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Thursday, May 10, 2018 Overland Park Convention Center 6000 College Blvd, Overland Park, Kansas 66211 Co-sponsored by the Employee Benefits Institute of Kansas City, Inc. and UMKC School of Law employeebenefitsinstitute.com Employee Benefits Institute JOIN US AT THE 2018 Institute Chairperson: Thomas Delaney Empower Retirement, Great West Financial Continuing Legal Education Credit: Missouri 8.4 hours | Kansas hours pending Continuing Education Credit is Available for Missouri and Kansas Life & Health Insurance Professionals; Certified Public Accountants; Human Resource Professionals; Certified Financial Planners 2

OUR HISTORY Employee Benefits Institute...Debbie Boll, MRIGlobal Robert A. Browning, Spencer Fane LLP Becky Cogdill, Willis Towers Watson Dana L. Dreier, CBIZ MHM, LLC and Mayer Hoffman

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Page 1: OUR HISTORY Employee Benefits Institute...Debbie Boll, MRIGlobal Robert A. Browning, Spencer Fane LLP Becky Cogdill, Willis Towers Watson Dana L. Dreier, CBIZ MHM, LLC and Mayer Hoffman

Debbie Boll, MRIGlobalRobert A. Browning, Spencer Fane LLPBecky Cogdill, Willis Towers WatsonDana L. Dreier, CBIZ MHM, LLC and Mayer Hoffman

McCann P.C.James “Jamie” P. Dutton, Gallagher Benefit

Services, / Arthur J. Gallagher & Co.Cindy J. Dwyer, MHM Retirement Plan SolutionsRobert S. Fischgrund, CBIZ Retirement Plan

ServicesYvonne Frame, Cerner CorporationJonna R. Harris, Blue Cross & Blue Shield of Kansas

CitySamuel A. Henson, Lockton Retirement ServicesDawn M. Hoy, Children’s Mercy Kansas CityBrian M. Johnston, Jackson Lewis, P.C.Gerard J. Karlin, Deloitte & Touche LLPMichelle Kelly, U.S. Department of Labor, Employee

Benefits Security Administration

Craig Kovarik, Husch Blackwell LLP Bob Latz, Brown & Ruprecht, PCTammy Leslie, Saint Luke’s Health SystemDaniel J. McCarroll, UMKC School of Law

Continuing Legal EducationAndrew McDonnell, H&R Block, Inc.Phil McKnight, Stinson Leonard Street LLPColleen Meurer, Hallmark Cards, IncorporatedJim North, Jr., The Todd OrganizationTim O’Grady, Sprint CorporationTroy L. Redstone, PHD. Retirement ConsultingJohn L. Utz, Utz & Lattan, LLC Mark Whiting, Mercer

Regional Ambassador: Gwen Bryant, HoganTaylor

2018 EMPLOYEE BENEFITS INSTITUTE STEERING COMMITTEE

OUR HISTORY

In the fall of 1986, Michael J. Baker, then Assistant Dean at the University of Missouri – Kansas City School of Law with responsibility for continuing legal education, was eager to expand the law school’s CLE offerings and create an employee benefits symposium. Mike, along with John Utz, Tom Graves, Al Martin, Myron Sildon and their steering committee created the Employee Benefits Institute.

The first program was held on June 5, 1987, at the Hyatt Regency. Approximately 120 individuals attended. Now in its 32nd year, The Employee Benefits Institute has grown into one of the most important conferences in the region and has expanded its presence to include targeted workshops throughout the year and additional networking opportunities.

Celebrating 32 years of being the premier benefits conference in the Midwest

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LODGING INFORMATION

A block of rooms is reserved for Wednesday and Thursday, May 9 & 10, 2018 at a rate of $194.00 single or double at Sheraton Overland Park Hotel, which is connected to the Convention Center and is located at 6100 College Boulevard, Overland Park, Kansas 66211, www.sheraton.com/overlandpark. To reserve your room call 866-837-4214 and mention “UMKC Employee Benefits Institute Room Block." Deadline for room reservations is April 9, 2018.

2018 Institute Chairperson: Thomas Delaney, Empower Retirement, Great West Financial

Thursday, May 10, 2018Overland Park Convention Center

6000 College Blvd,Overland Park, Kansas 66211

Co-sponsored by the Employee Benefits Institute ofKansas City, Inc. and UMKC School of Law

employeebenefitsinstitute.com

Employee Benefits Institute

JOIN US AT THE

2018 Institute Chairperson:Thomas DelaneyEmpower Retirement, Great West Financial

Continuing Legal Education Credit: Missouri 8.4 hours | Kansas hours pending

Continuing Education Credit is Available for Missouri and Kansas Life & Health Insurance Professionals; Certified Public Accountants;

Human Resource Professionals; Certified Financial Planners

2

2

2

Em

plo

yee

Ben

efits

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itut

e

REGISTRATION

MOCODE KAX81

Employee Benefits Institute 32nd Annual ConferenceThursday, May 10, 2018, Overland Park Convention Center

Register online at EmployeeBenefitsInstitute.com or complete the following form. For more information, call UMKC CLE at 816-235-1648 or email [email protected].

Enclosed is $_____ for _____ registration(s) for enrollment in the Employee Benefits Institue 32nd Annual Conference on Thursday, May 10, 2018 at the Overland Park Convention Center, 6000 College Blvd., Overland Park, Kan. 66211.

Registration fee: (check one)c$250 Includes digital material only.c$295 Includes hard copy printed material and digital material.c$45 I cannot attend the seminar. Please send me the course materials.

How did you hear about us?

