HomeMy WebLinkAboutR-2012-006 Section 125 Flexible Benefit Plan Adoption RESOLUTION NO. R-2012-006
A RESOLUTION ADOPTING AND RATIFYING THE SECTION 725 FLEXIBLE BENEFIT
PLAN ADOPTION FOR THE CITY OF RIVERSIDE
WHEREAS, the Board of Aldermen previously approved the Cafeteria Plan, Flex
Spending Account, and Dependent Care Assistance Plan on January 15'", 2001 and amended
said Plan on January 1, 2005; and
WHEREAS, the Board of Aldermen find there is a need to update the Section 125
Cafeteria Plan, Flex Spending Account and Dependent Care Assistance Plan as set forth in the
Section 125 Flexible Benefit Plan; and
WHEREAS, the Board of Aldermen further find it in the best interest to approve and
ratify the plan and related servicing agreements attached hereto as Exhibit A and Exhibit B for
services provided by American Fidelity Assurance Company;
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF ALDERMEN OF THE
CITY OF RIVERSIDE, MISSOURI, AS FOLLOWS:
THAT the Section 125 Flexible Benefits Plan Adoption Agreement effective as of
January 1, 2012 is hereby approved, adopted, and ratified, and that the proper officers of the
organization are hereby authorized and directed to execute and deliver to Third Party
Administrator or to assist in the administration of the Plan; and
FURTHER THAT the Plan and Statement of Terms and Conditions attached hereto as
Exhibit A& B are hereby approved and ratified; and
FURTHER THAT the City Administrator, Mayor and/or Finance Director are hereby
authorized to execute all documents necessary to implement the Plan, and to set up adequate
accounting and administrative procedures to provide benefits under the Plan.
FURTHER THAT the proper officers of City of Riverside shall act as soon as possible to
notify the employees of the group of the adoption of the Cafeteria Plan by delivering to each
employee a copy of the summary description of the Plan in the form of the Summary Plan
Description presented to this meeting, which form is hereby approved.
PASSED AND ADOPTED k�ytre Board of Aldermen and APPROVED by the Mayor of
the City of Riverside, Missouri, thej''/ of January, 2012.
� � ����°�
Mayor Kathleen L. Rose
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RobPn Littrell, ity Clerk
Appr s to form:
cy T mp n, City Attorney
SECTION 125 FLEXIBLE BENEFIT PLAN
ADOPTTON AGREEMENT
The undersigned Employer hereby adapts the Section 125 Flexible Benefit Plan for those
Employees who shall qualify as Participants hereunden The Employer hereby selects the
following Plan specifieations:
A. EMPLOYER INFORMATION
Name of Employer: CITY OF RNERSIDE MISSOLJRI
Address: 2950 NW VNION RD
RiVL,RSIDL, MO 64150
Employer ldentifcation Number: 44-6005867
Nature of Business: MiJNICIPALITY
Name of Plan: CITY OF RIVERSIDE MiSSOURI
FLEXIRT,F, BENEFIT PLAN
Plan Number: 501
B. EFFECTTVF. DATE
Original effective date of the Plan: January 15, 2001
if Amendment to existing plan,
effective date of amendment: January 1, 2012
C. ELIGIBILITY ItEQUIRF,MF,NTS FOR PARTICIPATION
Eligibility requirements for each component plan under this Section 125 document will
be applicable and, if different, will be listed in item F.
Length of Service: Pirst day of the month following
employment.
Minimum Hours: All employees with 40 hours of scrvice or
more each week. An hour of service is each
hour £or which an employee receives, or is
entitled to receive, payment for performance
of duties for the Employer.
Age: Minimum age of 0 years.
D. PLAN YEAR The current plan year will begin on January
l, 2012 and end on June 30, 2012. F,ach
subsequent plan year will begin on July 1
and end on June 30.
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E. EMPLOYF.R CONTRIBUTIONS
Non-Elective Contributions:
The Employer may at its sole discretion
provide a non-elective contribution to
provide benefits for each Participanl under
the Plan. This amount will be set by the
Employer each Plan Year in a uniform and
non-discriminalory manner. [f this non- '
elective contribution amount exceeds the
cost of benefits elected by the Participant,
excess amounts will not be paid to the
Participant as taxable cash.
Electivc Contributions
(Salary Reduction): The m�ximum amount available to each
Participant for the purchase of elected
benetits through salary reduction will be:
100% of compensation per entire plan year.
Each Participant may authorize the
Employer to reduce his or her compensation
by the amount needed for the purchase of
benerls elecled, less the amount of non-
elective contributions. An elcction for
salary reduction will be made on the benetit
election fonn.
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F. AVAILABLE BENEFITS: Each of the following components should be considered a
plan that comprises this PLan.
1. Groua Medical Insurancc -- The terms, conditions, and
limitations for the Group Medical Insurance will be as set forkh in the
insurance policy or policies described below: (See Section V of the Plan
Document)
American Fidelity Assurance Company Accidcnt Only Plan
BlueCross
Eli ig bilit ��quirements for Participation, if different than Item C.
2. Disabilitv Income Insurance -- The terms, conditions, and limitations for the
Disability lncome Tnsurance will be as set forth in the insurance policy or policies
described below: (See Section VI of the Plan Document)
N/A
Eli�ig bility Requirements for Participation, if different than item C.
3. Cancer Covera�e -- 1'he terms, conditions, and limitations for the Cancer
Coverage will be as set forth in the insurance policy or policies described helow:
(See Section V of the Plan Document)
American Fidelity Assurance Company G12 and su6sequent
policies
Eli i� bilitv Requirements for Participation, if different than item C.
4. DentalNision Insurance -- Thc tcrms, conditions, and limitations for the
DentaWision Insurance will be as set forth in the insurance policy or policies
described below: (See Section V of the Plan Document)
Delta Dental
Vision Service Plan
Eligibilitv Requirements for Participation, if different than Item C.
5. Group Life Insurance which will be comprised of Group-term life insurance
and Individual term life insurance under Section 79 of the Code.
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The terms, conditions, and limitations for the Group Life Insurance will be as set
forth in the insurancc policy or policies described below: (See Section VTI of the
Plan Document)
American Fidelity Assurance Company
Tndividual life coverage under Section 79 is available as a benefit, and the face
amount when combined with the group-term life, if any, may not exceed $50,000.
Eli ��tv Requirements for Participation, if diFferent than Item C.
6. De�endent Care Assistance Plan -- The terms, conditions, and
limitations for the Depcndcnt Care Assistance Plan will be as set
forth in Section TX of the Plan Document and described below:
Minimum Contribution -$ 120.00 per Plan Year
Maximum Contribution -$ 5000.00 per Plan Year
Recordkeeper: American Fidelity Assurance Company
Elieibilit �} Requirements for Participation, if different than Item C.
N/A
7. Medical Exaense Reimbursement Plan -- The terms, conditions, and
limitations for the Medical Cxpense Reimbursement Plan will be as set
forth in Section VIII of thc Plan Document and dcscribed below:
Minimum Coverage -$ 120.00 per Plan Year
Maximum Coverage -$ 5000.00 per Plan Year
Recordkeeper: American Fidclity Assurance Company
Restrictions: N/A
Grace Period: The provisions in Section 8.06 of the Plan to permit a Grace
Period with respect to the Medical Expense Reimbursement Plan are
elected.
HEART: The provisions in Section 8.07 of the Plan to permit the
Qualified Reservist Distribution of the Hcroes Earnings Assistance and
Relief Tax Act (HEART) are elected.
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Debit Card: The provisions in Section R.OS of lhe Plan to permit the offer
of the Debit Card wilh respect to the Medical Expense Reimbursement
Plan are elected. �,
Eli�ibilitv Requirements for Participation, if different than Item C.
8. Health Savines Accounts — The Plan permits contributions to be made to a
Nealth Savings Account on a preta�c basis in accordance with Section X of the
Plan and the following provisions:
l lSA 'I'rustee — As designated by the employee and tnutually agreed
upon by the employer.
Maximum Contribution — As indexed annually by the IRS.
Limitation on Eligible Medical Expenses — For purposes of the Medical
Reimbursement Plan, Eligiblc Medical Expenses of a Participant that is eligible
for and elects Co participate in a Flealth Savings Account shall be limited to
expensesfor:
Dental and Vision
Eligibility Requirements for Participation, if different than Item C.
a. An Employee must completc a Ccrtification of Ncalth Savings Account
Eligibility which confirms that the Participant is an eligible individual who
is entitled to establish a Health Savings Account in accordance with Code
Section 223(c)(1).
b. Gligibility for the 1lealth Savings Account shall begin on the later of (i)
first day of the month coinciding with or next following the Employee's
commencemenl of coverage under the High Deductible Health Plan, or (ii)
the first day f'ollowing the end of'a Gr1ce Period available to the Employee
with respect to the Medical Reimbursement Accounts that are not limited
to vision and dental expenses (unless the participant has a$0.00 balance
on the last day of the plan year).
c. An Employee's eligibility for the Health Savings Account shall be
determined monthly.
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The I'lan shall be construed, enforced, administered, and the validity determined in
accordance with the applicable provisions of the Employee Retirement Income Security Act
of 1974, (as amended) if applicablc, the Internal Revenue Code of 1986 (as amended), and
the laws of the State of Missouri. Should any provision be dctermined to be void, invalid,
or unenforceable by any court of competent jurisdiction, the Plan will continue to operate,
and for purposes of the jurisdiction of the cnurt only, will be deemed not to include the
provision determined to be void.
� �~' I
This Plan is hereby adopted this l7 -- day of �.;SC�.�rt.L�. n,-v�- , 2011.
