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Home My WebLink About1994-12-19-0900AM-Special11 • 7 JIM. t b , t 1 _i r i 't ri . BRAZOS COUNTY BRYAN. TEXAS 4 • ,1. D S 4 R'- 15 P;1 h 2 AGENDA BRAZOS COUNTY COMMISSIONERS' COURT MEETING THE COMMISSIONERS' COURT WILLMEET IN SPECIAL SESSION ON DECEMBER 19, 1994, AT 9:00 A.M. IN THE COMMISSIONERS' COURTROOM OF THE BRAZOS COUNTY COURTHOUSE, 300 EAST 26TH STREET, SUITE 115, BRYAN, TEXAS. 1. Invocation. 2. Pledge of Allegiance. 3. Consider and take action on the approval of the minutes of the meetings held on December 5, 1994. 4. Consider and take action on budget amendments. 5. Consider and take action on approval to advertise for bids on utility tractor for Road and Bridge. 6. Consider and take action on acceptance of easement grant from Louis Arthur and Stephanie Adam Malachek for improvements to Batts Ferry Road in Pct. 1. 7. Consider and take action on the Plan Document and Reimbursement Services Agreement for the Flexible Benefits Plan. 8. Consider and take action on the appointment of a Crime Stoppers Deputy/ Director. 9. Consider and take action on personnel change of status. 10. Consider and take action on payment of claims. ~i . Adjourn. The building is wheelchair accessible. Handicap parking spaces are available. Any request for sign interpretive services must be made 48 hours before the meeting. To make arrangements call (409) 361-4102. A' • I r N t L • ~ w_ar. ._r_,~~~ua..4. - - _.l_ - .J.a.u.I._...r_~....e...a~..~..... •..~.~.~a...~r.~.~a.tirti-.. COMMISSIONERS' COURT SPECIAL MEETING DECEMBER 19, 1994 A special meeting of the Commissioners' Court of Brazos County, Texas was held in the Commissioners' Courtroom in the Courthouse in Bryan, Brazos County, Texas, beginning at 9:00 a.m. on Monday, December 19, 1994, with the following members of the Court present: R. J. Holmgreen, County Judge, Presiding; Gary Norton, Commissioner of Precinct 1; Walter Wilcox, Commissioner of Precinct 2; Randy Sims, Commissioner of Precinct 3; Milton Turner, Commissioner of Precinct 4; Mary Ann Ward, County Clerk. The following citizens and officials were in attendance: Bea Green Secretary to Commissioners John Reynolds Auditor Cheryl Turney Auditor's Office Richard Vance County Engineer Bobby Riggs Sheriff Rita Watkins Sheriff's Office Ralph Jones Jail Administrator Andrew Ximenes Brazos County Resident Al Jones County Judge Elect Michael C. Mulvey B/CS Eagle .Peggy O'Connor KBTX-TV Commissioner Sims gave the invocation and led the pledge of allegiance. The Court next considered approval of the minutes of the Commissioners' Court meetings held December 5, 1994. On motion by Commissioner Sims, seconded by Commissioner Norton, the Court voted unanimously to approve the minutes as submitted. The Court next considered Budget Amendment #94/95-09, which would transfer funds from various departments to pay for Capital Expenditures and transfer funds from the Courts to pay for the assessments from the 2nd Administrative Assessment and the 1st and 14th Appeals Assessment. On motion by Commissioner Wilcox, seconded by Commissioner Norton, the Court voted unanimously to approve the budget amendment as submitted, a copy of which is attached hereto. The next matter for consideration was approval to •4 is 1 .1 {^1 VOL ~L--PAGF, .~.[...Lf,Y.Y W a N raw - Commissioners Court meeting December 19, 1994 • is • t Y e 4 1 i z t. i i advertise for bids for a utility tractor for the Road and Bridge Department. On motion by Commissioner Wilcox, seconded by Commissioner Norton, the Court voted unanimously to authorize the Purchasing Agent to advertise for bids for a utility tractor. The next matter for consideration by the Court was acceptance of an easement grant conveyed to Brazos County as easement for the purpose of expanding and improving Batts Ferry Road in Precinct 1. On motion by Commissioner Norton, seconded by Commissioner Turner, the Court voted unanimously to authorize the County Judge to accept the easement grant of 0.99 acre of land from Arthur Malechek, III and wife Stephanie Adam Malachek for the expansion of Batts Ferry Road located in Precinct 1. On motion by the County Judge, seconded by Commissioner Sims, the Court voted unanimously to adopt a resolution authorizing the County Judge to execute the Adoption Agreement and any related documents or amendments which may be necessary or appropriate to adopt the Flexible Benefits Plan or maintain its compliance with applicable federal, state and local law. This plan is a Cafeteria Plan within the context of Section 125 of the Internal Revenue Code for the benefit of Brazos County's eligible employees. A copy of the Plan Document is attached hereto. The next matter for consideration was the appointment of a Crime Stoppers Deputy/Coordinator. County Sheriff, Bobby Riggs, announced that Deputy Chris Kirk will be the Coordinator. Commissioner Sims added that the Crime Stoppers Board of Directors was very pleased with the selection. Brazos County will be responsible for the salary and benefits of the Director along with the benefits of the secretary. The Sheriff's Department will move a street deputy to an investigator's position and then fill the street deputy position. Total cost to the County will be approximately $30,000. On motion by Commissioner Sims, seconded by VOL~PAGE~L7 • ~ _ xR~_ .1. i .:a.+.Jr.r .i. r..,~ ..a _.s. ^ ti.,+ra..u... ........1J_._a~.i...___~., ..w - I A ~1F 1 t. i r4 r a k r r 1 • iJ t-•n r • y1i ..ir • _ T rrw r i ~ : C F'. rY•,► r r~ Commissioners Court meeting December 19, 1994 Commissioner Norton , the Court voted unanimously to appoint Chris Kirk as the Coordinator of Crime S toppers. The Court proceeded to consider the change of status of the following employees. NAME DEPARTMENT REASON Ea Brown, Jacqueline County Clerk Comp Training Pittman, Wanda District Attorney Resignation Aranza, Danielle M Juvenile Serv. New Emp Temp ll Ramage, Jack M Jr. Juvenile Serv. New Emp Temp f ! Thurman, Hope D Juvenile Serv. New Emp Temp McClain, Danny R Road & Bridge Resignation . Weaver, Wallace R Road & Bridge Termination Lewis, John S Road & Bridge Termination Hawkins, Daniel L Road & Bridge Termination Espinosa, Carlos V Road & Bridge New Emp Temp Campbell, Natasha District Attorney New Employee on motion by Commissioner Turner, seconded by Commissioner Sims, the Court voted unanimously to approve the changes as submitted. The Court next considered the following Claims as submitted by the County Treasurer for payment: 10--General Fund Claims-29310--thru-29643-- 30--Capital Projects Claims-29644--thru 54--HealthDepartment---------Claims729656--thru-29691-- 