Registrant’s identification: (check all that apply)cAttorney cCPAcCorporate Executive cFinancial Services Professional cInsurance ProfessionalcHR/Compensation/Benefit ProfessionalscPlan Administrator cInsurance OfficecOther (please indicate)

Please select your breakout sessions

1:15 p.m. cA. Benefit Tech Trends You Can’t Afford to IgnorecB. Empower Your Employees with Financial Wellness

2:30 p.m. cC. Health Plan Litigation UpdatecD. Savings Plan Lawsuits on the Rise: Best Practices for Plan Fiduciaries

Name

Firm/Company

Address

City State Zip

PhoneFax

Email

Please make check payable to “University of Missouri” and mail with completed form to: UMKC Law School CLE, 4825 Troost Ave, Suite 211, Kansas City, Missouri 64110

Pay by credit card: (may be faxed to 816-235-6552)

cVISA cMastercard cDiscover cAmEx

Cardholder’s Name (as it appears on card)

Card Number Expiration Date

Page 2: OUR HISTORY Employee Benefits Institute...Debbie Boll, MRIGlobal Robert A. Browning, Spencer Fane LLP Becky Cogdill, Willis Towers Watson Dana L. Dreier, CBIZ MHM, LLC and Mayer Hoffman

Debbie Boll, MRIGlobalRobert A. Browning, Spencer Fane LLPBecky Cogdill, Willis Towers WatsonDana L. Dreier, CBIZ MHM, LLC and Mayer Hoffman McCann P.C.James “Jamie” P. Dutton, Gallagher Benefit Services, / Arthur J. Gallagher & Co.Cindy J. Dwyer, MHM Retirement Plan SolutionsRobert S. Fischgrund, CBIZ Retirement Plan ServicesYvonne Frame, Cerner CorporationJonna R. Harris, Blue Cross & Blue Shield of Kansas CitySamuel A. Henson, Lockton Retirement ServicesDawn M. Hoy, Children’s Mercy Kansas CityBrian M. Johnston, Jackson Lewis, P.C.Gerard J. Karlin, Deloitte & Touche LLPMichelle Kelly, U.S. Department of Labor, Employee Benefits Security Administration

Craig Kovarik, Husch Blackwell LLP Bob Latz, Brown & Ruprecht, PCTammy Leslie, Saint Luke’s Health SystemDaniel J. McCarroll, UMKC School of Law Continuing Legal EducationAndrew McDonnell, H&R Block, Inc.Phil McKnight, Stinson Leonard Street LLPColleen Meurer, Hallmark Cards, IncorporatedJim North, Jr., The Todd OrganizationTim O’Grady, Sprint CorporationTroy L. Redstone, PHD. Retirement ConsultingJohn L. Utz, Utz & Lattan, LLC Mark Whiting, Mercer

Regional Ambassador: Gwen Bryant, HoganTaylor

2018 EMPLOYEE BENEFITS INSTITUTE STEERING COMMITTEE

OUR HISTORY

In the fall of 1986, Michael J. Baker, then Assistant Dean at the University of Missouri – Kansas City School of Law with responsibility for continuing legal education, was eager to expand the law school’s CLE offerings and create an employee benefits symposium. Mike, along with John Utz, Tom Graves, Al Martin, Myron Sildon and their steering committee created the Employee Benefits Institute.

The first program was held on June 5, 1987, at the Hyatt Regency. Approximately 120 individuals attended. Now in its 32nd year, The Employee Benefits Institute has grown into one of the most important conferences in the region and has expanded its presence to include targeted workshops throughout the year and additional networking opportunities.

Celebrating 32 years of being the premier benefits conference in the Midwest

Thursday, M

ay 10, 2018em

ployeeb

enefitsinstitute.com

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5100 Rockhill Ro

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ansas City, M

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Permit #6113

LODGING INFORMATION

A block of rooms is reserved for Wednesday and Thursday, May 9 & 10, 2018 at a rate of $194.00 single or double at Sheraton Overland Park Hotel, which is connected to the Convention Center and is located at 6100 College Boulevard, Overland Park, Kansas 66211, www.sheraton.com/overlandpark. To reserve your room call 866-837-4214 and mention “UMKC Employee Benefits Institute Room Block." Deadline for room reservations is April 9, 2018.

2018 Institute Chairperson: Thomas Delaney, Empower Retirement, Great West Financial

Thursday, May 10, 2018Overland Park Convention Center

6000 College Blvd,Overland Park, Kansas 66211

Co-sponsored by the Employee Benefits Institute ofKansas City, Inc. and UMKC School of Law

employeebenefitsinstitute.com

Employee Benefits Institute

JOIN US AT THE

2018 Institute Chairperson:Thomas DelaneyEmpower Retirement, Great West Financial

Continuing Legal Education Credit:

Missouri 8.4 hours | Kansas hours pendingContinuing Education Credit is Available for Missouri and Kansas

Life & Health Insurance Professionals; Certified Public Accountants; Human Resource Professionals; Certified Financial Planners

2

2

2

Em

plo

yee Benefits Institute

REGISTRATION

MOCODE KAX81

Employee Benefits Institute 32nd Annual ConferenceThursday, May 10, 2018, Overland Park Convention Center

Register online at EmployeeBenefitsInstitute.com or complete the following form. For more information, call UMKC CLE at 816-235-1648 or email [email protected].

Enclosed is $_____ for _____ registration(s) for enrollment in the Employee Benefits Institue 32nd Annual Conference on Thursday, May 10, 2018 at the Overland Park Convention Center, 6000 College Blvd., Overland Park, Kan. 66211.

Registration fee: (check one)c$250 Includes digital material only.c$295 Includes hard copy printed material and digital material.c$45 I cannot attend the seminar. Please send me the course materials.

How did you hear about us?

Registrant’s identification: (check all that apply)cAttorney cCPA cCorporate Executive cFinancial Services Professional cInsurance Professional cHR/Compensation/Benefit Professionals cPlan Administrator c Insurance Office cOther (please indicate)

Please select your breakout sessions

1:15 p.m. cA. Benefit Tech Trends You Can’t Afford to IgnorecB. Empower Your Employees with Financial Wellness

2:30 p.m. cC. Health Plan Litigation UpdatecD. Savings Plan Lawsuits on the Rise: Best Practices for Plan Fiduciaries

Name

Firm/Company

Address

City State Zip

Phone Fax

Email

Please make check payable to “University of Missouri” and mail with completed form to: UMKC Law School CLE, 4825 Troost Ave, Suite 211, Kansas City, Missouri 64110

Pay by credit card: (may be faxed to 816-235-6552)

cVISA cMastercard cDiscover cAmEx

Cardholder’s Name (as it appears on card)

Card Number Expiration Date

Page 3: OUR HISTORY Employee Benefits Institute...Debbie Boll, MRIGlobal Robert A. Browning, Spencer Fane LLP Becky Cogdill, Willis Towers Watson Dana L. Dreier, CBIZ MHM, LLC and Mayer Hoffman

