# CHUBB EMPLOYEE BENEFIT PLAN FOLLOW FORM ENDORSEMENT [CLAIMS MADE]

| Named Insured | International Business Machines Corporation |
|---------------|-------------------------------------------|
| Endorsement Number | 021 |

| Policy Symbol | XEU |
|---------------|-----|
| Policy Number | Specimen Policy |
| Policy Period | 05/21/2024 to 05/21/2025 |
| Effective Date of Endorsement | 05/21/2024 |

Issued By (Name of Insurance Company) | ACE Property and Casualty Insurance Company |

**THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following:**

**ENHANCED COMMERCIAL UMBRELLA LIABILITY POLICY**

The policy is amended as follows:

1. Except insofar as coverage is available to you through "other insurance" and for the full limits of insurance shown in the Schedule of Retained Limits, this insurance does not apply to liability arising out of any actual or alleged negligent act, error, omission, misstatement, misleading statement, neglect or breach of duty in the "administration" of any "employee benefit program(s)".

2. "Administration" includes but is not limited to performing any of the following functions for an "employee benefit program":

   a. Counseling "employees" on your "employee benefit programs";
   b. Interpreting your "employee benefit programs";
   c. Handling records for your "employee benefit programs";
   d. Effecting enrollment, termination or cancellation of "employees" under your "employee benefit programs";
   e. Calculation of benefits, periods of service, and compensation credits for your "employee benefit programs";
   f. Collection of contributions and application of contributions as provided in your "employee benefit programs";
   g. Preparation of reports required by government agencies, or "employee" communication materials concerning your "employee benefit programs"; or
   h. Processing of claims for your "employee benefit programs".

3. "Employee benefit program(s)" include but are not limited to group life insurance, group accident or health insurance, pension plans, stock subscription plans, travel, vacation or saving plans, profit sharing plans, social security benefits, unemployment insurance, workers' compensation and disability benefits insurance, and any other similar benefit program.

4. The coverage provided by this endorsement applies on the basis of claims first made against you during the period of this policy, and shall apply to those claims provided:

   a. The date such claim is first made against you is during our "policy period", or within 180 days of the termination of our policy period, and
   b. The injury, "loss", or damage occurs prior to the termination of this policy.

MS-275567.6 (3/19)
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