From: Stephanie Kier [skier@relphbenefitadvisors.

com] Sent: Tuesday, November 30, 2010 3:37 PM To: HHS HealthInsurance (HHS) Cc: DeAnna Backus; Stephanie Kier Subject: Waiver of Annual Dollar Limits Application- REQUIRES ATTENTION Importance: High Attachments: HRA Waiver application 113010.pdf; Springbrook Standalone HRA amended and restated 1-1-10 (2).pdf
Please see the attached waiver application along with a copy of the HRA Plan Document for Springbrook. Please respond directly to DeAnna Backus at Springbrook. Contact information is included on the application. Stephanie L. Kier Account Executive Relph Benefit Advisors 1150-G Pittsford-Victor Rd. Pittsford, NY 14534 P: 585-248-8720 Ext. 245 f: 585-415-4323

Document obtained by CompleteColorado.com

Relph Benefit Advisors is a member of the Benefit Advisors Network (BAN) , the premier national credentialed network of independent employee benefit brokerage and consulting firms. BAN member firms share investment and human capital in state of the art technology and employee benefit expertise to deliver optimum results for their clients. CONFIDENTIALITY NOTICE: The information contained in this electronic communication, including any attachments, is confidential information, is intended only for the use of the recipients named above, and may be protected by law. If the reader of this message is not an intended recipient, you are hereby notified that any review, use, dissemination, distribution or copying of this communication, or any of its contents, is strictly prohibited. If you have received this communication in error, please notify us immediately of the error by return e-mail and please permanently remove the original message and any copy of it from your system. Thank you

Co m

pl

et eC

ol o

Visit us at: http://www.relphbenefitadvisors.com for the latest news and information

ra do .

file:///T|/...20Standalone%20HRA/Waiver%20of%20Annual%20Dollar%20Limits%20Application-%20REQUIRES%20ATTENTION.htm[08/08/2011 12:08:45 PM]

co m

Springbrook:000001

Document obtained by CompleteColorado.com

Ex. 4 Ex. 4

Co m

pl

et eC

ol o

ra do .
Ex. 4

co m
Springbrook:000002

Document obtained by CompleteColorado.com

Pages 3 through 15 redacted for the following reasons: ---------------------------Exemption 4

Co m

pl

et eC

ol o
Springbrook:000003

ra do .

co m

Co m

pl

et eC

Lisa M. Keels, J.D. U.S. Department of Health & Human Services Office of Consumer Information and Insurance Oversight Office of Oversight lisa.keels@hhs.gov 301-492-4168

ol o
Springbrook:000004

file:///T|/...20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Request%20for%20info%2012.20.10.htm[08/08/2011 12:08:46 PM]

ra do .

From: Keels, Lisa (HHS/OCIIO) Sent: Monday, December 20, 2010 1:11 PM To: backusd@springbrookny.org Cc: Habit, Sandra (HHS/OCIIO) Subject: Springbrook Standalone HRA Waiver Application - Request for Additional Information Dear DeAnna, Thank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act (PHS Act) Section 2711. In order to expedite your application, please provide the following information: Please state the number of people covered under each of the following tiers of coverage: o $Ex. 4 single coverage o $Ex. 4 o-person coverage o $Ex. 4 family coverage In order to complete your application, please provide this information by 5:00 pm, December 21, 2010. Once this information is received and the application is complete, it will be processed by the Department of Health and Human Services (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 30 days of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decision. Thank you, Lisa

Document obtained by CompleteColorado.com

co m

From: Keels, Lisa (HHS/OCIIO) Sent: Wednesday, December 22, 2010 4:46 PM To: backusd@springbrookny.org Cc: Habit, Sandra (HHS/OCIIO) Subject: FW: Springbrook Standalone HRA Waiver Application - Request for Additional Information
Dear DeAnna, I just left you a voicemail message to follow up on our conversation and my email below from Monday, December 20th. As I mentioned, in order to complete your application for an annual limits waiver, please let us know how many people are covered under each tier of coverage. I will be out of the office beginning tomorrow, Thursday, December 23, through next week. I will be checking my voicemail periodically, but I recommend trying to contact me via email if you have any questions. I will be checking my email tomorrow and intermittently next week. Thank you, Lisa
From: Keels, Lisa (HHS/OCIIO) Sent: Monday, December 20, 2010 1:11 PM To: 'backusd@springbrookny.org' Cc: Habit, Sandra (HHS/OCIIO) Subject: Springbrook Standalone HRA Waiver Application - Request for Additional Information