�J
CITY OF PQIVEI25IDE MISSOURI
(Name nf F,mployer) )
. _. . � � � ,
Witness: - '� " By: , ��-
` ' „ :
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Title: �-.7 �..-�e,� Title:�'-, �� H-, , �
APPENDIX A
Related Employers that have adopted this Plan
Name(s):
N/A
7'HlS DOCUMENT IS NOT COMPLETE WITHOUT SECTIONS I THROUGH XIII
PDOSllsw 16079 12/7/2011 12:40 AM
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SECTION 125 FLEXIBLE BFNEFIT PLAN
SECTION I
PURPOSE
The �mployer is establishing this Flexible Benefit Plan in order to make a broader range of benefits available to
its Employees and their Beneficiaries. This Plan allows Employees to choose among different types of bencfits
and select the combination best suited to their individual goals, desires, and needs. These choices indude an
option to receive certain benefits in lieu of taxable compensation.
In establishing this Plan, the Employer desires to attract, reward, and retain highly qualified, competent
Employees, and believes this Plan will help achicve that goal.
It is the intent of the Cmployer to establish this Plan in conformity wilh Section ] 25 of the [nternal Revenue
Code of 1986, as amended, and in compliance with applicable rules and regulations issued by the Internal
Revenue Service. This Plan will grant to eligible Employces an opportunity to purchase qualified benefits
which, when purchased alone by thc Employer, would not be taxable. I
SECTION II I
DEFINITIONS
The following words and phrases appcar in this Plan and will have the meaning indicated below unless a
different meaning is plainly reyuired by the context:
2.01 Administrator 'I'he Gmployer unless another has been designated in writing by the
Employer as Administrator within the meaning of Section 3(16) of ERISA
(if applicable).
2.02 Reneficiary Any person or persons desi�nated by a participating Etnployee to receive
any benefit payable under the Plan on account of the F,mployee's death.
2.03 Code Internal Revenue Code of 1986, as amended.
2.04 Dependent Any of the following:
(a) Tax Dependent: A Dependent includes a Participant's spouse and
any othcr person who is a Participant's dependent within the
meaning of Code Section 152, provided that, with respect to any
plan that provides benefits that are excluded froin an Employce's
income under Code Section 105, a Participant's dependent (i) is
any person within the meaning of Code 5ection 152, determined
without regard to Subsections (b)(1), (b)(2), and (d)(1)(B)
thereof, and (ii) includes any child of the Participant to whom
Code Section 152(e) applies (such child will be treated as a
dependent of both divorced parents).
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(b) 5tudent on a Medicallv Necessarv Leave of Absence: With
respect to any plan that is considered a group health plan under
Michelle's Law (and not a HIPAA excepted benefit under Code
Sections 9831(b), (c) and 9832(c)) and to the extenY the Employer is
required by Michelle's Law to provide continuation coverage, a
Dependent includes a child who qualifies as a Tax Dependent
(defined in Section 2.04(a)) because of his or her full-time student
status, is enrolled in a group health plan, and is on a medically
necessary leavc of absence from school. The child will continue to
be a Dependent if the medically necessary leave of absence
commences while the child is suffering from a serious illness or
injury, is medically necessary, and causes the child to lose student i
status for purposes of the geoup health plan's benefits coverage,
Written physician certification thal the child is sut�ering front a
serious illness or injury and that the leave of abscnce is medically
necessary is required at thc Administrator's request. The child will
� no longer be considered a Dependent as of the earliest date that the
child is no longer on a medically pecessary leave of absence, the
date that is one year aRer lhe first day of the medically necessary
leave of absence, or the date benefits would otherwise terminate
under either the group health plan ar this Plan. Terms related to
Michelle's Law, and not otherwise defined, will have the meaning
provided under the Michelle's Law provisions of Code Section
9813.
(c) Adult Children: With respect to any plan that provides benefits
that are exclucied from an �mplo}�ee's income under Code Seetion
] O5, a Dependent includes a child of a Participant who as of the end
of the calendar year has not allained age 27. A`child' for purpose
of this Section 2.04(c) means an individual who is a son, daughter,
stepson, or stepdaughter of the Participant, a legally adopted
individual of the Participant, an individual who is lawfully placed
with the Participant for legal adoption by thc Participant, or an
eligible foster child who is placed with the Varticipant by an
authorized placement agency or by judgment, decree, or other order
of any court of competent jurisdiction. An adult child described in
this Section 2.04(c) is only a Dependent with respect to benefits
provided after March 30, 2010 (subject to any other limitations of
the Plan).
Dependenl for purposes of the Dependent Care Reimbursement Plan
is defined in Section 9.04(a).
2.05 Effective Date Thc effcctivc date of this Plan as shown in Item B of the Adoption
Agreement.
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2.06 Elective Contribution The amount the Participant authorizes the Employer to reduce
compensation for the purchase of benefits elected.
2.07 Eligible Employee Employee meeting the eligibility requirements for participation as shown
in Item C of the Adoption Agreement.
2.08 Employee Any person employed by die Employcr on or after the Lffective Date.
2.09 Employer The entity shown in Item A of the Adoption Agreement, and any Related
Employers authorized to participate in the Plan with the approval of the
Employer. Related Employers who participate in this Plan are listed in
Appendix A to the Adoption Agreement. For the purposes of Section
1 I.01 and 1 1.02, only the Cmployer as shown in Item A of the Adoption
Agreement may amend or terminate the Plan.
2.10 Empinyer Contributions Amounts that have not been actually received by lhe Parti�ipant and 1re
available to the Participant for the purpose of selecting benefits under the
Plan. This term includes Non-Elective Contributions and F.lective
Contributions through salary reduction.
2.1 1 Entry Date The date that an Employec is eligible to participate in the Plan.
2.12 ERISA The Employee Retirement Income Security Act of 1974, Vublic Law 93-
406 and all regulations and rulings issued thereunder, as amended (if
applicable).
2.13 Fiduciary The named fiduciary shall mean the Employer, the Administrator and
other parties designaled as such, bul only with respect to any specifie
duties of each for the Plan as may be set forth in a written agreemcnt.
2.14 Health Savings Account A`9iealth savings account" as defined in Section 223(d) of the Internal
Revcnuc Code of 1986, as amended established by the Participant wilh the
IISA 7'rustee.
2.15 HSA Trustee 7'he 7'rustee of the Health Savings Account which is designated in Section
F.8 of the Adoption Agrcement.
2.16 Highly Compensated Any Employee who at any time during the Plan Year is a°highly
compensated employee" as defined in 5ection 414(q) of the Code.
2.17 High Deductible Health A health plan that meets the statutory requirements for annual deductibles
Plan and out-of-pocket expenses set forth in Code section 223(c)(2).
2.18 HIYAA The Health Tnsurance Porlabilily and Accountability Act of 1996, as
amended.
2.19 lnsurer Any insurance company that has issued a policy pursuant to the terms of
this Plan.
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2.20 Key Employee Any Participant who is a"key employee" as defined in Section 416(i) of
thc Code.
2.21 Non-Electivc A contribution amount made available by the Employer for the
Contribution purchase of benet7ts elected by the Participant.
2.22 Participant An Cmployee who has qualified for Plan participation as provided in Item
C of Che Adoption Agreement.
2.23 Plan The Plan referred to in Tlem A of the Adoption Agreement as may be �
amended from time to time.
2.24 Plan Year The Plan Year as specified in Item D of the Adoption Agreement.
2.25 Policy An insurance policy issued as a part of this Plan.
2.26 Preventative Care Medical expenses which meet the safe harbor definition of "preventative
care" set forth in IRS Notice 2004-23, which includes, but is not limited
to, the following: (i) periodic health evaluations, such as annual physicals
(and the tests and diagnostic procedures ordered in conjunction with such
evaluations); (ii) well-baby and/or well-child care; (iii) immunizations for
adults and children; (iv) tobacco cessation and obesity weight-loss
programs; and (v) screening devices. I lowever, preventative care does not
gener111y include any service or benefit intended to treat an existing
illness, injury or condition.
2.27 Recordkeeper The person designated by the Employer Co perform recordkeeping and
other ministerial duties with respect to the Medical Expense
Reimbursement Plan and/or the Dependent Care Reimbursement Plan.
2.28 Related Employer Any employer that is a member of a related group of organizations with
the Employer shown in Ilem A of the Adoption Agreement, and as
specified under Code Section 414(b), (c) or (m).
SECTION III
ELI(GIBILITY, ENROLLMENT, AND PARTICIPATION
3.01 ELIGIBILITY: Each Employee of the Employcr who has tnet the eligibility requirements of Item C of
the Adoption Agrcement will be eligible to participate in the Plan on lhe Entry Date specified or the
Effective Date of lhe Plan, whichever is later. Dependent eligibility to receive benefits under any of
the plans listed in Item F of the Adoption Agreement will be described in the documents govcrning
those benefit plans. To the extent a Dependent is eligible to receive benefits under a plan listed in Item
F, an Eligible F.mployee may elect coverage under this Plan with respect to such Dependent.
Notwithstanding the foregoing, life insurance coverage on the life of a Dependent may not be elected
under this Plan.
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3.02 ENROLLMENT: An eligible Employee may enroll (or re-enroll) in the Plan by submitting to the
Employer, during an enrollment period, an Election Form which specifies his or her benefit elections for
the Vlan Year and which meets such standards for completeness and accuracy as the F,mployer may
establish. A Participant's Election Form shall be completed prior to the beginning of the Plan Year, and
shall not be effective prior to the date such form is submitted to the Gmployer. Any Election Form
submitted by a Participant in accordance wilh this Section shall remain in effect until the earlier of the
following datcs: the date the Participant terminates participation in the Plan; or, the eff'ective date of a
subsequently filed Clection Form.
