November 16, 2010 Department of Health and Human Services Office of Consumer Information and Insurance Oversight, Office

of Oversight Attention James Mayhew, Room 737-F-04 200 Independence Ave. SW Washington, DC 20201 Dear Mr. Mayhew:

Andersen Corporation is interested in applying for a waiver from the restricted annual limits set forth in the interim final regulations under the Patient Protection and Affordable Care Act for three of our medical plans. The waiver would apply for the plan year beginning on January 1, 2011 and ending on December 31, 2011. The information on the plans is listed below: Feature Terms of the Plans for Which the Waiver is Being Sought

Annual Limits and Rates Associated with These Plans

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Number of Individuals Covered by These Plans

Andersen Corporation Plan Provision See the attached SPDs for the Silver Line New Jersey Union Drivers and Grandfathered Production Plan (Plan U), Silver Line New Jersey Union Production Medical Plan (Plan T1/T2) and the Silver Line Illinois Union Production Medical Plan (Plan P2). Page 5 of each SPD has an overview of the coverage provided by each plan. These plans are offered to union employees at our Silver Line Window business. They have employees primarily in New Jersey and Illinois. As of November 16 there are (b)(4) employees enrolled in the Silver Line New Jersey Union Drivers and Grandfathered Production Plan (Plan U); (b)(4) employees enrolled in the Silver Line New Jersey Union Production Medical Plan (Plan T1/T2); and (b)(4) employees enrolled in the Silver Line Illinois Union Production Medical Plan (Plan P2). The annual limits of $ (b)(4) per member and $ (b)(4) per member are specified in the attached SPDs and the excerpts from the union contracts. The 2010 2011 weekly employee rates are attached as Exhibit A and are taken from the union contracts.

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ANDERSEN:000001

Feature Reason that Compliance with the Interim Final Regulations would Increase Premiums

Attestation

If you have any questions about this letter, please contact me directly at 651-264-2836. Sincerely,

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Kathy Prondzinski Director, Corporate Benefits Design Andersen Corporation 100 Fourth Avenue North Bayport, MN 55003

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Andersen Corporation Plan Provision According to our actuary, if Silver Line increased the annual limit in all three plans to $750,000, the 2011 cost of the plans (total premium) would increase by (b)(4) approximately This is a significant impact to the business. S is faced with attempting to renegotiate the plan design and/or employee contributions with the union to better reflect the cost of the plan that was in place prior to health care reform being passed. The plan design must be significantly reduced to pay for the removal of the annual limits. If we are not successful in renegotiating the plan design, Silver Line may have to eliminate jobs to account for the increase in costs to the business. A spreadsheet depicting the increase to the business is attached as Exhibit B. I attest that these plans were in force prior to September 23, 2010 and that applying an annual limit of $750,000 to these plans would result in a significant increase in premiums paid by Andersen Corporation for health care coverage for our employees.

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ANDERSEN:000002

11/3/2011

Lancey, Brandon (CMS/OSORA)

From: Sent: To: Subject: Attachments: Prondzinski, Kathy [Kathy.Prondzinski@AndersenCorp.com] Wednesday, December 01, 2010 6:11 PM OCIIO Oversight FW: Waiver - 2nd request PPACA limited benefits waiver letter - 11-16-2010 FINAL.doc; Exhibit A and Exhibit B - 2011 Actuarial Support of cost increase of hc reform.xls; 2010 Silver Line Plan U SPD_FINAL_ 6 14 10.pdf; 2010 Silver Line Plan T1 SPD_FINAL_ 6 14 10.pdf; 2010 Silver Line Plan P2 SPD_FINAL_12 9 09.pdf; Silver Line NJ Union Contract.tif; Silver Line IL Production Contract.tif High

Importance: To whom it may concern:

Your attention to this matter is greatly appreciated. Kathy Prondzinski Kathy Prondzinski Director, Corporate Benefits Design Andersen Corporation 100 Fourth Avenue North Bayport, MN 55003 Tel: 651-264-2836 Fax: 651-275-6585 kprondzinski@andersencorp.com

Think of the environment before you print!

From: Prondzinski, Kathy Sent: Tuesday, November 16, 2010 2:03 PM To: OCIIOOversight@hhs.gov Cc: Subject: Waiver Importance: High

Attached please find: Andersen Corporations application for waiver from the restricted annual limits set forth in the interim final regulations under the Patient Protection and Affordable Care Act (PPACA) Exhibits A and B (actuarial support of the cost impact of health care reform and employee contributions for 2010 and 2011) Summary Plan Descriptions (SPDs) for the three plans for which we are requesting a waiver Excerpts from the Silver Line New Jersey Union Contract and The Silver Line Illinois Production Union Contract, outlining the employee contribution agreements with the company Should you need any further information, please feel free to contact me, using the information below. Thank you,
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Although I know that HHS has 30 days in which to determine if we will be granted a waiver, our union has refused to continue to bargain until we hear back from HHS on whether or not a waiver has been granted. I therefore am respectfully asking if there is an answer to our request for a waiver yet. The sooner we hear back, the sooner we can proceed with either informing our associates that the annual limits will remain in place, and that their plan will remain unchanged, or, in the case that the waiver is not granted, continuing to bargain with the union and try to offset the additional cost of raising the limits by changing plan design and/or increasing contributions.

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Kathy Prondzinski

Kathy Prondzinski Director, Corporate Benefits Design Andersen Corporation 100 Fourth Avenue North Bayport, MN 55003 Tel: 651-264-2836 Fax: 651-275-6585 kprondzinski@andersencorp.com

Think of the environment before you print!

