John M. and Nancy L. Jerose - Page 6

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                    -    you have not chosen to receive them but they would           
                         not reduce the normal retirement benefit under the           
                         retirement plan sponsored by your participating              
               employer.                                                              
               Other Sources                                                          
               If you are eligible to receive any salary, wages,                      
               partnership or proprietorship draw, commissions, or similar            
               pay from any work you do, we will not consider such income             
               for the 12 consecutive months starting on the day you become           
               entitled to it, as long as the sum of:                                 
               -    the income described above,                                       
               -    the Schedule Amount, and                                          
               -    benefits from any source described in Other Sources,              
                    is not more than 100% of your monthly pay.  If the sum            
                    is more than 100% of your monthly pay, we will subtract           
                    the amount over 100% from the Schedule Amount when                
               determining your benefit under the policy.                             
               After 12 months, we will consider 70% of the amount                    
               determined after reducing any salary, wages, partnership or            
               proprietorship draw, commissions or similar pay you earn               
               from any work you do, by any family care expense, or                   
               Any group disability insurance contract, except one                    
               sponsored by the participating employer, or an affiliated              
               employer.                                                              
               As a result of degenerative disk disease of the spine and              
          permanent nerve damage, petitioner ceased working at Memorial               
          Hospital in September of 1999.  Due to her illness, petitioner              
          was prevented from engaging in any gainful employment after 1999.           
          During taxable year 2000, petitioner received disability benefits           
          under the Fortis policy in the amount of $9,481.                            
               The Fortis Co. sent to petitioner and respondent a Form W-2,           
          Wage and Tax Statement, for taxable year 2000 reflecting wages,             
          tips, and other compensation paid to petitioner in the amount of            
          $9,481.                                                                     





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