Document obtained by CompleteColorado.com

Lisa M. Keels, J.D. U.S. Department of Health & Human Services Office of Consumer Information and Insurance Oversight Office of Oversight lisa.keels@hhs.gov 301-492-4168
Springbrook:000005

file:///T|/...20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Request%20for%20info%2012.22.10.htm[08/08/2011 12:08:47 PM]

Co m

Dear DeAnna, Thank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act (PHS Act) Section 2711. In order to expedite your application, please provide the following information: Please state the number of people covered under each of the following tiers of coverage: o $Ex. 4 single coverage o $Ex. 4 o-person coverage Ex. 4 o $ family coverage In order to complete your application, please provide this information by 5:00 pm, December 21, 2010. Once this information is received and the application is complete, it will be processed by the Department of Health and Human Services (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 30 days of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decision. Thank you, Lisa

pl

et eC

ol o

ra do .

co m

From: Keels, Lisa (HHS/OCIIO) Sent: Thursday, December 23, 2010 9:33 AM To: Stephanie Kier; backusd@springbrookny.org; Kim Sawdey; John Bartholf Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Springbrook Standalone HRA Waiver Application - Request for Additional Information
Thanks, Stephanie. Lisa
From: Stephanie Kier [mailto:skier@relphbenefitadvisors.com] Sent: Thursday, December 23, 2010 9:32 AM To: backusd@springbrookny.org; Stephanie Kier; Kim Sawdey; Keels, Lisa (HHS/OCIIO); John Bartholf Subject: Re: Springbrook Standalone HRA Waiver Application - Request for Additional Information

Document obtained by CompleteColorado.com

Lisa, Here is the info you requested. Opt out ( Ex. 4 ) Single ($Ex. 4 Ex. 4 2 person Ex. 4 Ex. 4 Family ($ Ex. 4 Ex. 4
Ex. 4

Please let DeAnna and me know if you need anything else. Stephanie Kier Sent from my HTC on the Now Network from Sprint!

From: Keels, Lisa (HHS/OCIIO) [mailto:Lisa.Keels@hhs.gov] Sent: Wednesday, December 22, 2010 4:46 PM To: DeAnna Backus Cc: Habit, Sandra (HHS/OCIIO) Subject: [!! SPAM] FW: Springbrook Standalone HRA Waiver Application - Request for Additional Information

Dear DeAnna, I just left you a voicemail message to follow up on our conversation and my email below from Monday, December 20th. As I mentioned, in order to complete your application for an annual limits waiver, please let us know how many people are
Springbrook:000006

file:///T|/...0with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Correspondence%2012.23.10.htm[08/08/2011 12:08:47 PM]

Co m

DeAnna Backus Assistant Director, Human Resources Springbrook (607) 286-7171, ext. 268 Email: backusd@springbrookny.org www.springbrookny.org

pl

I will need assistance on this. Please see below. I wont be back in the office until Wednesday, 12/29.

et eC

----- Reply message ----From: "DeAnna Backus" <backusd@springbrookny.org> Date: Wed, Dec 22, 2010 4:49 pm Subject: FW: Springbrook Standalone HRA Waiver Application - Request for Additional Information To: "Stephanie Kier" <skier@relphbenefitadvisors.com>, "Kim Sawdey" <ksawdey@relphbenefitadvisors.com>

ol o

ra do .

co m

Document obtained by CompleteColorado.com covered under each tier of coverage. I will be out of the office beginning tomorrow, Thursday, December 23, through next week. I will be checking my voicemail periodically, but I recommend trying to contact me via email if you have any questions. I will be checking my email tomorrow and intermittently next week. Thank you, Lisa From: Keels, Lisa (HHS/OCIIO) Sent: Monday, December 20, 2010 1:11 PM To: 'backusd@springbrookny.org' Cc: Habit, Sandra (HHS/OCIIO) Subject: Springbrook Standalone HRA Waiver Application - Request for Additional Information Dear DeAnna, Thank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act (PHS Act) Section 2711. In order to expedite your application, please provide the following information: Please state the number of people covered under each of the following tiers of coverage: $Ex. 4 single coverage $Ex. 4 two-person coverage $Ex. 4 family coverage In order to complete your application, please provide this information by 5:00 pm, December 21, 2010. Once this information is received and the application is complete, it will be processed by the Department of Health and Human Services (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 30 days of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decision. Thank you, Lisa Lisa M. Keels, J.D. U.S. Department of Health & Human Services Office of Consumer Information and Insurance Oversight Office of Oversight lisa.keels@hhs.gov 301-492-4168

