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Docusign Envelope ID: 921 F7A24-D5CE4BCC-9F3C-5E7844661266 Insurer to complete the National Association of Insurance Commissioners' annual financial statement. All books and records maintained by Administrator on behalf of Insurer for a calendar or fiscal year shall be maintained for the period in which Administrator is providing service for Insurer and for five years there- after. Ga. Comp. R. & Regs. r. 120-2-49-.05(2) — (4). If applicable, Administrator shall maintain a cash receipts register of all premiums or contributions received. The minimum detail required in the register shall be: (a) date received and deposited; (b) the mode of payment; (c) the policy number; (d) name of group policyholder, (e) names of certificate -holders; (f) individual premium amounts; and (g) agent. Ga. Comp. R. & Regs. r. 120-249-.05(5). 5.3 The description of a disbursement shall be in sufficient detail to identify the source docu- ment substantiating the purpose of the disbursement, and shall include all of the following: (a) the check number; (b) the date of disbursement; (c) the person to whom the disbursement was made; (d) the amount disbursed (if the amount disbursed does not agree with the amount billed or authorized, Administrator shall prepare a written record as to the application of the disbursement); (e) and ledger account number. Ga. Comp. R. & Regs. r. 120-249-.05(6). 5.4 If the disbursement is for the earned administrative fee or commission, the disbursement shall be supported by a written record reflecting the identifying deposit from which the fee was matched. Ga. Comp. R. & Regs. r. 120-2-49-.05(7). 5.5 All journal entries for receipts and disbursements shall be supported by evidential matter. The evidential matters must be referenced in the journal entry so that it may be traced for verification. Ga. Comp. R. & Regs. r. 120-2-49-.05(8). 5.6 Administrator shall prepare and maintain monthly financial institution account reconcilia- tions if such service is requested by Insurer as provided in Agreement. Ga. Comp. R. & Regs. r. 120-2-49- .05(9). 5.7 Administrator shall prepare a report to be filed with Insurer and plan sponsor within ninety days of the end of the fiscal year of the plan, which discloses at least all of the following: (a) The total premiums or contributions received from the plan sponsor, or Eligible Persons (if applicable); (b) The total administration fees withdrawn by Administrator, if any, pursuant to the Agreement; (c) The total Claim payments made during the reporting period; (d) A copy of the annual report shall be retained as part of the official record of the Administrator for at least five (5) years; (e) Any additional information required by the Agreement; and (f) The names of all Insurers, reinsurance carriers or ultimate risk bearers providing any type of insurance coverage to the plan sponsor. Ga. Comp. R. & Regs. r. 120-2-49-.05(10). 5.8 Return premiums or contributions shall be paid to the Insurer or credited to the account of the Insurer within thirty days after receipt by Administrator. If the return premium or contribution is credited to the Insurer, the credit must be shown and applied to the next billing statement sent to the Insurer. Ga. Comp. R. & Regs. r. 120-2-49-.05(11). 6. Fiduciary Account. The Parties agree that Administrator will not collect premiums or insurance charges on behalf of or for Insurer. Return premiums received from such Insurer, if any, shall be held by Administrator in a fiduciary capacity. Such funds shall be immediately remitted to the person or persons entitled thereto, or shall be deposited promptly in a fiduciary bank account established and maintained by Administrator. If charges or premiums so deposited have been collected on behalf of or for more than one insurer, or self insurer, Administrator shall cause the bank in which such fiduciary account is maintained to 103 This document is CONFIDENTIAL AND PROPRIETARY to RIGHTWAY Healthcare, Inc. and may not be reproduced, transmitted, published, or disclosed to others without the prior written authorization of RIGHTWAY Healthcare, Inc.