Lincoln MoneyGuard Reserve. Insured. Jolene Johnson, Female, Issue age 56 SAMPLE

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1 Lincoln Life & Annuity Company of New York One Granite Place P.O. Box 515 Concord, NH Phone Fax Web Josephine Ohn PO Box 123 Anywhere, NY Lincoln MoneyGuard Reserve Insured Jolene Johnson, Female, Issue age 56 Your Financial Representative(s) Fred Smith 12 Anywhere Street El Paso, TX Phone: (123) Joe Smith 1 Main Street Concord, NH Phone: (603) JOE.SMITH@METROCASE.NET POLICY Policy Date Sep 12, 2016 Statement Period Vinnie Carter N Main Street Urtown, TX Phone: (123) VINNIE.CARTER@YOURAGENT.COM Lily Wilton 1 Church Street Unit 12B Concord, NH Phone: (603) LILY.WILTON@METROCASE.NET Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Lincoln Life & Annuity Company of New York is domiciled in Syracuse, NY. Page 1 LCN This sample policy does not reflect actual policy values and is for illustrative purposes only. For agent or broker use only. Not for use with the public.

2 - Take charge of your financial future! Whether you re looking to learn more about our annuity and insurance products, file a claim, or connect with our Customer Care Representatives, let guide your way. You can also view important announcements and read up on special topics like investing basics, retirement and legacy planning, and long-term care funding. Did you know? When you register on you ll have immediate 24/7 access to the most up-to-date information on your policy including policy values, historical information, correspondence and you can use the site to download forms. LincolnConciergeCare.com - Advantages for You and Your Family Lincoln provides tools to assist you and your family members with long-term care planning needs even before you are eligible for benefits. To access these tools or to inquire about filing a claim, please visit LincolnConciergeCare.com. These valuable resources and support tools are provided by Lincoln at no cost and can help you and your loved ones: Reduce the challenges typically faced when seeking care by providing information to assist in the decision-making process Find elder care providers and facilities in your community that fit your needs Determine services needed to maintain independence Review eligibility for benefits that are covered by your policy Additionally, Lincoln Concierge Care Coordination provides a wealth of educational materials on health, aging, elder care, and so much more. Lincoln s Long-Term Care Claims Specialists are available to answer any questions you have about your policy and, if the time comes, assist you when filing a claim. All these resources are available to you and your family NOW at LincolnConciergeCare.com. MONEYGUARD Reserve provides expense reimbursement for Qualified Long-Term Care expenses including: Adult day care Home health care Hospice services Nursing home care services Assisted living Alternative care services For more information about covered services, please contact our Customer Care Representatives at Page 2

3 Your policy benefits as of 09/11/2017 Long-Term Care (LTC) Benefits OR Death Benefit OR Return of Premium (ROP) Total LTC Benefits* $193, Death Benefit* $130, Surrender Value* $1, Monthly Maximum Benefit Amount* $2, Specified Amount* $130, Policy Value* as of 09/11/2017 $11, Minimum Total Benefit Duration* 6 Years Residual Death Benefit* Not Available Surrender Charge* -$5, Acceleration Inflation Rate* Not Available Outstanding Loan Balance* -$5, Acceleration Benefits* $60, Loan Value Available* $0.00 Extension Inflation Rate* 2% compound Return of Premium Amount* $0.00 Your Payment Details Extension Benefits* $133, Plannned Premium* $20, Premium Frequency Annual Premium Paid to Date $20, * For additional information on selected terms, see the Important Definitions at the end of this statement. Page 3

