individual contracts with each carrier may be treated as a unit for purposes of this reoort. 4 Current value of olan's interest under this contract in the general account at year end... I 4 I 5 Current value of olan's interest under this contract in separate accounts at year end ! 5 I 6 Contracts With Allocated Funds: a State the basis of premium rates ~ b Premiums paid to carrier.... c Premiums due but unpaid at the end of the year. d If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amount. Specify nature of costs ~ e Type of contract: (1) 0 individual policies (2) 0 group deferred annuity f (3) D other (specify) If contract purchased, in whole or in part, to distribute benefits from a terminating plan, check here 7 Contracts With Unallocated Funds (Do not include portions of these contracts maintained in separate accounts) a Type of contract: (1) 0 deposit administration (2) 0 immediate participation guarantee (3) Dguaranteed investment (4) 0 other ~ b Balance at the end of the previous year b c Additions: (1) Contributions deposited during the year... (2) Dividends and credits (3) Interest credited during the year... (4) Transferred from separate account c 11 7c 2) 7c 3) 7c 41 (5) other (specify below) 7c(5) 0 (6)Total additions.... d Total of balance and additions (add lines 7b and 7c(6)).. e Deductions: (1) Disbursed from fund to pay benefits or purchase annuities during year (2) Administration charge made by carrier.... (3) Transferred to separate account..... (4) other (specify below) 7e 1) 7e 21 7e 31 7e 4) c(6l 7d 0 0 (5) Total deductions... f Balance at the end of the current year (subtract line 7e(5) from line 7d)......I 7e/5) 7f 0 0

23 Schedule A (Form 5500) 2016 Page4 Part Ill Welfare Benefit Contract Information lf more than one contract covers the same group of employees of the same employer(s) or members of the same employee organizations(s), the information may be combined for reporting purposes if such contracts are experience-rated as a unit. Where contracts cover individual employees, the entire group of such individual contracts with each carrier may be treated as a unit for purposes of this report. 8 Benefit and contract type (check all applicable boxes) a OHealth (other than dental or vision) bo Dental co Vision d DLife insurance e OTemporary disability (accident and sickness) f DLong-term disability g OSupplemental unemployment h OPrescription drug i DStop loss (large deductible) j OHMO contract contract IOIndemnity contract m OOther (specify) ~ 9 Experience-rated contracts: a Premiums: (1) Amount received a/1 (2) Increase (decrease) In amount due but unpaid a(2 (3) Increase (decrease) in unearned premium reserve a(3 (4) Earned ((1) + (2) - (3)) al4\ b Benefit charges (1) Claims paid b(1 (2) Increase (decrease) in claim reserves b(2) (3) Incurred claims (add (1) and (2)) bf3) (4) Claims charged , b(4\ C Remainder of premium: (1) Retention charges (on an accrual basis) -- (A) Commissions c/1)1A) (B) Administrative service or other fees c(1)(B) (C) Other specific acquisition costs....,,, c(1 )(C) (D) Other expenses c(1 )(D) (E) Taxes c(1 )(E) (F) Charges for risks or other contingencies c(1 )(F) (G) other retention charges c(1)(G) (H) Total retention cl1 l(hl (2) Dividends or retroactive rate refunds. (These amounts were Dpaid in cash, or Dcredited.).... 9cl2\ d Status of policyholder reserves at end of year: (1) Amount held to provide benefits after retirement d/1l (2) Claim reserves '... 9d(2\ (3) Other reserves dl3\ e Dividends or retroactive rate refunds due. (Do not include amount entered in line 9c{2).) e 10 Nonexperience-rated contracts: a Total premiums or subscription charges paid to carrier a 81,421 b If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, other than reported in Part I, line 2 above, report amount Specify nature of costs. 10b Part IV Provision of Information 11 Did the insurance company fail to provide any information necessary to complete Schedule A?. nyes pg No 12 If the answer to line 11 is "Yes," specify the information not provided. >-

24 SCHEDULE A (Form 5500) Department of the Treasury Internal Revenue Service Department of Labor Employee Benefits Security AdmlnistraUon Pension Benefit Guaranty Corporation Insurance Information This schedule is required to be filed under section 104 of the Employee Retirement Income Security Act of 1974 (ERlSA). File as an attachment to Form f Insurance companies are required to provide the information pursuant to ERlSA section 103(a)(2). For calendar plan year 2016 or fiscal plan year beginning 07/01/2016 and ending 06/30/2017 A Name of plan B Three-digit COLUMBIA UNIVERSITY RETIREE MEDICAL AND LIFE INSURANCE plan number (PN\ ~ BENEFITS PLAN I 0MB No This Form Is Open to Public lnsoectlon 517 C Plan sponsor's name as shown on line 2a of Form 5500 D Employer Identification Number (EIN) TRUSTEES OF COLUMBIA UNIVERSITY C/0 BENEFITS DEPARTMENT Part I! Information Concerning Insurance Contract Coverage, Fees 1 and Commissions Provide information for each contract I on a seoarate Schedule A. lndlvidual contracts orouoed as a unit in Parts 11 and Ill can be reported on a sinqle Schedule A. 1 Covera e Information: (a} Name of insurance carrier CIGNA LIFE INSURANCE COMPANY OF NEW YORK (b) EIN (c) NAIC (d) Contract or identification number (e) Approximate number of persons covered at end of policy or contract year Policv or contract year (I) From (g) To FLY ,096 04/01/ /30/ Insurance fee and commission information. Enter the total fees and total commissions paid. List in line 3 the agents, brokers, and other persons in descendin order of the amount aid. a Total amount of commissions aid b Total amount of fees aid Persons receiving commissions and fees. (Complete as many entries as needed to report all persons). (a} Name and address of the agent, broker, or other person to whom commissions or fees were paid ALEXANDER BENEFITS CONSULTING, LLC TH ST, SUITE 2870 DENVER co Fees and other commissions oaid commissions paid (cl Amount (d) Purpose (e) Oraanization 740 (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions oaid (c) Amount Fees and other commissions oaid (d) Purpose le) Oraanization For Paperwork Reduction Act Notice, see the Instructions for Form Schedule A (Form 5500) 2016 v

25 Schedule A (Form 5500) 2016 Page2-CJ (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions paid (c) Amount Fees and other commissions oaid (d) Purpose (e) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions oaid (c) Amount Fees and other commissions naid (d) Purpose (e) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid {b} Amount of sales and base commissions oaid (c) Amount Fees and other commissions oaid (d) Purpose (e) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions oaid (c)amount Fees and other commissions oaid (d) Purpose (e) Organization (a) Name and address of the agent, broker, or other person to whom commissions or fees were paid commissions oaid (c) Amount Fees and other commissions paid (d) Purpose (e) Organization