60--Payroll-------------------Claims-29692--thru-29695-- 61--Health & Life Ins--------- Claims-29696--thru-29698-- 90--Brazos County Grants Claims-29699--thru-29828-- 91--MPO----------------------- Claims-29829--thru-29833-- 97--Narc. Traf. Task Force Claims-29834--thru-------- On motion by the County Judge, seconded by Commissioner Norton, the Court voted unanimously to approve the Claims as submitted. The Court next considered an order appointing James A. Amis, Jr.' to sit as Special Judge in County Court at Law I December 21, 22, 27, 28, 29, and 30, 1994 to allow Judge Davis to take vacation time. On motion by Commissioner Norton, seconded by Commissioner Turner, the Court voted unanimously to approve the Order naming James A. Amis, Jr. as Special Judge for County Court at Law I for the dates of December 21, 22, 27, 28, 29, and 30, 1994. A full copy of the Order is attached to and made a part of these minutes. There being no further business to come before the Court, the meeting was adjourned. ! VO _PAGE G-1% 7 Y L e r. • r 5 i • Walter Wilcox Commissioner, Precinct 2 Milton Turner Commissioner, Precinct 4 i:. s Gary on Comm oner, Precinct 1 Randy ms Commissioner, Precinct 3 A VIAA4- Mary Ward County Clerk ~I R. J Ho green Coun y Judge The foregoing minutes of the Commissioners Court meeting held December 19, 1994 have been examined and are approved in open Court this the 27th day of December, 1994, in Bryan, Brazos ' County, Texas. r VOL ~ PAGE 3. k f• • I 1 - r 1 E i I l BRAZOS COUNTY, TEXAS BUDGET AMENDMENT(S) FOR THE 1994-1995 BUDGET YEAR NO. 94/95-09 On this the 19th day of December 1994 at a special meeting of the Commissioners' Court, the following members were present: R. J. Holmgreen, County Judge, Presiding Gary Norton, Commissioner, Precinct 11 Walter Wilcox, Commissioner, Precinct 2; Randy Sims, Commissioner, Precinct 3s Milton Turner, Commissioner, Precinct 4; Mary Ann Ward, County Clerk. The following proceedings were held: THAT WHEREAS, on December 19, 1994, the Court heard and approved a budget amendment for the 1994-1995 budget year for Brazos County, Texas. WHEREAS, an expenditure is necessary due to the necessity to meet unusual and unforeseen conditions which could not be reasonably included in the original budget adopted September 8, 1994 the following amendment(s) to the original are hereby authorized, as described on the attached 1 page(s). ADOPTED AND APPROVED this the 19th day of December 1994 THE COMMISSIONERS' COURT OF BRAZOS COUNTY, TEXAS. By: R. J. Holmgreen, County Judge • w .3 t Original: County Clerk's Office and attached to the original budget Copies: County Auditor County Treasurer Commissioners' Court Minutes Budget Amendment File VOL.. AG a i` ry~~y Budget Amend. No. 94/9 5-09 FUND DEPT ACCOUNT 4 ACCOUNT NAME INCREASE (DECREASE) REASON General Brazos Cnt 10-28-5310 Maintenance of Buildings 7,888 Brazos Cnt 10-28-6371 Improvement - Other 3,772 JP 7-1 10-37-6210 Office Furniture & Equip 495 JP 7-1 10-37-5210 Office Furniture 261 Const 4 10-55-6211 Radio Equipment 817 Revenue 10-00-3111 Reserve for Encumbrances (13,233) R&B General 20-40-5710 Road & Bridge Supplies 293 Revenue 20-00-3111 Reserve for Encumbrances (293) Cap Proj Courthouse 30-62-6224 Jail Equipment (Elevator) 37,577 Courthouse- 30-62-6230 Fuel Management System 4,880 Revenue 30-00-3111 Reserve for Encumbrances (42,457) Recs M&P Recs. M&P 32-32-6212 Compurter Equipment 17,323 Revenue 32-00-3111 Reserve for Encumbrances (17,323) * *INC. TO DEPT BUDGET $0 + A Jud Sys AJS 46-41-5577 2nd Admin Assessment 4,000 AJS 46-99-8310 Transfer in from Gen Fund (4,000) AJS 46-41-5578 lst & 14th Appeals Assess 11,700 AJS 46-41-5518 Other Miscellaneous (11,700) General 10-99-8113 T/0 to App. Jud. Fund 4,000 CC1$l 10-15-5221 Special Service (800) 85th DC 10-16-5221 Special Service (800) 272nd DC 10-17-5221 Special Service (800) 361st DC 10-20-5221 Special Service (800) CC12 10-30-5221 Special Service (800) + **DEC. TO DEPT BUDGET $0 41 1 I~ r~ f 1 i Combissioners Court meeting December 19, 1994 ` a..• - ~ L .r n....~ .a- - ~..F a~.).A. .~-..n_~.n ..._a--...r. u.. n r-- n. ..au 'l I BRAZOS COUNTY BRYAN. TEXAS RESOLUTION OF THE COIrIIrlISSIONERS COURT The undersigned County Judge of BRAZOS COUNTY hereby certifies that the COMMISSIONERS COURT of BRAZOS COUNTY adopted the following Resolution at a meeting of the COMMISSIONERS COURT held on December 12, 1994 and that such Resolution remains in full force and effect: WHEREAS, the COMMISSIONERS COURT of BRAZOS COUNTY wishes to adopt a•Cafeteria Plan within the context of Section 125 'of the Internal Revenue Code for the benefit of Brazos County's eligible employees. NOW, THEREFORE, BE IT RESOLVED, that the COMMISSIONERS COURT hereby adopts the BRAZOS COUNTY Flexible Benefits Plan (consisting of the Flexible Benefits plan Document, the Adoption Agreement, and component Benefit Plans and Policies) effective as of the date specified in the Adoption Agreement. RESOLVED FURTHER, that the County Judge of BRAZOS COUNTY is authorized, without further COMMISSIONERS COURT approval, to + execute the Adoption Agreement, and any related documents or amendments which may be necessary or appropriate to adopt the Plan or maintain its compliance with applicable federal, state, and local law. ATTEST: County Judge: Coun Clerk (SEAL] VOPAGE ILL + y N • • 0 ELIG®ILITY - r All Employees employed by the Employer shall be eligible to participate under the Plan exoZ the following: (Describe) An eligible Employee may become a Participant in the Plan: ; [ ] Immediately, upon his first day of employment (but not prior to the Effective Date of the Plan ! [ ] On the _ following commencement of employment [ X ] On the first day of the month following 30 DAYS of employment provided the Employee completes a Salary Redirection Agreement. However, eligibility for coverage under any given Benefit Plan or Policy shall be determined by the terms of that Benefit Plan or Policy, and reductions of the Employee's Compensation to pay Pre-tax or After-tax Premiums shall commence when the Employee becomes covered under the applicable Benefit Plan or Policy. BENEFITS PROVIDED UNDER THE PLAN The Employer elects to offer to eligible Employees the following Benefit Plans and Policies subject to the terms and conditions of the Plan. These component Benefit Plans and Policies are specifically incorporated herein by reference. The maximum Pre-tax Premiums a Participant can contribute via the Salary Redirection Agreement is the aggregate cost of the applicable Benefit Plans or Policies selected minus any Nonelective Contribution made