Debbie Boll, MRIGlobalRobert A. Browning, Spencer Fane LLPBecky Cogdill, Willis Towers WatsonDana L. Dreier, CBIZ MHM, LLC and Mayer Hoffman McCann P.C.James “Jamie” P. Dutton, Gallagher Benefit Services, / Arthur J. Gallagher & Co.Cindy J. Dwyer, MHM Retirement Plan SolutionsRobert S. Fischgrund, CBIZ Retirement Plan ServicesYvonne Frame, Cerner CorporationJonna R. Harris, Blue Cross & Blue Shield of Kansas CitySamuel A. Henson, Lockton Retirement ServicesDawn M. Hoy, Children’s Mercy Kansas CityBrian M. Johnston, Jackson Lewis, P.C.Gerard J. Karlin, Deloitte & Touche LLPMichelle Kelly, U.S. Department of Labor, Employee Benefits Security Administration

Craig Kovarik, Husch Blackwell LLP Bob Latz, Brown & Ruprecht, PCTammy Leslie, Saint Luke’s Health SystemDaniel J. McCarroll, UMKC School of Law Continuing Legal EducationAndrew McDonnell, H&R Block, Inc.Phil McKnight, Stinson Leonard Street LLPColleen Meurer, Hallmark Cards, IncorporatedJim North, Jr., The Todd OrganizationTim O’Grady, Sprint CorporationTroy L. Redstone, PHD. Retirement ConsultingJohn L. Utz, Utz & Lattan, LLC Mark Whiting, Mercer

Regional Ambassador: Gwen Bryant, HoganTaylor

2018 EMPLOYEE BENEFITS INSTITUTE STEERING COMMITTEE

OUR HISTORY

In the fall of 1986, Michael J. Baker, then Assistant Dean at the University of Missouri – Kansas City School of Law with responsibility for continuing legal education, was eager to expand the law school’s CLE offerings and create an employee benefits symposium. Mike, along with John Utz, Tom Graves, Al Martin, Myron Sildon and their steering committee created the Employee Benefits Institute.

The first program was held on June 5, 1987, at the Hyatt Regency. Approximately 120 individuals attended. Now in its 32nd year, The Employee Benefits Institute has grown into one of the most important conferences in the region and has expanded its presence to include targeted workshops throughout the year and additional networking opportunities.

Celebrating 32 years of being the premier benefits conference in the Midwest

Thursday, M

ay 10, 2018em

ployeeb

enefitsinstitute.com

OV

ER

LAN

D PA

RK

CO

NV

EN

TION

CE

NTE

R6000 C

OLLE

GE

BLV

D, O

VE

RLA

ND

PAR

K, K

S 66211

UN

IVER

SITY OF M

ISSOU

RI-KA

NSA

S CITY

Co

ntinuing Leg

al Ed

ucation

5100 Rockhill Ro

adK

ansas City, M

O 64110-2499

UM

KC

is an equal o

pp

ortunity/affirm

ative action institutio

n.

No

npro

fit Org

.U

.S. Postag

ePA

IDK

ansas City, M

o.

Permit #6113

LODGING INFORMATION

A block of rooms is reserved for Wednesday and Thursday, May 9 & 10, 2018 at a rate of $194.00 single or double at Sheraton Overland Park Hotel, which is connected to the Convention Center and is located at 6100 College Boulevard, Overland Park, Kansas 66211, www.sheraton.com/overlandpark. To reserve your room call 866-837-4214 and mention “UMKC Employee Benefits Institute Room Block." Deadline for room reservations is April 9, 2018.

2018 Institute Chairperson: Thomas Delaney, Empower Retirement, Great West Financial

Thursday, May 10, 2018Overland Park Convention Center

6000 College Blvd,Overland Park, Kansas 66211

Co-sponsored by the Employee Benefits Institute ofKansas City, Inc. and UMKC School of Law

employeebenefitsinstitute.com

Employee Benefits Institute

JOIN US AT THE

2018 Institute Chairperson:Thomas DelaneyEmpower Retirement, Great West Financial

Continuing Legal Education Credit:

Missouri 8.4 hours | Kansas hours pendingContinuing Education Credit is Available for Missouri and Kansas

Life & Health Insurance Professionals; Certified Public Accountants; Human Resource Professionals; Certified Financial Planners

2

22

Em

plo

yee Benefits Institute

REGISTRATION

MOCODE KAX81

Employee Benefits Institute 32nd Annual ConferenceThursday, May 10, 2018, Overland Park Convention Center

Register online at EmployeeBenefitsInstitute.com or complete the following form. For more information, call UMKC CLE at 816-235-1648 or email [email protected].

Enclosed is $_____ for _____ registration(s) for enrollment in the Employee Benefits Institue 32nd Annual Conference on Thursday, May 10, 2018 at the Overland Park Convention Center, 6000 College Blvd., Overland Park, Kan. 66211.

Registration fee: (check one)c$250 Includes digital material only.c$295 Includes hard copy printed material and digital material.c$45 I cannot attend the seminar. Please send me the course materials.

How did you hear about us?

Registrant’s identification: (check all that apply)cAttorney cCPA cCorporate Executive cFinancial Services Professional cInsurance Professional cHR/Compensation/Benefit Professionals cPlan Administrator c Insurance Office cOther (please indicate)

Please select your breakout sessions

1:15 p.m. cA. Benefit Tech Trends You Can’t Afford to IgnorecB. Empower Your Employees with Financial Wellness

2:30 p.m. cC. Health Plan Litigation UpdatecD. Savings Plan Lawsuits on the Rise: Best Practices for Plan Fiduciaries

Name

Firm/Company

Address

City State Zip

Phone Fax

Email

Please make check payable to “University of Missouri” and mail with completed form to: UMKC Law School CLE, 4825 Troost Ave, Suite 211, Kansas City, Missouri 64110

Pay by credit card: (may be faxed to 816-235-6552)

cVISA cMastercard cDiscover cAmEx

Cardholder’s Name (as it appears on card)

Card Number Expiration Date

Page 4: OUR HISTORY Employee Benefits Institute...Debbie Boll, MRIGlobal Robert A. Browning, Spencer Fane LLP Becky Cogdill, Willis Towers Watson Dana L. Dreier, CBIZ MHM, LLC and Mayer Hoffman

STANDARD SPONSORS

11:30 AM LUNCHEON (INCLUDED IN REGISTRATION FEE) SPONSORED BY UTZ & LATTAN, LLC

3:35 PM3:30 PM ROOM CHANGE

8:15 AM

2:30 PM CHOOSE C OR D SPEAKERS BREAKOUT SESSIONS

9:15 AM

Co-sponsored by Employee Benefits Institute of Kansas City, Inc.