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11/15/2010

NJ Grandfathered Production & Drivers Plan

2010 SL NJ Union GP & Drivers (U) Union Plan A 2011 SL NJ Union GP & Drivers (U) Union Plan A Required HC Reform Changes In-Network In-Network March 1, 2013 All dependents to age 26

NJ Production Plan
2010 SL NJ Union Production (T1/T2) Union Plan B 2011 SL NJ Union Production (T1/T2) Union Plan B Required HC Reform Changes In-Network March 1, 2013 In-Network March 1, 2013 All dependents to age 26

Illinois Production Plan

2010 SL IL Union Production Union Plan P2 2011 SL IL Union Production Union Plan P2 Required HC Reform Changes In-Network February 1, 2011 No out of network coverage In-Network February 1, 2011 No out of network coverage All dependents to age 26

Contract Expires Dependent Eligibility Deductible Out-of-Pocket Max Calendar Year Max Lifetime Maximum Coinsurance Preventive Care Office Visit Inpatient Facility IP/OP Surgery ER

March 1, 2013

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(b)(4)
$750,000

(b)(4)

$750,000

(b)(4)

$750,000 None

Prescription Drug

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Benefit Percentage Impact from 2010 Design

2010 Union Plan (U) A
EE Mthly EE%

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Total Cost Change Total Cost % Change Total Cost Co Cost Projected Change Co Cost % Change Co Cost EE Cost Projected Change EE Cost % Change EE Cost

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Actuarial Rates Employee Contributions Employee Only (T2) Employee Only Employee + Spouse Employee + Children Family

EE Count Rate

2011 Union Plan (U) A

Rate EE Mthly EE%

et eC

(b)(4) (b)(4)

(b)(4)

EE

2010 Union Plan (T1/T2) B

(b)(4)

2011 Union Plan (T1/T2) B

(b)(4)

(b)(4)

Required Health Care Reform Changes

Co

EE Count Rate

2010 IL Prod Plan P2

EE Mthly EE%

2011 IL Prod Plan P2

Rate EE Mthly* EE%

* NOTE: this contract expires Feb. 1, 2011. These employee contributions are illustrative ONLY based on current the contract language and are subject to change after negotiations begin Dec. 2010
(b)(4)

(b)(4)

(b)(4)

(b)(4)

(b)(4)

(b)(4)

ANDERSEN:000221

Silver Line Union Employee Weekly Contributions

EXHIBIT A
Silver Line NJ Union Medical Plan Weekly Employee Contributions Union Plan A (Grandfathered Production & Drivers - U) Count 2010 2011 2012 Employee Only Employee + Spouse Employee+ Child(ren) Family Total Contributions Annual Increase $
(b)(4) (b)(4)

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(b)(4) (b)(4) (b)(4) (b)(4) (b)(4)

Count

Union Plan B (Production - T1/T2) 2010 2011 2012

Contract Language: Weekly Employee Contributions Will Increase 2010 2011 2012 Employee Only Employee + Spouse Employee + Childr(ren) Family
(b)(4)

* Silver Line IL Union Production Medical Plan Weekly Employee Contributions Employee Only Employee + Spouse Employee+ Child(ren) Family Total Contributions Annual Increase
(b)(4)

* Silver Line Illinois Union Contract Lang ontract expires Feb. 1, 2011 Increases in premium cost shall be shared with the company paying and the employee paying of the increase provided that the Employee's share be capped a per week p ontract year. If the same language remains for 2011, it is a increase with the cap.

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(b)(4)

* NOTE: this contract expires Feb. 1, 2011. These employee contributions are illustrative ONLY based on current the contract language and are subject to change after negotiations begin Dec. 2010

ANDERSEN:000222

Silver Line Union Employee Weekly Contributions

e:

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From: Prondzinski, Kathy [Kathy.Prondzinski@AndersenCorp.com] Sent: Monday, December 20, 2010 4:28 PM To: Habit, Sandra (HHS/OCIIO) Cc: Parrucci, Tammy Subject: RE: Waiver Application - Andersen Corporation
Attached please find: I. The completed annual limits spreadsheets. II. The following information is also being provided as requested: I am confirming that the plan was created pursuant to the Taft-Hartley Act. The expiration of the last collective bargaining agreement is December 31, 2012. I confirm that the plan was in existence before March 23, 2010. We will be complying with the requirements of the Grandfathering Regulation, 45 CFR 147.140. This should constitute a complete application. As stated in our earlier emails, time is of the essence, due to the suspension of our collectively bargained negotiations. A timely response is most appreciated. Kathy Prondzinski Director, Corporate Benefits Design Andersen Corporation 100 Fourth Avenue North Bayport, MN 55003 Tel: 651-264-2836 Fax: 651-275-6585 kprondzinski@andersencorp.com

Attachments: waiver_application_forms_.zip

From: Habit, Sandra (HHS/OCIIO) [mailto:Sandra.Habit@hhs.gov] Sent: Thursday, December 16, 2010 2:05 PM To: Prondzinski, Kathy Subject: Waiver Application - Andersen Corporation

II. In addition, please provide the following information: Confirm whether the plan was created pursuant to the Taft-Hartley Act. And if so, please state the expiration of the last collective bargaining agreement. Please confirm that your plan was in existence before March 23, 2010, and if so, whether it will be complying with the requirements of the Grandfathering Regulation, 45 CFR 147.140? 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,
ANDERSEN:000234

file:////co-adshare/...s/DFOI%20Processing%20Team/Brandon/Andersen%20Corporation/Reqeust%20for%20info%20response%2012.20.10.htm[11/03/2011 4:09:09 PM]

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Ms. Prondzinski, Thank you 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: I. Please complete the entire annual limits spreadsheet, available at: http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html. Please return the completed spreadsheet to this email address as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell should contain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None, and/or provide an explanation regarding why you are unable to complete that particular cell in a separate document.

