YOUR RIGHTS UNDER ERISA

The following section contains information provided to You by the Fund Manager of Your Plan to meet the requirements of the Employee Retirement Income Security Act of 1974. It does not
constitute a part of the Plan or of any insurance policy issued in connection with the Plan. All inquiries relating to the following material should be referred directly to Your Fund Manager.

SUMMARY PLAN DESCRIPTION

NAME OF PLAN

The Plan for which this Summary Plan Description is provided is known as the I.B.E.W. Local 25 Health & Benefit Plan.

MAINTENANCE OF PLAN

The Plan is maintained by I.B.E.W. Local 25 Heath & Benefit Fund located at 372 Vanderbilt Motor Parkway, Hauppauge, New York, 11788.

EMPLOYER IDENTIFICATION NUMBER AND PLAN NUMBER

The employer identification number (PIN) assigned by the Internal Revenue Service to the plan sponsor is 11-1630810. The Plan number assigned by the Plan sponsor is 501.

TYPE OF WELFARE PLAN

The Plan is a Plan Participant and Dependents Death Benefit, Medical, Dental, Optical, Hearing, Prescription, Supplemental Unemployment Benefit and Medical Reimbursement Account Plan.

ADMINISTRATION OF PLAN

The Plan is administered by the Board of Trustees of I.B.E.W. Local 25 Health & Benefit Fund.

FUND MANAGER

Name of Fund Manager:
Owen MRumelt

Address:
372 Vanderbilt Motor Pkwy.
Hauppauge, New York 11788
Telephone Number: (631) 434-3344
Fax Number: (631) 434-3397

AGENT FOR SERVICE OF LEGAL PROCESS
The person designated as agent for service of legal process upon the Fund is Archer, Byington, Glennon & Levine, LLP.

The address at which process may be served on such entity is One Huntington Quadrangle, Suite 4C10, Melville, NY 11747. In addition, service of process may be made upon the Fund Manager or any Trustee.

TRUSTEES

The name, title and address of the principal place of business of each Trustee of the Fund are:

EMPLOYER ADDRESS
Steven Cadieux Roland’s Electric Co., Inc.
307 Suburban Avenue
Deer Park, NY 11729
Paul Dunn Mainline Electric Corp.
295 Broadway
Huntington Station. NY 11746
Clifford Seaman Gordon L. Seaman, Inc.
29 Old Dock Road
Yaphank, NY 11980
Pat Santoro Com-Bell Systems
561 Acorn Street, Unit C
Deer Park, NY 11729
UNION ADDRESS
Kevin Casey Local 25, I.B.E.W.
370 Vanderbilt Motor Pkwy.
Hauppauge, NY 11788
Godfrey King Local 25. I.B.E.W.
370 Vanderbilt Motor Pkwy.
Hauppauge, NY 11788
James P. Malley Local 25, I.B.E.W.
370 Vanderbilt Motor Pkwy.
Hauppauge, NY 11788
Sean Plant Local 25, I.B.E.W.
370 Vanderbilt Motor Pkwy.
Hauppauge, NY 11788

COLLECTIVE BARGAINING AGREEMENTS

The Plan is maintained pursuant to Local 25, I.B.E.W. Collective Bargaining Agreements. A copy of such agreement(s) may be obtained upon written request to the Fund Manager, who may make a reasonable charge for the copies, and is available for examination by Plan Participants and beneficiaries at the Fund Office.

ELIGIBILITY AND BENEFITS

The Plan’s requirements respecting eligibility for participation, the conditions pertaining to eligibility to receive benefits, and description or summary of the benefits are included in this
booklet.

SOURCES OF PLAN CONTRIBUTIONS

Contributions to the Fund are made by contributing employers and in certain instances by Plan Participants of the Fund.

MEDIUM FOR PROVIDING BENEFITS

Benefits under the Plan are self-insured by the Fund, except for insured Death Benefits.

DATE OF END OF PLAN’S FISCAL YEAR

The date of the end of each year for purposes of maintaining the Plan’s fiscal records is December 31.

CLAIM PROCEDURES

  1. Presenting Claims for Benefits:Claim forms may be obtained from:
    I.B.E.W. Local 25 Health & Benefit Fund
    372 Vanderbilt Motor Parkway
    Hauppauge, New York 11788
    (631) 434-3344
    www.eibofli.comPlease see page 51 of this booklet for the requirements as to notice of claims.
  2. Claims Denial Procedure:
    Any denial of a claim for benefits will be provided by MagnaCare and shall consist of a written explanation which will include:

    1. Specific reasons for the denial;
    2. Reference to the pertinent Plan provisions upon which the denial is based;
    3. A description of any additional information You might be required to provide and explanations of why it is needed; and
    4. An explanation of the Plan’s claim review procedure.

You, Your beneficiary (when an eligible claimant), or a duly authorized representative may appeal any denial of a claim for benefits by filing a written request for a full and fair review to the Fund. In connection with such a request, documents pertinent to the administration of the Plan may be reviewed, and comments and issues outlining the basis of the appeal may be submitted in writing.
You may have representation throughout the review procedure. A request for a review must be filed within 180 days after receipt of the written notice of denial of a claim. The full review will be held and a decision rendered by the Fund, no later than 60 days after receipt of the request for review. If there are any special circumstances, they will be made as soon as possible, but not later than 120 days after the receipt of the request for review. If such an extension of time is needed, You will be notified in writing prior to the beginning of the extension period. The decision after review will be in writing and will include specific reasons for the decision, as well as specific references to the pertinent Plan provisions on which the decision is based.