Click here to report this email as spam. Visit us on the web at http://www.springbrookny.org

Co m

pl

et eC

ol o

ra do .

file:///T|/...0with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Correspondence%2012.23.10.htm[08/08/2011 12:08:47 PM]

co m

Springbrook:000007

From: Keels, Lisa (HHS/OCIIO) Sent: Monday, December 27, 2010 6:50 PM To: Stephanie Kier Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Springbrook Standalone HRA Waiver Application - Request for Additional Information Hi Stephanie, Thanks for your email. The Springbrook HRA application is currently being processed with the information you provided on Thursday, December 23rd. At this point, your application is complete, and you should be hearing from HHS soon. Thanks again, Lisa ________________________________________ From: Stephanie Kier [skier@relphbenefitadvisors.com] Sent: Monday, December 27, 2010 3:28 PM To: Keels, Lisa (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Springbrook Standalone HRA Waiver Application - Request for Additional Information Lisa,

Document obtained by CompleteColorado.com

Sincerely, Stephanie Stephanie Kier Account Executive Relph Benefit Advisors

Thanks, Stephanie. Lisa

From: Stephanie Kier [mailto:skier@relphbenefitadvisors.com] Sent: Thursday, December 23, 2010 9:32 AM To: backusd@springbrookny.org; Stephanie Kier; Kim Sawdey; Keels, Lisa (HHS/OCIIO); John Bartholf Subject: Re: Springbrook Standalone HRA Waiver Application - Request for Additional Information Lisa,
Springbrook:000008

file:///T|/...ns%20with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Completion%2012.27.10.txt[08/08/2011 12:08:48 PM]

Co m

From: Keels, Lisa (HHS/OCIIO) [mailto:Lisa.Keels@hhs.gov] Sent: Thursday, December 23, 2010 9:33 AM To: Stephanie Kier; backusd@springbrookny.org; Kim Sawdey; John Bartholf Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Springbrook Standalone HRA Waiver Application - Request for Additional Information

pl

et eC

ol o

I hope you had a wonderful holiday. Per your email below I can see that you are out of the office this week but will be checking email periodically. Can you please let me know the status of the HRA Waiver Application for Springbrook? I wanted to reach out to you early this week to make sure Springbrook was all set. Please let me know when you get a chance. Thank you.

ra do .

co m

Here is the info you requested. Opt out Ex. 4 SingleEx. 4 2 pers Ex. 4 Family Ex. 4

Document obtained by CompleteColorado.com

Please let DeAnna and me know if you need anything else. Stephanie Kier Sent from my HTC on the Now Network from Sprint! ----- Reply message ----From: "DeAnna Backus" <backusd@springbrookny.org> Date: Wed, Dec 22, 2010 4:49 pm Subject: FW: Springbrook Standalone HRA Waiver Application - Request for Additional Information To: "Stephanie Kier" <skier@relphbenefitadvisors.com>, "Kim Sawdey" <ksawdey@relphbenefitadvisors.com> I will need assistance on this. Please see below. I wont be back in the office until Wednesday, 12/29.

Dear DeAnna,

Thank you, Lisa

From: Keels, Lisa (HHS/OCIIO) Sent: Monday, December 20, 2010 1:11 PM To: 'backusd@springbrookny.org' Cc: Habit, Sandra (HHS/OCIIO) Subject: Springbrook Standalone HRA Waiver Application - Request for Additional Information Dear DeAnna, Thank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act (PHS Act) Section 2711. In order to expedite your application, please provide the
Springbrook:000009

file:///T|/...ns%20with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Completion%2012.27.10.txt[08/08/2011 12:08:48 PM]

Co m

I will be out of the office beginning tomorrow, Thursday, December 23, through next week. I will be checking my voicemail periodically, but I recommend trying to contact me via email if you have any questions. I will be checking my email tomorrow and intermittently next week.

pl

I just left you a voicemail message to follow up on our conversation and my email below from Monday, December 20th. As I mentioned, in order to complete your application for an annual limits waiver, please let us know how many people are covered under each tier of coverage.

et eC

From: Keels, Lisa (HHS/OCIIO) [mailto:Lisa.Keels@hhs.gov] Sent: Wednesday, December 22, 2010 4:46 PM To: DeAnna Backus Cc: Habit, Sandra (HHS/OCIIO) Subject: [!! SPAM] FW: Springbrook Standalone HRA Waiver Application - Request for Additional Information

ol o

ra do .