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Think of the environment before you print!

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Sandy

Sandy Habit Department of Health and Human Services Office of Consumer Information and Insurance Oversight 301-492-4175 Sandra.Habit@hhs.gov

negotiations with our union. A further bargaining session is scheduled Monday, December 20 th in anticipation of receiving a response

From: Prondzinski, Kathy Sent: Wednesday, December 01, 2010 5:11 PM To: OCIIOOversight@hhs.gov Subject: FW: Waiver - 2nd request Importance: High

To whom it may concern: Although I know that HHS has 30 days in which to determine if we will be granted a waiver, our union has refused to continue to bargain until we hear back from HHS on whether or not a waiver has been granted. I therefore am respectfully asking if there is an answer to our request for a waiver yet. The sooner we hear back, the sooner we can proceed with either informing our associates that the annual limits will remain in place, and that their plan will remain unchanged, or, in the case that the waiver is not granted, continuing to bargain with the union and try to offset the additional cost of raising the limits by changing plan design and/or increasing contributions.
ANDERSEN:000235

file:////co-adshare/...s/DFOI%20Processing%20Team/Brandon/Andersen%20Corporation/Reqeust%20for%20info%20response%2012.20.10.htm[11/03/2011 4:09:09 PM]

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to our waiver application by December 16 th . If we do not receive a timely response from HHS, the bargaining process will be delayed further to the prejudice of the Company, the Union and the employees. Your attention and cooperation are greatly appreciated. Kathy Kathy Prondzinski Director, Corporate Benefits Design Andersen Corporation 100 Fourth Avenue North Bayport, MN 55003 Tel: 651-264-2836 Fax: 651-275-6585 kprondzinski@andersencorp.com

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response by the close of business today, Thursday, December 16 th . As stated in our earlier email (below), time is of the essence due to the suspension of critically important collective bargaining

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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. _______________________________________________________________________________________________________________ To Whom It May Concern: On November 16, 2010, Andersen Corporation submitted to HHS an application for a waiver from the restricted annual limits set forth in the interim final regulations under the Patient Protection and Affordable Care Act for three of its medical plans. The waiver would apply for the plan year beginning on January 1, 2011 and ending on December 31, 2011. We understand that HHS intends to rule on complete waiver applications within 30 days of receipt. Therefore, we anticipate receiving a

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 Your attention to this matter is greatly appreciated. Kathy Prondzinski Kathy Prondzinski Director, Corporate Benefits Design Andersen Corporation 100 Fourth Avenue North Bayport, MN 55003 Tel: 651-264-2836 Fax: 651-275-6585 kprondzinski@andersencorp.com

Think of the environment before you print!

From: Prondzinski, Kathy Sent: Tuesday, November 16, 2010 2:03 PM To: OCIIOOversight@hhs.gov Cc: Subject: Waiver Importance: High

Think of the environment before you print!

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Kathy Prondzinski Director, Corporate Benefits Design Andersen Corporation 100 Fourth Avenue North Bayport, MN 55003 Tel: 651-264-2836 Fax: 651-275-6585 kprondzinski@andersencorp.com

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Attached please find: Andersen Corporations application for waiver from the restricted annual limits set forth in the interim final regulations under the Patient Protection and Affordable Care Act (PPACA) Exhibits A and B (actuarial support of the cost impact of health care reform and employee contributions for 2010 and 2011) Summary Plan Descriptions (SPDs) for the three plans for which we are requesting a waiver Excerpts from the Silver Line New Jersey Union Contract and The Silver Line Illinois Production Union Contract, outlining the employee contribution agreements with the company Should you need any further information, please feel free to contact me, using the information below. Thank you, Kathy Prondzinski

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file:////co-adshare/...s/DFOI%20Processing%20Team/Brandon/Andersen%20Corporation/Reqeust%20for%20info%20response%2012.20.10.htm[11/03/2011 4:09:09 PM]

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ANDERSEN:000236

From: Habit, Sandra (HHS/OCIIO) Sent: Thursday, December 16, 2010 3:05 PM To: 'Kathy.Prondzinski@AndersenCorp.com' Subject: Waiver Application - Andersen Corporation Ms. Prondzinski, Thank you 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: I. Please complete the entire annual limits spreadsheet, available at: http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html. Please return the completed spreadsheet to this email address as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell should contain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None, and/or provide an explanation regarding why you are unable to complete that particular cell in a separate document.

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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.

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Sandy Habit Department of Health and Human Services Office of Consumer Information and Insurance Oversight 301-492-4175 Sandra.Habit@hhs.gov

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II. In addition, please provide the following information: Confirm whether the plan was created pursuant to the Taft-Hartley Act. And if so, please state the expiration of the last collective bargaining agreement. Please confirm that your plan was in existence before March 23, 2010, and if so, whether it will be complying with the requirements of the Grandfathering Regulation, 45 CFR 147.140? 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, Sandy

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ANDERSEN:000237

ANNUAL LIMIT WAIVER APPLICATION 2010

MN

01/01/2011

Kathy Prondzinski

100 Fourth Ave N

Bayport

MN

55003

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Annual Limit Waiver Request Applicant Name Silver Line Building Products, LLC. Silver Line Building Products, LLC.