4 Long-Term Care Benefits - Based on inflation option chosen Monthly Maximum Benefit by policy year $2, Year 6 $2, $34, Year 5 $2, $33, Year 4 $2, $32, Year 3 $2, $2, $31, Year 1 Year 2 $30, $30, Annual Maximum Benefit by policy year Acceleration Benefits Extension Benefits $60, $133, You have chosen 2 years of Acceleration coverage. You have chosen 4 years of Extension coverage at a compounding rate of 3% annually. The graph above depicts the total benefit limits for reimbursement available under your policy and are the total benefits available as of 09/11/2017. These values assume the Monthly Maximum is used for the entire duration of the claim. The duration could be extended if claims are lower than the Monthly Maximums. The values reflected above assume all Planned Premiums are paid when due and no loans, decreases or Withdrawals are taken for the life of the policy. For further explanation of rider benefits, please refer to your policy. Your projected Monthly Maximum benefit at age: 75 would be $ 12, would be $ 15, would be $ 18, Your projected Total benefits at age: 75 would be $ 147, would be $ 180, would be $ 226, For additional information on selected terms, see the Important Definitions at the end of this statement. Page 4

5 Transaction detail by month Period Premium Received* ($) Premium Expense Charges* ($) Monthly Insurance Charges* ($) Rider Charges* ($) Interest Credited* ($) Withdrawals* ($) Impact from Claim Payments* ($) Policy Value ($) 09/11/ /12/ /11/ , , , /12/ /11/ , /12/ /11/ , /12/ /11/ , /12/ /11/ , /12/ /11/ , /12/ /11/ , /12/ /11/ , /12/ /11/ , /12/ /11/ , /12/ /11/ , /12/ /11/ , , Total 20, , , , Annual Effective Interest Rate* as of Sep 11, 2017 is 4.00% and will not be less than the guaranteed rate of 4.00%, equivalent to the daily rate of %. * For additional information on selected terms, see the Important Definitions at the end of this statement. Page 5

6 Loan activity Date Transaction Amount ($) Balance ($) 06/30/2017 Loan 5, , /11/2017 Interest charge , The Loan Interest Rate* is 3.98% * For additional information on selected terms, see the Important Definitions at the end of this statement. Page 6

7 Policy Expiration Dates - Projected under Guaranteed Assumptions: If no further premiums are paid October 2030 Please Note: The above projections assume no coverage changes, new loans or withdrawals are made in the future. If your policy currently has a loan, these projections assume loan interest is at current loan charges/rates and capitalize annually. The interest rate charge for any outstanding loan will be at a rate of 3.98%. Premiums received by Lincoln after the anniversary date of this statement period are not recorded on this statement and any projections provided do not account for such payments. Based on the assumptions provided above, the policy is not on schedule to provide coverage for the lifetime of the insured. We recommend contacting your financial representative for any questions or concerns you have regarding this policy expiration projection. If you have concerns regarding the performance of the policy, please contact our Customer Care Center at Monday through Friday between the hours of 8:00 a.m. 6:00 p.m. (Eastern Time) or access through your online account at to request a current illustration. To help monitor your policy performance and compare it to your objectives when you purchased your policy, an in force illustration of future Death Benefits and Policy Values will be available for your review within 5 business days of your policy anniversary. You may be entitled to additional benefits not listed on this annual policy statement, please refer to your policy for all benefits. Page 7

8 IMPORTANT POLICY OWNER NOTICE Secondary Addressee It s important to review your insurance coverage with your financial representative every year. Major life events such as births, weddings, retirement, or any changes you have made to documents like wills or trusts may be a good reason to re-evaluate your current coverage, to review your beneficiaries, and make any changes needed. Please call your financial representative today to schedule an appointment. You should consider requesting more detailed information about your policy to understand how it may perform in the future. You should not consider replacement of your policy or make changes in your coverage or take a loan or withdrawal without requesting a current illustration. The interest rate charge for any outstanding loan will be at a rate of 3.98%. You may annually request, without charge, such an illustration; by contacting your financial representative or our Customer Care Center at the number below. If you do not receive a current illustration of your policy within 30 days from your request, you should contact your state insurance department. Notify Lincoln promptly if information contained in this document is not accurate. Please feel free to re-confirm any oral communication in writing to further protect your rights. Our Customer Care Center can be contacted by calling or writing to us at P.O. Box 515, Concord, NH You have a right to designate a third party, in addition to yourself, to receive grace period and lapse notices of your insurance coverage. If you wish to change or review your third party designation, please contact one of our Customer Care Representatives at , anytime Monday through Friday between the hours of 8:00 a.m. 6:00 p.m. (Eastern Time). Joe Smith 123 Anywhere Street Home, State For additional information on selected terms, see the Important Definitions at the end of this statement. Page 8