A Participant's right to elect certain benefit coverage shall be limited hereunder to the extent such rights
are limited in the Policy. Furthermore, a Participant will not be entitled to revoke an election after a
period of coverage has commenced and to make a new election with respect to the remainder of the
period of coverage unless both the revocation and the new election are on account of and consistcnt with
a change in status, or other allowable events, as determined by Section 125 of the lnternal Revenue i
Code and the regulations thereunder.
3.03 TERMINATION OF PARTICTPA'1'ION: A Participant shall continue to participate in lhe Plan until the
earlier of the following dates:
(a) The date the Participant terminates employment by death, disability, retirement or other
separation from service; or
(b) The date the Parkicipant ceases to work for the Employer as an eligible Employee; or
(c) The date of tennination of the Plan; or
(d) The first date a Participant fails to pay required contributions while on a leave of absence.
3.05 SEPARAT[ON FROM SERViCE: The existing elections of an Employee who separates from the
employment service of the Cmployer shall be deemed to be automatically terminated and the Employee
will not receive benefits for thc remaining portion of the Ylan Year.
3.06 QUALIFYING LEAVE iJNDER FAMILY LEAVE ACT: Notwithstanding any provision to the
contrary in this Plan, if a Particinant goes on a qualifying unpaid leave under the Family and Medical
Leave Act of 1993 (FMLA), to the extent required by the FMLA, the Ecnployer will continue to
maintain the Participant's cxistino coverage under the Plan with respecl to benefits under Section V and
Section VTIT of the Ylan on the same terms and conditions as though he were still an active Employee. If
the Employee opts to continue his coverage, the Employee may pay his Elective Contrihution with after-
tax dollars while on leave (or pre-tax dollars lo the extent he receives compensation during the leave),
or the Lmployee may be given the option to pre-pay all or a portion of his Elective Contribution for the
expected duration of the leave on a pre-tax salary reduction basis out of his pre-leave compensation
(including unused sick days or vacation) by making a special election to th�t effect prior to the date such
compensation would normally be made available to him (provided, however, that pre-tax dollars may
not be utilized to fund coverage during the next plan year), or via other arrangements agreed upon
between the Employee and the Administrator (e.g., the Administrator may fund coverage during the
leave and withhold amounts upon the Gmployee's return). Upon return from such leave, the Employee
will be permitted to reenter the Plan on the same basis the Employee was participating in the Plan prior
to his leave, or as otherwise required by the FMLA.
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SECTION iV
CONTRIBUTIONS
4.01 F.MPLOYER CONTRIBUTiONS: The Employer may pay the costs of the benefits elected under the
Plan with funds from the sources indicated in item E of the Adoption Agreement. The Employer
Contribution may be made up of Non-Elective Contributions and/or Elective Contributions authorized
by each Participant on a salary reduction basis.
4.02 TRREVOCABILITY OF ELECTIONS: A Participant may file a written election form with the
Administrator before the end of the current Plan Year rcvising the rate of his contributions or
discontinuing such contributions effective as of the first day of the next following Plan Year. The
Participant's Elective Contrihutions will automatically terminate as of the date his employment
terminates. Excepl as provided in this Section 4A2 and Section 4.03, a Participnnt's election under the
Plan is irrevocable for the duration of the plan year to which it relates. The exceptions to the
irrevocability requirement which would permit a mid-year election change in benefits and the salary
reduction amount elected are seC out in the Treasury regulations promulgated under Code Section 125,
vvhich includc the following:
(a) Chan�e in Status. A Participant may cliange or revoke his election under the Plan upon the
occurrence of a valid change in status, but only if such change or termination is made on account of,
and is consistent with, the change in status in accordance with the Treasury regulations promulgated
under Section 125. The Employer, in its sole discretion as Administrator, shall determine whelher a
requested change is on account of and consistent with a change in status, as follows:
(I) Change in Employee's legal marital status, including marriage, divorce, death of spouse, legal
separation, and annulment;
(2) Change in number of Dependents, including birth, adoption, placement for adoption, and death;
(3) Change in employment status, including any employment status change affecting benefit
eligibiliry of the Employee, spouse or Dependent, such as termination or commencernent of
employment, change in hours, strike or lockout, a commencement or return from an unpaid
leave of absence, and a chan�e in work site. If the eligibility for either the cafeteria Plan or any
underlying benefit plans of the Employer of the Employee, spouse or Dependent relies on the
employment status of that individual, and there is a change in that indiviclual's employment
status resulting in gaining or losing eligibilily under the Plan, this constitutes a valid change in
status. This category only applies if benefit eligibility is lost or gained as a result of the event.
If an Employee terminates and is rehired within 30 days, the F,mployee is required to step back
inlo his previous election. lf the Cmployee terminates and is rehired after 30 days, the
Employee may either step back into the previous election or make a new election;
(4) Dependent satisfies, or ceases to satisfy, Dependent eligibility requirements due to attainment
of age, gain or loss of student status, marriage or any similar circumstances; and
(5) Residence change of Employee, spouse or Dependent, affecting thc Employee's eli�ibility for
coverage.
(b) Special Enrollment Ri�. If a Participint or his or her spouse or Dependent is entitled to special
enrollment rights under a group health plan (other than an excepted benefit), as required by H[PAA
under Code Section 9801(n or Section 2701( fl of the Public Health Service Act, then a Participant
may revoke a prior election for group health plan coverage and make a new election, provided that
the election change corresponds with such HIPAA special enrollment right. As required by HIPAA,
a special enrollment right will arise in the following circumstances: (i) a Participant or his or her
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spouse or Dependent declined to enroll in group health plan coverage because he or she had
coverage, and eligibility for such coverage is subsequently lost because the coverage was provided
under CORRA and the COBRA coverage was exhausted, or the coverage was non-COBRA
coverage and the coverage terminated due to loss of eli�ibility for coverage or the employer
contributions for the coverage were terminated; (ii) a new Dependent is acquired as a result of
marriage, birth, adoption, or placement for adoption; (iii) the Participant's or his or her spouse's or
Dependent's coverage under a Medicaid plan or under a children's health insurance program (CHIP)
is terminated as a result of loss of eligibility for such coverage and lhe Participant requests coverage
under the group health plan not later than 60 days after the date of termination of such coverage; or
(iv) the Participant, his or her spouse or Dependent becomes eligible for a state premium assistance
subsidy from a Medicaid plan or through a state children's insurance pro=ram with respect to �
coverage underthe group health plan and the Participantrequests coverage underthe group health
plan not laler than 60 days after the date the Participant, his or her spouse or Dependent is
determined to be eligible for such assistance. An election change under (iii) or (iv) of this provision
must be requested wilhin 60 days after the termination of Medicaid or state health plan coverage or
the determination of' eligibility for a state premium assistance subsidy, as applicable. Special
enrollment rights under the heallh insurance plan will be determined by thc terms of the health
insurance plan. �
(c) Certain Jud�ments, Decrees or Orders. If a judgment, decree or order resulting from a divorce, legal
separation, annulment or change in legal custody (including a qualified medical child support order
[QMCSO]) rcquires accident or health coverage for a ParticipanCS child or for a fostcr child who is
a dependent of the Plrticipant, the Participant may have a mid-year election change to add or drop
coverage consistent with the Order.
(d) Entitlement to Medicare or Medicaid. If a Participant, Participant's spouse or Participant's
Dependent who is enrolled in an accident or health plan of the Employer becomes entitled to
Medicare or Medicaid (other than coverage consisting solely of benefits under Section 1928 of the
Social Security Act providing for pediatric vaccines), the Participant may cancel or reduce health
coverage under the Gmployer's Plan. Loss of Medicare or Medicaid entitlement would allow the
Participant to add health coverage under the Employer's Plan.
(e) Familv Medical Leave Act. If an Employee is taking leave under thc rules of the Family Medical
Leave Act, the Employee may rcvoke previous elections and re-elecl benetits upon return to work.
(t) COBRA Qualifvin_�. If an Employee has a COBRA qualifying event (a reduction in hours of
the Employee, or a Dependent ceases eligibility), the F,mployee may increase his pre-tax
contributions for coverage under the Employer's Plan if a COBRA event ocatrs with respect to the
Employee, the Employee's spouse or Dcpcndent. The COBRA rule does not apply to COF3RA
coverage under another Fm�loyer's Plan.
(g) Changes in Eli i� bilitv for Adult Children. To the extcnt the Employer amends a plan listed in Item
F of the Adoption Agreement that provides benefits that are excluded from an Cmployee's income
under Code Section 105 to provide that Adult Children (as defined in Section 2.04(c)) are eligible to
receive benefits under the plan, an Eligible Employee may make or change an election under this
Plan to add coverage for the Adult Child and to make any corresponding change lo the Eligible
F.n�ployee's coverage that is consistent with adding coverage for the Adult Child.
(h) Notwithstanding anything to the contrary in this Section 4.02, the change in election rules in this
Section 4.02 do not apply to the Medical �xpense Reimburseenent Plan, or may not be modified
14
with respect to the Medical Expense Reimbursement Plan if the Plan is being administered by a
Recordkecper other than the Employer, unless the Employer and the Recordkeeper otherwise agree
in writing.
4.03 OTIIER CXCEPTIONS TO IRREVOCABILITY OF ELECTIONS. Other exceptions to the
ireevocability of election requirement pemiil mid-year election changes and apply to all qualified
benefits except for Medical Expense Reimbursement Plans, as follows:
(a) Chanee in Cost. ff the cost of a benefit package option under the Plan significantly increases during
the plan year, Participants may (i) make a corresponding increase in their salary reduction amount,
(ii) revoke their elections and make a prospective elecCion under another benefit option offcring
similar coverage, ar(iii) revoke election completely if no similar coveragc is available, including in
spouse or dependent's plan. If tk�e cost significantly decreases, employees may elect coverage even
if they had not previously participated and may drop their previous election for a similar coverage
option in order to elect the benefit package option that has decreased in cost during the year. If the
increased or decreased cost of a henefit package option under the Plan is insignificant, the
participant's salary reduction amolmt shall be lutomatically adjusted. �'
(b) Si�nificant curtailment of covera�e.