Policy Name (use a new row for each Applicant (Plan/ Policy policy application) Situs) City Silver Line Illinois Union Production Medical Plan Minneapolis Silver Line Illinois Union Production Medical Plan Minneapolis

Applicant (Plan/ Plan/ Policy Policy Effective Date Contact Situs) (mm/dd/yyyy) Name State

Street Address

City

State

Phone Number (including Zip Code area code)

MN

01/01/2011

Kathy Prondzinski

100 Fourth Ave N

Bayport

MN

55003

651-2642836

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Email Address kathy.prondzi nski@anders encorp.com Limited Benefit kathy.prondzi nski@anders encorp.com Limited Benefit Yes Yes

Total Number of Individuals Current Covered by Type of Plan Overall Policy Coverage Annual (include all Self(e.g., Limited Limit (in Benefit, HRA, Insured Individual or dependents dollars) Rx only, Other) (Yes/No) Group Policy covered)

Group

(b)(4)

651-2642836

Group

PRA Disclosure Statement

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According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1105. The time required to complete this information collection is estimated to average ( 8 hours) or ( 240 minutes) per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

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ANDERSEN:000238

ANNUAL LIMIT WAIVER APPLICATION 2010

Ambulatory

Emergency

Hospitalization

Laboratory

Pediatric

Maternity/ Newborn

Mental Health/ Substance Abuse

Rehabilitative/ Devices

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Preventive/ Wellness Prescription

Current Essential Benefits Annual Limits (Annual Limit for Each Essential Benefit)

Office Visit Hospital Inpatient Emergency Room Rx Copays/Coinsurance Copay/Coinsurance Copay/Coinsurance Copay/Coninsurance

Coinsura Coinsura Copay (if Coinsuranc Copay (if nce (if Copay (if nce (if Copay (if Coinsuran ce (if applicabl applicabl applicabl applicabl applicabl e (if applicabl Plan applicable) e) e) e) e) e) applicable) e) Deductible

(b)(4)

ANDERSEN:000239

ANNUAL LIMIT WAIVER APPLICATION 2010

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Total

Current Monthly Premium Rates or Premium Equivalent Rates (in dollars)*:

Projected Rate Increase that would result from compliance with $750,000 Annual Limit Renewal Monthly Premium Rates or Premium Equivalent Rates if Waiver Granted Restriction (in dollars) (Average Premium by Individual)* (in dollars)*

Employer Employee Individual/ Employee contribution contribution (if applicable) (if applicable) Tier*

Total

Employer Employee contribution contribution (if applicable) (if applicable)

Total

Employer Employee contribution contribution (if applicable) (if applicable)

Decrease in Access to Benefits that Projected Rate Increase would result that would result from from compliance with $750,000 compliance Annual Limit Restriction with $750,000 (in dollars)(Average Annual Limit Premium by Individual) Restriction (Difference of Column AT (describe and AQ divided by briefly in cell Column AQ) or in a

Plan Administr ator/ CEO of Health Insuranc e Issuer Name Kathy Prondzins ki Kathy Prondzins ki

Title of Individual Providing Attestation

Employee

None

Corporate Benefits Director

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(b)(4)

Employee + Family

None

Corporate Benefits Director

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* When completing the columns requesting premium rate information, please express the premium rates as a composite rate (if premiums are a range based on years of service or age) and by tier (Employee, Employee + Spouse, Employee + Child, Family, etc.) as applicable. If you are an issuer, please provide the premium amount in the column titled, "Total" (Column AN, AQ and AT).

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ANDERSEN:000240

ANNUAL LIMIT WAIVER APPLICATION 2010

Annual Limit Waiver Request Applicant Name

MN

01/01/2011

Kathy Prondzinski

100 Fourth Ave N

Bayport

MN

55003

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651-2642836

Silver Line Building Products, LLC.

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Silver Line Building Products, LLC.

Policy Name (use a new row for each Applicant (Plan/ Policy policy application) Situs) City Silver Line New Jersey Union Grandfathere d Production and Driver Medical Plan Minneapolis Silver Line New Jersey Union Grandfathere d Production and Driver Medical Plan Minneapolis

Applicant (Plan/ Plan/ Policy Policy Effective Date Contact Situs) (mm/dd/yyyy) Name State

Street Address

City

State

Phone Number (including Zip Code area code)

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Email Address kathy.prondzi nski@anders encorp.com Limited Benefit Yes kathy.prondzi nski@anders encorp.com Limited Benefit Yes

Total Number of Individuals Current Covered by Type of Plan Overall Policy Coverage Annual (include all Self(e.g., Limited Limit (in Benefit, HRA, Insured Individual or dependents dollars) Rx only, Other) (Yes/No) Group Policy covered)

Group

(b)(4)

MN

01/01/2011

Kathy Prondzinski

100 Fourth Ave N

Bayport

MN

55003

651-2642836

Group

PRA Disclosure Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1105. The time required to complete this information collection is estimated to average ( 8 hours) or ( 240 minutes) per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

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ANDERSEN:000241

ANNUAL LIMIT WAIVER APPLICATION 2010

Ambulatory

Emergency

Hospitalization

Laboratory

Pediatric

Maternity/ Newborn

Mental Health/ Substance Abuse

Rehabilitative/ Devices

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Preventive/ Wellness Prescription

Current Essential Benefits Annual Limits (Annual Limit for Each Essential Benefit)

Office Visit Hospital Inpatient Emergency Room Rx Copays/Coinsurance Copay/Coinsurance Copay/Coinsurance Copay/Coninsurance

Coinsura Coinsura Copay (if Coinsuranc Copay (if nce (if Copay (if nce (if Copay (if Coinsuran ce (if applicabl applicabl applicabl applicabl applicabl e (if applicabl Plan applicable) e) e) e) e) e) applicable) e) Deductible