26 Schedule A (Form 5500) 2016 Page 3 Part II Investment and Annuity Contract Information Where individual contracts are provided, the entire group of such individual contracts with each carrier may be treated as a unit for purposes of this report. 4 Current value of plan's interest under this contract in the general account at year end 4 I 5 Current value of plan's interest under this contract in separate accounts at year end.. 5 I 6 Contracts With Allocated Funds: a State the basis of premium rates ~ b Premiums paid to carrier Sb I C Premiums due but unpaid at the end of the year r_6~c---,f d lf the carrier, service, or other organization incurred any specific costs in connection with the acquisition or 6 (1 retention of the contract or policy, enter amount ~--c' ~ Specify nature of costs ~ e Type of contract: (1) 0 individual policies (2) 0 group deferred annuity f (3) 0 other (specify) If contract purchased, in whole or in part, to distribute benefits from a terminating plan, check here 7 Contracts With Unallocated Funds (Do not include portions of these contracts maintained in separate accounts) a Type of contract: (1) 0 deposit administration (2) 0 immediate participation guarantee (3) 0 guaranteed investment (4) 0 other ~ D b c Balance at the end of the previous year.... Additions: (1) Contributions deposited during the year.. (2) Dividends and credits... (3) Interest credited during the year... (4) Transferred from separate account... (5) Other (specify below) c(1l 7c(21 7c(3) 7c(4l 7c(5l b (6)Total additions... d Total of balance and additions (add lines 7b and 7c(6)). e Deductions: (1) Disbursed from fund to pay benefits or purchase annuities during year (2) Administration charge made by carrier.... (3) Transferred to separate account. (4) other (specify below).... 7e(1) 7e(2) 7el3l 7e/4)... r._7~c~(6,.,)e-+ o....! 7d O f (5) Total deductions Balance at the end of the current year (subtract line 7e(5) from line 7d)....,...7'--e=',l-=--5)' ,-o.J n o

27 Schedule A (Form 5500) 2016 Page 4 Part Ill Welfare Benefit Contract Information If more than one contract covers the same group of employees of the same employer(s) or members of the same employee organizations(s), the information may be combined for reporting purposes if such contracts are experience-rated as a unit. Where contracts cover individual employees, the entire group of such individual contracts with each carrier may be treated as a unit for purposes of this report. 8 Benefit and contract type (check all applicable boxes) a OHealth (other than dental or vision) bddental co Vision d ~ Life insurance 9 e OTemporary disability (accident and sickness) f OLong-term disability g OSupplemental unemployment h DPrescription drug I OStop loss (large deductible) j OHMO contract k OPPO contract IOIndemnity contract mdother (specify) ~ Experience-rated contracts: a Premiums: (1) Amount received a/1l (2) Increase (decrease) in amount due but unpaid a(2) (3) Increase (decrease) in unearned premium reserve a(3) (4) Earned ((1) + (2) - (3)) a/4l b Benefit charges (1) Claims paid b(1) (2) Increase (decrease) in claim reserves b(2) I (3) Incurred claims (add (1) and (2)) b(3\ (4) Claims charged bl4) C Remainder of premium: (1) Retention charges (on an accrual basis) -- (A) Commissions c(1l(A) (8) Administrative service or other fees c(1)(B) (C) Other specific acquisition costs c(1 )(C) (D) Other expenses c(1)(D) (E) Taxes c(1)(E) (F) Charges for risks or other contingencies c(1 )(F) (G) Other retention charges c(1)(G) (H) Total retention cl1\IH\ (2) Dividends or retroactive rate refunds. (These amounts were 0 paid in cash, or 0 credited.) c(2l d Status of policyholder reserves at end of year: (1) Amount held to provide benefits after retirement (3) Other reserves d(3\ e Dividends or retroactive rate refunds due. (Do not include amount entered in line 9c{2).) e 10 Nonexperience-rated contracts: a Total premiums or subscription charges paid to carrier a 24,654 9d/1) (2) Claim reserves d(2) b If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, other than reported in Part l, line 2 above, report amount Specify nature of costs. 10b Part IV Provision of Information 11 Did the insurance company fail to provide any information necessary to complete Schedule A?... (xi Yes D No 12 If the answer to line 11 is "Yes," specify the information not provided. ~ 3E) ORGANIZATION CODE

28 SCHEDULE C (Form 5500) Department or the Treasury Internal Revenue Service Dapartment of Labor Emplcyee Benefits Security Administration Pension Benefit Guaranty Corporation Service Provider Information This schedule is required to be filed under section 104 of the Employee Retirement Income Security Act of 1974 (ERlSA). ~ File as an attachment to Form For calendar plan year 2016 or fiscal plan year beginning 07/01/2016 A Name of plan COLUMBIA UNIVERSITY RETIREE MEDICAL AND LIFE INSURANCE BENEFITS PLAN and ending 06/30/2017 B Three-digit 0MB No This Form is Open to Public Inspection. plan number (PN) ~ 517 I C Plan sponsor's name as shown on llne 2a of Form 5500 D Employer Identification Number (EIN) TRUSTEES OF COLUMBIA UNIVERSITY C/O BENEFITS DEPARTMENT f Part I 1Service Provider Information (see instructions) You must complete this Part, in accordance with the instructions, to report the information required for each person who received, directly or indirectly, $5,000 or more in total compensation (i.e., money or anything else of monetary value) in connection with services rendered to the plan or the person's position with the plan during the plan year. lf a person received only eligible indirect compensation for which the plan received the required disclosures, you are required to answer line 1 but are not required to include that person when completing the remainder of this Part. 1 Information on Persons Receiving Only Eligible Indirect Compensation a Check 'Yes" or "No" to indicate whether you are excluding a person from the remainder of this Part because they received only eligible indirect compensation for which the plan received the required disclosures (see instructions for definitions and conditions).. b If you answered line 1a "Yes," enter the name and EIN or address of each person providing the required disclosures for the service providers who received only eligible indirect compensation. Complete as many entries as needed (see instructions). (b) Enter name and EIN or address of person who provided you disclosures on eligible indirect compensation (b) Enter name and ElN or address of person who provided you disclosures on eligible indirect compensation (b) Enter name and EIN or address of person who provided you disclosures on eligible indirect compensation (b) Enter name and EIN or address of person who provided you disclosures on eligible indirect compensation For Paperwork Reduction Act Notice, see the Instructions for Form Schedule C (Form 5500) 2016 v

29 Schedule C (Form 5500) 2016 Page2-D (b) Enter name and EIN or address of person who provided you disclosures on eligible indirect compensation (b) Enter name and EIN or address of person who provided you disclosures on eligible indirect compensation (b) Enter name and EIN or address of person who provided you disclosures on eligible indirect compensation (b) Enter name and EIN or address of person who provided you disclosures on eligible indirect compensation (b) Enter name and EIN or address of person who provided you disclosures on eligible indirect compensation (b) Enter name and EIN or address of person who provided you disclosures on eligible indirect compensation (b) Enter name and EIN or address of person who provided you disclosures on eligible indirect compensation (b) Enter name and EIN or address of person who provided you disclosures on eligible indirect compensation

