LTD Policy

Home Office: Schaumburg, Illinois • Administrative Office: Philadelphia, Pennsylvania POLICYHOLDER: Goshen Community Schools POLICY NUMBER: LTD 134339 EFFECTIVE DATE: January 1, 2023 ANNIVERSARY DATES: January 1, 2024 and each January 1st thereafter. PREMIUM DUE DATES: The first Premium is due on the Effective Date. Further Premiums are due monthly, in advance, on the first day of each month. This Policy is delivered in Indiana and is governed by its laws and/or the Employee Retirement Income Security Act of 1974 ("ERISA") as amended, where applicable. Reliance Standard Life Insurance Company is referred to as "we", "our" or "us" in this Policy. The Policyholder and any subsidiaries, divisions or affiliates are referred to as "you", "your" or "yours" in this Policy. We agree to provide insurance to you in exchange for the payment of Premium and a signed Application. This Policy provides income replacement benefits for Total Disability from Sickness or Injury. It insures those Eligible Persons for the Monthly Benefit shown on the Schedule of Benefits. The insurance is subject to the terms and conditions of this Policy. The Effective Date of this Policy is shown above. This Policy stays in effect as long as Premium is paid when due. The "TERMINATION OF THIS POLICY" section of the GENERAL PROVISIONS explains when the insurance terminates. This Policy is signed by our President and Secretary. Secretary President GROUP LONG TERM DISABILITY INSURANCE NON-PARTICIPATING LRS-6564 Ed. 4/06