(b)(4)

ANDERSEN:000242

ANNUAL LIMIT WAIVER APPLICATION 2010

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Total

Current Monthly Premium Rates or Premium Equivalent Rates (in dollars)*:

Projected Rate Increase that would result Renewal Monthly Premium Rates or from compliance with $750,000 Annual Limit Premium Equivalent Rates if Waiver Granted Restriction (in dollars) (Average Premium (in dollars)* by Individual)*

Employer Employee Individual/ Employee contribution contribution (if applicable) (if applicable) Tier*

Total

Employer Employee contribution contribution (if applicable) (if applicable)

Total

Employer Employee contribution contribution (if applicable) (if applicable)

Decrease in Access to Benefits that Projected Rate Increase would result that would result from from compliance with $750,000 compliance Annual Limit Restriction with $750,000 (in dollars)(Average Annual Limit Premium by Individual) Restriction (Difference of Column AT (describe and AQ divided by briefly in cell Column AQ) or in a

Plan Administr ator/ CEO of Health Insuranc e Issuer Name

Title of Individual Providing Attestation

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Employee

None

Kathy Prondzins ki

Corporate Benefits Director

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(b)(4)

Employee + Family

None

Kathy Prondzins ki

Corporate Benefits Director

* When completing the columns requesting premium rate information, please express the premium rates as a composite rate (if premiums are a range based on years of service or age) and by tier (Employee, Employee + Spouse, Employee + Child, Family, etc.) as applicable. If you are an issuer, please provide the premium amount in the column titled, "Total" (Column AN, AQ and AT).

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ANDERSEN:000243

ANNUAL LIMIT WAIVER APPLICATION 2010

Annual Limit Waiver Request Applicant Name Silver Line Building Products, LLC. Silver Line Building Products, LLC.

MN

01/01/2011

Kathy Prondzinski

100 Fourth Ave N

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Policy Name (use a new row for each Applicant (Plan/ Policy policy application) Situs) City Silver Line New Jersey Union Production Medical Plan Minneapolis Silver Line New Jersey Union Production Medical Plan Minneapolis

Applicant (Plan/ Plan/ Policy Policy Effective Date Contact Situs) (mm/dd/yyyy) Name State

Street Address

City

State

Phone Number (including Zip Code area code)

MN

01/01/2011

Kathy Prondzinski

100 Fourth Ave N

Bayport

MN

55003

651-2642836

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Email Address kathy.prondzi nski@anders encorp.com Limited Benefit Yes kathy.prondzi nski@anders encorp.com Limited Benefit Yes

Total Number of Individuals Current Covered by Type of Plan Overall Policy Coverage Annual (include all Self(e.g., Limited Limit (in Benefit, HRA, Insured Individual or dependents dollars) Rx only, Other) (Yes/No) Group Policy covered)

Group

(b)(4)

Bayport

MN

55003

651-2642836

Group

PRA Disclosure Statement

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According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1105. The time required to complete this information collection is estimated to average ( 8 hours) or ( 240 minutes) per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

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ANDERSEN:000244

ANNUAL LIMIT WAIVER APPLICATION 2010

Ambulatory

Emergency

Hospitalization

Laboratory

Pediatric

Maternity/ Newborn

Mental Health/ Substance Abuse

Rehabilitative/ Devices

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ra do .c om
Preventive/ Wellness Prescription

Current Essential Benefits Annual Limits (Annual Limit for Each Essential Benefit)

Office Visit Hospital Inpatient Emergency Room Rx Copays/Coinsurance Copay/Coinsurance Copay/Coinsurance Copay/Coninsurance

Coinsura Coinsura Copay (if Coinsuranc Copay (if nce (if Copay (if nce (if Copay (if Coinsuran ce (if applicabl applicabl applicabl applicabl applicabl e (if applicabl Plan applicable) e) e) e) e) e) applicable) e) Deductible

(b)(4)

ANDERSEN:000245

ANNUAL LIMIT WAIVER APPLICATION 2010

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Total

Current Monthly Premium Rates or Premium Equivalent Rates (in dollars)*:

Projected Rate Increase that would result from compliance with $750,000 Annual Limit Renewal Monthly Premium Rates or Premium Equivalent Rates if Waiver Granted Restriction (in dollars) (Average Premium by Individual)* (in dollars)*

Employer Employee Individual/ Employee contribution contribution (if applicable) (if applicable) Tier*

Total

Employer Employee contribution contribution (if applicable) (if applicable)

Total

Employer Employee contribution contribution (if applicable) (if applicable)

Decrease in Access to Benefits that Projected Rate Increase would result that would result from from compliance with $750,000 compliance Annual Limit Restriction with $750,000 (in dollars)(Average Annual Limit Premium by Individual) Restriction (Difference of Column AT (describe and AQ divided by briefly in cell Column AQ) or in a

Plan Administr ator/ CEO of Health Insuranc e Issuer Name

Title of Individual Providing Attestation

Employee

None

Kathy Prondzins ki

Corporate Benefits Director

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(b)(4)

Employee + Family

None

Kathy Prondzins ki

Corporate Benefits Director

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* When completing the columns requesting premium rate information, please express the premium rates as a composite rate (if premiums are a range based on years of service or age) and by tier (Employee, Employee + Spouse, Employee + Child, Family, etc.) as applicable. If you are an issuer, please provide the premium amount in the column titled, "Total" (Column AN, AQ and AT).