DeAnna Backus Assistant Director, Human Resources Springbrook (607) 286-7171, ext. 268 Email: backusd@springbrookny.org www.springbrookny.org<http://www.springbrookny.org/>

co m

following information:

Document obtained by CompleteColorado.com

Please state the number of people covered under each of the following tiers of coverage: $
Ex. 4

single coverage

$Ex. 4 two-person coverage $

Ex. 4

family coverage

Lisa M. Keels, J.D. U.S. Department of Health & Human Services Office of Consumer Information and Insurance Oversight Office of Oversight lisa.keels@hhs.gov 301-492-4168

Click here<https://www.mailcontrol.com/sr/wQw0zmjPoHdJTZGyOCrrhg==> to report this email as spam. Visit us on the web at http://www.springbrookny.org<http://www.springbrookny.org/>

Co m

pl

et eC

ol o

ra do .

Thank you, Lisa

file:///T|/...ns%20with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Completion%2012.27.10.txt[08/08/2011 12:08:48 PM]

co m

In order to complete your application, please provide this information by 5:00 pm, December 21, 2010. Once this information is received and the application is complete, it will be processed by the Department of Health and Human Services (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 30 days of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decision.

Springbrook:000010

From: Stephanie Kier [skier@relphbenefitadvisors.com] Sent: Monday, December 27, 2010 3:28 PM To: Keels, Lisa (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Springbrook Standalone HRA Waiver Application - Request for Additional Information
Lisa, I hope you had a wonderful holiday. Per your email below I can see that you are out of the office this week but will be checking email periodically. Can you please let me know the status of the HRA Waiver Application for Springbrook? I wanted to reach out to you early this week to make sure Springbrook was all set. Please let me know when you get a chance. Thank you. Sincerely, Stephanie Stephanie Kier Account Executive Relph Benefit Advisors
From: Keels, Lisa (HHS/OCIIO) [mailto:Lisa.Keels@hhs.gov] Sent: Thursday, December 23, 2010 9:33 AM To: Stephanie Kier; backusd@springbrookny.org; Kim Sawdey; John Bartholf Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Springbrook Standalone HRA Waiver Application - Request for Additional Information

Document obtained by CompleteColorado.com

From: Stephanie Kier [mailto:skier@relphbenefitadvisors.com] Sent: Thursday, December 23, 2010 9:32 AM To: backusd@springbrookny.org; Stephanie Kier; Kim Sawdey; Keels, Lisa (HHS/OCIIO); John Bartholf Subject: Re: Springbrook Standalone HRA Waiver Application - Request for Additional Information

Lisa,

Here is the info you requested. Opt ou Single Ex. 4 2 perso Ex. 4 Family Ex. 4
Ex. 4

Please let DeAnna and me know if you need anything else. Stephanie Kier Sent from my HTC on the Now Network from Sprint! ----- Reply message ----From: "DeAnna Backus" <backusd@springbrookny.org> Date: Wed, Dec 22, 2010 4:49 pm Subject: FW: Springbrook Standalone HRA Waiver Application - Request for Additional Information
Springbrook:000011

file:///T|/...0with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Status%20check%2012.27.10.htm[08/08/2011 12:08:48 PM]

Co m

pl

et eC

Thanks, Stephanie. Lisa

ol o

ra do .

co m

Document obtained by CompleteColorado.com To: "Stephanie Kier" <skier@relphbenefitadvisors.com>, "Kim Sawdey" <ksawdey@relphbenefitadvisors.com>

I will need assistance on this. Please see below. I wont be back in the office until Wednesday, 12/29.

