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Proxy 275
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Proxy 275
Meeting Response/Proxy
Meeting Type:
Annual/Executive Meeting for Safety Group #275
Date:
Tuesday, April 21st, 2026
Time:
11:00 am
Location:
Virtual Zoom (meeting notice will be sent the morning of 4/21)
Proxy for Safety Group 275- 2026
Required Field
Yes, I (the undersigned) plan on attending the Safety Group #275 Annual Meeting.
No, I (the undersigned) do not plan to attend the Safety Group #275 Annual Meeting.
If I do not attend the annual meeting, I (the undersigned), a member of the New York State Hospital Compensation Safety Group #275, underwritten by NYSIF, hereby authorizes Barry Lovell of Lovell Safety Management Co., LLC, as Group Manager, to hold our proxy and vote on our behalf. This voting proxy revokes all proxies previously issued by this group member prior to the date of this proxy. It shall remain valid for this and future meetings until withdrawn in writing by the member or until the member issues a superseding proxy. By signing below, the undersigned acknowledges and agrees that the Group Manager may serve as proxy and waives any conflict of interest, actual or perceived, that may arise from the Group Manager serving in this capacity. The undersigned certifies that they are authorized to act and to execute this proxy on behalf of the insured.
Company Name
*
Policy Number
*
Full Name of Signatory
*
Title
*
Phone #
Email Address
*
*
signature
keyboard
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Esignature - Use Mouse or Finger pad to sign
Date
• Members will be provided with at least 20 days’ notice of a scheduled annual meeting and must either attend or authorize a proxy to vote on their behalf. • This proxy must be submitted to the Group Manager no later than seven (7) days prior to the meeting. • Members may revoke this proxy at any time by submitting a superseding proxy or written revocation no later than seven (7) days prior to the meeting. • NYSIF is the sole arbiter of proxy validity.
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