by the Employer. It is intended that such Pre-tax Premium accounts shall, for tax purposes, constitute an Employer contribution, but may constitute Employee contributions for state insurance law purposes. [ X ] Group Medical Insurance. [ X ] Vision Care Insurance. [ X ] Disability Income-Short Term (A&S). [ X ] Cancer Insurance. ( X ] Accidental Death and Dismemberment. [ X ] Group Dental Coverage. [ X ] Group Term Life Insurance. [ X ] Disability Income-Long Term (LTD). [ X ] Intensive Care Insurance. [ X ] Accident Insurance [ X ] Hospital Indemnity Insurance (HIP) [ X ] Medical Care Expense Reimbursement described in Section 5.01(b) of the Plan, not to exceed $5.000 per Plan Year pursuant to the BRAZOS COUNTY Medical Care Expense Reimbursement Plan. [ X ] Dependent Care Expense Reimbursement described in Section 5.01(c) of the Plan not to exceed $5,000 per Plan Year or $2,500 for married filing separate returns pursuant to the BRAZOS COUNTY Dependent Care Expense Reimbursement Plan. VO~ AGE 5~--, * • 1ua-_ r '_1__\ 07 • J • . I f r i J r i { ADOPTION AGREEMENT FOR THE 1 BRAZOS COUNTY FLEXIBLE BENEFITS PLAN ESTABLISHMENT OF THE PLAN ; The Employer named below established as set forth herein, a Flexible Benefits Plan (the "Plan") as of the Effective Date r isisting of this Adoption Agreement, the Plan Document and the Benefit ' Plans and Policies a^if}cally referred to herein including the Dependent Care Expense Reimbursement Plan and/or an Medical Care Expense Reimbursement Plan. The purpose of the S Flexible Benefits Plan is to provide eligible Employees a choice between cash and the specified welfare benefits described in this Adoption Agreement. Pre-tax Premium elections under the Plan are intended to qualify for the exclusion from income provided in Section 12S of the Internal Revenue Code of 1986. 1) Name and Address of Employer: 2) Employer Telephone Number: 3) Employer's Federal Tax Identification Number: 4) Employer's Fiscal Year: S) Effective Date of this Plan: 6) Last Day of the First Plan Year: Subsequent Plan Years: 7) Name and Address of the Plan Administrator if different from the Employer: 8) Name and Address of any Trustee of the Plan: 9) Name and Address of registered agent for service of legal process: 10) Affiliated Employers which will participate in the Plan: 11) Employer's type of business: OW2/93 venim EMPLOYER INFORMATION BRAZOS COUNTY SANDIE WALKER 300 EAST 26TH #313 BRYAN, TX 77803 (409) 361-4350 74-6000433 10/01 - 09/30 01/01/95 12/31/9S 01/01 - 12/31 CLAIMS PROCESSOR: FLEX ONE 1932 WYNNTON ROAD COLUMBUS, GA 31999 NONE R.J. HOLMGREEN COUNTY JUDGE OTHER I Copyri& Januvy 1, 1990 It k r VO PA2 E ' • 1, , THE FUNDING AGENT The Employer selects the following Funding Agent for the Plan (check one): [ J The Employer, which will comply with the requirements of Section 7.02 of the Plan. [ ] The Flexible Benefits Trust created concurrently with the execution of the Plan, which shall receive contributions under the Plan in accordance with-Section 7.03 of the Plan. ADMINISTRATIVE EXPENSES Administrative Expenses incurred in operating the Plan shall be paid by (check one): [ ] The Employer, except as otherwise noted in the Plan. The Participants, except as otherwise noted in the Plan. 'S ACKNOWLE As evidenced by the formal execution of this Adoption Agreement, the undersigned Employer adopted and established this Plan on the Effective Date as the Flexible Benefits Plan of the undersigned Employer. In doing so, the undersigned Employer acknowledges that this Adoption Agreement and this Plan are important legal instruments with significant legal and tax implications. The Employer also acknowledges that it has read this Adoption Agreement and the Plan in their entirety, has consulted independent legal and tax counsel other than representatives of American Family Life Assurance Company of Columbus (AFLAC), to the extent considered necessary, and accepts full responsibility for participation of Employees hereunder and the operation of the Plan. The Employer acknowledges that as sponsor, it and the Plan Administrator (if different from the Employer) shall have sole responsibility to comply with all filing, reporting, and disclosure requirements imposed by the Department of Labor,' Internal Revenue Service, or any other government agency, specifically including, but not limited to creating, filing, and distributing Summary Annual Reports, Form 5500's, and Summary Plan Descriptions. Furthermore, the Employer further acknowledges that it shall bear sole responsibility for amending the Plan as necessary to ensure compliance with applicable tax, labor, and other laws and regulations. It is also understood and agreed that American Family Life Assurance Company of Columbus (AFLAC), and its Subsidiaries, agents, and representatives, are not providing legal or tax advice to the undersigned Employer in connection with this Plan and that no representations are made by it with respect to the operation of the Flexible Benefits Plan pursuant to the sample documents provided by American Family Life Assurance Company of Columbus (AFLAC) to the Employer. This Plan shall be construed and enforced according to the Internal Revenue Code of 1986, as amended from time to time, the applicable' regulations thereto and the laws of the state of the principal place of business of the Employer, i ~o f t v01,_'-PAGE,, • • • • y • 1 j . f ' A 4 I IN WITNESS WHEREOF, the Employer has caused this Plan and Adoption Agreement to be executed on the/_ day of , 1924L to ratify the adoption of the Plan adopted and effective as of the Effective Date. R f ATTEST: s Emplo er:Z n i By Title: CDt i m mi MM 6►1r Date: 'D 12C . Q LR ~i k 1 s 4 P 4 1 1 t I i` I f t vU A4Q,.~ THE FOLLOWING DOCUMENT IS THE BEST IMAGE POSSIBLE DUE TO THE POOR QUALITY OF THE ORIGINAL r C - ' TABLE OF CONTEN73 FLEXIBLE BENEFM PLAN r PREAMBLE ARTICLE I - DEFINITIONS 1 t 1.01 'Affiliated Employer' . 1 i 1.02 'After-tax Premium(s)' 1 1.03 'Anniversary Date' 1 1.04 'Benefit Plan(s) or-Policy(ies)' I 1.05 'Board of Directors' I 1.06 'Change in Family Status' I 1.07 'Code' 1 1.08 'Compensation' 1 1.09 'Dependent' I 1.10 'Dependent Care Expense Reimbursement' 1 ' 1.11 'Earned Income' 2 1.12 "Effective Date' 2 1.13 'Eligible Employment Related Expenses' 2 . 