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ANDERSEN:000246

From: Habit, Sandra (HHS/OCIIO) Sent: Thursday, December 30, 2010 3:16 PM To: 'kathy.prondzinski@andersencorp.com' Subject: Andersen Corporation Approval Letter for a Waiver of the Annual Limits Requirements 12-30-2010 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 Andersen Corporation. HHS has reviewed your application and made its determination. Please see the attached letter. The following plans have been approved:

Silver Line New Jersey Union Grandfathered Production and Driver Medical Plan Silver Line New Jersey Union Production Medical Plan Silver Line New Jersey Union Production Medical Plan Silver Line Illinois Union Production Medical Plan Silver Line Illinois Union Production Medical Plan

Please confirm receipt of this letter by replying to this e-mail. Please let me know if I can be of further assistance. Sincerely,

ANDERSEN:000247

file:////co-adshare/...pproval%20Letter%20for%20a%20Waiver%20of%20the%20Annual%20Limits%20Requirements%2012-30-2010.htm[11/03/2011 4:09:11 PM]

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Silver Line New Jersey Union Grandfathered Production and Driver Medical Plan

 Sandy Habit Department of Health and Human Services Office of Consumer Information and Insurance Oversight 301-492-4175 Sandra.Habit@hhs.gov

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ANDERSEN:000248

file:////co-adshare/...pproval%20Letter%20for%20a%20Waiver%20of%20the%20Annual%20Limits%20Requirements%2012-30-2010.htm[11/03/2011 4:09:11 PM]

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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.

From: Prondzinski, Kathy [Kathy.Prondzinski@AndersenCorp.com] Sent: Thursday, December 30, 2010 4:45 PM To: Habit, Sandra (HHS/OCIIO) Subject: Re: Andersen Corporation Approval Letter for a Waiver of the Annual Limits Requirements 12-302010
Thank you for your very prompt response to our request. I confirm receipt of our approval of the Silver Line union plans.

From: Habit, Sandra (HHS/OCIIO) [mailto:Sandra.Habit@hhs.gov] Sent: Thursday, December 30, 2010 02:15 PM To: Prondzinski, Kathy Subject : Andersen Corporation Approval Letter for a Waiver of the Annual Limits Requirements 12-30-2010

Silver Line Illinois Union Production Medical Plan Silver Line Illinois Union Production Medical Plan

Please confirm receipt of this letter by replying to this e-mail.

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Silver Line New Jersey Union Production Medical Plan

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Silver Line New Jersey Union Production Medical Plan

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Silver Line New Jersey Union Grandfathered Production and Driver Medical Plan

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ANDERSEN:000249

file:////co-adshare/...FOI%20Processing%20Team/Brandon/Andersen%20Corporation/Approval%20receipt%2012.30.10.htm[11/03/2011 4:09:11 PM]

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Good Afternoon, Thank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act Section 2711 for Andersen Corporation. HHS has reviewed your application and made its determination. Please see the attached letter. The following plans have been approved:
Silver Line New Jersey Union Grandfathered Production and Driver Medical Plan

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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

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.

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ANDERSEN:000250

file:////co-adshare/...FOI%20Processing%20Team/Brandon/Andersen%20Corporation/Approval%20receipt%2012.30.10.htm[11/03/2011 4:09:11 PM]

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Think of the environment before you print!

From: Habit, Sandra (HHS/OCIIO) [mailto:Sandra.Habit@hhs.gov] Sent: Thursday, December 16, 2010 2:05 PM To: Prondzinski, Kathy Subject: Waiver Application - Andersen Corporation

Ms. Prondzinski, Thank you 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:
ANDERSEN:000251

file:////co-adshare/...0Waivers%20-%20Torres/DFOI%20Processing%20Team/Brandon/Andersen%20Corporation/Completion%2012.21.10.htm[11/03/2011 4:09:12 PM]

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Attached please find: I. The completed annual limits spreadsheets. II. The following information is also being provided as requested: I am confirming that the plan was created pursuant to the Taft-Hartley Act. The expiration of the last collective bargaining agreement is December 31, 2012. I confirm that the plan was in existence before March 23, 2010. We will be complying with the requirements of the Grandfathering Regulation, 45 CFR 147.140. This should constitute a complete application. As stated in our earlier emails, time is of the essence, due to the suspension of our collectively bargained negotiations. A timely response is most appreciated. Kathy Prondzinski Director, Corporate Benefits Design Andersen Corporation 100 Fourth Avenue North Bayport, MN 55003 Tel: 651-264-2836 Fax: 651-275-6585 kprondzinski@andersencorp.com

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From: Prondzinski, Kathy [mailto:Kathy.Prondzinski@AndersenCorp.com] Sent: Monday, December 20, 2010 4:28 PM To: Habit, Sandra (HHS/OCIIO) Cc: Parrucci, Tammy Subject: RE: Waiver Application - Andersen Corporation

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From: Habit, Sandra (HHS/OCIIO) Sent: Tuesday, December 21, 2010 10:51 AM To: 'Prondzinski, Kathy' Subject: RE: Waiver Application - Andersen Corporation December 21, 2010 Ms. Prondzinski, Thank you for your information. Your application is now complete and you will receive a determination of your application within 30 days. Take care and have a happy holiday! Thank you, Sandy

I. Please complete the entire annual limits spreadsheet, available at: http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html. Please return the completed spreadsheet to this email address as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell should contain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None, and/or provide an explanation regarding why you are unable to complete that particular cell in a separate document.

