� � � � � !"� "� � !� #$ � %&� � '� � ("� %&"� '� � (")� � � (� "� !)� � � !� � � � !� *+ ' !'"� ,""� � "� '� !� � '� !� � "+� (� '� � � � � !� ""� "� � � "+ - .,"� � "� !� � � #''� � !)� � '� " � � � � � '"� )� ""� #'� � '!")� "� )� � $"� ""+� �"� � � '� � "� � " � � "+ ' "� #� %� "& � /� '� ,"� )� '"� � ""� � "� � !'"� � � .,"� +� � '"� � "� "� � '� "� )'� � "� "� � � '� � #� � #� ""!� *0"� . ,"� � +� �"� � � '� � "� � " � � "+� (� "!� !+ !""� � #$� .� � '� � � � 1� '#")� � "� � '� � � '� " � #� + - � "� � #'� 2� !"� � '� � � +� -� � � #� '!� � � 2 � !� � � " � !� '� !'+� � � � "� � '� � � )� ' "'� !� � � � '� ,� � � + -'" � #� � !� "� � � � � " � $� � � !� #� � � � #� %� "� � '"&)� ""� � � � � � � !)� � � � ")� � � � � )� � � "1 "!1 (!� "� � ')� ""� � "� � � � 3!1 /)� � ,.!")� � � 1 4'"" ""')"!! '' "#'+'","" ! #' '! !5"1 6""")" ""1
Benefit Summary - Hospital Indemnity Page 1 Page 3