(i) With no loss of coveraee. If the coverage under a benefit package option is significantly
curtailed or ceases during the Plan Year, aftected Participants may revoke their elections for thc
curtailed coverage and make a new prospective election for coverage under another benefit
package option providing similar coverage.
(ii) With loss of coveraQe. If there is a significant curtailment of coverage with loss of coverage,
affecled Parlicipants may revoke election for curtailed coverage and make a new prospective
election for coverage under another benefit package option providing similar coverage, or drop
coverage if no similar benefit package option is available.
(c) Addition or Significant Improvement of Benefit Packa�e Option. if during the Plan Year a new
benefit package option is added or significantly improved, eligible employees, whether currently
participating or not, may revoke their existing election and cicct the newly added or newly improved
option.
(d) Chanoe in CoveraQe of a Spouse or Dependent Under Another Employer's Plan. If there is a
change in coverage of a spouse, former spouse, or Dependent under another employer's plan, a
Participant may make a prospective election change that is on account of and corresponds with a
change made under the plan of the spouse or Dependent. This rule applies if (1) mandatory changes
in coverage are initiated by eitlier the insurer of spouse's plan or Uy the spouse's employer, or (2)
optional changcs are initiated by the spouse's employer or by the spouse through open enrollmcnt.
(e) Loss of coverage under other �roun health covera�e. If during the Plan Year coverage is lost under
any group health coverage sponsored by a governmental or educational institution, a Participant may
prospcctively changc his on c�r elcction to add group health coverage for the affected Participant or
his or her spouse or dependent.
4.04 CASH BENEFIT: Available amounts not used for the purchasc of benefits under this Plan may be
considered a cash benefit under the Plan payable to the Participant as laxable income to lhe extenl
indicated in Item E of the Adoption Agreement.
15
4.05 PAYMENT FROM EMPLOYER'S GENERAL t1SSETS: Payment of benefits under this Plan shall be
made by the Fmployer from Elective Contributions which shall be held as a part of its general assets.
4.06 EMPLOYER MAY HOLD ELECTIVE CONTRIBUTI�NS: Pending payment of benefits in
accordance with the ternis of this Plan, Elective Contributions may be retained by the Employer in a
separate account ar, if electcd by the Employer and as permitted or required by regulations of the
Internal Revenue Service, Department of Labor or other governmental agency, such amounls of Elective
Contributions may be held in a trust pending payment. �
4.07 MAXTMUM EMPLOYGR CONTRIBt1TIONS: With respect to each Parlicipant, the maximum
amount made available to pay benefits for any Plan Year shall not exceed the Employer's Contribution
specified in the Adoption Agreement and as provided in this Plan.
SECTION V
GROUP MEDICAL INSURANCE BENEFiT PLAN
5.01 PURVOSE: 7'hese benefits provide the group medical insurance benefits to Participants.
5.02 ELiC7iBiLITY: Eligibility will be as required in Items F(1), F(3), and F(4) of the Adoption Agreement.
5.03 DESCRIPTION OF BENEFITS: The bene6ts available under this Plan will be as defined in Items F(1),
]�(3), and F(4) of the Adoption Agreement.
5.04 TERMS, COND1770NS AND L[MfTAT[ONS: The terms, conditions and limitations of the benefits
offered shall be as specifically described in the Policy identified in the Adoption Agreement.
5.05 COBRA: To the extent required by Section 4980B of the Code and Sections 601 through 607 of
ERiSA, Participants and Dependents shall be entilled to continued participation in this Group Medical
lnsurance Bene6t Plan by contributing monthly (from their personal assets previously subject to
taxation) 102% of the amount of the premium for the desired benefit during the period that such
individual is entitled to elect continuation coverage, provided, however, in the event the continuation
period is extended to 29 months due to disability, the premium to be paid for continuation coverage for
the 1 I month extension period shall be 150%, of the applicable premium.
5.06 SECT[ON 105 AND 106 PLAN: It is the intention of the Employer that these benefits shall be eligible
for exclusion from lhe � income of the Participants eovered by this benefit plan, as provided in Code
Sections l05 and 106, and all provisions of this benefit plan shall be construed in a manner consistent
with that intention. lt is also the intention of the F,mployer to comply with the provisions of the
Consolidated Omnibus Budget Reconciliation Act of 1985 as outlined in the policies identified in the
Adoption Agreement.
5.07 CONTRiBUTIONS: Contributions for these benefits will be provided by the F.mployer on behalf of a
Participant as provided for in Item L. of'the Adoption Agreement.
5.08 11NTF'ORMF,D SERVTCF,S EMPi3OYMF,N'f AND REEMPLOYMENT RIGHTS ACT:
Notwithstanding anything to the contrary herein, the Group Medical Insurance Benefit Plan shall
16
comply with the applicable provisions of lhe Uniformed Services Employment and Reemployment
Rights Act of 1994 (Public Law 103-353).
SECTION Vl
DISABILITY INCOME BENEFiT PLAN
6.01 PURPOSE: This benefit provides disability insurance designated to provide income to Participants
during periods of absence from employment because of disability.
6.02 LLIGIBILITY: Eligibility will be as required in Item F(2) of the Adoption Agreement.
6.03 DESCRIPT�ON OP RF,NEFf"fS: 'fhe benefits available under this Plan will be as defined in item F(2)
of the Adoption Agreement.
6.04 1'ERMS. CONDITIONS AND LIMITATIONS: The terms, conditions and limitations of the Disability
lncome Benefits offercd shall be as specifically described in the Policy identitied in the Adoption
Agreement.
6.05 SECTION 104 AND 106 PLAN: Tt is the intention of the Cmployer that the premiums paid for thcse
benefits shall be eligible for exclusion from the gross income of the Participants covered by this benefit
plan, as provided in Code Sections 104 and 106, and all provisions of this benefit plan shall be
construed in a manner consistent with that intention.
6.06 CONTRiBUT10NS: Contributions for this benetit will be provided by the Employer on behalf of a
Participant as provided for in Item E of the Adoption Agreement.
SECTION Vll
GROUP AND INDIVIDi1AL LIFE INSUI2ANCE PLAN
7.01 PURPOSC: This benefit provides �roup life insurance beneftts to Participants and may provide certain
individual policies as provided for in Item F(5) of the Adoption Agreement.
7.02 ELIGiB�LiTY: Eligibility will be as required in Item F(5) of the Adoption Agrcement.
7.03 DESCRIPTION OF BENEFITS: The benefits available under this Plan will be as defined in Item F(5)
of the Adoption Agreement.
7.04 TERMS, CONDIT[ONS. AND LIM[TATIONS: The terms, conditions, and limitations of the group life
insurance are specifically described in the Policy identified in the Adoption Agreement.
7.05 SECTION 79 PLAN: It is the intention of the Employer that the premiums paid for the benefits
described in Item F(5) of the Adoption Agreement shall be eligible for exclusion from the gross income
of the Participants covered by this benefit plan to the extent provided in Code Section 79, and all
provisions of this benefit plan shall be construed in a manner consistent with that intention.
17
7.06 CON'fRIBUTIONS: Contributions for this benefit will be provided by the F_,mployer on behalf of a
Participant as provided for in Item E of the Adoption Agreement. Any individual policies purchased by
the F.mployer for the Participant will be owned by the Participant.
SECTION VIII
MEDICAL EXPENSF. RF.IMBURSEMENT PLAN
8.�1 PURPOSF_,: `fhe Medical Expense Reimbursement Plan is designed to provide for reimbursement of
Eligible Medical Expenses (as defined in 5ection 8.04) that are not reimbursed under an insurance plan,
through damages, or from any other source. 1t is the intention of the L',mployer that amounts allocated
for this benetit shall be eligible for exclusion from gross income, as provided in Code Sections 105 and
106, for Participants who elect this benefit and all provisions of this Section Vlll shall be construed in a
manner consistent with that intention.
8.02 �LI('iBTLI7'Y: The eligibility provisions are sct forth in ltem F(7) of the Adoption Agreement.
8.03 TERMS, COND1TfONS, AND LIMITATIONS:
(a) Accounts. The Reimbursemenl Recordkeeper shall establish a recordkeeping account for each
Participant. 'I'he Reimbursement Recordkeeper shall maintain a record of each account on an on-
going basis, increasing the balances as contributions are credited during the ycar and decreasing the
balances as Eligible Medical Lxpenses are reimbursed. No interest shall be payable on amounts
recorded in any Participant's account.
(b) Maximum benefit. The maximum amount of reimbursement for each Participant shall be limited to
the amount of the Participant's Elective Contribution allocated to the program during the Plan Year,
not to exceed the maximum amount set forth in Item F(7) of the Adoption Agreement.
(c) Claim Procedure. In order to be reimbursed f'or any medical expenses incurred during the Vlan Year,
the Yarticipant shall complete the form(s) provided for such purpose by the Reimbursement
Recordkeeper. The Participant shall submit the completed form to the Reimhursement
Recordkeeper with an original bill or other proof of the expense acceptable to the Reimbursement
Recordkeeper. No reimbursement shall be made on the basis of an incomplete form or inadequate
evidcnce of expense as delermined by the Reimbursement Recordkeeper. Forms for reimbursement
of Eligible Medical Expenses must be submitted no later than the ninetieth (90th) day following the
last day of the Plan Year during which the Lligible Medical Expenses wcre incurred.
Reimbursemenl payments shall only be made to the Participant, or the Participant's legal
representative in the event of incapacity or death of lhe Participant. Forms for reimbursement shall
be reviewed in accordance with the claims procedure set forth in Section XII.