and UMKC School of Law

2018 Institute Chairperson: Thomas Delaney

Empower Retirement, Great West Financial

Continuing Legal Education Credit: Missouri 8.4 hours / Kansas pending

Continuing education credit is available for Missouri and Kansas Life & Health Insurance Professionals;

Certified Public Accountants; Human Resource Professionals; Certified Financial Planners

Thursday, May 10, 2018Overland Park Convention Center

6000 College Blvd,Overland Park, Kansas 66211

PREMIUM SPONSORS

THANK YOUto all our sponsors

employeebenefitsinstitute.com

SCHEDULE 7:30 AM REGISTRATION AND BREAKFAST SPONSORED BY: HAYNES BENEFITS PC

8:00 AM WELCOME & PROGRAM OVERVIEW

CONFERENCE BAG SPONSOR: BOK FINANCIAL

AT THE INTERSECTION OF HEALTH AND RETIREMENT

HUGH O’TOOLEMassMutual Financial Group, Enfield, Connecticut

BRADFORD P. CAMPBELLDrinker, Biddle & Reath LLP, Washington D.C.

Bradford P. Campbell is a nationally recognized figure in employer-sponsored retirement plans. He is the former Assistant Secretary of Labor for Employee Benefits and former head of the Employee Benefits Security Administration. As ERISA’s former “top cop” and primary federal regulator, Brad provides his clients with insight and knowledge across a broad range of ERISA-plan related issues. He provides employee benefits advice to financial service providers and plan sponsors, particularly in relation to ERISA Title I issues, including fiduciary conduct and prohibited transactions. A prominent voice in the debate over the Department of Labor fiduciary regulation, Brad testified before four Congressional committees regarding the effects of the regulation, and provides clients with strategic and legal advice related to the final rule.

10:15 AM BREAK SPONSORED BY MCCLOUD & ASSOCIATES, INC.

PHARMACY VALUE CHAIN TRENDS AND DISRUPTION

ALEX JUNG Principal, Parthenon-EY, Chicago, Illinois

Alex Jung is a partner in Parthenon EY, with over 30 years of experience focused on growth and risk mitigation engagements including leading the healthcare analysis unit at Mercer and leading the national healthcare practice at Aon. She has worked globally for Fortune 500 companies to develop and implement large scale strategic transactions including the divestiture of Walgreen’s PBM, acquisition of AllianceBoots and other assets while at Walgreens. Her domain expertise in healthcare and life sciences includes hospital operations, pharmacy and drug manufacturing, patient clinical intervention programs and employer benefits plan designs and funding. Alex is a regular speaker at national events and has been quoted in numerous articles in Kennedy Research, Forrester, Forbes Magazine and is on the editorial board of Inside Patent Care magazine.

CHRIS CHANMercer

BRAD MANDACINALockton Companies, Kansas City, Missouri

KATHRYN BAKICHThe Segal Company, Washington, D.C.

TODD A. SOLOMONMcDermott Will & Emery LLP, Chicago, Illinois

JASON WARMBIRWillis Towers Watson, Chicago, Illinois

Chris is an Innovation Imagineer at Mercer’s Health Innovation LABS, where he’s focused on building creative solutions that complement our clients’ health and welfare benefits programs. His leadership role at LABS has him focused on developing strategies and products through the use of human centered design, machine learning, consumer data insights, and creating customer delight. Chris is especially interested in emerging health care topics that focus on personalized medicine, neuroplasticity/brain science, changing market dynamics, multigenerational needs and global public health challenges. He is based in Mercer’s San Francisco office. Prior to this role, Chris spent 14 years with another major consulting firm, where he launched and led several specialized teams (differing in cross-functional and geographic focus), all with the spirit of building an innovative culture within the organization and with its clients. Outside of work Chris is an artist, a blogger (www.theartofchan.com) and a trendspotter and has personal interests in 80’s toys, the known history of Westeros, brand anthropomorphism and data visualization – which influence the innovative ideas that he develops in the health care space. He’s also dismayed by the number of buzzwords written into this bio, so if you’ve made it this far, kudos to you. Chris graduated from the University of California with a degree in neurobiology.

Brad is accountable for Lockton’s HR Tech Practice. The team helps hundreds of employers per year evaluate and implement the technology they use to run their businesses. He is a keynote speaker, contributes to various publications, and named a top benefit technology innovator.

PATRICK M. DELANEYT. Rowe Price, Baltimore, Maryland

Patrick Delaney is a retirement insights leader for T. Rowe Price’s U.S. intermediary business and a Vice President of T. Rowe Price Investment Services, Inc. In his current role, he plays a key part in developing the firm’s point of view and position on major topics and issues that impact the retirement industry—including plan design, demographic trends, sponsor and participant target date utilization, investment selection, and financial wellness. He is a frequent speaker at client and industry events, and he serves as a retirement SME to recordkeepers, consultants, advisors, TPAs, and plan sponsors. Patrick has been with T. Rowe Price since 2000. He earned a B.A. in economics from Gettysburg College, and is a Series 7 and 63 registered representative.

Kathryn Bakich is a Senior Vice President in Segal’s Washington, DC office and is the firm’s National Health Compliance Practice Leader. Bakich is one of the country’s leading experts on employer sponsored health coverage. She specializes in providing research and analysis on federal laws and regulations affecting health coverage including: ERISA, Medicare, HIPAA, COBRA, the Newborns’ and Mothers’ Health Protection Act, the Mental Health Parity Act and the Women’s Health and Cancer Rights Act. Bakich is a recognized expert on the 2010 Patient Protection and Affordable Care Act. She speaks regularly about the law, helps plan sponsors understand its short and long-term effects on their plans and assists clients with preparing comments on the legislation for submission to the Treasury, Labor, and Health & Human Services Departments. Previously, Bakich represented multiemployer health plans in private practice and was an appellate administrative law judge. She graduated from the University of Missouri with a BA in Political Science ('79), an MA in Public Policy ('82) and a JD ('85). She has been admitted to the Bar in the District of Columbia, United States Supreme Court and multiple federal district and appellate courts.