1.14 'Eligible Medical Expenses' s 2 1.15 'Employee' 2 , 1.16 'Employer' 2 1.17 'ERISA" 3 1.18 'Highly Compensated Individual' 3 i 1.19 'Key Employee' 3 1.20 'Medical Care Expense Reimbursement' 3 1.21 "Nonelective Contributions' 3 ' 1.22 'Participant' 3 1.23 'Plan' 3 1.24 'Plan Administrator' 3 1.25 'Plan Year" 3 1.26 'Pre-tax Premium(s)' r 3 1.27 'Qualified Benefit' 4 1.28 'Qualifying Employment-Related Expenses' - 4 1.29 'Qualifying Individual' 4 1.30 'Qualifying Services' 4 1.31 'Reimbursement Account(s) or Account(s)' 4 1.32 'Salary Redirection Agreement' " 5 1.33 'Spouse' 5 1.34 'Student' 5 1.35 'Trustee' 5 ARTICLE II - ELIGIBILITY AND PARTICIPATION = a • • 5 • 2.01 Eligibility to Participate , 5 2.02 Entry Date 5 2.03 Termination of Participation 5 2.04 Eligibility to Participate in Reimbursement Benefits 6 VO AGE,. • 1 • • . • ARTICLE III - PREMIUM ELECTIONS 6 3.01 Election of Premiums 6 3.02 Initial Election Period 6 3.03 Annual Election Period 7 ~ 3.04 Change of Premium Election 7 3.05 Termination of Election g ` ARTICLE IV - PREMIUM PAYMENTS AND CREDITS # AND DEBITS TO ACCOUNTS 8 i 4.01 Source of Premium Payments g 4.02 Allocations Irrevocable During Plan Year 8 { 4.03 Reduction of Certain Elections to Prevent Discrimination 8 s 4.04 Modification of Amount Withheld due to Premium Increases 8 4.05 Medical Expense Reimbursement 9 4.06 Dependent Care Expense Reimbursement 9 ARTICLE V - BENEFITS 10 5.01 Qualified Benefits to 5.02 Cash Benefit 12 5.03 Repayment of Excess Reimbursements 12 5.04 Termination of Reimbursement Benefits 12 5.05 COBRA Coverage 12 5.06 Coordination of Benefits Under Health FSA 12 ARTICLE VI - PLAN ADMINISTRATION 13 6.01 Allocation of Authority 13 r 6.02 Provision for Third-Party Plan Service Providers 13 6.03 Fiduciary Liability 14 6.04 Compensation of Plan Administrator 14 6.05 Bonding 14 6.06 Payment of Administrative Expenses 14 6.07 Funding Policy t i 14 t 6.08 Disbursement Reports 14 6.09 Reporting and Disclosure Obligations 14 " 6.10 Indemnification 14 6.11 Substantiation of Expenses 15 6.12 Reimbursement 15 6.13 Annual Statements 15 ARTICLE VII - FUNDING AGENT 15 7.01 Funding of the Plan 15 7.02 The Employer as Funding Agent 15 7.03 Trust as Funding Agent \ 1S • 9 VOL A r 14 ,t .J ~f r f t i F !Ff L~ E F r, Aftw . ARTICLE VIII - CLAIMS PROCEDURES 16 8.01 Application to Plan Benefits 16 8.02 Procedure If Benefits are Denied Under' the Plan 16 i 8.03 Requirement for Written Notice of Claim Denial 16 8.04 Right to Request Hearing on Benefit Denial ' 17 8.05 Disposition of Disputed Claims 17 ARTICLE IX - AMENDMENT OR TERMINATION OF PLAN 17 ' 9.01 Permanency 17 9.02 Employer's Right to Amend 17 9.03 Employer's Right to Terminate 17 9.04 Determination of Effective Date of Amendment or Termination 17 ARTICLE X - GENERAL PROVISIONS 18 10.01 Not an Employment Contract 18 10.02 Applicable Laws 18 10.03 Post-Mortem Payments 18 10.04 Nonalienation of Benefits 18 10.05 Mental or Physical Incompetency 18 10.06 Inability to Locate Payee 18 10.07 Requirement for Proper Forms 18 10.08 Source of Payments 19 10.09 Multiple Functions 19 10.10 Tax Effects 19 10.11 Gender and Number 19 10.12 Headings 19 . 10.13 Incorporation by Reference 19 10.14 Severability 19 10.15 Effect of Mistake 19 ' 10.16 Provisions Relating to Insurers 20 ARTICLE XI • CONTINUATION COVERAGE UNDER COBRA 20 11.01 Continuation Coverage After Termination of Normal Participation 20 11.02 Who is a "Qualified Beneficiary" 20 11.03 Who is not a 'Qualified Beneficiary' 20 11.04 What is a 'Qualifying Event" 20 11.05 What Benefit is Available Under Continuation Coverage 21 11.06 Notice Requirements 21 11.07 Election Period 22 11.08 Duration of Continuation Coverage 22 11.09 Automatic Termination of Continuation Coverage 22 i VOL.- , AG • ii PREAMBLE Y i i 5 i 1 The Employer hereby establishes a Flexible Benefits Plan ("Plan") for its Employees for ,v purposes of providing eligible Employees with the opportunity to choose from among the fringe benefits available under the Plan. The Plan is intended to qualify as a cafeteria plan under the ~ provisions of Code Section 125. The Dependent Care Expense Reimbursement Plan ("DCR") is intended to qualify as a Code Section 129 dependent care assistance plan, and the Medical Care Expense Reimbursement Plan is intended to qualify as a Code Section 105 medical expense reimbursement plan. Although printed within this document, the DCR and Medical Care Expense Reimbursement Plans are separate written plans for purposes of administration and all reporting and nondiscrimination requirements imposed by Sections 105 and 129 of the Code and all applicable provisions of ERISA. EI a F ' l f E ~ • VO AQE • _ - r r E 1 I 1' a • IL I iI\ Ii } FUMBLE BENEFITS PLAN ARTICLE I DEFINITIONS 1.01 "AAtllated Employer" means any Employer within the context of Code Section 414(b), (c), (m), or (n) of the Code which will be treated as single employer for purposes of Code Section 125. ' • 1.02 "After-tax Premium(s)" means amounts withheld from an Employee's Compensation pursuant to a Salary Redirection Agreement to purchase coverages available under the Adoption Agreement on an after-tax basis. 1.03 "Anniversary Date" means the first day of any PlanYear. 1.04 "Benefit Plan(s) or Policy(ies)" means those coverages available to a Participant under the Adoption Agreement. 1.05 "Board of Directors" means the Board of Directors of the Employer. 1.06 "Change In Family Status" means, and is limited to, a Participant's marriage or divorce; the death of a Participant's spouse or child; the birth or adoption of a Participant's child; the termination of employment (or commencement of employment) of the Participant's spouse; a change in employment status from full-time to part-time (or vice versa) by the Participant or the Participant's spouse; an unpaid leave of absence by either the Participant or the Participant's spouse; a significant change in the health coverage of the Participant or the Participant's spouse's attributable to the spouse's employment; or such other events as may be described by the Internal Revenue Service from time to time as a Change in Family Status. 1.07 "Code" means the Internal Revenue Code of 1986, as amended. 1.08 "Compensation" means the cash wages or salary paid to an Employee by the Employer. 1.09 "Dependent" means any individual who is a dependent of the Participant within the purview of Code Sec. 152(x), except for the Dependent Care Expense Reimbursement Plan, in the case of an Employee who has been divorced, Dependent shall be defined as set forth in Section 21(e)(5) (e.g., dependent of the custodial parent). 1.10 "Dependent Care Expense Reimbursement" shall have the meaning assigned to it by Section 5.01(c) of the Plan. 1 . ~ •r r' err' / ~ - ~ • ti' ~ tat yl-y _ r 1 ~ a t .1I I ay ~1 I P F i I 4 r • r r a I E I i 1.11 "Earned Income" means all income derived from wages, salaries, tips, self-employment, and other Employee Compensation (such as disability or wage continuation benefits), but does not include (a) any amounts received pursuant to any dependent care assistance program under Section 129 of the Code, (b) any amount received as a pension or annuity, or (c) workers compensation. 