30 Schedule C (Form 5500) 2016 Page Information on Other Service Providers Receiving Direct or Indirect Compensation. Except for those persons for whom you answered "Yes" to line 1a above, complete as many entries as needed to list each person receiving, directly or indirectly, $5,000 or more in total compensation (i.e., money or anything else of value) In connection with services rendered to the plan or their position with the plan during the plan year, (See instructions). (a) Enter name and EIN or address (see instructions) EMPIRE HEALTHCHOICE ASSURANCE, INC (b) (c) (d) (e) (f) (g) (h) Service Relationship to Enter direct Did service provider Did Indirect compensation Enter total indirect Did the service Code(s) employer, employee compensation paid receive indirect include eligible indirect compensation received by provider give you a organization, or by the plan. If none, compensation? (sources compensation, for which the service provider excluding formula instead of person known to be enter -0-. other than plan or plan plan received the required eligible indirect an amount or a party-in-interest sponsor) disclosures? compensation for which you estimated amount? answered "Yes" to element 12 (f). If none, enter NONE 49 Yes 0 No fill Yes 0 No 0 Yes 0 No ,390 (a) Enter name and ElN or address (see instructions) STATE STREET GLOBAL ADVISORS (b) (c) (d) (e) (f) (g) (h) Service Relationship to Enter direct Did service provider Did indirect compensation Enter total indirect Did the service Code(s) employer, employee compensation paid receive indirect include eligible indirect compensation received by provider give you a organization, or by the plan. If none, compensation? {sources compensation, for which the service provider excluding formula instead of person known to be enter -0-. other than plan or plan plan received the required eligible indirect an amount or a party-in-interest sponsor) disclosures? compensation for which you estimated amount? 51 answered "Yes" to element (f). If none, enter TRUSTEE 18 Yes fill No 0 Yes fill No 0 Yes fill No 0 454,484 0 (a) Enter name and EIN or address (see instructions) UNITEDHEALTHCARE SERVICES, LLC (b) (c) (d) (e) (f) (g) (h) Service Relationship to Enter direct Did service provider Did indirect compensation Enter total indirect Did the service Code(s) employer, employee compensation paid receive indirect include eligible indirect compensation received by provider give you a organization, or by the plan. If none, compensation? (sources compensation, for which the service provider excluding formula instead of person known to be enter -0-. other than plan or plan plan received the required eligible indirect an amount or a party-in-interest sponsor) disclosures? compensation for which you estimated amount? 12 answered 'Yes" to element (f). If none, enter NONE 328,766 Yes 0 No fill Yes 0 No 0 Yes 0 No 0

31 Schedule C (Form 5500) 2016 Page4-C=:J 2. Information on Other Service Providers Receiving Direct or Indirect Compensation. Except for those persons for whom you answered "Yes" to line 1a above, complete as many entries as needed to list each person receiving, directly or indirectly, $5,000 or more in total compensation (i.e., money or anything else of value) in connection with services rendered to the plan or their position with the plan during the plan year. (See instructions). (a) Enter name and EIN or address (see instructions) TOWERS WATSON DELAWARE INC (b) (c) (d) (e) (f) (g) (h) Service Relationship to Enter direct Did service provider Did indirect compensation Enter total indirect Did the service Code(s) employer, employee compensation paid receive indirect include eligible indirect compensation received by provider give you a organization, or by the plan. If none, compensation? {sources compensation, for which the service provider excluding formula instead of person known to be enter -0-. other than plan or plan plan received the required eligible indirect an amount or a party-in-interest sponsor) disclosures? compensation for which you estimated amount? answered "Yes" to element 22 {f). lf none, enter NONE No 0 Yes 0 No [jg Yes 0 No!jg 0 24,440 (a) Enter name and EIN or address (see instructions) EXPRESS SCRIPTS, INC (b) (c) (d) (e) (f) (g) (h) Service Relationship to Enter direct Did service provider Did indirect compensation Enter total indirect Did the service Code(s) employer, employee compensation paid receive indirect include eligible indirect compensation received by provider give you a organization, or by the plan. lf none, compensation? (sources compensation, for which the service provider excluding formula instead of person known to be enter-0-. other than plan or plan plan received the required eligible indirect an amount or a party-in-interest sponsor) disclosures? compensation for which you estimated amount? 12 answered "Yes" to element (f). If none, enter NONE 21,083 Yes 0 No@ Yes 0 No 0 Yes 0 No 0 (a) Enter name and EIN or address {see instructions) OPTUMRX, INC (b) (c) (d) (e) (f) (g) (h) Service Relationship to Enter direct Did service provider Did indirect compensation Enter total indirect Did the service Code(s) employer, employee compensation paid receive indirect include eligible indirect compensation received by provider give you a organization, or by the plan. If none, compensation? (sources compensation, for which the service provider excluding formula instead of person known to be enter -0-. other than plan or plan plan received the required eligible indirect an amount or a party-in-interest sponsor) disclosures? compensation for which you estimated amount? 12 answered "Yes" to element 50 (f). If none, enter NONE 99 Yes@ No 0 Yes D No gg Yes@ No 0 14,302 0

32 Schedule C (Form 5500) 2016 Page5-c:=J Part I IService Provider Information (continued) 3. If you reported on line 2 receipt of indirect compensation, other than eligible indirect compensation, by a service provider, and the service provider is a fiduciary or provides contract administrator, consulting, custodial, investment advisory, investment management. broker, or recordkeeping services, answer the following questions for (a) each source from whom the service provider received $1,000 or more In indirect compensation and (b) each source for whom the service provider gave you a formula used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Complete as many entries as needed to report the required information for each source. (a) Enter seivice provider name as it appears on line 2 TOWERS WATSON DELAWARE INC (d) Enter name and EIN (address) of source of indirect compensation (b) Service Codes (see instructions) (c) Enter amount of indirect compensation 24,440 ( e) Describe the indirect compensation, including any formula used to determine the seivice provider's eligibility for or the amount of the indirect compensation. EMPIRE HEALTHCHOICE ASSURANCE INC SALES AND BASE COMMISION PAID (a) Enter seivice provider name as it appears on ltne 2 (b) Service Codes (see instructions) (c) Enter amount of indirect compensation OPTUMRX, INC. (d) Enter name and EIN (address) of source of indirect compensation COLUMBIA UNIVERSITY $0.12 PER CLAIM (e) Describe the indirect compensation, including any formula used to determine the service provider's eligibility for or the amount of the indirect compensation. 0 (a) Enter service provider name as it appears on line 2 (b) Service Codes (see instructions) (c) Enter amount of indirect compensation OPTUMRX, INC. (d) Enter name and EIN (address) of source of indirect compensation COLUMBIA UNIVERSITY (e) Describe the indirect compensation, including any formula used to determine the service provider's eligibility for or the amount of the indirect compensation. ORX BILLS DRUG MANUFACTURERS FOR REBATES BASED UPON ITS AGREEMENTS WITH THEM. FROM ~HE TIME THAT ORX RECEIVES REBATES UNTIL IT DISTRIBUTES THEM, IT ACCRUES INTEREST [AT THE CURRENT BANK RATE. THIS RATE HAS BEEN LESS THAN 1% FOR THE PERIOD. 0

33 Schedule C (Form 5500) 2016 Page6-[=:J Part II j Service Providers Who Fail or Refuse to Provide Information 4 Provide, to the extent possible, the following information for each service provider who failed or refused to provide the information necessary to complete this Schedule (a) Enter name and EIN or address of service provider (see (b) Nature of (C) Describe the information that the service provider failed or refused to instructions) Service provide Code(sl (a) Enter name and EIN or address of service provider (see (b) Nature of (c) Describe the information that the service provider failed or refused to instructions} Service provide Code(sl (a) Enter name and EIN or address of service provider {see (b) Nature of (c) Describe the information that the service provider failed or refused to instructions) Service provide Codetsl (a) Enter name and EIN or address of service provider (see instructions) (b) Nature of Service Code(sl (c) Describe the information that the service provider failed or refused to provide (a) Enter name and EIN or address of service provider (see instructions) (b) Nature of Service Code!sl (c) Describe the information that the service provider falled or refused to provide (a) Enter name and ElN or address of service provider (see instructions) (b) Nature of Service Codetsl (c) Describe the information that the service provider failed or refused to provide