Todd A. Solomon is the head of McDermott’s Benefits, Compensation & Employment Practice Group. Todd focuses his practice on designing, amending and administrating pension, profit sharing, 401(k), employee stock ownership and 403(b) plans, as well as nonqualified deferred compensation arrangements. He also counsels privately and publicly held corporations and tax-exempt entities regarding fiduciary issues under the Employee Retirement Income Security Act (ERISA), employee benefits issues involved in corporate transactions, executive compensation matters and the implementation of benefit programs for domestic partners of employees. Todd chairs the Firm's Pro Bono and Community Service Committee. He received the 2008 McDermott Will & Emery award for Outstanding Achievement and Commitment to Pro Bono and Service to the Community. Additionally, he is a member of the McDermott's Diversity and Inclusion Committee and has been involved with evaluating the Firm's domestic partner benefits policies and working with businesses in Chicago in jointly advocating for lesbian, gay, bisexual and transgender (LGBT) rights in the workplace.

Jason is a Vice President with Willis Towers Watson with over 12 years of experience in the insurance and risk transfer industry. He provides risk solutions to organizations on Privacy/Cyber Liability and Technology / Errors & Omissions.

THE FIVE FACES OF HEALTHCARE

A. BENEFIT TECH TRENDS YOU CAN’T AFFORD TO IGNORE

B. EMPOWER YOUR EMPLOYEES WITH FINANCIAL WELLNESS

C. HEALTH PLAN LITIGATION UPDATE

D. SAVINGS PLAN LAWSUITS ON THE RISE: BEST PRACTICES FOR PLAN FIDUCIARIES

1:15 PM CHOOSE A OR B SPEAKERS BREAKOUT SESSIONS

Looking at trends driving change between patients, providers, insurers, entrepreneurs and employers. From Amazon/JP Morgan/Berkshire Hathaway to new technologies/therapies and their effect on patients and benefit design, we will examine many of the factors impacting all sides of our healthcare ecosystem.

Technology has transformed and disrupted every corner of human resources — and the benefits function is no exception. Brad will detail the dramatic increase in options and hottest trends in benefits tech, including artificial intelligence to make an administrator’s life easier, social tools to improve employee engagement and some of the emerging technologies benefit leaders will want to put on their radar in the months ahead.

Employers understand that workplaces function better when employees are financially fit. Employees who are less stressed are usually more productive, have less absenteeism, and have higher morale. Providing employees with tools and techniques for managing financial stress can translate to a more productive workforce. In addition, workers who are financially well enough to retire on time could potentially help mitigate rising long-term health care costs for their employers.

2:15 PM BREAK SPONSORED BY MHM RETIREMENT PLAN SOLUTIONS

1:00 PM DESSERT BREAK SPONSORED BY BUKATY COMPANIES

This session will give a high level overview of the landscape relating to lawsuits brought against sponsors of savings plans, such as 401(k) plans and 403(b) plans. The session will focus on the best practices and immediate steps plan fiduciaries can take in order to protect themselves from such claims and limit liability in the event a claim is brought.

While our people are our greatest assets they can also pose the biggest privacy and network threat to an organization. People risks are the next frontier in cyber risk management. Cyber risk impacts every aspect of operations, but current focus has been on capital and technology risk management strategies. Employees are the main cause of cyber incidents, whether through negligent/accidental actions or malicious insiders. Boards and C-Suite are increasingly accountable for cyber risk and are looking to key stakeholders, including Risk Managers, CISOs & CHROs. We will discuss how employee behavior undermines employer confidence, and potential actions for employee benefit plan management.

CYBER SECURITY:PEOPLE AND CYBER: WHY DOES THIS MATTER TO YOU?

4:35 PM CLOSING REMARKS & NETWORKING SOCIAL HOUR SPONSORED BY GALLAGHER

American Century InvestmentsBukaty Companies

CignaDelta Dental of Missouri

Fidelity InvestmentsHaynes Benefits PC

Kansas State University Global CampusMassMutual

Prudential RetirementPurchasing Power

SurencyT. Rowe PriceTaben Group

Total Rewards KCU.S. Department of Labor-Employee

Benefits Security Administration UMB Healthcare Services

UnitedHealthcareVanguard

EXHIBITORS

Come and learn about how to monetize human capital improvement techniques. Ever wonder how closely inter-related physical, emotional and financial wellness might be? What impact might financial wellness have on physical health? Are financial stress and worker compensation costs directly related? Do employees who are financially unprepared to retire represent an ever increasing significant balance sheet impact to an employer? How can we quantify these liabilities and risks? What employer unique data is required to properly project employer specific liability? What prescriptive techniques can be employed to mitigate costs and risks?

The presentation will cover an overview of the value chain from drug manufacturer to wholesaler to PBMs to plan sponsors. The key takeaways include:-What should employers be thinking about and asking their benefits consultants about the changes in the industry?-How do each of the players operate, make money and deliver value? -What goes on in these confidential contracts that should be transparent?-And finally what are regulators trying to address with all the rhetoric?

10:30 AM

12:00 PM

WHAT PLAN SPONSORS NEED TO KNOW: WHAT THE REGULATORS ARE UP TO IN 2018

LUNCHEON PRESENTATION

CONFERENCE POWERSTRIP SPONSOR: LOCKTON COMPANIES

LANYARD SPONSOR: JACKSON LEWIS P.C.

CONFERENCE APP SPONSOR: WILLIS TOWERS WATSON

Learn the lay of the land in Washington, including the Trump Administration’s regulatory and enforcement priorities affecting plan sponsors. New state initiatives that could alter the benefits landscape will be described. Topics will include:-DOL’s Regulatory Agenda, including the Fiduciary Rule and Association Health Plans-DOL’s enforcement priorities for plan sponsors-ERISA litigation trends-State-based workplace IRA programs and how they might affect you-Common Plan Mistakes and the Fiduciary Process

Hugh O’Toole is Senior Vice President and Head of Workplace Distribution for Massachusetts Mutual Life Insurance Co. (MassMutual). As Head of Workplace Distribution, O’Toole leads all distribution and customer acquisition functions for MassMutual’s retirement plans and workplace insurance businesses, including the retirement and worksite sales teams, sales engineering, advisor engagement and the Viability Advisory Group. In his role as leader of the Viability Advisory Group, O’Toole is responsible for directing and promoting the firm’s efforts to quantify the value of helping employers and employees make the most of their retirement and other employee benefits. Before joining MassMutual, O’Toole led Principal Financial Group’s growth in the nonprofit and worksite insurance markets. He joined Principal after the insurer purchased his firm, Professional Pensions, Inc., which disrupted the nonprofit retirement plans market by making available lower- cost investment offerings previously available only to corporate retirement plans. O’Toole is graduated from the State University of New York in Oneonta with a BS in psychology. He is a Registered Principal.