(d) Fundine. The funding of the Medical Reimbursement Plan shall be through contributions by the
Employer from its general assets to the extent of Elective Contributions directed by Participants.
Such contributions shall be made by the Employer when benefit payments and account
administrative expenses become due and payable under this Medical Expense Reimbursement Plan.
(e) Forfeiture. Any amounts remaining to the credit of the Participant at the end of the Plan Year and
not used for Eligible Medical Expenses incurred during the Participant's participaCion during the
Plan Year shall be forfeited and shall remain assets of the Plan. With respect to a Participant who
18
termi�ates employment with the Employer and who has not elected to continue coverage under this
Plan pursuant to COBRA rights referenced under Section 8.03(fl herein, such Participant shall not
be entitled to reimbursement for Eligible Medical Expenses incurred after his termination date
regardless if such Participant has any amounts of Employer Contributions remaining to his credit.
Upon the death of any Participant who has any amounts of Employer Contributions remaining to his
credit, a dependent of the Participant may elect to continue to claim reimbursement for �ligible
Medical Expenses in the same manner as the Participant could have for the balance of the Plan Ycar.
I
I
(fl COBRA. To the exlent required by Section 4980B of the Code and Sections 601 through 607 of
F,RIS;l (`COBR.A"), a Participant and a Participant's Dependents shal] be entiticd to elect continued
participation in this Medical Expense Reimbursement Plan only through the end of the plan year in
which lhe yualifying event occurs, by contributing monthly (from their personal assets previously
subject to taxation) to the EmployerlAdministrator, ] 02% of the amount of desired reimbursement
through the end of the Plan Year in which the qualifying event occurs. 5pecifically, such individuals
will be eligible for COBRA continuation coverage only if they have a positive Medical Expense
Reimbursement Account balance on the date of the qualifying evcnt. Participants who have a deficit
balance in their Medic�l Expense Reimbursement Account on the date of their qualifying event shall
not be entitled to elect COBRA coverage. In lieu of COBRA, Participants may continue their
coverage through the end of the current Plan Year by paying those premiums out of their last
paycheck on a pre-tax basis.
(g) Nondiscrimination. Benefits provided under this Medical Expense Reimbursement Plan shall not be
provided in a manner that discriminates in favor of Employees or Dependents who are highly
compensated individuals, as provided under Section ] OS(h) of the Code and regulations promulgated
thereunder.
(h) Uniform Covera e,� Rule. Notwithstanding that a Participant has not had withheld and credited to his
account all of his contrihutions elected with respect to a particular Plan Year, the entire aggregate
annual amount elected with respect Co this Mcdical Expense Reimbursement Plan, shall be available
at all times during such Plan Year to reimburse the participant f'or Eligible Medical Expcnses with
respect to lhis Medical Expense Rein�bursement Plan. To Che extcnt contrihutions with respect to
this Medical Expense Reimbursement Plan are insufficient lo pay such Gligible Medical Expenses,
it shall be the Employer's obligation to provide adequate funds to cover any short fall for such
Eligible Medical Lxpenses for a Participant; provided subsequent contributions wilh respect to this
Medical Expense Reimbursement Plan by the Varticipant shall be availlble to reimburse the
Employer for funds advanced to cover a previous short fall.
(i) Uniformed Services Emplovment and Reemployment Ri�hts Act. Notwithstanding anything to the
contrary herein, this Medical Expense Reimbursement Plan shall comply with the applicable
provisions of the Uniformed Scrvices Employment and Reemployment Rights Act of 1994 (Public
Law 103-353).
(j) Proration of Limit. In the event that the Employer has purchased a uniform coverage risk policy
from the Recordkeeper, then the Maximum Coverage amount specified in Section F.7 of the
Adoption Agreemenl shall be pro rated with respect to (i) an Employee who becomes a Participant
and enters the Plan dttring the Plan Year, and (ii) short plan ycars initiated hy the Employer. Such
Maximum Coveragc amount will be pro rated by dividing the annual Maximum Coverage amount
by 12, and multiplying the quotient by the number of remaining months in the Plan Year for the new
Participant or the nttmber of months in the short Plan Year, as applicable.
19
(k) Continuation Covera�e for Certain Dependent Children. Tn the event that benefits under the Medical
Expense Reimbursement Plan does not qualify for the exception from the portability rules of
HIPAA, then, effective for Plan Years beginning on or after October 9, 2009, norivithstanding the
foregoing provisions, coveragc for a Dependent child who is enrolled in the Medical F,xpense
Reimbursement Plan as a student at a post-secondary educational institution will not terminate due
to a medically necessary leave of absenee before a date that is the earlier of:
• the date that is one year after the first day of the medically necessary leave of absence; or
• the date on which such coverage would otherwise terminate under the terms of the Plan.
For purposes of this paragraph, "medically necessary leave of lbsence" means a leave of absence oF
thc child from a post-secondary educational institution, or any other change in enrollment of the
child at the institution, that: (i) commences while the child is suffering from a serious illness or
injury; (ii) is medically necessary; and (iii) causes the child to lose student status for purposes of
coverage under the terms of the Plan. A written certification must be provided by a treating I
physician of the dependcnt child to the Plan in order for the continuation coverage requirement to
apply. The physician's certification must state that the child is suffering from a serious illness or
injury and that the leave of absence (or other change in enrollment) is medically necessary.
8.04 ELIGiBLE MEDICAL EXPENSES
(a) (a) Eli�ible Medical Expense in General. The phrase `Eligible Medical Expense' means any
expense incurred by a Participant or any of his Dependents (subject to the restrictions in Sections
8.04(b) and (c)) during a Plan Ye3r that (i) qualifies as an expense incurred by the Participant or
Dzpendents for medical care as defined in Code Section 213(d) and meets thc requirements
outlined in Code Section 125, (ii) is excluded from gross income of the I'articipant under Code
Section 105(b), and (iii) has not been and will not be paid or reimbursed by any other insurancc
plan, through damages, ar from any other source. Notwithstanding the above, capital
expenditures are not Eligible Medical Expenses under this Plan. Further, nohvithstandin� the
above, effective January l, 20] l, only the following drugs or medicines will constitute Eligible
Medical Cxpenses:
(i.) Drugs or medicines thlt require a prescription;
(ii.) Drugs or medicines tliat are available without a prescription ("over-the-counter
drugs or medicines") and the Participant or Dependent obtains a prescription; and
(iii.) Insulin.
(b) F.xpenses Incurred After Commencement of Participation. Only medical care expenses incurred by
a Participant or the Participant's Dependent(s) on or after the date such ParticipanC commenced
participation in the Mcdical Expense Reimbursement Plan shall constitute an �ligible Medicll
Expense.
(c) Eli ib�penses Incurred by De�endents. For purposes of this 5ection, F,ligible Medical Expenses
incurred by Dependents defined in 5ection 2.04(c) are eligible far reimbursement if incurred after
March 3�, 2010; Eligible Medical Expenses incurred by Dependents defined in Sections 2.04(a) and
(b) are eligible for reimbursement if incurred either before or after March 30, 2010 (subject to the
restrictions of Section 8.04(b)).
20
(d) Health Savings Accounts. If the Employer has elected in Item F.8 of the Adoption Agreement to
allow Eligible F,mployees to contribute to Health Savings Accounts under the Plan, then for a
Participant who is eligible for and elects to contribute to a Health Savings Accounts, Eligible
Medical Expenses shall he limiled as set forth in Item F.8 of the Adoption Agreement.
8.05 USE OF DEBIT CARD: In the event that the Employer elects to allow the use of debit cards ("Debit
Cards") for reimbursement of Eligible Medical Expenses (other than over-lhe-counter drugs or
medicines) under the Medical Expense Reimbursement Plan, the provisions described in this Section
shall apply. However, beginning January l, 2011, a Debit Card may not be used to purchase drugs or
medicines over-the-counter. I
(a) Substantiation. The following procedures shall be applied for purposes of substantiating claimed
Eligible Medical Expenses after the use of a Debit Card to pay the claimed Eligible Medical
Expense:
(i) If the dollar amount of the transaction at a health care provider equals the dollar amount
of the co-payment for that service under the Emplo_ycr's major medical plan of the
specific ernployee-cardholder, the charge is fully substantiated without the need for
submission of a receipt or further review.
(ii) If the merchant, scrvice provi�er, or olher independent third-party (e.g., pharmacy benefit
manager), at the time and point of sa]e, provides information to verify to the
Recordkeeper (including electronically by e-mail, the internet, intranet, or telephone) that
the charge is for a medical expense, the charge is fully substantiated without the need for
submission of a receipt or further rcview.
(b) Status of Charges. All charges to a Debit Card, other than co-paymcnts and real-time substantiation
as described in Subsection (a) above, are treated as conditional pending confirmation of the charge,
and additional third-party informalion, such as merchant or service provider receipts, describing the
service or product, the date of the service or sale, and the amount, must be submitCed for review and
substantiation.
(c) Correction Procedures for Improper Pa_ rny ents• In the event that a claim has been reimbursed and is
subsequently identified as not yualifying for reimbursement, one or all of the following procedures
shall apply:
(i) First, upon the Recordkeeper's identification of the improper paymenC, the Eligible
Employee will be required to pay back to the Plan an amounl eyual to the improper
payment.
(ii) Second, where the Eligible Employee does not pay back to the Plan the amount of the
improper payment, the Employer will have the amount of the improper payment withheld
from the Gligible Employee's wages or other compensation to the extent consistent with
applicable law.
(iii) Third, if the improper payment still remains outstanding, the Plan tnay utilize a claim
substitution or offset approach to resolve improper claims payments.