DeAnna Backus Assistant Director, Human Resources Springbrook (607) 286-7171, ext. 268 Email: backusd@springbrookny.org www.springbrookny.org

From: Keels, Lisa (HHS/OCIIO) [mailto:Lisa.Keels@hhs.gov] Sent: Wednesday, December 22, 2010 4:46 PM To: DeAnna Backus Cc: Habit, Sandra (HHS/OCIIO) Subject: [!! SPAM] FW: Springbrook Standalone HRA Waiver Application - Request for Additional Information

Dear DeAnna, I just left you a voicemail message to follow up on our conversation and my email below from Monday, December 20th. As I mentioned, in order to complete your application for an annual limits waiver, please let us know how many people are covered under each tier of coverage. I will be out of the office beginning tomorrow, Thursday, December 23, through next week. I will be checking my voicemail periodically, but I recommend trying to contact me via email if you have any questions. I will be checking my email tomorrow and intermittently next week. Thank you, Lisa From: Keels, Lisa (HHS/OCIIO) Sent: Monday, December 20, 2010 1:11 PM To: 'backusd@springbrookny.org' Cc: Habit, Sandra (HHS/OCIIO) Subject: Springbrook Standalone HRA Waiver Application - Request for Additional Information Dear DeAnna, Thank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act (PHS Act) Section 2711. In order to expedite your application, please provide the following information: Please state the number of people covered under each of the following tiers of coverage: $Ex. 4 single coverage $Ex. 4 two-person coverage $Ex. 4 family coverage In order to complete your application, please provide this information by 5:00 pm, December 21, 2010. Once this information is received and the application is complete, it will be processed by the Department of Health and Human Services (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 30 days of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decision.

Co m

pl

et eC

ol o

ra do .

file:///T|/...0with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Status%20check%2012.27.10.htm[08/08/2011 12:08:48 PM]

co m

Springbrook:000012

Document obtained by CompleteColorado.com Thank you, Lisa Lisa M. Keels, J.D. U.S. Department of Health & Human Services Office of Consumer Information and Insurance Oversight Office of Oversight lisa.keels@hhs.gov 301-492-4168

Click here to report this email as spam.

Co m

pl

et eC

ol o
Springbrook:000013

file:///T|/...0with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Status%20check%2012.27.10.htm[08/08/2011 12:08:48 PM]

ra do .

Visit us on the web at http://www.springbrookny.org

co m

From: Stephanie Kier [skier@relphbenefitadvisors.com] Sent: Monday, January 03, 2011 8:42 AM To: Keels, Lisa (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Springbrook Standalone HRA Waiver Application - Request for Additional Information Importance: High Hi Lisa, Can you please tell me the status of the waiver for Springbrook? Stephanie Kier Account Executive Relph Benefit Advisors

Document obtained by CompleteColorado.com

Thanks for your email. The Springbrook HRA application is currently being processed with the information you provided on Thursday, December 23rd. At this point, your application is complete, and you should be hearing from HHS soon. Thanks again, Lisa ________________________________________ From: Stephanie Kier [skier@relphbenefitadvisors.com] Sent: Monday, December 27, 2010 3:28 PM To: Keels, Lisa (HHS/OCIIO) Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Springbrook Standalone HRA Waiver Application - Request for Additional Information Lisa,

I hope you had a wonderful holiday. Per your email below I can see that you are out of the office this week but will be checking email periodically. Can you please let me know the status of the HRA Waiver Application for Springbrook? I wanted to reach out to you early this week to make sure Springbrook was all set. Please let me know when you get a chance. Thank you. Sincerely, Stephanie Stephanie Kier Account Executive Relph Benefit Advisors
Springbrook:000014

file:///T|/...ications%20with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Question%201.3.11.txt[08/08/2011 12:08:49 PM]

Co m

pl

et eC

ol o

Hi Stephanie,

ra do .

-----Original Message----From: Keels, Lisa (HHS/OCIIO) [mailto:Lisa.Keels@hhs.gov] Sent: Monday, December 27, 2010 6:50 PM To: Stephanie Kier Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Springbrook Standalone HRA Waiver Application - Request for Additional Information

co m

Document obtained by CompleteColorado.com From: Keels, Lisa (HHS/OCIIO) [mailto:Lisa.Keels@hhs.gov] Sent: Thursday, December 23, 2010 9:33 AM To: Stephanie Kier; backusd@springbrookny.org; Kim Sawdey; John Bartholf Cc: Habit, Sandra (HHS/OCIIO) Subject: RE: Springbrook Standalone HRA Waiver Application - Request for Additional Information

Thanks, Stephanie. Lisa From: Stephanie Kier [mailto:skier@relphbenefitadvisors.com] Sent: Thursday, December 23, 2010 9:32 AM To: backusd@springbrookny.org; Stephanie Kier; Kim Sawdey; Keels, Lisa (HHS/OCIIO); John Bartholf Subject: Re: Springbrook Standalone HRA Waiver Application - Request for Additional Information Lisa, Here is the info you requested. Opt ou Ex. 4 SingleEx. 4 2 pers Ex. 4 Family Ex. 4 Please let DeAnna and me know if you need anything else.