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Page 5: OUR HISTORY Employee Benefits Institute...Debbie Boll, MRIGlobal Robert A. Browning, Spencer Fane LLP Becky Cogdill, Willis Towers Watson Dana L. Dreier, CBIZ MHM, LLC and Mayer Hoffman

STANDARD SPONSORS

11:30 AM LUNCHEON (INCLUDED IN REGISTRATION FEE) SPONSORED BY UTZ & LATTAN, LLC

3:35 PM3:30 PM ROOM CHANGE

8:15 AM

2:30 PM CHOOSE C OR D SPEAKERS BREAKOUT SESSIONS

9:15 AM

Co-sponsored by Employee Benefits Institute of Kansas City, Inc.

and UMKC School of Law

2018 Institute Chairperson: Thomas Delaney

Empower Retirement, Great West Financial

Continuing Legal Education Credit: Missouri 8.4 hours / Kansas pending

Continuing education credit is available for Missouri and Kansas Life & Health Insurance Professionals;

Certified Public Accountants; Human Resource Professionals; Certified Financial Planners

Thursday, May 10, 2018Overland Park Convention Center

6000 College Blvd,Overland Park, Kansas 66211

PREMIUM SPONSORS

THANK YOUto all our sponsors

employeebenefitsinstitute.com

SCHEDULE 7:30 AM REGISTRATION AND BREAKFAST SPONSORED BY: HAYNES BENEFITS PC

8:00 AM WELCOME & PROGRAM OVERVIEW

CONFERENCE BAG SPONSOR: BOK FINANCIAL

AT THE INTERSECTION OF HEALTH AND RETIREMENT

HUGH O’TOOLEMassMutual Financial Group, Enfield, Connecticut

BRADFORD P. CAMPBELLDrinker, Biddle & Reath LLP, Washington D.C.

Bradford P. Campbell is a nationally recognized figure in employer-sponsored retirement plans. He is the former Assistant Secretary of Labor for Employee Benefits and former head of the Employee Benefits Security Administration. As ERISA’s former “top cop” and primary federal regulator, Brad provides his clients with insight and knowledge across a broad range of ERISA-plan related issues. He provides employee benefits advice to financial service providers and plan sponsors, particularly in relation to ERISA Title I issues, including fiduciary conduct and prohibited transactions. A prominent voice in the debate over the Department of Labor fiduciary regulation, Brad testified before four Congressional committees regarding the effects of the regulation, and provides clients with strategic and legal advice related to the final rule.

10:15 AM BREAK SPONSORED BY MCCLOUD & ASSOCIATES, INC.

PHARMACY VALUE CHAIN TRENDS AND DISRUPTION

ALEX JUNG Principal, Parthenon-EY, Chicago, Illinois

Alex Jung is a partner in Parthenon EY, with over 30 years of experience focused on growth and risk mitigation engagements including leading the healthcare analysis unit at Mercer and leading the national healthcare practice at Aon. She has worked globally for Fortune 500 companies to develop and implement large scale strategic transactions including the divestiture of Walgreen’s PBM, acquisition of AllianceBoots and other assets while at Walgreens. Her domain expertise in healthcare and life sciences includes hospital operations, pharmacy and drug manufacturing, patient clinical intervention programs and employer benefits plan designs and funding. Alex is a regular speaker at national events and has been quoted in numerous articles in Kennedy Research, Forrester, Forbes Magazine and is on the editorial board of Inside Patent Care magazine.

CHRIS CHANMercer

BRAD MANDACINALockton Companies, Kansas City, Missouri

KATHRYN BAKICHThe Segal Company, Washington, D.C.

TODD A. SOLOMONMcDermott Will & Emery LLP, Chicago, Illinois

JASON WARMBIRWillis Towers Watson, Chicago, Illinois

Chris is an Innovation Imagineer at Mercer’s Health Innovation LABS, where he’s focused on building creative solutions that complement our clients’ health and welfare benefits programs. His leadership role at LABS has him focused on developing strategies and products through the use of human centered design, machine learning, consumer data insights, and creating customer delight. Chris is especially interested in emerging health care topics that focus on personalized medicine, neuroplasticity/brain science, changing market dynamics, multigenerational needs and global public health challenges. He is based in Mercer’s San Francisco office. Prior to this role, Chris spent 14 years with another major consulting firm, where he launched and led several specialized teams (differing in cross-functional and geographic focus), all with the spirit of building an innovative culture within the organization and with its clients. Outside of work Chris is an artist, a blogger (www.theartofchan.com) and a trendspotter and has personal interests in 80’s toys, the known history of Westeros, brand anthropomorphism and data visualization – which influence the innovative ideas that he develops in the health care space. He’s also dismayed by the number of buzzwords written into this bio, so if you’ve made it this far, kudos to you. Chris graduated from the University of California with a degree in neurobiology.

Brad is accountable for Lockton’s HR Tech Practice. The team helps hundreds of employers per year evaluate and implement the technology they use to run their businesses. He is a keynote speaker, contributes to various publications, and named a top benefit technology innovator.

PATRICK M. DELANEYT. Rowe Price, Baltimore, Maryland

Patrick Delaney is a retirement insights leader for T. Rowe Price’s U.S. intermediary business and a Vice President of T. Rowe Price Investment Services, Inc. In his current role, he plays a key part in developing the firm’s point of view and position on major topics and issues that impact the retirement industry—including plan design, demographic trends, sponsor and participant target date utilization, investment selection, and financial wellness. He is a frequent speaker at client and industry events, and he serves as a retirement SME to recordkeepers, consultants, advisors, TPAs, and plan sponsors. Patrick has been with T. Rowe Price since 2000. He earned a B.A. in economics from Gettysburg College, and is a Series 7 and 63 registered representative.

Kathryn Bakich is a Senior Vice President in Segal’s Washington, DC office and is the firm’s National Health Compliance Practice Leader. Bakich is one of the country’s leading experts on employer sponsored health coverage. She specializes in providing research and analysis on federal laws and regulations affecting health coverage including: ERISA, Medicare, HIPAA, COBRA, the Newborns’ and Mothers’ Health Protection Act, the Mental Health Parity Act and the Women’s Health and Cancer Rights Act. Bakich is a recognized expert on the 2010 Patient Protection and Affordable Care Act. She speaks regularly about the law, helps plan sponsors understand its short and long-term effects on their plans and assists clients with preparing comments on the legislation for submission to the Treasury, Labor, and Health & Human Services Departments. Previously, Bakich represented multiemployer health plans in private practice and was an appellate administrative law judge. She graduated from the University of Missouri with a BA in Political Science ('79), an MA in Public Policy ('82) and a JD ('85). She has been admitted to the Bar in the District of Columbia, United States Supreme Court and multiple federal district and appellate courts.