1.12 "Effective Date" means the effective date of the Plan specified in the Adoption Agreement. 1.13 "Eligible Employment Related Expenses" means those Qualifying Employment-Related Expenses (as defined below) paid or incurred incident to maintaining employment after the date of the Employee's participation in the Dependent Care Expense Reimbursement Plan and during the Plan Year, other than amounts paid to: (a) an individual with respect to whom a Dependent deduction is allowable under Code Sec. 151(a) to the Participant or his Spouse; (b) the Participant's Spouse; or (c) a child of the Participant who is under 19 years of age. 1.14 "Eligible Medical Expenses" means those expenses incurred by the Employee, or the Employee's Spouse or Dependents, after the date of the Employee's participation in the Medical Care Expense Reimbursement Plan and during the Plan Year otherwise allowable as deductions under Code Sec. 213 (without regard to the limitations contained in Sec. 213(a)), but shall not include an expense incurred for the payment of premiums under a health insurance plan. For purposes of this Plan, an expense is 'incurred' when the Participant or beneficiary is furnished the medical care or services giving rise to the claimed expense. 1.15 "Employee" means any individual who is considered to be in a legal employer-employee relationship with the Employer for federal withholding tax purposes. Such term includes 'former employees' for the limited purpose of allowing continued eligibility for benefits hereunder for the remainder of the Plan Year in which an employee ceases to be employed by the Employer. The term 'Employee' shall not include any self-employed individual who receives from the Employer "net earnings from self employment' within the meaning of Code Section 401(c)(2) unless such individual is also an Employee. % 1.16 "Employer" means the organization(s) named in the Adoption Agreement, provided, however, that when the Plan provides that the Employer has a certain power (e.g.,the appointment of a Plan Administrator, entering into a contract with a third party insurer, or amendment or termination of the plan) the term "Employer' shall mean only that entity named on the first line of the Adoption Agreement, and not any Affiliated Employer. Affiliated Employers who sign the Adoption Agreement shall be bound by the Plan as adopted and subsequently amended unless they clearly withdraw from participation herein. 2 • ,s . IN VOL G __W ~ _ , . : _ ~_.....~......,.a-i...._...:s .'Ca't%..~...lYt_.. - t - ~....I.u>...~.a..4........~~a.~..~...a:..r,..._.. ~ .mss, - -..c...._..~ I - Ar 1.17 "ERISA" shall mean the Employee Retirement Income Security Act of 1974, as amended. 1.18 "Highly Compensated Individual" means an individual defined under Code Section 125(e), 129(d)(2), or 105(hx5), as amended, as a "highly compensated individual' or a "highly compensated employee." 1.19 "Key Employee" means an individual who is a "key employee' as defined in Code Section 125(b)(2), as amended. 1.20 "Medical Care Expense Reimbursement" shall have the meaning assigned to it by Section 5.01(b) of the Plan. 1.21 "Nonelective Contribution(s)" means any amount which the Employer in its sole discretion may contribute on behalf of each Participant to provide benefits for such Participant and his or her Dependents, if applicable under the Plan. The amount of Nonelective Contribution for each Participant may be adjusted upward or downward in the contributing Employer's sole discretion. The amount shall be calculated for each Plan Year in a uniform and nondiscriminatory manner based upon the Participant's dependent status, commencement or termination date of the Participant's employment during the Plan Year, and such other factors as the Employer shall prescribe. In no event will any Nonelective Contribution be disbursed to a Participant if the cost of the benefit(s) elected is less than the Nonelective Contribution allocable thereto. Any excess shall be returned to the Employer. ' 1.22 "Participant" means an Employee who becomes a Participant pursuant to Article II. 1.23 "Plan" means the Adoption Agreement, the Flexible Benefits Plan and (if applicable) the related Trust created by this document. 1.24 "Plan Administrator" means the person(s) appointed by the Employer with authority and responsibility to manage and direct the operation and administration of the Plan. If no such person is named, the Plan Administrator shall be the Employer. US "Plan Year" means the twelve month period specified in the Adoption Agreement provided, however, that a period of less than twelve months may be a Plan Year for the initial Plan Year, the final Plan, Year, and a transition period to a different Plan Year. 1.26 "Pre-tax Premium(s)" means any amount withheld from the Employee's Compensation pursuant to a Salary Redirection Agreement which is intended to be paid on a pre-tax basis. This amount shall not exceed the amount specified in the Adoption Agreement, and for purposes of Code Section 125, shall be treated as an Employer contribution (this amount may, however, be treated as an Employee contribution for purposes of state insurance'laws). 3 VOL-- PAGE ' • - it / M t 1 i i f k • ;r F A&W .y 4 7 . ,mot 1.27 "Qualified Benefit" means any benefit excluded from the Employee's taxable income a~ under Chapter I of the Code (other than Sections 117, 124, 127, or 132), and any other benefit t permitted by the Income Tax Regulations (i.e., group-term life insurance coverage that is includable R in gross income by virtue of exceeding the dollar limitation on nontaxable coverage under Code Sec. 79). 1.28 "Qualifying Employment-Related Expenses" means those expenses that would be considered to be employment-related expenses under Section 21(b)(2) of the Code (relating to expenses for household and dependent care services necessary for gainful employment) if paid for by the Employee to provide Qualifying Services. 1.29 "Qualifying Individual" means: (a) a Dependent of the Participant who is under the age of thirteen (13); (b) a Dependent of a Participant who is mentally or physically incapable of caring for himself or herself; or (c) the Spouse of a Participant who is mentally or physically incapable of caring for himself or herself. 