From: Keels, Lisa (HHS/OCIIO) [mailto:Lisa.Keels@hhs.gov] Sent: Wednesday, December 22, 2010 4:46 PM To: DeAnna Backus Cc: Habit, Sandra (HHS/OCIIO) Subject: [!! SPAM] FW: Springbrook Standalone HRA Waiver Application - Request for Additional Information Dear DeAnna, I just left you a voicemail message to follow up on our conversation and my email below from Monday, December 20th. As I mentioned, in order to complete your application for an annual limits waiver, please let us know how many people are covered under each tier of coverage.
Springbrook:000015

file:///T|/...ications%20with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Question%201.3.11.txt[08/08/2011 12:08:49 PM]

Co m

DeAnna Backus Assistant Director, Human Resources Springbrook (607) 286-7171, ext. 268 Email: backusd@springbrookny.org www.springbrookny.org<http://www.springbrookny.org/>

pl

et eC

Stephanie Kier Sent from my HTC on the Now Network from Sprint! ----- Reply message ----From: "DeAnna Backus" <backusd@springbrookny.org> Date: Wed, Dec 22, 2010 4:49 pm Subject: FW: Springbrook Standalone HRA Waiver Application - Request for Additional Information To: "Stephanie Kier" <skier@relphbenefitadvisors.com>, "Kim Sawdey" <ksawdey@relphbenefitadvisors.com> I will need assistance on this. Please see below. I won't be back in the office until Wednesday, 12/29.

ol o

ra do .

co m

Document obtained by CompleteColorado.com I will be out of the office beginning tomorrow, Thursday, December 23, through next week. I will be checking my voicemail periodically, but I recommend trying to contact me via email if you have any questions. I will be checking my email tomorrow and intermittently next week.

Thank you, Lisa From: Keels, Lisa (HHS/OCIIO) Sent: Monday, December 20, 2010 1:11 PM To: 'backusd@springbrookny.org' Cc: Habit, Sandra (HHS/OCIIO) Subject: Springbrook Standalone HRA Waiver Application - Request for Additional Information

Thank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements of the Public Health Service Act (PHS Act) Section 2711. In order to expedite your application, please provide the following information: Please state the number of people covered under each of the following tiers of coverage: $
Ex. 4

single coverage

$Ex. 4 two-person coverage $

Ex. 4

family coverage

Click here<https://www.mailcontrol.com/sr/wQw0zmjPoHdJTZGyOCrrhg==> to report this email as spam. Visit us on the web at http://www.springbrookny.org<http://www.springbrookny.org/>

Co m

Lisa M. Keels, J.D. U.S. Department of Health & Human Services Office of Consumer Information and Insurance Oversight Office of Oversight lisa.keels@hhs.gov 301-492-4168

pl

Thank you, Lisa

et eC

In order to complete your application, please provide this information by 5:00 pm, December 21, 2010. Once this information is received and the application is complete, it will be processed by the Department of Health and Human Services (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 30 days of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decision.

ol o

ra do .

file:///T|/...ications%20with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Question%201.3.11.txt[08/08/2011 12:08:49 PM]

co m

Dear DeAnna,

Springbrook:000016

From: Keels, Lisa (HHS/OCIIO) Sent: Monday, January 03, 2011 10:25 AM To: 'Stephanie Kier' Cc: backusd@springbrookny.org Subject: FW: Springbrook Standalone HRA Approval Letter for a Waiver of the Annual Limits Requirements 12-30-2010 Attachments: Updated Jan 1 Approval Letter .pdf Importance: High

Document obtained by CompleteColorado.com

Good Afternoon, Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2711 for Springbrook Standalone HRA. HHS has reviewed your application and made its determination. Please see the attached letter. Please confirm receipt of this letter by replying to this e-mail. Please let me know if I can be of further assistance. Sincerely,
Sandy Habit Department of Health and Human Services Office of Consumer Information and Insurance Oversight 301-492-4175 Sandra.Habit@hhs.gov