Todd A. Solomon is the head of McDermott’s Benefits, Compensation & Employment Practice Group. Todd focuses his practice on designing, amending and administrating pension, profit sharing, 401(k), employee stock ownership and 403(b) plans, as well as nonqualified deferred compensation arrangements. He also counsels privately and publicly held corporations and tax-exempt entities regarding fiduciary issues under the Employee Retirement Income Security Act (ERISA), employee benefits issues involved in corporate transactions, executive compensation matters and the implementation of benefit programs for domestic partners of employees. Todd chairs the Firm's Pro Bono and Community Service Committee. He received the 2008 McDermott Will & Emery award for Outstanding Achievement and Commitment to Pro Bono and Service to the Community. Additionally, he is a member of the McDermott's Diversity and Inclusion Committee and has been involved with evaluating the Firm's domestic partner benefits policies and working with businesses in Chicago in jointly advocating for lesbian, gay, bisexual and transgender (LGBT) rights in the workplace.

Jason is a Vice President with Willis Towers Watson with over 12 years of experience in the insurance and risk transfer industry. He provides risk solutions to organizations on Privacy/Cyber Liability and Technology / Errors & Omissions.

THE FIVE FACES OF HEALTHCARE

A. BENEFIT TECH TRENDS YOU CAN’T AFFORD TO IGNORE

B. EMPOWER YOUR EMPLOYEES WITH FINANCIAL WELLNESS

C. HEALTH PLAN LITIGATION UPDATE

D. SAVINGS PLAN LAWSUITS ON THE RISE: BEST PRACTICES FOR PLAN FIDUCIARIES

1:15 PM CHOOSE A OR B SPEAKERS BREAKOUT SESSIONS

Looking at trends driving change between patients, providers, insurers, entrepreneurs and employers. From Amazon/JP Morgan/Berkshire Hathaway to new technologies/therapies and their effect on patients and benefit design, we will examine many of the factors impacting all sides of our healthcare ecosystem.

Technology has transformed and disrupted every corner of human resources — and the benefits function is no exception. Brad will detail the dramatic increase in options and hottest trends in benefits tech, including artificial intelligence to make an administrator’s life easier, social tools to improve employee engagement and some of the emerging technologies benefit leaders will want to put on their radar in the months ahead.

Employers understand that workplaces function better when employees are financially fit. Employees who are less stressed are usually more productive, have less absenteeism, and have higher morale. Providing employees with tools and techniques for managing financial stress can translate to a more productive workforce. In addition, workers who are financially well enough to retire on time could potentially help mitigate rising long-term health care costs for their employers.

2:15 PM BREAK SPONSORED BY MHM RETIREMENT PLAN SOLUTIONS

1:00 PM DESSERT BREAK SPONSORED BY BUKATY COMPANIES

This session will give a high level overview of the landscape relating to lawsuits brought against sponsors of savings plans, such as 401(k) plans and 403(b) plans. The session will focus on the best practices and immediate steps plan fiduciaries can take in order to protect themselves from such claims and limit liability in the event a claim is brought.

While our people are our greatest assets they can also pose the biggest privacy and network threat to an organization. People risks are the next frontier in cyber risk management. Cyber risk impacts every aspect of operations, but current focus has been on capital and technology risk management strategies. Employees are the main cause of cyber incidents, whether through negligent/accidental actions or malicious insiders. Boards and C-Suite are increasingly accountable for cyber risk and are looking to key stakeholders, including Risk Managers, CISOs & CHROs. We will discuss how employee behavior undermines employer confidence, and potential actions for employee benefit plan management.

CYBER SECURITY:PEOPLE AND CYBER: WHY DOES THIS MATTER TO YOU?

4:35 PM CLOSING REMARKS & NETWORKING SOCIAL HOUR SPONSORED BY GALLAGHER

American Century InvestmentsBukaty Companies

CignaDelta Dental of Missouri

Fidelity InvestmentsHaynes Benefits PC

Kansas State University Global CampusMassMutual

Prudential RetirementPurchasing Power

SurencyT. Rowe PriceTaben Group

Total Rewards KCU.S. Department of Labor-Employee

Benefits Security Administration UMB Healthcare Services

UnitedHealthcareVanguard

EXHIBITORS

Come and learn about how to monetize human capital improvement techniques. Ever wonder how closely inter-related physical, emotional and financial wellness might be? What impact might financial wellness have on physical health? Are financial stress and worker compensation costs directly related? Do employees who are financially unprepared to retire represent an ever increasing significant balance sheet impact to an employer? How can we quantify these liabilities and risks? What employer unique data is required to properly project employer specific liability? What prescriptive techniques can be employed to mitigate costs and risks?

The presentation will cover an overview of the value chain from drug manufacturer to wholesaler to PBMs to plan sponsors. The key takeaways include:-What should employers be thinking about and asking their benefits consultants about the changes in the industry?-How do each of the players operate, make money and deliver value? -What goes on in these confidential contracts that should be transparent?-And finally what are regulators trying to address with all the rhetoric?

10:30 AM

12:00 PM

WHAT PLAN SPONSORS NEED TO KNOW: WHAT THE REGULATORS ARE UP TO IN 2018

LUNCHEON PRESENTATION

CONFERENCE POWERSTRIP SPONSOR: LOCKTON COMPANIES

LANYARD SPONSOR: JACKSON LEWIS P.C.