negotiations with our union. A further bargaining session is scheduled Monday, December 20 th in anticipation of receiving a response

response by the close of business today, Thursday, December 16 th . As stated in our earlier email (below), time is of the essence due to the suspension of critically important collective bargaining

to our waiver application by December 16 th . If we do not receive a timely response from HHS, the bargaining process will be delayed further to the prejudice of the Company, the Union and the employees. Your attention and cooperation are greatly appreciated. Kathy Kathy Prondzinski Director, Corporate Benefits Design Andersen Corporation 100 Fourth Avenue North Bayport, MN 55003
ANDERSEN:000252

file:////co-adshare/...0Waivers%20-%20Torres/DFOI%20Processing%20Team/Brandon/Andersen%20Corporation/Completion%2012.21.10.htm[11/03/2011 4:09:12 PM]

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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. _______________________________________________________________________________________________________________ To Whom It May Concern: On November 16, 2010, Andersen Corporation submitted to HHS an application for a waiver from the restricted annual limits set forth in the interim final regulations under the Patient Protection and Affordable Care Act for three of its medical plans. The waiver would apply for the plan year beginning on January 1, 2011 and ending on December 31, 2011. We understand that HHS intends to rule on complete waiver applications within 30 days of receipt. Therefore, we anticipate receiving a

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Sandy Habit Department of Health and Human Services Office of Consumer Information and Insurance Oversight 301-492-4175 Sandra.Habit@hhs.gov

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II. In addition, please provide the following information: Confirm whether the plan was created pursuant to the Taft-Hartley Act. And if so, please state the expiration of the last collective bargaining agreement. Please confirm that your plan was in existence before March 23, 2010, and if so, whether it will be complying with the requirements of the Grandfathering Regulation, 45 CFR 147.140? 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, Sandy

Tel: 651-264-2836 Fax: 651-275-6585 kprondzinski@andersencorp.com From: Prondzinski, Kathy Sent: Wednesday, December 01, 2010 5:11 PM To: OCIIOOversight@hhs.gov Subject: FW: Waiver - 2nd request Importance: High

Think of the environment before you print!

From: Prondzinski, Kathy Sent: Tuesday, November 16, 2010 2:03 PM To: OCIIOOversight@hhs.gov Cc: Subject: Waiver Importance: High

Attached please find: Andersen Corporations application for waiver from the restricted annual limits set forth in the interim final regulations under the Patient Protection and Affordable Care Act (PPACA) Exhibits A and B (actuarial support of the cost impact of health care reform and employee contributions for 2010 and 2011) Summary Plan Descriptions (SPDs) for the three plans for which we are requesting a waiver Excerpts from the Silver Line New Jersey Union Contract and The Silver Line Illinois Production Union Contract, outlining the employee contribution agreements with the company Should you need any further information, please feel free to contact me, using the information below. Thank you, Kathy Prondzinski

Kathy Prondzinski Director, Corporate Benefits Design Andersen Corporation 100 Fourth Avenue North Bayport, MN 55003
ANDERSEN:000253

file:////co-adshare/...0Waivers%20-%20Torres/DFOI%20Processing%20Team/Brandon/Andersen%20Corporation/Completion%2012.21.10.htm[11/03/2011 4:09:12 PM]

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To whom it may concern: Although I know that HHS has 30 days in which to determine if we will be granted a waiver, our union has refused to continue to bargain until we hear back from HHS on whether or not a waiver has been granted. I therefore am respectfully asking if there is an answer to our request for a waiver yet. The sooner we hear back, the sooner we can proceed with either informing our associates that the annual limits will remain in place, and that their plan will remain unchanged, or, in the case that the waiver is not granted, continuing to bargain with the union and try to offset the additional cost of raising the limits by changing plan design and/or increasing contributions. Your attention to this matter is greatly appreciated. Kathy Prondzinski Kathy Prondzinski Director, Corporate Benefits Design Andersen Corporation 100 Fourth Avenue North Bayport, MN 55003 Tel: 651-264-2836 Fax: 651-275-6585 kprondzinski@andersencorp.com

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Tel: 651-264-2836 Fax: 651-275-6585 kprondzinski@andersencorp.com

Think of the environment before you print!

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ANDERSEN:000254

file:////co-adshare/...0Waivers%20-%20Torres/DFOI%20Processing%20Team/Brandon/Andersen%20Corporation/Completion%2012.21.10.htm[11/03/2011 4:09:12 PM]

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From: Prondzinski, Kathy [Kathy.Prondzinski@AndersenCorp.com] Sent: Tuesday, December 21, 2010 12:15 PM To: Habit, Sandra (HHS/OCIIO) Subject: RE: Waiver Application - Andersen Corporation
Thank you! And Happy Holiday to you as well! Kathy

From: Habit, Sandra (HHS/OCIIO) [mailto:Sandra.Habit@hhs.gov] Sent: Tuesday, December 21, 2010 9:51 AM To: Prondzinski, Kathy Subject: RE: Waiver Application - Andersen Corporation

Attached please find: I. The completed annual limits spreadsheets. II. The following information is also being provided as requested: I am confirming that the plan was created pursuant to the Taft-Hartley Act. The expiration of the last collective bargaining agreement is December 31, 2012. I confirm that the plan was in existence before March 23, 2010. We will be complying with the requirements of the Grandfathering Regulation, 45 CFR 147.140. This should constitute a complete application. As stated in our earlier emails, time is of the essence, due to the suspension of our collectively bargained negotiations. A timely response is most appreciated. Kathy Prondzinski Director, Corporate Benefits Design Andersen Corporation 100 Fourth Avenue North Bayport, MN 55003 Tel: 651-264-2836 Fax: 651-275-6585 kprondzinski@andersencorp.com

Think of the environment before you print!