9 Important definitions Acceleration Benefits - Benefits available under the Convalescent Care Benefits Rider to pay for Qualified Long-Term Care expenses prior to the death of the insured. Each payment may reduce your Death Benefit. Acceleration Inflation Rate - The rate used to calculate the increase in Long-Term Care Acceleration benefits as defined in the Optional Inflation Protection provision section in your policy. Annual Effective Interest Rate - The rate at which we credit interest to the Policy Value. At no time will this rate be less than the Guaranteed Minimum Interest Rate shown on your policy schedule. Death Benefit - The amount payable upon the death of the insured as described in your policy less any Outstanding Loan Balance. Extension Benefits - Benefits available under the Extension of Benefits Rider to pay for Qualified Long-Term Care expenses prior to the death of the insured and after the Acceleration Benefits have been exhausted. Extension Inflation Rate - The rate used to calculate the increase in Long-Term Care Extension benefits as defined in the Optional Inflation Protection section in your policy. Impact from Claim Payments - The impact to your Policy Value as a result of Long-Term Care payments as defined in your policy. Interest Credited - An amount added by us to your Policy Value as outlined in your policy. Loan Interest Rate - The interest rate charged on the loan principal as outlined in your policy. Loan Value Available - The maximum amount currently accessible to the policyholder in the form of a loan. This amount is in addition to any existing policy loans. Minimum Total Benefit Duration - The sum of the Acceleration Benefit duration and Extension Benefit duration as elected. Monthly Insurance Charges- The portion of the monthly expense attributable to the cost of insurance for each policy month. Monthly Maximum Benefit Amount - The maximum amount that is available to be paid each month to reimburse the costs incurred by the insured for Covered Services under the riders. Outstanding Loan Balance - The amount of any outstanding loan against the policy, including loan interest accrued but not yet charged. Referred to as Debt in your policy. Planned Premium - The amount of periodic premium planned to be paid to the Company on a scheduled basis. Policy Value - The value of your policy as a result of various account activity as shown in the Transaction detail by month section of this statement. Referred to as Gross Cash Value in your policy. Premium Expense Charge - The charge applied to each premium paid as shown in your policy. Premium Received - The amount of payment received during the current policy year. Residual Death Benefit - Death Benefit paid after Acceleration Benefits have been exhausted as defined in your policy and shown in your policy schedule. Page 9

10 Important definitions - continued Return of Premium Amount - An amount returned to the policy owner upon surrender of the policy. The amount of the benefit is reduced by any Outstanding Loans, Withdrawals or benefits paid under the Accelerated Benefit Rider. Described as Return of Premium Benefit in your policy. Rider Charges - The charges attributable to Riders elected. Specified Amount - The dollar amount you chose which is used to determine the amount of the Death Benefit and the amount of certain rider benefits. Surrender Charge - A charge applied upon full surrender of the policy. There may also be a partial Surrender Charge associated with a Withdrawal (see Withdrawal definition). Surrender Value - An amount equal to the Policy Value less any Outstanding Loan Balance less any applicable Surrender Charges plus any applicable Return of Premium Amount. Total LTC Benefits - The sum of Acceleration Benefits and Extension Benefits available to pay for Qualified Long-Term Care expenses prior to the death of the insured. Withdrawals - Requested disbursements from the Policy Value which may impact other values and be subject to additional fees/charges as outlined in your policy. Withdrawals are referred to as Partial Surrenders in your policy. Page 10 MGR-SOA-FLI004_Z01