(iv} If the above correction efforts prove unsuccessful, or are otherwise unavailable, the
Eligible Etnployee will remain indebted to the Employer for the amount of the improper
21
payment. [n that event and consistent with its business practices, the Employer may treat
the payment as it would any other business indebtedness.
(v) In addition to the above, the Employer and Lhe Plan may take other actions they may
deem necessary, in their sole discretion, to ensure that further violations of the terms of
the Debit Card do not occur, including, but not limited to, denial of access to the Debit
Card until the indebtedness is repaid by the Eligible Cmployee.
(d) Intent to Comply with Rev. Rul. 2003-43. it is the Employer's intent lhat any use of Debit Cards to
pay Eligible Medical F.xpenses shall comply with the guidelines for use of such cards set forth in
Rev. Rul. 2003-43, and this Section 8.05 shall be construed and interpreted in a manner necessary to
comply with such guidelines.
8.06 GRACE PERIOD: If the Employer clects in Section F.7 of the Adoption Agreement to permit a Grace
Period with respecc to the Medical Reimbursement Plan, the provisions of this Section 8.06 sliall apply.
Notwithstanding anything to the contrary herein and in accordance with Internal Revenue Service Notice
2005-42, a Participant who has unused contributions relating to the Medical Reimbursement Plan from
the immediately preceding Plan Year, and who incurs Eligib(e Medical Expenses for such qualified
benefit during the Grace Period, may bc paid or reimbursed for those Eligible Medical Expenses from
the unused conlribulions as if the expenses had been incurred in the immediately preceding Plan Year.
For purposes of this Section, `Grace Period' shall tnean the period extending to the I S` day of the third
calendar month after the end of the immediately preceding Vlan Year to which it relates. Eligible
Medical Gxpenses incurred during the Grace Period shall be reimbursed first from unused contributions
allocated to the Medical Reimbursement Plan for the prior Plan Year, and then from unused
contribulions for the current Plan Year, if participant is enrolled in current Plan Year.
8A7 OUALIFICD RCSERVIST DISTRIBUTIONS: Notwithstanding anything in the Plan to thc
contrary, an individual who, by reason of being a member of a reserve component (as defined in
37 U.S.C. § I Ol ), is ordered or called to active duty for a period in excess of 179 days or for an
indefinite period may elect to receive a distribution of all or a portion of thc unused Elective
Contributions in his or her Account relating to the Medical Expense Reimbursement Plan if the
distribution is made during the period beginning on the date of such order or call and ending on
the last date that reimbursemcnts could otherwise be made under the Plan for the Plan Year that
includes the date of such order or call. If the distribution is for the entire amount of unused
Elective Contributions available in the Medical Expense Reimbursement Plan, then no additional
reimhursement requests will be processed for the remainder of the Plan Year.
SECTION IX
DEPENDENT CARE REIMBURSEMENT PLAN
9.01 PURPOSE: The Dependent Care Reimbursement Plan is designed to provide for reimbursement of
certain employment-related dependent care expenses of the Participant. It is the intention of thc
�mployer that amounts allocated for this benefit shall be eligible for exclusion from gross income, as
provided in Code Section 129, for Participants who elect this benefit, and all provisions of this Section
IX shall be construcd in a manner consistent with that intention.
9.02 ELIGBILITY: The eligibility provisions are set forth in Item F(6) of the Adoption Agreement.
22
9.03 TERMS. CONDITIONS, AND LIM[7'ATIONS:
(a) Accounts. The Reimbursement Kecordkeeper shall establish a recordkeeping account for each
Participant. The Reimbursement Recordkeeper shall maintain a record af each account on an on- '�
going basis, increasing the balances as contributions are credited during the year and decreasing the
balances as Eligible Dependent Care Expenses are reimbursed. No interest shall be payable on
amounts recorded in any Participant's account.
(b) Maximum Benefit. The maximum amount of reimbursement for each Participant shall be limiled to
the arnount of the Participant's allocation to the program during the Plan Year not to exceed the
maximum amount set forlh in Item F(6) of the adoption agreement.
(c) For purpose of this 5ection TX, lhe phrase "earned income" shall mean wages, salaries, tips and othcr
employee compensation, but only if such amounts are includible in gross income for the laxable
ycar. A Participant's spouse who is physically or mentally incapable of self-care as described in
Section 9.04(a)(ii) or a spouse who is a fiill-time student within thc mcaning of Code Section
21(e)(7) shall be deemed to have earned income for each month in which such spouse is so disabled
(or a full-time sludent). The amount of such deemed eamed income shall be $250 per month in the
case of' one Dependent and $500 per month in the case of two or rnore Dependents.
(d) Claim Procedure. In order to be reimbursed for any dependent care expenses incurred during the
Plan Ycar, thc Participant shall complete the form(s) provided for such purpose by the
Reimbursement Recordkeeper. The Participant shall submit the completed form to the
Reimbursement Recordkeeper with an original bill or other proof of the expense from an
independent third party acceplable Lo the Reimbursement Recordkeeper. No reimbursement shall be
made on the basis of an incomplete form or inadequate evidence of the expense as determined by the
Reimbursement Recordkeeper. Claims for reimbursement of F,ligible i)ependent Care Cxpenses
must be submitted no later than the ninetieth (90th) day following the last day of the Plan Year
during which the Eligible Dependent Care Expenses were incurrcd. Reimbursement payments shall
only be made to the Participant, or the YarticipanYs legal representative in the event of the incapacity
or death of the Participant. Forms for reimbursement sha11 be reviewed in accordance with the
claims procedure set forth in Section XiT.
(e) Fundin�. The funding of the Dependent Care Reimbursement Plan shall be through contributions by
the Employer from its general assets Lo Che exlenl of F,leclive Contributions directed by Participants.
Such contributions shall be made by the Employer when benefit payments and account
administration expenses become due and payable under this Dependent Care Expense
Reimbursement Plan.
(fl Forfeiture. Any amounts remaining to the credit of the Participant at the end of the Plan Year and
not used for Eligible Dependent Care Expenses incurred during the Plan Year shall be forfeited and
rcmain asscts of thc Plan.
(g) Nondiscrimination. Benefits provided under this Dependent Care Reimbursement Plan shall not be
provided in a manner that discriminates in favor of Hi�;hly Compensated Employees (as defined in
Code Section 414(q)) or their dependents, as provided in Code Section 129. In addition, no more
than 25 percent of the aggregate Eligible Dependent Care Expenses shall be reimbursed during a
Plan Year to five percent owners, as provided in Code Section 129.
9.04 DEFINITIONS
23
(a) "Dependent" (for purposes of this Section IX) means any individual who is:
(i) a ParticipanYs qualifying child (as defined in Code Secdon 152 (c)) who has not attained
the age of 13; or
(ii) a dependent (qualifying child or qualii}�ing relative, as defined in Code Section 152 (c)
and (d), respectively) or [he spouse of a Participant who is physically or mentally
incapable of self-care, and who has the same principal place of abode as the taxpayer for
more [han half of the taxable year. For purposes of this Dependent Care Reimbursement
Plan, an individual shall be considered physically or mentally incapable of self-care if, as
a result of a physical or mental defect, the individual is incapable of caring for his or her
hygienic or nutritional needs, or requires full-time attention oCanother person for his or
her own safety or the safety of others.
(b) "Dependent Care Center" (for purposes of this Section IX) shall be a facility which:
(i) provides care for more than six individuals (othcr than individuals who reside at the
faci I ity); �
(ii) receives a fee, payment, or gant for providing services for any of the individuals
(regardless ofwhether such facility is operated for profit); and
(iii) satisfies all applicable laws and regulltions of a state or unit of local government.
(c) "Eligiblc Dependent Care Expenses" (for purposes of this Section 1X) shall mean expenses incurred
by a Participant which are:
(i) incurred for the care of a Dependent of the Participant or for related household services;
(ii) paid or payable to a Dependent Care Service Provider; and
(iii) incurred to enable the Participant to be gainfiilly employed for any period for which there
are one or more Dependents with respect to the Participant.
"Eligible Dependent Care Cxpenses" shall not include expenses incurred for services outsidc the
Participant's household for the care of a Dependent unless such Dependent is (i) a qualifying
child (as defined in Code Section 152 (c)) under the age of 13, ar(ii) a dependent (qualifying
child or qualifying relative, as defined in Code Section 152 (c) and (d), respectively)), who is
physically or mentally incapable of sclf-care, and who has the same principal place of abode as
the Participant for more lhan half of the taxable year, or (iii) the spouse of a Participant who is
physically or mentally incapable of self-care, and who has the same principal place of abode as
the Participant for more than haH' of the taxable year. F,ligible Dependent Care Expenses shall
be deemed to be incurred at the time the services to which the expenses relate are rendered.
(d) "Dependent Care Service Provider" (for purposes of this Sectioo IX) means:
(i) a Dependent Care Center, or
(ii) a person who provides care or other services described in Section 9.04(h) and who is no[
a related individual described in Section 129(c) ofthe Code.
SECTION X
HEALTI� SAViNGS ACCOUNTS
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10.01 PURPOSE: If elected by the Employer in Section F.8 of the Adoption Agreement, the Plan will permit
pre-tax contributions to the Health 5avings Account, and the provisions of this Article X shall apply.
10.02 BENEFITS: A Participant can elect benefits under the Health Savings Accounts portion of this Plan by
elccting to pay his or her Health Savings Account contributions on a prc-tax salary reduction basis. In
addition, the Employer may make contributions to the Health Savings Account for the benefit of the �
Participant. I
10.03 TERMS. CONDITIONS AND LIMiTAT10N:
(a) Maximum Benefit. The maximum annual contributions that may be made to a Participanf s Health
Savings Account under this Plan is set forth in Section F.8 of the Adoption Agreement.