Springbrook:000017

file:///T|/...Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Response%20to%20second%20status%20check%201.3.11.htm[08/08/2011 12:08:49 PM]

Co m

pl

et eC

From: Habit, Sandra (HHS/OCIIO) Sent: Thursday, December 30, 2010 5:36 PM To: 'backusd@springbrookny.org' Subject: Springbrook Standalone HRA Approval Letter for a Waiver of the Annual Limits Requirements 12-30-2010 Importance: High

ol o

ra do .

have received the approval letter (attached to this email) on Thursday, December 30 th . As stated below, please confirm receipt of the letter by replying to Sandra Habit (sandra.habit@hhs.gov). Thank you, Lisa

co m

Hi Stephanie, In response to your email from his morning, the Springbrook HRA waiver application was approved. DeAnna Backus should

Document obtained by CompleteColorado.com

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full extent of the law.

Co m

pl

et eC

ol o
Springbrook:000018

file:///T|/...Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Response%20to%20second%20status%20check%201.3.11.htm[08/08/2011 12:08:49 PM]

ra do .

co m

From: Habit, Sandra (HHS/OCIIO) Sent: Thursday, December 30, 2010 5:36 PM To: 'backusd@springbrookny.org' Subject: Springbrook Standalone HRA Approval Letter for a Waiver of the Annual Limits Requirements 12-30-2010 Importance: High Attachments: Updated Jan 1 Approval Letter .pdf Good Afternoon, Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2711 for Springbrook Standalone HRA. HHS has reviewed your application and made its determination. Please see the attached letter. Please confirm receipt of this letter by replying to this e-mail. Please let me know if I can be of further assistance. Sincerely,
Sandy Habit Department of Health and Human Services Office of Consumer Information and Insurance Oversight 301-492-4175 Sandra.Habit@hhs.gov

Document obtained by CompleteColorado.com

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full extent of the law.

Co m

pl

et eC

ol o
Springbrook:000019

file:///T|/...ions%20with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/SpringbrookApproval.htm[08/08/2011 12:08:49 PM]

ra do .

co m

Document obtained by CompleteColorado.com

Co m

pl

et eC

ol o
Springbrook:000020

ra do .

co m

Document obtained by CompleteColorado.com

Co m

pl

et eC

ol o
Springbrook:000021

ra do .

co m

From: DeAnna Backus [backusd@springbrookny.org] Sent: Monday, January 03, 2011 10:51 AM To: Habit, Sandra (HHS/OCIIO) Subject: RE: Springbrook Standalone HRA Approval Letter for a Waiver of the Annual Limits Requirements 12-302010
Hi Sandra, I did receive this email, and have forwarded it on to Stephanie Kier at Relph Benefits. Thank you!

Document obtained by CompleteColorado.com

From: Habit, Sandra (HHS/OCIIO) [mailto:Sandra.Habit@hhs.gov] Sent: Thursday, December 30, 2010 5:36 PM To: DeAnna Backus Subject: [!! SPAM] Springbrook Standalone HRA Approval Letter for a Waiver of the Annual Limits Requirements 12-30-2010 Importance: High

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full extent of the law.

Springbrook:000022

file:///T|/...ith%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Approval%20receipt%201.3.11.htm[08/08/2011 12:08:50 PM]

Co m

Good Afternoon, Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2711 for Springbrook Standalone HRA. HHS has reviewed your application and made its determination. Please see the attached letter. Please confirm receipt of this letter by replying to this e-mail. Please let me know if I can be of further assistance. Sincerely,
Sandy Habit Department of Health and Human Services Office of Consumer Information and Insurance Oversight 301-492-4175 Sandra.Habit@hhs.gov

pl

et eC

ol o

ra do .

co m

DeAnna Backus Assistant Director, Human Resources Springbrook (607) 286-7171, ext. 268 Email: backusd@springbrookny.org www.springbrookny.org

Click here to report this email as spam.

Document obtained by CompleteColorado.com

Visit us on the web at http://www.springbrookny.org

Co m

pl

et eC

ol o
Springbrook:000023

file:///T|/...ith%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Approval%20receipt%201.3.11.htm[08/08/2011 12:08:50 PM]

ra do .

co m