34 Schedule C (Form 5500) 2016 Page7-c:::J Part Ill I Termination Information on Accountants and Enrolled Actuaries (see instructions) (complete as many entries as needed) a Name: b EIN: C Position: d Address: e Telephone: Explanation: a Name: b EIN: C Position: d Address: e Telephone: Explanation: a Name: b EIN: C Position: d Address: e Telephone: Explanation: a Name: b EIN: C Position: d Address: e Telephone: Explanation: a Name: b EIN: c Position: d Address: e Telephone: Explanation:

35 SCHEDULED (Form 5500) Department of the Treasury Internal Revenue Service DFE/Participating Plan Information This schedule is required to be filed under section 104 of the Employee Retirement Income Security Act of 1974 (ERISA). Department of labor ~ File as an attachment to Form Employee Benefits Security Adminlslralion 1 For calendar--;:;;lan~ear 2016 or fiscalolan vear beainnina 07/01/2016 and endina A Name of plan COLUMBIA UNIVERSITY RETIREE MEDICAL AND LIFE INSURANCE BENEFITS PLAN B Three-digit plan number (PN) ~ 0MB No This Form is Open to Public Inspection. 517 C Plan or DFE sponsor's name as shown on line 2a of Form 5500 D Employer Identification Number (EIN) r TRUSTEES OF COLUMBIA UNIVERSITY c/o BENEFITS DEPARTMENT Part I 1 Information on interests in MTIAs, CCTs, PSAs, and IEs (to be completed by plans and DFEs)!Comolete as manv entries as needed to reoort all interests in OF Es\ a Name of MTIA, CCT, PSA, or IE:US AGGREGATE BOND INDX NL QP CTF b Name of sponsor of entity listed in (a): STATE STREET GLOBAL ADVISORS TRUST COMPANY d Entity e Dollar value of interest in MTIA, CCT, PSA, or C EIN-PN C le at end of ear see instructions 38,348,448 a Name of MTIA, CCT, PSA, or IE:MSCI EAFE INDEX NL QP CTF b Name of sponsor of entity listed in (a): STATE STREET GLOBAL ADVISORS TRUST COMPANY c EIN-PN d Entity e Dollar value of interest in MTIA, CCT, PSA, or C IE at end of ear see instructions 30,646,181 a NameofMTIA,CCT,PSA,or E: S & p 100 INDEX NL QP CTF b Name of sponsor of entity listed in (a): STATE STREET GLOBAL ADVISORS TRUST COMPANY d Entity e Dollar value of interest in MTlA, CCT, PSA, or C EIN-PN C IE at end of ear see instructions 26,989,135 a Name ofmtia, CCT, PSA, or IE: S & P 500 CTF INDEX NL QP CTF b Name of sponsor of entity listed in (a):state STREET GLOBAL ADVISORS TRUST COMPANY d Entity C EIN-PN C e Dollar value of interest in MTIA, CCT, PSA, or IE at end of ear see instructions a Name ofmtia, CCT, PSA, or IE:US TIPS INDEX NL QP CTF b Name of sponsor of entity listed in (a): STATE STREET GLOBAL ADVISORS TRUST COMPANY d Entity e Dollar value of interest in MTIA, CCT, PSA, or C EIN-PN C IE at end of ear see instructions 9,573,718 a Name of MTIA, CCT, PSA, or IE: b Name of sponsor of entity listed in (a): C EIN-PN d Entity e Dollar value of interest in MTIA, CCT, PSA, or IE at end of ear see instructions a Name of MTIA, CCT, PSA, or IE: b Name of sponsor of entity listed in (a): C EIN-PN d Entity e Dollar value of interest in MTIA, CCT, PSA, or IE at end of ear see instructions For Papel'W'ork Reduction Act Notice, see the Instructions for Form Schedule D (Form 5500) 2016 v

36 Schedule D (Form 5500) 2016 Page2-D a Name of MTIA, CCT, PSA, or IE: b Name of sponsor of entity listed in (a): C EIN-PN d Entity e Dollar value of interest in MTIA, CCT, PSA, or IE at end of ear see instructions a Name of MTIA, CCT, PSA, or IE: b Name of sponsor of entity listed in (a): C EIN-PN d Entity e Dollar value of interest in MTIA, CCT, PSA, or IE at end of ear see instructions a Name of MTIA, CCT, PSA, or IE: b Name of sponsor of entity listed in (a): C EIN-PN d Entity e Dollar value of interest in MTIA, CCT, PSA, or IE at end of ear see instructions a Name of MTIA, CCT, PSA, or IE: b Name of sponsor of entity listed in (a): C EIN-PN d Entity e Dollar value of Interest in MTIA, CCT, PSA, or IE at end of ear see instructions a Name of MTIA, CCT, PSA, or IE: b Name of sponsor of entity Ksted in (a): C EIN-PN d Entity e Dollar value of interest in MTIA, CCT, PSA, or IE at end of ear see instructions a Name of MTIA, CCT, PSA, or IE: b Name of sponsor of entity listed in (a): C EIN-PN d Entity e Dollar value of interest in MTIA, CCT, PSA, or le at end of ear see instructions a Name of MTIA, CCT, PSA, or IE: b Name of sponsor of entity listed in (a): C EIN-PN d Entity e Dollar value of interest in MTIA, CCT, PSA, or IE at end of ear see instructions a Name of MTIA, CCT, PSA, or IE: b Name of sponsor of entity listed in (a): C EIN-PN d Entity e Dollar value of interest in MTIA, CCT, PSA, or IE at end of ear see instructions a Name of MTIA, CCT, PSA, or IE: b Name of sponsor of entity listed in (a): C EIN-PN d Entity e Dollar value of interest in MTIA, CCT, PSA, or IE at end of ear see instructions a Name of MTIA, CCT, PSA, or IE: b Name of sponsor of entity listed in (a): C EIN-PN d Entity e Dollar value of interest in MTIA, CCT, PSA, or le at end of ear see instructions

37 Schedule D (Form 5500) 2016 Page3-Q Part II a Plan name b Name of plan sponsor IC EIN-PN a Plan name b Name of plan sponsor a b Plan name Name of plan sponsor C EIN-PN C EIN-PN a Plan name b Name of plan sponsor C EIN-PN a Plan name b Name of plan sponsor C EIN-PN a Plan name b Name of plan sponsor C EIN-PN a Plan name b Name of plan sponsor C EIN-PN a Plan name b Name of plan sponsor C EIN-PN a Plan name b Name of plan sponsor C EIN-PN a Plan name b Name of plan sponsor IC EIN-PN a Plan name b Name of plan sponsor IC EIN-PN a Plan name b Name of plan sponsor IC EIN-PN

