Group Whole Life Policy

AMERICAN HERITAGE LIFE INSURANCE COMPANY HOME OFFICE: 1776 AMERICAN HERITAGE LIFE DRIVE JACKSONVILLE, FLORIDA 32224-6687 www.allstatebenefits.com (904) 992-1776 A Stock Company GROUP WHOLE LIFE INSURANCE POLICY POLICYHOLDER: GOSHEN COMMUNITY SCHOOLS POLICY NUMBER: 39072 POLICY EFFECTIVE DATE: January 1, 2023 POLICY ANNIVERSARY DATE: January 1, 2024 and the first day of January each calendar year thereafter. GOVERNING JURISDICTION: Indiana American Heritage Life Insurance Company (referred to as we, us, or our) agrees to pay the benefits described in this policy, subject to all of the definitions, terms, conditions, and provisions in this policy, the certificates, and any attached rider(s). We issue this policy, the certificates, and any attached rider(s) based on the policyholder’s and the employee’s or member’s applications and enrollment forms and in return for the payment of required premiums. Premiums are payable to us. The first premium is due on the effective date of this policy. This policy may be changed in whole or in part. The approval must be in writing, signed by one of our executive officers, and endorsed on or attached to this policy. No other person, including an agent, may change this policy or waive any part of it. This policy may include enrollment, risk management, and other support services related to the policyholder’s benefit program. This policy is delivered in and is governed by the laws of the governing jurisdiction and, to the extent applicable, by the Employee Retirement Income Security Act of 1974 (ERISA). PLEASE READ THIS POLICY CAREFULLY! This policy is a legal contract between American Heritage Life Insurance Company and the policyholder. The policyholder should read this policy carefully and contact us promptly with any questions. Signed for American Heritage Life Insurance Company at its home office in Jacksonville, Florida. Secretary President GROUP WHOLE LIFE INSURANCE MATURITY BENEFIT PAID TO THE CERTIFICATE HOLDER ON THE MATURITY DATE IF THE INSURED IS LIVING ON THAT DATE DEATH BENEFIT PAYABLE AT DEATH OF INSURED PRIOR TO MATURITY DATE NON-PARTICIPATING – NO DIVIDENDS GWLPIN Page 1