CONFERENCE APP SPONSOR: WILLIS TOWERS WATSON

Learn the lay of the land in Washington, including the Trump Administration’s regulatory and enforcement priorities affecting plan sponsors. New state initiatives that could alter the benefits landscape will be described. Topics will include:-DOL’s Regulatory Agenda, including the Fiduciary Rule and Association Health Plans-DOL’s enforcement priorities for plan sponsors-ERISA litigation trends-State-based workplace IRA programs and how they might affect you-Common Plan Mistakes and the Fiduciary Process

Hugh O’Toole is Senior Vice President and Head of Workplace Distribution for Massachusetts Mutual Life Insurance Co. (MassMutual). As Head of Workplace Distribution, O’Toole leads all distribution and customer acquisition functions for MassMutual’s retirement plans and workplace insurance businesses, including the retirement and worksite sales teams, sales engineering, advisor engagement and the Viability Advisory Group. In his role as leader of the Viability Advisory Group, O’Toole is responsible for directing and promoting the firm’s efforts to quantify the value of helping employers and employees make the most of their retirement and other employee benefits. Before joining MassMutual, O’Toole led Principal Financial Group’s growth in the nonprofit and worksite insurance markets. He joined Principal after the insurer purchased his firm, Professional Pensions, Inc., which disrupted the nonprofit retirement plans market by making available lower- cost investment offerings previously available only to corporate retirement plans. O’Toole is graduated from the State University of New York in Oneonta with a BS in psychology. He is a Registered Principal.

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Page 6: OUR HISTORY Employee Benefits Institute...Debbie Boll, MRIGlobal Robert A. Browning, Spencer Fane LLP Becky Cogdill, Willis Towers Watson Dana L. Dreier, CBIZ MHM, LLC and Mayer Hoffman

Debbie Boll, MRIGlobalRobert A. Browning, Spencer Fane LLPBecky Cogdill, Willis Towers WatsonDana L. Dreier, CBIZ MHM, LLC and Mayer Hoffman McCann P.C.James “Jamie” P. Dutton, Gallagher Benefit Services, / Arthur J. Gallagher & Co.Cindy J. Dwyer, MHM Retirement Plan SolutionsRobert S. Fischgrund, CBIZ Retirement Plan ServicesYvonne Frame, Cerner CorporationJonna R. Harris, Blue Cross & Blue Shield of Kansas CitySamuel A. Henson, Lockton Retirement ServicesDawn M. Hoy, Children’s Mercy Kansas CityBrian M. Johnston, Jackson Lewis, P.C.Gerard J. Karlin, Deloitte & Touche LLPMichelle Kelly, U.S. Department of Labor, Employee Benefits Security Administration

Craig Kovarik, Husch Blackwell LLP Bob Latz, Brown & Ruprecht, PCTammy Leslie, Saint Luke’s Health SystemDaniel J. McCarroll, UMKC School of Law Continuing Legal EducationAndrew McDonnell, H&R Block, Inc.Phil McKnight, Stinson Leonard Street LLPColleen Meurer, Hallmark Cards, IncorporatedJim North, Jr., The Todd OrganizationTim O’Grady, Sprint CorporationTroy L. Redstone, PHD. Retirement ConsultingJohn L. Utz, Utz & Lattan, LLC Mark Whiting, Mercer

Regional Ambassador: Gwen Bryant, HoganTaylor

2018 EMPLOYEE BENEFITS INSTITUTE STEERING COMMITTEE

OUR HISTORY

In the fall of 1986, Michael J. Baker, then Assistant Dean at the University of Missouri – Kansas City School of Law with responsibility for continuing legal education, was eager to expand the law school’s CLE offerings and create an employee benefits symposium. Mike, along with John Utz, Tom Graves, Al Martin, Myron Sildon and their steering committee created the Employee Benefits Institute.

The first program was held on June 5, 1987, at the Hyatt Regency. Approximately 120 individuals attended. Now in its 32nd year, The Employee Benefits Institute has grown into one of the most important conferences in the region and has expanded its presence to include targeted workshops throughout the year and additional networking opportunities.

Celebrating 32 years of being the premier benefits conference in the Midwest

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LODGING INFORMATION

A block of rooms is reserved for Wednesday and Thursday, May 9 & 10, 2018 at a rate of $194.00 single or double at Sheraton Overland Park Hotel, which is connected to the Convention Center and is located at 6100 College Boulevard, Overland Park, Kansas 66211, www.sheraton.com/overlandpark. To reserve your room call 866-837-4214 and mention “UMKC Employee Benefits Institute Room Block." Deadline for room reservations is April 9, 2018.

2018 Institute Chairperson: Thomas Delaney, Empower Retirement, Great West Financial

Thursday, May 10, 2018Overland Park Convention Center

6000 College Blvd,Overland Park, Kansas 66211

Co-sponsored by the Employee Benefits Institute ofKansas City, Inc. and UMKC School of Law

employeebenefitsinstitute.com

Employee Benefits Institute

JOIN US AT THE

2018 Institute Chairperson:Thomas DelaneyEmpower Retirement, Great West Financial

Continuing Legal Education Credit:

Missouri 8.4 hours | Kansas hours pendingContinuing Education Credit is Available for Missouri and Kansas

Life & Health Insurance Professionals; Certified Public Accountants; Human Resource Professionals; Certified Financial Planners

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REGISTRATION

MOCODE KAX81

Employee Benefits Institute 32nd Annual ConferenceThursday, May 10, 2018, Overland Park Convention Center

Register online at EmployeeBenefitsInstitute.com or complete the following form. For more information, call UMKC CLE at 816-235-1648 or email [email protected].

Enclosed is $_____ for _____ registration(s) for enrollment in the Employee Benefits Institue 32nd Annual Conference on Thursday, May 10, 2018 at the Overland Park Convention Center, 6000 College Blvd., Overland Park, Kan. 66211.

Registration fee: (check one)c$250 Includes digital material only.c$295 Includes hard copy printed material and digital material.c$45 I cannot attend the seminar. Please send me the course materials.

How did you hear about us?

Registrant’s identification: (check all that apply)cAttorney cCPA cCorporate Executive cFinancial Services Professional cInsurance Professional cHR/Compensation/Benefit Professionals cPlan Administrator cInsurance Office cOther (please indicate)

Please select your breakout sessions

1:15 p.m. cA. Benefit Tech Trends You Can’t Afford to IgnorecB. Empower Your Employees with Financial Wellness

2:30 p.m. cC. Health Plan Litigation UpdatecD. Savings Plan Lawsuits on the Rise: Best Practices for Plan Fiduciaries

Name

Firm/Company

Address

City State Zip

Phone Fax

Email

Please make check payable to “University of Missouri” and mail with completed form to: UMKC Law School CLE, 4825 Troost Ave, Suite 211, Kansas City, Missouri 64110

Pay by credit card: (may be faxed to 816-235-6552)

cVISA cMastercard cDiscover cAmEx

Cardholder’s Name (as it appears on card)

Card Number Expiration Date