38 SCHEDULE H (Form 5500) Internal Revenue Service Department of Labor Employee Benefits Security Administration Pension Benefit Guaranty Corporallon For calendar plan vear 2016 or fiscal plan vear beqinnlnq A Name of plan COLUMBIA UNIVERSITY RETIREE MEDICAL BENEFITS PLAN Financial Information This schedule is required to be filed under section 104 of the Employee Retirement Income Security Act of 1974 (ERISA), and section 605B{a) of the Internal Revenue Code (the Code). OMBNo ~ File as an attachment to Form This Form is Open to Public Inspection 07/01/2016 and endino 06/30/2017 B AND LIFE INSURANCE Three-digit plan number (PN) ~ I 517 C Plan sponsor's name as shown on line 2a of Form 5500 D Employer Identification Number (EIN) TRUSTEES OF COLUMBIA UNIVERSITY C/0 BENEFITS DEPARTMENT I Part I IAsset and Liability Statement 1 Current value of plan assets and liabilities at the beginning and end of the plan year. Combine the value of plan assets held in more than one trust. Report the value of the plan's interest in a commingled fund containing the assets of more than one plan on a line-by-line basis unless the value Is reportable on lines 1c(9) through 1c(14). Do not enter the value of that portion of an insurance contract which guarantees, during this plan year, to pay a specific dollar benefit at a future date. Round off amounts to the nearest dollar. MTIAs, CCTs, PSAs, and les do not complete lines 1b(1), 1b(2), 1c(B), 1g, 1h, and 1i. CCTs, PSAs, and !Es also do not complete lines 1 d and 1 e. S ee instructions.. Assets (a) BeQinninQ of Year lb) End of Year a Total non!nterest-bearing cash b Receivables (less allowance for doubtful accounts): (1) Employer contributions (2) Participant contributions (3) other C General investments: (1) Interest-bearing cash (include money market accounts & certificates of deposit) (2) U.S. Government securities (3) Corporate debt instruments (other than employer securities): (A) Preferred (B) All other (4) Corporate stocks (other than employer securities): (A) Preferred (B) Common (5) Partnership/joint venture interests (6) Real estate (other than employer real property) (7) Loans (other than to participants) (8) Participant loans (9) Value of interest in common/collective trusts {10) Value of interest in pooled separate accounts (11) Value of interest in master trust investment accounts... (12) Value of interest in investment entities (13) Value of interest in registered investment companies (e.g., mutual funds)......,... (14) Value of funds held in insurance company general account (unallocated contracts) (15) Other a 1 b(1) 1b(2) 1b(3) 1c(1) 1c(2) 1c(3)(A) 1c(3)(B) 1c(4)(A) 1c(4)(B) 1c(5) 1c(6) 1c(7) 1c(8) 1c(9) 171,619,54E 192,340,338 1c(10) 1c(11) 1c(12) 1c(13) 1c(14) 1c(15) For Paperwork Reduction Act Notice, see the Instructions for Form Schedule H (Form 5500) 2016 v

39 Schedule H (Form 5500) 2016 Page 2 1 d Employer-related investments: (1) Employer securities.... (2) Employer real property.... e Buildings and other property used in plan operation.... f Total assets (add all amounts in lines 1a through 1e) g Benefit claims payable h Operating payables.. Acquisition indebtedness... Other liabilities.... Liabilities k Total liabilities (add all amounts in lines 1g through1j) Net Assets Net assets (subtract line 1 k from line 1f)... (a) Beginning of Year (b) End of Year 1d(1) 1d(2) 1e ,619, ,340,338 1g 1h 11 1j 187, ,873 1k 187, ,873...Lj 1_I-~----1_7_1_,_4_3_lc_,_6_6_2_,_/ 1_9_1-C..,_8_6_2c_,_4_6_5_ IPart II!income and Expense Statement 2 Plan income, expenses, and changes in net assets for the year. Include all income and expenses of the plan, including any trust(s) or separately maintained fund(s) and any payments/receipts to/from insurance carriers. Round off amounts to the nearest dollar. MT1As, CCTs, PSAs, and IEs do not complete lines 2a, 2b(1)(E), 2e, 21, and 2g. a Contributions: Income (1) Received or receivable in cash from: (A) Employers. (B) Participants (C) Others (including rollovers).... (2) Noncash contributions. (3) Total contributions. Add lines 2a(1)(A), (B), (C), and line 2a(2).... b Earnings on Investments: (1) Interest: (A) Interest-bearing cash (including money market accounts and certificates of deposit).... (B) U.S. Government securities..... (C) Corporate debt instruments.... (D) Loans (other than to participants)... (E) Participant loans.... (F) Other... (G) Total interest. Add lines 2b(1 )(A) through (F).... (2) Dividends: (A) Preferred stock.... (B) Common stock (C) Registered investment company shares (e.g. mutual funds)... (D) Total dividends. Add lines 2b(2)(A), (B), and (C) (3) Rents.... (4) Net gain (loss) on sale of assets: (A) Aggregate proceeds.. (B) Aggregate carrying amount (see instructions).. (C) Subtract line 2b(4)(B) from line 2b(4)(A) and enter result.... (5) Unrealized appreciation (depreciation) of assets: (A} Real estate.... (B) other... (C) Total unrealized appreciation of assets. Add lines 2b(5)(A) and (B) (a) Amount 2a(1)(A) 4,406,560 2a(1)(B) 6,001,945 2a(1)(C) 2a(2) (b) Total 2a(3) 10,408,505 2b(1)(A) 2b(1)(B) 2b(1)(C) 2b(1)(D) 2b(1)(E) 2b(1)(F) 2b(1)(G) 0 2b(2)(A) 2b(2)(B) 2b(2)(C) 2b(2)(D) 0 2b(3) 2b(4)(A) 2b(4)(B) 2b(4)(C) 0 2b(5)(A) 2b(5)(B) 2b(5)(C) 0