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From: Prondzinski, Kathy [mailto:Kathy.Prondzinski@AndersenCorp.com] Sent: Monday, December 20, 2010 4:28 PM To: Habit, Sandra (HHS/OCIIO) Cc: Parrucci, Tammy Subject: RE: Waiver Application - Andersen Corporation

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ANDERSEN:000255

file:////co-adshare/...0-%20Torres/DFOI%20Processing%20Team/Brandon/Andersen%20Corporation/Completion%20response%2012.21.10.htm[11/03/2011 4:09:13 PM]

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December 21, 2010 Ms. Prondzinski, Thank you for your information. Your application is now complete and you will receive a determination of your application within 30 days. Take care and have a happy holiday! Thank you, Sandy

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 From: Habit, Sandra (HHS/OCIIO) [mailto:Sandra.Habit@hhs.gov] Sent: Thursday, December 16, 2010 2:05 PM To: Prondzinski, Kathy Subject: Waiver Application - Andersen Corporation

negotiations with our union. A further bargaining session is scheduled Monday, December 20 th in anticipation of receiving a response

response by the close of business today, Thursday, December 16 th . As stated in our earlier email (below), time is of the essence due to the suspension of critically important collective bargaining

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. _______________________________________________________________________________________________________________ To Whom It May Concern: On November 16, 2010, Andersen Corporation submitted to HHS an application for a waiver from the restricted annual limits set forth in the interim final regulations under the Patient Protection and Affordable Care Act for three of its medical plans. The waiver would apply for the plan year beginning on January 1, 2011 and ending on December 31, 2011. We understand that HHS intends to rule on complete waiver applications within 30 days of receipt. Therefore, we anticipate receiving a

to our waiver application by December 16 th . If we do not receive a timely response from HHS, the bargaining process will be delayed further to the prejudice of the Company, the Union and the employees.
ANDERSEN:000256

file:////co-adshare/...0-%20Torres/DFOI%20Processing%20Team/Brandon/Andersen%20Corporation/Completion%20response%2012.21.10.htm[11/03/2011 4:09:13 PM]

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Sandy Habit Department of Health and Human Services Office of Consumer Information and Insurance Oversight 301-492-4175 Sandra.Habit@hhs.gov

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II. In addition, please provide the following information: Confirm whether the plan was created pursuant to the Taft-Hartley Act. And if so, please state the expiration of the last collective bargaining agreement. Please confirm that your plan was in existence before March 23, 2010, and if so, whether it will be complying with the requirements of the Grandfathering Regulation, 45 CFR 147.140? 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, Sandy

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Ms. Prondzinski, Thank you 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: I. Please complete the entire annual limits spreadsheet, available at: http://www.hhs.gov/ociio/regulations/annual_limit_waivers.html. Please return the completed spreadsheet to this email address as an attachment. We will only be able to process spreadsheets that are fully complete (i.e., every cell should contain the information requested). If a cell on the spreadsheet does not pertain to your plan, please write None, and/or provide an explanation regarding why you are unable to complete that particular cell in a separate document.

 Your attention and cooperation are greatly appreciated. Kathy Kathy Prondzinski Director, Corporate Benefits Design Andersen Corporation 100 Fourth Avenue North Bayport, MN 55003 Tel: 651-264-2836 Fax: 651-275-6585 kprondzinski@andersencorp.com From: Prondzinski, Kathy Sent: Wednesday, December 01, 2010 5:11 PM To: OCIIOOversight@hhs.gov Subject: FW: Waiver - 2nd request Importance: High

From: Prondzinski, Kathy Sent: Tuesday, November 16, 2010 2:03 PM To: OCIIOOversight@hhs.gov Cc: Subject: Waiver Importance: High

Attached please find: Andersen Corporations application for waiver from the restricted annual limits set forth in the interim final regulations under the Patient Protection and Affordable Care Act (PPACA) Exhibits A and B (actuarial support of the cost impact of health care reform and employee contributions for 2010 and 2011) Summary Plan Descriptions (SPDs) for the three plans for which we are requesting a waiver Excerpts from the Silver Line New Jersey Union Contract and The Silver Line Illinois Production Union Contract, outlining the employee contribution agreements with the company Should you need any further information, please feel free to contact me, using the information below.
ANDERSEN:000257

file:////co-adshare/...0-%20Torres/DFOI%20Processing%20Team/Brandon/Andersen%20Corporation/Completion%20response%2012.21.10.htm[11/03/2011 4:09:13 PM]

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To whom it may concern: Although I know that HHS has 30 days in which to determine if we will be granted a waiver, our union has refused to continue to bargain until we hear back from HHS on whether or not a waiver has been granted. I therefore am respectfully asking if there is an answer to our request for a waiver yet. The sooner we hear back, the sooner we can proceed with either informing our associates that the annual limits will remain in place, and that their plan will remain unchanged, or, in the case that the waiver is not granted, continuing to bargain with the union and try to offset the additional cost of raising the limits by changing plan design and/or increasing contributions. Your attention to this matter is greatly appreciated. Kathy Prondzinski Kathy Prondzinski Director, Corporate Benefits Design Andersen Corporation 100 Fourth Avenue North Bayport, MN 55003 Tel: 651-264-2836 Fax: 651-275-6585 kprondzinski@andersencorp.com

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Thank you, Kathy Prondzinski

Kathy Prondzinski Director, Corporate Benefits Design Andersen Corporation 100 Fourth Avenue North Bayport, MN 55003 Tel: 651-264-2836 Fax: 651-275-6585 kprondzinski@andersencorp.com

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ANDERSEN:000258

file:////co-adshare/...0-%20Torres/DFOI%20Processing%20Team/Brandon/Andersen%20Corporation/Completion%20response%2012.21.10.htm[11/03/2011 4:09:13 PM]

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Think of the environment before you print!