(b) Mid-Year Election Chan�es. Notwithstanding any to the contrary herein, a Participant election with
respecl lo contributions for the Health Savings Account shall be revocable during the duration of the
Plan Year to which the election relates. Consequently, a Participant may change his or her election
with respect to contributions for the l lealth Savings Account at any time.
10.04 RESTRICTIONS ON MEDICAL REIMBURSEMENT YLAN: If the Lmployer has elected in Section
F.S of the Adoplion Agreement both Health Savings Accounts under this Plan and the Medical Expense
Reimbursement Plan, then the Eligible Medical Expenscs that may be reimbursed under the Medical
Reimbursement Plan for Participants who are eligible for and elect to participate in Health Savings
Accounts shall be limited as set forth in Section F.8 of the Adoption Agreement.
10.05 NO ESTABLISHMEN'I' OF ERISA PLAN: It is the intent of the Employer that the establishment of
Health Savings Accounts are completely voluntary on the part of Participants, and that, in accordance
with Department of I,abor Field Assistance Bulletin 2004-1, the Health Savings Accounts are not
"employee welfare benefit plans" for purposes of Title I of ERISA.
SECTION XI
AMF,NDMT;IVT AND TERMINATION
11.01 AMENDMENT: The Employer shall have the right at any time, and from time to time, to amend, in
whole or in parf, any or all of the provisions of this Plan, provided that no such amendment sh111 change
the terms and conditions of' payment of any benefits to which Participants and covered dependents
otherwise have become entitled to under the provisions of the Plan, unless such amendmen[ is made to
comply with federal or local laws or regulations. The Employer also shall have the right to make any
amendment retroactively which is necessary to bring the Plan into conformity with the Code. In
addition, the Employcr may amend any provisions or any supplemcnts to the Plan and may merge or
combine supplements or add additional supplemenls to the Plan, or separate existing supplements into
an additional number of supplements.
I 1.02 TERMINATION: The Employer shall have the right at any time to terminate this Plan, provided that
such termination shall not eliminate any obligations of the �mployer which therefore have arisen under
the Plan.
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SECTiON XII
ADMINISTRATION
I
12.01 NAMED FIDUC[ARIES: The Administrator shall be the fiduciary of the Plan.
12.02 APPOINTMENT OF RECORDKEF,PER: "I'he Employer may appoint a Reimbursement Recordkeeper
which shall have the power and responsibility of perfortning recordkecping and other ministerial duties
arisinb under the Medical Expense Rcimbursement Plan and the Dependent Care Reimbursement Plan
provisions of this Plan. The Reimbursement Recordkeeper shall serve at the pleasure of, and may be
removed by, the Employer without cause. Tlle Recordkeeper shall receive reasonable compensation for
its services as shall be agreed upon from time to time between the Administrator and the Recordkeeper.
12.03 POWERS AND RESPONSIBILITIES OF ADMINISTRATOR
(a) GeneraL The Administrator shall be vested with all powcrs and authority necessary in order to
amend and administer the Plan, and is authorized to make such rules and regulations as it may deem
necessary to carry out the provisions of the Plan. The Administrator shall dctermine any questions
arising in the administration (including all questions of eligibility and determination of amount, time
and manner of payments of benefits), construction, interpretation and application of the Plan, and the
decision of the Administrator shall be final and binding on all persons.
(b} Recordkeeping. The Administrator shall keep full and complete records of the administration of the
Plan. The Administrator shall prepare such reports and such informalion concerning the Plan and
the administration thereof by the Administrator as may be required under the Code or ERISA and
the regulations promulgated thereunder.
(c) Inspection of Records. The Administrator shall, during normal business hours, make available to
each Participant for examination by the Participant at the principal office of the Administrator a
copy of the Plan and such records of the Administrator as may pertain to such Participant. No
Participant shall have the right to inquire as to or inspect the accounts or records with respect to
other Participants.
12.04 COMPENSATI�N AND EXPENSES OF ADMINISTRATOR Thc Administrator shall serve without
compensation for services as such. All expenses of the Administrat�r shall be paid by the Employer.
Such expenses shall include any expense incident to the functioning of the Plan, including, but not
limited to, attorncys' fees, accounting and cicrical charges, actuary fees and other costs of administering
the Plan.
12.05 LIABILiTY OP ADMINiSTRATOR: F_,xcept as prohibited by law, the Administrator shall not be liable
personally for any loss or dama�e or depreciation which may result in connection with the exercise of
duties or of discretion hereunder or upon any other act or omission hereunder except when due to willful
misconduct. In [he event the Administrator is nol covered by fiduciary liability insurance or similar
insurance arrangements, the Cmployer shall indemnify and hold harmless the Administrator from any
and all claims, losses, damages, expenses (including reasonable counsel fees approved by the
Administrator) and liability (including any reasonable amounts paid in settlement with the Employer's
approval) arising from any act or omission of the Adminislrator, except when the same is determined to
be due to the willful misconduct of the Administrator by a court of competentjurisdiction.
26
12.06 DCLEGATIONS OF RESPONSIBILITY: The Administrator shall have the authority to delegate, from
time to time, all or any part of its responsibililies under the Plan to such person or persons as it may
deem advisable and in the same manner to revoke any such delegation of responsibilities which shall
have the same forcc and effect for all purposes hereunder as if such action had been taken by the
Administrator. The Administrator shall not be liable for any acts or omissions of any such delegate.
The delegate shall report periodically to the Administrator concerning the discharge of the delegated
responsibilities.
12.07 RIGHT TO RECENE AND RELEASE NECESSARY INFORMATION: The Administrator may
release or obtain any information necessary for the application, implementation and determination of
this Plan or other Plans without consent or notice to any person. This infonnation may be released to or
obtained from any insurance company, organization, or person subject to applicable law. Any
individual claiming benefits under this Plan shall fumish to the Administrator such information as may
be necessary to implement this provision.
12.08 CLAIM FOR BEN�FITS: To obtain payment of any benefits under the Plan a Participant must comply
with the rules and procedures of the particular benefit program elected pursuant to this Plan under which
the Participa�t claims a benefit.
12.09 C'rENF,RAI, CI,ATNIS RFVTEW PROCRDURE: This provision shall apply only to the extent that a
claim for benefits is not governed by a similar provision of a benefit program available under this Plan
or is not governcd by Scction 12. l0.
(a) Initial Claim for Benefits. Each Participant may submit a claim for benefits to the Administrator as
provided in 5ection 12.08. A Yarticipant shall have no right to seek review of a denial of benefits, or
to bring any action in any court to enforce a claim for benefits prior to his filing a claim for benefits
and exhausting his rights to review under this section.
Whcn a claim for benefits has been filed properly, such claim for benefits shall be evaluated and the
claimant shall be notified of the approval or the denial within (90) days after the receipt of such
claim unless special circumstances require an extension of time for processing the claim. If such an
extension of time for processing is required, written notice of thc extension shall bc furnished to the
claimant prior to the termination of the initial ninety (90) day period which shall specify the special
circumstances requiring an extension and the date by which a final decision will be reached (which
dale shall not be later than one hundred and eighty (180) days after the date on which the claim was
filed.) A claimant shall be given a written notice in which the claimant shall be advised as to
whether thc claim is granted or denied, in whole or in part. If a claim is denied, in whole or in part,
the claimant shall be given written notice which shall contain (a) the specific reasons for the denial,
(b) references to pertinent plan provisions upon which the denial is based, (c) a c�escription of any
addilional material or information necessary to perfect the claim and an explanation of why such
material or infonnation is necessary, and (d) the claimant's rights to seek review of lhe denial.
(b) Review of Claim Dcnial. If a claim is denied, in whole or in part, the claimant shall have the right to
request that the Adminislrator review the denial, provided that the claimant files a written request for
review with the Administrator within sixty (60) days after lhe date on which the claimant received
written notification of the denial. A claimant (or his duly authorized representative) may review
pertinent documents and submit issues and comments in writing to the Administrator. Within sixty
(60) days after a request is received, the review shall be made and the claimant shall be advised in
writing of the decision on review , unless special circumstances require an extension of time for
processing the review, in which case the claimant shall be given a written notification within such
27
initial sixty (60) day period specifying the reasons for the extension and when such review shall be
completed (provided that such review shall he completed within one hundred and riventy (120) days
after the date on which the request for review was filed.) The decision on review shall be forwarded
to [he claimant in writing and shall include specific reasons for the decision and references to plan
provisions upon which the decision is based. A decision on review shall be final and binding on all
persons.
(c) Exhaustion of Remedies. Tf a claimant fails to file a request for review in accordance with the I
procedures herein outlined, such claimant shall have no rights to review and shall have no right to
bring action in any court and the denial of the claim shall become final and binding on all persons
for all purposes.
12.10 SPF.C�A�. CLAiMS REVIEW PROCEDURL: The provisions of this Section 12.10 shall be applicable
to claims under the Group Medical Reimbursement Plan and the Group Medical Insurance Plan,
effective on the first day of the first Plan Year beginning on or after luly l, 2002, bul in no evenC later
than January 1, 2003, provided such plans are subject to ERISA.
(a) 13enefit Uenials: The Administrator is responsible for evaWating all claims for reimbursement under
the Medical Expense Reimbursement Plan and the Group Medical Insurance Plan.