40 Schedule H (Fonn 5500) 2016 Page 3 (6) Net investment gain (loss) from common/collective trusts.. (7) Net Investment gain (loss) from pooled separate accounts.. (8) Net investment gain (loss) from master trust investment accounts.... (9) Net investment gain (loss) from investment entities.... (10) Net investment gain (loss) from registered investment companies (e.g., mutual funds)... C Other Income.. d Total income. Add all income amounts in column (b) and enter total.... Expenses e Benefit payment and payments to provide benefits: (1) Directly to participants or beneficiaries, including direct rollovers.. (2) To insurance carriers for the provision of benefits.. (3) other... (4) Total benefit payments. Add lines 2e(1) through (3)... f Corrective distributions (see instructions)... g Certain deemed distributions of participant loans (see instructions)... h Interest expense... k I Administrative expenses: (1) Professional fees.... (2) Contract administrator fees.. (3) Investment advisory and management fees... (4) Other.... (5) Total administrative expenses. Add lines 21(1) through (4).. Total expenses. Add all expense amounts in column (b) and enter total... Net Income and Reconciliation Net income (loss). Subtract line 2j from line 2d... Transfers of assets: (1) To this plan.... (2) From this plan..... (a) Amount (b) Total 2b(6) 22,930,482 2b(7) 2b(8) 2b(9) 2b(10) 2c 2d 33,338,987 2e(1) 2e(2) 11,581,158 2e(3) 2e(4) 11,581, g 2h 2i(1) 2i(2) 872,542 2i(3) 454,484 21(4) 21(5) 1,327,026 2j 12,908,184 20,430,803 IPart Ill IAccountant's Opinion 3 Complete lines 3a through 3c if the opinion of an independent qualified public accountant is attached to this Form Complete line 3d if an opinion is not attached. a The attached opinion of an independent qualified public accountant for this plan is (see instructions): (1) 0 Unqualified (2) DQualified (3) ~ Disclaimer (4) 0 Adverse b Did the accountant perform a limited scope audit pursuant to 29 CFR *8 and/or 103*12(d)?!jg Yes 0 No c Enter the name and EIN of the accountant (or accounting firm) below: (1) Name: PRICEWATERHOUSECOOPERS (2) EIN: d The opinion of an independent qualified public accountant is not attached because: (1) 0 This form is filed for a CCT, PSA, or MTIA. (2) 0 It will be attached to the next Form 5500 pursuant to 29 CFR *50. IPart IV ICompliance Questions 4 CCTs and PSAs do not complete Part IV. MTlAs, 103*12 IEs, and GIAs do not complete lines 4a, 4e, 4f, 4g, 4h, 4k, 4m, 4n, or *12 IEs also do not complete lines 4j and 41. MTIAs also do not complete line 41. During the plan year: Yes No Amount a Was there a failure to transmit to the plan any participant contributions within the time period described in 29 CFR *102? Continue to answer 'Yes" for any prior year failures until fully corrected. (See instructions and DOL's Voluntary Fiduciary Correction Program.).... 4a X b Were any loans by the plan or fixed income obligations due the plan in default as of the close of the plan year or classified during the year as uncollectible? Disregard participant loans secured by participant's account balance. (Attach Schedule G (Form 5500) Part I if"yes" is checked.).... 4b X

41 Schedule H (Form 5500) 2016 Page4-0 C d e f g Were any leases to which the plan was a party in default or classified during the year as uncollectible? (Attach Schedule G (Form 5500) Part II if"yes" is checked.).... Were there any nonexempt transactions with any party-in-interest? (Do not include transactions reported on line 4a. Attach Schedule G (Form 5500) Part 111 if ''Yes" is checked.) ' , Was this plan covered by a fidelity bond? Did the plan have a loss, whether or not reimbursed by the plan's fidelity bond, that was caused by fraud or dishonesfy? Did the plan hold any assets whose current value was neither readily determinable on an established market nor set by an independent third party appraiser? g X h Did the plan receive any noncash contributions whose value was neither readily determinable on an established market nor set by an independent third party appraiser? h X i Did the plan have assets held for investment? (Attach schedule(s) of assets if 'Yes" is checked, and see instructions for format requirements.) i X j Were any plan transactions or series of transactions in excess of 5% of the current value of plan assets? (Attach schedule of transactions if"yes" is checked, and see instructions for format requirements.) j X k Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought under the control of the PBGC? k X I Has the plan failed to provide any benefit when due under the plan? X m n If this is an individual account plan, was there a blackout period? (See instructions and 29 CFR ) m If 4m was answered "Yes," check the "Yes" box if you either provided the required notice or one of the exceptions to providing the notice applied under 29 CFR ~ n 0 Defined Benefit Plan or Money Purchase Pension Plan Only: Were any distributions made during the plan year to an employee who attained age 62 and had not 5a separated from service? Has a resolution to terminate the plan been adopted during the plan year or any prior plan year? If 'Yes," enter the amount of any plan assets that reverted to the employer this year... 0 Yes No Amount: 4c 4d 4e 41 4o Yes No Amount X X X X 25,000,000 5b If, during this plan year, any assets or liabilities were transferred from this plan to another plan(s), identify the plan(s) to which assets or liabilities were transferred (See instructions) 5b(1) Name of plan(s) 5b(2) EIN(s) 5b(3) PN(s) 5c If the plan is a defined benefit plan, is it covered under the PBGC insurance program (See ERISA section 4021.)?... 0 Yes If "Yes" is checked, enter the My PAA confirmation number from the PBGC premium filing for this plan year IPart V l Trust Information Sa Name of trust 0 No ONot determined. (See instructions.) 6b Trust's EIN Sc Name of trustee or custodian Sd Trustee's or custodian's telephone number

42 Plan Name Plan Sponsor EIN 13-S ERISA Plan# 517 Plan Year Ending 06/30/2017 COLUMBIA UNIVERSITY RETIREE MEDICAL AND LIFE INSURANCE BENEFITS PLAN The required attachment marked with an "X" in the Attachment column is included within the Accountant's Opinion attachment to Sch. H, Part III, Line 3, which consists of the entire audit report issued by the plan's Independent Qualified Public Accountant (IQPA), Form/Schedule Line# Description Attachment 5500 Sch. H Line 3 Financial statements used in formulating the IQPA's opinion 5500 Sch. H Line 4i Schedule of Assets (Held at End of Year) X 5500 Sch. H Line 4i Schedule of Assets (Acquired and Disposed of Within Year) 5500 Sch. H Line 4j Schedule of Reportable Transactions X 5500 Sch. H Line 4a Schedule of Delinquent Participant Contributions X

43 Plan Name Plan Sponsor EIN ERISA Plan# 517 Plan Year Ending 06/30/2017 COLUMBIA UNIVERSITY RETIREE MEDICAL AND LIFE INSURANCE BENEFITS PLAN The required attachment marked with an "X" in the Attachment column is included within the Accountant's Opinion attachment to Sch. H, Part III, Line 3, which consists of the entire audit report issued by the plan's Independent Qualified Public Accountant (IQPA). Form/Schedule Line# Description Attachment 5500 Sch. H Une 3 Financial statements used in formulating the IQPA's opinion 5500 Sch. H Line 4i Schedule of Assets (Held at End of Year) X 5500 Sch. H Line 4i Schedule of Assets (Acquired and Disposed of Within Year) 5500 Sch. H Line 4j Schedule of Reportable Transactions X 5500 Sch. H Line 4a Schedule of Delinquent Participant Contributions X

44 Columbia University Retiree Medical and Life Insurance Benefits Plan Financial Statements and Supplemental Schedules June 30, 2017 and 2016

45 Columbia University Retiree Medical and Life Insurance Benefits Plan Index Page(s) Report of Independent Auditors Financial Statements Statements of Net Assets Available for Benefits June 30, 2017 and Statement of Changes in Net Assets Available for Benefits Year Ended June 30, Statements of Plan Benefit Obligations June 30, 2017 and Statement of Changes in Plan Benefit Obligations Year Ended June 30, Notes to Financial Statements June 30, 2017 and Supplemental Schedules Schedule H, Line 41 - Schedule of Assets (Held at End of Year) June 30, Schedule H, Line 4j - Schedule of Reportable Transactions Year Ended June 30, *All other schedules required by 29 CFR of the Department of Labor's Rules and Regulations for Reporting and Disclosure under the Employee Retirement Income Security Act of are not included because they are not applicable.