1.30 "Qualifying Services" means services relating to the care of a Qualifying Individual that enable the Participant or his Spouse to remain gainfully employed which are performed: (a) in the Participant's home; or (b) outside the Participant's home for (1) the care of a Dependent of the Participant who is under age 13, or (2) the care of any other Qualifying Individual who resides at least eight (8) hours per day in the Participant's household. If the expenses are incurred for services provided by a dependent care center (i.e., a facility that provides care for more than 6 individuals not residing at the facility), the center must comply with all applicable state and local laws and regulations. 1.31 "Reimbursement Account(s) or Account(s)" shall be the funding mechanism by which amounts are withheld from an Employee's Compensation and retained for future Medical Care Expense Reimbursement or Dependent Care Expense Reimbursement. These amounts may either be retained by the Employer, sent to a third party plan administrator, and/or kept in trust for Employees. No money shall actually be allocated to any individual Participant Account(s); any'such Account(s) shall be of a memorandum nature, maintained by the Administrator for accounting purposes, and shall not be representative of any identifiable trust assets. No interest will be credited to or paid on amounts credited to the Participant Account(s). u. H,, 4 VOL i y _ ~v.,' w.,~...._...a_.~iyt... i.+:..JL• - -•..l..sr~:i...n.aJ.:.u.i.n..s...:t_.....o~.w..,rv....:,..w,. +r.•.... _.r.>. . 1 . I • 1.32 "Salary Redirection Agreement" means the form by which an eligible Employee or Participant enrolls in the specific component Benefit Plans or Policies and elects Pre-tax Premiums or After-tax Premiums in accordance with Article III. 1.33 "Spouse" means an individual who Is legally married to a Participant, but for purposes of the Dependent Care Expense Reimbursement Plan provisions, shall not include an individual legally separated from the Participant under a divorce or separate maintenance decree, nor shall it include an individual who, although married to the Participant, files a separate federal income tax return, maintains a separate, principal residence from the Participant during the last six months of the taxable year, and does not furnish more than one-half of the cost of maintaining the principal place of abode of the Qualifying Individual. 1.34 "Student" means an individual who, during each of five (5) or more calendar months during the Plan Year, is a full time student at any college or university, the primary function of which is the conduct of formal instruction, and which routinely maintains a regular faculty and curriculum and normally has an enrolled student body in attendance at the location where its educational activities are regularly presented. 1.35 "Trustee" (if applicable) means the person(s) or institution (and their successors) named on the signature page attached hereto, who have assented to being so named by their signature to this Agreement, otherwise empowered to hold and disburse the funds that are created hereunder. ARTICLE II ELIGIBILITY AND PARTICIPATION 2.01 Eligibility to Participate. Each Employee who meets the criteria set forth in the Adoption Agreement shall be eligible to participate in the Plan as of any applicable Entry Date. Eligibility for the benefits elected in the Adoption Agreement shall be subject to the additional requirements, if any, specified in the applicable Benefit Plan or Policy. The provisions of this Article are not intended to override any eligibility requirement(s) or waiting period(s) specified in the applicable Benefit Plans or Policies. ' 2.02 Entry Date. Each eligible Employee shall become a Participant in the Plan on the Entry Date specified in the Adoption Agreement provided that he has satisfied the requirements of the Adoption Agreement. 2.03 Terminatlon of Participation. Participation shall terminate on the earliest of: 1) the date an Employee ceases to be an Employee; ii) when an Employee ceases to meet the eligibility requirements of Section 2.01 of this Agreement Plan; iii) the date a participant revokes a Salary Redirection Agreement pursuant to Section 4.02; or iv) the date the Plan terminates, Provided, however, that a former Employee who makes required contributions for coverage under the Company's Benefit Plans or Policies shall be deemed to continue his participation in the Plan (to the extent thereof) as long as such contributions are made. 5 V'L • • • k , , 4 S I ' Aa.. sl Subject to any specific limitations for any particular benefit which the Participant has elected, (a) participation shall be continued during a leave of absence for which the Participant continues to receive a salary from his or her employer and (b) participation shall be suspended during an unpaid leave of absence, provided that nothing in this Section shall prevent a Participant on unpaid leave from utilizing any available Reimbursement Account benefits, as provided below, as if such Participant were otherwise actively employed by the Company. 2.04 Eligibility to Participate in Reimbursement Benefits. An Employee, who is otherwise an Eligible Participant pursuant to Sections 2.01 and 2.02 shall be eligible to receive Medical and/or Dependent Care Expense Reimbursements (if selected by the Employer in the Adoption Agreement) if a Salary Redirection Agreement is properly executed and submitted on which the aforementioned benefit(s) have been selected. ARTICLE III PREMIUM ELECTIONS • i t S c 3.01 Election of Premiums. A Participant may elect any combination of Pre-tax Premiums or After-tax Premiums to fund any Benefit Plan or Policy available under the Adoption Agreement, provided however, that only Qualified Benefits (other than group term life insurance coverage in excess of $50,000) may be funded with Pre-tax Premiums. 