The Administrator will decide a Participant's claim within a reasonable time not longer than 30 days
after it is rcceived. This time period may be extended for an additional I S days for matters beyond
the control of the Administrator, including in cases where a claim is incomplete. The Parlicipanl
will receive written notice of any extension, including the reasons for the extension and information
on the date hy which a decision by the Administrator is expected to be made. The Participant will
be given 45 days in which to complete an incomplete claim. "1'he Administrator may secure
independcnt medical or other advice and require such other evidence as it deems necessary to decide
the claim.
lf the Administrator denies the claim, in whole or in part, the Participant will be furnished with a
written notice of adverse benefit determination setting forth:
1. lhe specific reason or reasons for the denial;
2. reference to the specific Plan provision on which the denial is issued;
3. a description of any additional material or information necessary for the Participant to
complete his claim and an explanation of why such material or information is necessary,
and
4. appropriate informaLion as to the steps to be taken if the Participant wishes to appeal the
Adroinistrator's deternlination, including the parlicipanCs right to submit written
comments and have them considered, his right to review (on request and at no charge)
relevant documents and other information, and his right to file suit under ERISA with
respect to any adverse determination after appeal of his claim.
(b) Apaealin� Denied Claims: If the Partiaipant's claim is denied in whole or in part, he may appeal to
the Administrator for a review of the denied claim. The appeal must be made in writing within 180
days of thc Administrator's initial notice of adverse benefit determination, or else the participant will
lose the right to appeal the deniaL If thc Participant does not appeal on time, he will also lose his
28
right to file suit in court, as he will have failed to exhaust his internal administrative appeal rights,
which is generally a prerequisite to bringing suit.
A Participant's written appeal should state the reasons that he feels his claim should not have
been denied. It should include any additional facts and/or documents that the Participant feels
support his claim. The Participant may also ask additional questions and make written
comments, and may review (on request and at no charge) documencs and other information
relevant to his appeal. The Administrator will review all written commcnt the Participant
submits with his appeal.
(c) Review of Appeal: The Administrator will review and decide the Participant's appeal within a
reasonable time not longer than 60 days after it is submitted and will notify the Participant of its
decision in writing. The individual who decides the appeal will not be the same individual who
decided the initial claim denial and wil] not be that individual's subordinate. The Administrator
may secure independent medical or other advice and require such other evidence as it deems
necessary to decide the appeal, except that any medical expert consulted in connection with the
appeal will be different from any expert consulted in conneclion wilh the initial claim. (7'he identity
of a medical expert consulted in connection with the Participant's appeal will be provided.) If the
decision on appeal affirms the initial denial of the Participant's claim, the Participant will be
furnished with a notice of adverse benefit determination on review setting forth:
I. The specific reason(s) for the denial,
2. The specific Plan provision(s) on which tlie decision is based,
3. A statement of the Participant's right to review (on request and at no charge) relevant
documents and other information,
4. If the Administrator relied on an "internal rule, �uideline, protocol, or other similar
criterion" in making the decision, a descriplion oFthe specific rule, guideline, protocol,
or other similar criterion or a statement that such a rule, �uideline, protocol, or other
similar criterion was relied on and that a copy of such rulc, guidclinc, protocol, or other
criterion will be provided f'ree of charge to the Participant upon request," and
5. A statement of the Participant's right to bring suit under ERISA § 502(a).
12.11 PAYMENT TO REPRESENTATIVE: In the event that a guardian, conservator or other legal
representative has been duly appointed for a Participant entitled to any paymenl under the Plan, any such
paytnent due may be made to the legal representative making claim theref'or, and such payment so made
shall be in complete discharge of the liabilities of the Plan therefor and the obligations of the
Administrator and the Employer.
12.12 PROTECTED HEALTN INFORMAT[ON. The provisions of this Section will apply only to those
portions of the Plan that are considered a group health plan for purposes of 45 CFR Parts I 60 and I 64.
The Plan may disclose PHI to employees of the Gmp(oyer, or to other persons, only to the extent such
disclosure is required or permitted pursuant to 45 CFR Parts 160 and 164. The Plan has implemented
administrative, physical, and technical safeguards to reasonably and appropriately protect, and restrict
access to and use of, electronic PHI, in accordance with Subpart C of 45 CFR Yart I 64. The applicable
claims procedures under the Plan shall be used to resolve any issues of non-compliance by such
individuals. The Employer will:
29
• not use or disclose PHI other than as permitted or required by the plan documents and permitted or
rcquired by law;
• reasonably and appropriately safeguard electronic PH1 created, received, maintained, or transmitted
to or by it on behalf of the Plan, in accordance with Subpart C of 45 CFR Part 164;
• implement administrative, physical, and technical safeguards that reasonably and appropriately
protect the confidentiality, integrity, and availability of the electronic PHl that it creates, receives,
maintlins, or transmits on behalf of the Plan;
• ensure that any agents including a subcontrnctors to whom it provides PHI received from the Plan
agrce to the same restrictions and conditions that apply to the Employer with respect to such
informalion;
• not use or disclose PHI for employment-related actions and decisions or in connection with any
other employee bcncfit plan of the Employer;
• report to the Plan any use or disclosure of'the information that is inconsistent with thc permitted uses
or disclosures provided for of which it becomes aware;
• make available PHI in accordance with 45 CFR Section 164.524;
• make available PHI for amendment and incorporate any amendments to PN[ in accordance with 45
CFR Section 164.526;
• make available the information required to provide an accounting of disclosures in accordance with
45 CFR Section 164.528;
• make its internal practices, books, and records relating to the use and disclosure of PHI received
from the Vlan available to the Secretary of Health and Human Services or his dcsignee upon request
for purposes of determining compliance with 45 CFR Section 164.504(t);
• if feasible, return or destroy all PHI received from the Plan that the Employer still maintains in any
form and retain no copies of such information whcn no longer needed for the purposes for which t#�e
disclosure was made, except that, if'such return or deslruction is not feasible, limit further uses and
disclosures to those purposes that make the return or destruction of the information infeasible; and,
• ensure that the adequate separation required in paragraph (�(2)(iii) of 45 CFR Section 164.504 is
established.
For purposes of this SecCion, "PH�" is "Protected Health Information" as defined in 45 CFR Section
160.103, which � means individually identifiable health information, except as provided in plragraph
(2) of the definition of "Protected Health lnformation" in 45 CFR Section 160.103, that is transmitted by
cicctronic media; maintained in electronic media; or transmitted or maintained in any other form or
medium by a covered entity, as defined in 45 CFR Section 164.104.
SECTION XIII
MISCELLANEOUS PROVISIONS
13.01 INABILITY TO LOCATE PAYEE: If the Plan Administrator is unable to make payment to any
Participant or other person to whom a payment is due under the Plan because it cannot ascertain the
idenlity or whereabouts of such Participant or other person after reasonable efforts have been made to
identify or locate such person, then such payment and all subsequent payments otherwise due to such
30
..�
1'articipant or other person shall be forfeited folfowing a reasonable time after the datc any such
payment first became due.
13A2 FORMS AND PROOFS: Cach Participant or Participant's Beneficiary eligible to receive any henefit
hereunder shall complete such forms and furnish such proofs, receipts, and releases as shall be required
by the Administrator.
13.03 NO GUARANTEE OF TAX CONSEOUENCES: Ncither the Administrator nor the Company makes
any commitment or guarantee that any amounts paid to or for the benefit of a Participant or a Dependent
under the Plan will be excludable from the Participant's or Dependent's gross income for federal or stale
income tax purposes, or that any other federal or state tax treatment will apply to or be available to any
Participant or Dependent.
13.04 PLAN NOT CONTRACT OF EMPLOYMENT: T'he Plan will not be deemed to constitute a contract
of employment between the Cmployer and any Participant nor will the Plan be considered an
inducement for the employment of 1ny Aarticipant or employee. Nothing contained in the Plan will be
deemcd to give any Participant or employee the right to be retained in the service of the Employer nor to
interfere with the right of the Employer to discharge any Participant or employee at any time regardless
of the etfect such dischargc may have upon that individual as a Participant in the Plan.
13.05 NON-ASS[GNAI3tLITY: No benefit under the Plan shall be liable for any debt, liability, contract,
engagement or tort of any Participant or his Beneticiary, nor be subject to charge, anticipation, sale,
assignment, transfcr, encumbrance, pledge, attachment, garnishment, execution or other voluntary or
involuntary alienation or othcr legal or equicable process, nor transferability by operalion of law.
13.0G SEVERAB[L�TY: If any provision of the Ylan will be Ileld by a court of competent jurisdiction to be
invalid or unenforceable, lhe remaining provisions hereof will continue to be fully effective.
13.07 CONSTRUCTION
(a) Words used herein in the masculinc or feminine gender shall be construed as the feminine or
masculine gender, respectively where appropriate.
(b) Words used herein in the sineular or plural shall be construed as the plural or singular, respectively,
where appropriate.
13.08 NONDISCRIM�NA'I'ION: in accordance with Code Section 125(b)(1), (2), and (3), this Plan is
intended not to discriminate in favor of Highiy Compensated Participants (as detined in Code Section
125(e)(1)) as to contributions and benefits nor t� provide more than 25% of all qualified benefits to Key�
F,mployecs. If, in the judgment of the Administrator, more than 25% of the total nontaxable bcnefits are
provided to Key Employees, or the Plan discriminates in any olher manncr (or is at risk of possiblc
discrimination), then, notwithstanding any other provision contained herein to the contrary, and, in
accordance with the applicable provisions of the Code, the Administrator shall, after written notification
to affected Varticipants, reduce or adjust such contributions and bencfits under the Plan as shall be
necessary to insure chat, in the judgment af the Administraror, the Plan shall not bc discriminatory.
13.09 LR1SA, The Plan shall be construed, enforced, and administered and the validily determined in
accordance with lhe applicable provisions of the Employee Retirement Income Security Act of 1974 (as
amended), the Internal Revenue Code of 1986 (as amendcd), and the laws of the State indicated in the
Adoption Agreement. Notwithstanding anything to the contrary hcrein, the provisions of ERISA will
not apply to this Plan if the Plan is exemrt from coverage under F,RISA. Should any provisions be
determined tu be void, invalid, �r unenforceable by any court of compeeent jurisdiction, the Plan will
31