46 pwc Report ofindependent Auditors To the Administrator of Columbia University Retiree Medical and Life Insurance Benefits Plan Report on the Financial Statements We were engaged to audit the accompanying financial statements of Columbia University Retiree Medical and Life Insurance Benefits Plan (the "Plan"), which comprise the statements of net assets available for benefits and of plan benefit obligations as of June 30, 2017 and 2016, and the related statement of changes in net assets available for benefits and of changes in plan benefit obligations for the year ended June 30, 2017, and the related notes to the financial statements. Management's Responsibilityfor the Financial Statements Management is responsible for the preparation and fair presentation of the financial statements in accordance with accounting principles generally accepted in the United States of America; this includes the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement, whether due to fraud or error. Audito, s'responsibility Our responsibility is to express an opinion on the financial statements based on conducting the audit in accordance with auditing standards generally accepted in the United States of America. Because of the matter described in the Basis for Disclaimer of Opinion paragraph, however, we were not able to obtain sufficient appropriate audit evidence to provide a basis for an audit opinion. Basis/or Disclaimer ofopinion As permitted by 29 CFR of the Department of Labor's Rules and Regulations for Reporting and Disclosure under the Employee Retirement Income Security Act of 1974, the plan administrator instructed us not to perform, and we did not perform, any auditing procedures with respect to the information summarized in Note 5, which was certified by State Street Global Advisors Trust Company ("State Street"), the custodian of the Plan's investment assets, except for comparing such information with the related information included in the financial statements. We have been informed by the plan administrator that State Street holds the Plan's investment assets and executes investment transactions. The plan administrator has obtained a certification from State Street as of June 30, 2017 and 2016 and for PricewaterhouseCoopers LLP, PricewaterhouseCoopers Center, 300 Madison Avenue, New York, NY T: (646) , F: (813) ,

47 pwc the year ended June 30, 2017, that the information provided to the plan administrator by State Street is complete and accurate. Disclaimer ofopinion Because of the significance of the matter described in the Basis for Disclaimer of Opinion paragraph, we have not been able to obtain sufficient appropriate audit evidence to provide a basis for an audit opinion. Accordingly, we do not express an opinion on the financial statements. Other Matter The supplemental schedules of assets (held at end of year) at June 30, 2017 and of reportable transactions for the year ended June 30, 2017 are required by the Department of Labor's Rules and Regulations for Reporting and Disclosure under the Employee Retirement Income Security Act of 1974 and are presented for the purpose of additional analysis and are not a required part of the financial statements. Because of the significance of the matter described in the Basis for Disclaimer of Opinion paragraph, we do not express an opinion on these supplemental schedules. Report on Form and Content in Compliance with DOL Rules and Regulations The form and content ofthe information included in the financial statements and supplemental schedules, other than that derived from the information ce1tified by the custodian, have been audited by us in accordance with auditing standards generally accepted in the United States of America and, in our opinion, are presented in compliance with the Department of Labor's Rules and Regulations for Reporting and Disclosure under the Employee Retirement Income Security Act of New York, New York April 10,

48 Columbia University Retiree Medical and Life Insurance Benefits Plan Statements of Net Assets Available for Benefits June 30, 2017 and Assets Investments, at fair value Common collective trust funds $ 192,340,338 $ 171,619,546 Total assets 192,340, ,619,546 Liabilities Amount payable to Columbia University 358,657 82,149 Accrued expenses 119, ,735 Total liabilities 477, ,884 Net assets available for benefits $ 191,862,465 $ 171,431,662 The accompanying notes are an integral part of these financial statements. 3

49 Columbia University Retiree Medical and Life Insurance Benefits Plan Statements of Changes in Net Assets Available for Benefits Year Ended June 30, 2017 Additions to net asset attributed to Net appreciation in the fair value of common collective trust funds Retiree contributions Employer contributions Total additions Deductions from net assets attributed to Benefits paid Insurance premiums Total benefits paid Administrative expenses Total deductions Net increase in net assets available for benefits Net assets available for benefits Beginning of year End of year $ 22,930,482 6,001,945 4,406,560 33,338,987 10,573,590 1,007,568 11,581,158 1,327,026 12,908,184 20,430, ,431,662 $ 191,862,465 The accompanying notes are an integral part of these financial statements. 4

50 Columbia University Retiree Medical and Life Insurance Benefits Plan Statements of Plan Benefit Obligations June 30, 2017 and 2016 Postretirement benefit obligations Participants currently receiving benefits Other fully eligible participants Participants not yet fully eligible for benefits $ 65,429,786 47,522,414 34,473,060 $ 72,263,530 46,815,205 36,398,147 Total plan benefit obligations $ 147,425,260 $ 155,476,882 The accompanying notes are an integral part of these financial statements. 5

51 Columbia University Retiree Medical and Life Insurance Benefits Plan Statement of Changes in Plan Benefit Obligations Year Ended June 30, 2017 Postretirement benefit obligations at beginning of year $ 155,476,882 Increase (decrease) during the year attributable to Additional benefits accumulated Interest Benefits paid Actuarial (gains)/ losses and other Change in actuarial assumptions 7,047,885 5,900,212 (11,581,158) (4,188,073) {5,230,488) Net decrease {8,051,622) Postretirement benefit obligations at end of year $ 147,425,260 The accompanying notes are an integral part of these financial statements. 6

52 Columbia University Retiree Medical and Life Insurance Benefits Plan Notes to Financial Statements June 30, 2017 and Plan Description The following description of the Columbia University Retiree Medical and Life Insurance Benefits Plan Trust (the "Plan") is provided for general informational purposes only. Participants should refer to the Plan document for more complete information. General The Plan provides health and life insurance benefits covering retired officers and support staff of Columbia University (the "University"), It is funded through the Columbia University Retiree Medical and Life Insurance Benefits Trust (the "Trust"), payments from the University's general assets and retiree contributions. The Plan is subject to the provisions of the Employee Retirement Income Security Act of The Trustees of the Trust are officers of the University. Pian Benefits The Plan covers health benefits (medical, hospital, surgical and prescription drugs) and life insurance to retirees and their eligible covered dependents. In general, eligibility for benefits under the Plan is completion of ten years of service at the University after attainment of age 55. The University subsidizes the cost of medical and life insurance benefits for all eligible retirees and pays insured premiums for retiree life insurance and certain medical options. For officers who retired after December 31, 2002, the University has eliminated life insurance coverage. For eligible unionized participants, a life insurance benefit of up to $6,000 is payable upon death after retirement. Plan Administration The general administration of the Plan and the responsibility for carrying out the Plan's provisions are performed by the Vice President for Human Resources of Columbia University. Funding Policy and Participant Contributions The University contribution for participants retired between July 1, 2004 and December 31, 2011 is as follows: Retiree o The Columbia Dollar Commitment (CDC) for pre-65 coverage is $248 per month for retiree coverage, $372 per month for retiree plus spouse coverage and $496 per month for retiree, spouse and one or more children coverage. The CDC for post-65 coverage is $144 per month for retiree coverage and $216 per month for retiree plus spouse coverage and $288 per month for retiree, spouse and one or more children coverage. Retirees pay the difference between the CDC and the cost of the plan. Spouse and Children o Columbia's contribution for spouses and children is 50% of its contribution for retired officers. 7