3.02 Initial Election Period. (a) Currently Eligible Employees. An Employee who is eligible to become a Participant in this Flexible Benefits Plan as of the Effective Date must complete, sign and file a Salary Redirection Agreement with the Plan Administrator during the election period (as specified by the Plan Administrator) immediately preceding the Effective Date in order to become a Participant on the Effective Date. The elections made by the Participant on this initial Salary Redirection Agreement shall be effective, subject to Section 3.04, for the Plan Year beginning on the Effective Date. (b) New Employees and Employees Who Have Not Yet Satisfied The Flexible Benefit Plan's Waiting Period. An Employee who becomes eligible to become a Participant in this Flexible Benefits Plan after the Effective Date must complete, sign and file a Salary Redirection Agreement with the Plan Administrator during the sixty (60) day period prior to the day the Employee first becomes eligible to participate in this Plan. If an Employee is eligible to participate in this Flexible Benefits Plan on the date he is first hired, a Salary Redirection Agreement must be completed, signed, and filed with the Plan Administrator within thirty (30) days from the date of hire. The elections made by the Participant on this initial Salary Redirection Agreement shall be prospectively effective as of the first pay period coinciding with or immediately following the date that the Salary Redirection Agreement is filed (or if later, the date of the employee's eligibility under the Flexible Benefits Plan) and, subject to Section 3.04, ending on the last day of the Plan Year in which such participation began. Coverage under the component Benefits Plan or Policies will be effective in accordance with the eligibility requirements contained in such Benefits Plans or Policies. • 6 VO as-.~-= F i V 4 f E C W, • I , ' I 1 ' r •Ir ~ (c) An eligible Employee who fails to complete, sign and file a Salary Redirection Agreement with the Plan Administrator in accordance with paragraph (a) or (b) above during an initial election period may become a participant on a later date In accordance with Section 3.03 or 3.04. 3.03 Annual Election Period. Each Employee who is a Participant or who is eligible to become a Participant may complete, sign and file a Salary Redirection Agreement during the election period (as specified by the Plan Administrator) preceding each Anniversary Date to be effective for the entire Plan Year beginning on the Anniversary Date. A Participant who fails to complete, sign and file a Salary Redirection Agreement as required by this Section 3.03 shall be deemed to have elected to continue the same coverages under the Benefit Plans or Policies funded by the same election (e.g., either Pre-tax Premiums or After-tax Premiums adjusted to reflect any increase or decrease in premium/cost) then in effect for such Participant. Notwithstanding the foregoing, annual elections for participation in the Medical Care and Dependent Care Expense Reimbursement Plans must be made by submitting a Salary Redirection Agreement prior to the beginning of each Plan Year - no deemed elections shall occur under such Plans. 3.04 Change of Premium Election. (a) A Participant may change or terminate his or her Pre-tax Premiums elected on the Salary Redirection Agreement within thirty (30) days of the occurrence of a Change in Family Status, but only if such change or termination is made on account of, and is consistent with, the Change in Family Status. An Employee who is eligible to become a Participant but failed to complete a Salary Redirection Agreement during the initial election period pursuant to Section 3.02(a) or (b) may become a Participant and file a Salary Redirection Agreement with respect to Pre-tax Premiums within thirty (30) days of the occurrence of a Change in Family Status, but only if the election under the new Salary Redirection Agreement is made on account of and is consistent with, the Change in Family Status. Elections made pursuant to this Section 3.04 shall be effective for the balance of the Plan Year in which the election is made beginning on the first day of the pay period next following the day the new Salary Redirection Agreement is filed with the Plan Administrator, other, than as provided in Section 3.04(b), below. (b) A Participant may revoke a prior election with respect to Pre-tax Premiums and in lieu thereof, receive on a prospective basis, coverage under another health plan with similar coverage if any independent, third-party provider of medical benefits previously elected by the Participant either significantly increases the premiums for such coverage, or significantly curtails the coverages available under such plans, during the Plan Year coverage period. A Participant otherwise entitled to make an alternate election under this Section must do so within 30 days of receipt of a written notice from the Plan Administrator of the significant change in cost or composition of the benefit originally elected. Such revocation and new election shall be effective on the first day of the payroll period coincident with or immediately following the date the Participant files his new Salary Redirection Agreement with the Plan Administrator. 7 VOL: =PAGE, 534 •e tJ •.a iii. n~i 1•..i•-'r'.:~.t ,'L ~ • . V f 'a I • • • L r , L 7 i Abw 3.05 Termination of Election. Except as otherwise provided in Section 2.03, Termination of employment shall automatically revoke any Salary Redirection Agreement. If revocation occurs under this Section 3.05, no new election with respect to Pre-tax Premiums may be made by such Participant during the remainder of the Plan Year. ARTICLE IV PREMIUM PAYMENTS AND CREDITS AND DEBITS TO ACCOUNTS 4.01 Source of Premium Payments. The Employer shall withhold from a Participant's Compensation on a Pre-tax or After-tax basis (as elected on the Salary Redirection Agreement) an amount equal to the contributions required from the Participant (less any applicable Nonelective Contribution) for coverage of the Participant, or the Participant's spouse or dependents, under the Benefit Plans or Policies elected by the Participant and maintained by the Employer as noted in the Adoption Agreement. Amounts withheld from a Participant's Compensation as Pre-tax Premiums or After-tax Premiums shall be forwarded to the appropriate insurer as soon as administratively feasible (or kept by the Employer or kept in trust in the event of a self-insured plan). The maximum amount of Pre-tax Premiums plus any Nonelective Contribution made available by the Employer for the benefit of each Plan Participant shall not exceed the aggregate amount set forth in the Adoption Agreement. 4.02 Allocations Irrevocable During Plan Year. Except as provided in Sections 3.04, 3.05, 4.03, and 4.04, neither (i) the insurance coverages nor amounts withheld therefor elected under Section 5.01(a), nor (ii) the amount to be credited to a Participant Account during the Plan Year pursuant to Sections 4.05 and 4.06, nor (iii) the allocation of such amounts to the appropriate Account(s) of the Participant, can be changed during the Plan Year. 4.03 Reduction of Certain Elections to Prevent Discrimination. If the Plan Administrator determines, before or during any Plan Year, that the Plan may fail to satisfy for such Plan Year any requirement imposed by the Code or any limitation on Pre-tax Premiums allocable to Key Employees or to Highly Compensated Individuals, the Plan Administrator shall take such action(s) as he deems appropriate, under rules uniformly applicable to similarly situated Participants, to assure compliance with such requirement or limitation. Such action may include, without limitation, a modification or revocation of a Highly Compensated Individual's or Key Employee's Salary Redirection Agreement without the consent of such Employee. 