53 Columbia University Retiree Medical and Life Insurance Benefits Plan Notes to Financial Statements June 30, 2017 and 2016 The University contribution for participants retired on or after January 1, 2012 is as follows: Retiree o The Columbia Dollar Commitment (CDC) for pre-65 coverage and post-65 coverage is $72 per month for retiree coverage $108 per month for retiree plus spouse coverage and $144 per month for retiree, spouse and one or more children coverage. Retirees pay the difference between the CDC and the cost of the plan. Spouse and Children o Columbia's contribution for spouses and children is 50% of its contribution for retired officers The Plan recognizes contributions in the plan year in which the contribution is received from the University. For support staff, the Plan is noncontributory for participants. Officers who retired before January 1, 1987 are not required to contribute for health coverage. Officers who retired after 1986 make monthly contributions towards the Plan. The monthly contribution depends on the date of retirement, the health plan chosen by the retiree and the level of coverage. Officers who retired after 1986 and before July 1, 1994 may be required to make contributions for certain Component Plans providing health care benefits. Contributions are set at the discretion of the Plan Administrator. The current amount of this contribution is $5 for retiree coverage and $10 for family coverage. For officers who retired after June 30, 1994, the Plan will pay a fixed dollar amount (Columbia Dollar Commitment or "CDC") toward the cost of a participant's medical coverage under the chosen health plan. Plan participants will be responsible for paying the difference between the cost of coverage under the health plan that they enroll in and the CDC. In no event will a participant be entitled to any part of the CDC in cash if the cost of coverage under the chosen health plan costs less than the CDC. The CDC is stipulated in the Plan and may be adjusted by amendment to the Plan. Contributions are collected by the University and remitted to the Plan. The health benefit claims made, insured premiums and certain administrative expenses are paid directly by the University and are reimbursed by the Plan. Amount payable to Columbia University represents those amounts paid by the University that have not been reimbursed by the Plan. Investments Plan investments are managed under the terms of agreement between the University and State Street Global Advisors Trust Company, ("State Street"), the custodian of the Plan's investment assets. State Street Global Advisors Trust Company holds the investment assets and acts as investment manager of the Plan's assets. 8

54 Columbia University Retiree Medical and Life Insurance Benefits Plan Notes to Financial Statements June 30, 2017 and Summary of Significant Accounting Policies Basis of Accounting The accompanying financial statements are prepared on the accrual basis of accounting and in conformity with accounting principles generally accepted in the United States of America. Investment Valuation and Income Recognition Investments are recorded at fair value. The Plan's trustees determine the Plan's valuation policies utilizing information provided by the investment advisors and custodian. Fair value is the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. See Note 4 for discussion of fair value measurements. Purchases and sales of securities are recorded on a trade-date basis. Interest income is recorded as earned. Dividends are recorded on the ex-dividend date, or as soon as the investment advisor is informed of the ex-dividend date. Net appreciation (depreciation) in the fair value of investments consists of the realized gains or losses and the unrealized appreciation or depreciation on those investments. Actuarial Method The actuarial method used to calculate plan benefit obligations is the projected unit credit method. Payment of Benefits Benefits paid to participants are recorded when paid. Claim payments are recorded when paid by the third party claims processor. Claim payments are net of prescription drug rebates and other credits, totaling $1,112,543 for the year ended June 30, Administrative Expenses Investment expenses and claim administration expenses are paid by the Plan. Other administrative expenses are paid by the University and are not reflected in the Plan's financial statements. Use of Estimates The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and changes therein, disclosure of contingent assets and liabilities, and benefit obligations and changes therein at the dates of the financial statements. Actual results could differ from those estimates. Risk and Uncertainties Investments are exposed to various risks, such as interest rate, market, and credit risks. Market values of investments can decline for a number of reasons, including changes in prevailing market and interest rates, increases in defaults, and credit rating downgrades. Due to the level of risk associated with certain investments, it is at least reasonably possible that changes in the values of investments will occur in the near term and that such changes could materially affect the amounts reported in the statement of net assets available for benefits. Plan contributions are made, and the actuarial present value of accumulated plan benefits are reported based on certain assumptions pertaining to interest rates, inflation rates and employee demographics, all of which are subject to change. Due to uncertainties inherent in the estimates 9

55 Columbia University Retiree Medical and Life Insurance Benefits Plan Notes to Financial Statements June 30, 2017 and 2016 and assumptions process, it is at least reasonably possible that changes in these estimates and assumptions in the near term would be material to the financial statements. New Authoritative Prouncements In July 2015, the Financial Accounting Standards Board issued Accounting Standards Update (ASU) , Plan Accounting: Defined Benefit Pension Plans (Topic 960), Defined Contribution Pension Plans (Topic 962), Health and Welfare Benefit Plans (Topic 965): (Part I) Fully Benefit Responsive Investment Contracts, (Part II) Plan Investment Disclosures, (Part Ill) Measurement Date Practical Expedient (Consensus of the Emerging Issues Task Force). The ASU designates contract value as the only required measure for fully benefit-responsive investment contracts; eliminates certain disclosure requirements related to investments; requires investments of employee benefit plans be grouped only by general type; removes certain disclosures for investments measured using the net asset value per share (or its equivalent) practical expedient; and permits plans to measure investments and investment-related accounts as of a month-end date that is closest to the plan's fiscal year-end, when the fiscal period does not coincide with a month-end. The ASU is effective for fiscal years beginning after December 15, 2015, with early application permitted. The Plan adopted ASU during the year, retrospectively applied the applicable amendments, and its implementation did not impact the net assets available for benefits. 3. Postretirement Benefit Obligations The postretirement benefit obligations represent the total actuarial present value of estimated future benefits that are attributed by the terms of the Plan to employees' service rendered to the date of the financial statements, reduced by the actuarial present value of contributions expected to be received in the future from current plan participants. Postretirement benefits include future benefits expected to be paid to or for (1) currently retired or terminated employees and their eligible dependents and (2) active employees and their eligible covered dependents after retirement from service with the University. Prior to an active employee's full eligibility date, the postretirement benefit obligation is the portion of the expected postretirement benefit obligation that is attributed to that employee's service rendered to the valuation date. The actuarial present value of the expected postretirement benefit obligations is determined by an independent actuarial firm and is the amount that results from applying actuarial assumptions to certain historical claims-cost data to estimate future annual incurred costs per participant. The obligation is adjusted for such estimates as the time value of money and the probability of payments between the valuation data and the expected date of payment. Health claims incurred by retired participants but not reported at year end are included in the postretirement benefit obligation. The Medicare Prescription Drug, Improvement and Modernization Act of 2003 was enacted for employers that sponsor postretirement health care plans that provide prescription drug benefits. The Act introduces a prescription drug benefit under Medicare (Medicare Part D) as well as a federal subsidy to sponsors of retiree health care benefit plans that provide a benefit that is at least actuarially equivalent to Medicare Part D.1. The Plan has not reflected any amount associated with the Medicare subsidy in calculating its postretirement benefit obligation because the Plan is not directly entitled to the Medicare subsidy. Significant actuarial assumptions are as follows: Discount rate - The plan benefit obligations were determined using discount rates of 3.85% and 3.70% at June 30, 2017 and 2016, respectively. 10