4.04 Modification of Amounts Withheld due to Premium Increases. If the cost of a health plan provided by an independent, third party provider increases or decreases during a Plan Year, then any Participant who has elected to participate in such health plan shall be required to make a corresponding change in his or her premium payments, and the Plan Administrator shall increase or decrease, as the case may be, the Pre-tax Premiums or After-tax Premiums (as applicable) under each affected Participant's Salary Redirection Agreement. 8 - VOL.. . ~ , I• r. F 4 ~ l 4.05 Medical Can Expense Reimbursement. (a) Debiting and Crediting of Accounts. Each Participant's Medical Care Expense Reimbursement Account ('Account') will be credited with amounts withheld from the Participant's Compensation for Medical Care Expense Reimbursement pursuant to the Salary Redirection Agreement. The Account will be debited for reimbursement amounts disbursed to the Participant in accordance with Article V of this document. The entire amount elected by the Participant on the Salary Redirection Agreement as an annual amount for the Plan Year for Medical Care Expense Reimbursement less any reimbursements already disbursed shall be available to the Participant at any time during the Plan Year without regard to the balance in the Account (provided that the periodic premiums have been paid). Thus, the maximum amount of Medical Care Expense Reimbursement at any particular time during the Plan Year will not relate to the amount which a Participant has had withheld up to that time. In no event will the amount of medical expense reimbursement benefits in any Plan Year exceed the annual amount specified for the Plan Year in the Salary Redirection Agreement for Medical Care Expense Reimbursement. Any amount allocated to the Account shall be forfeited by the Participant and restored to the Employer if it has not been applied to provide Medical Care Expense Reimbursement by the ninetieth (90th) day following the end of the Plan Year for•.which.the election was effective. Amounts so forfeited shall be used to offset administrative expenses. (b) Source of Payments. All Medical Care Expense Reimbursement benefits derived hereunder shall be paid exclusively from the amounts in each Employee's Medical Care Expense Reimbursement Account funded by amounts withheld from the Employee's wages pursuant to the Salary Redirection Agreement for Medical Care Expense Reimbursement and any Nonelective Contributions allocated thereto. In the event that an Employee's reimbursement for Medical Care Expense Reimbursement benefits exceeds the amount currently available in the Employee's Medical Care Expense Reimbursement Account, the Employer shall pay the excess amount up to the amount elected by the Participant on the Salary Redirection Agreement for Medical Care Expense Reimbursement less any reimbursements already disbursed. Future premium payments by the ' Employee shall then go to the Employer as reimbursement for the money so advanced on behalf of the Employee. (c) Employer Risk. If an Employee terminates employment before the Employer has been reimbursed for the money it has advanced on behalf of the Employee, the entire unreimbursed portion shall be deemed to be an "administrative expense" to be refunded to the Employer by any unused Account balance(s) (if any) as provided in Section 4.05(a). 4.06 Dependent Care Expense Reimbursement. 9 • VO .~-r. '~r;~-_ .--tom _ -'r• ..r ~ rl • - } t- 1•r a.i' { r ~d ~ , +t iI e~•5 1 t, ~ w M t n i _--4 • • A Araw t 1 r (a) Crediting and Debiting of Accounts. Each Participant's Dependent Care Expense Reimbursement Account ("Account') will be credited with amounts withheld from the Participant's Compensation for Dependent Care Expense Reimbursement pursuant to the Salary Redirection Agreement. The Account will be debited for reimbursement amounts disbursed to the Participant i in accordance with Article V of this document. In the event that the amount in the Account is less t than the amount of reimbursable benefit requests at any time during the Plan Year, the excess part It of the reimbursement will be carried over into following months (within the same Plan Year), to be paid out as the Account balance becomes adequate. In no event will the amount of Dependent Care Expense Reimbursement benefits exceed the amount withheld pursuant to the Salary Redirection Agreement for any Plan Year. Any amount allocated to the Account shall be forfeited by the Participant and restored to the Employer if it has not been applied to provide Dependent Care Expense Reimbursement for the Plan Year by the ninetieth (90th) day following the end of the Plan Year for which the election was effective. Amounts so forfeited shall be used to offset administrative costs. (b) Source of Payments. All Dependent Care Expense Reimbursement benefits derived hereunder shall be paid exclusively from the amounts in each Employee's Dependent Care Expense Reimbursement Account funded by amounts withheld from the Employee's wages pursuant to the Salary Redirection Agreement for Dependent Care Expense Reimbursement, and any Nonelective Contributions allocable thereto. ARTICLE V BENEFITS 5.01 Qualified Benefits. The Qualified Benefits available for election are one or more of the following: (a) Insurance Premium Payment. The Employer shall withhold from a Participant's Compensation an amount equal to the contributions required from the Participant (less any applicable Nonelective contribution) for coverage of the Participant, or the dependent coverage of the Participant's spouse or Dependents, under the Benefit Plans or Policies elected by the Participant and maintained by the Employer as noted in the Adoption Agreement. The benefits are subject to the terms and conditions of the applicable Benefit Plans or Policies specifically referred to in the Adoption Agreement and incorporated herein into this Plan. (b) Medical Care Expense Reimbursement. If pursuant to the Adoption Agreement, the Employer has elected to maintain a Medical Care Expense Reimbursement Plan, payment shall be made to the Participant in cash as reimbursement for Eligible Medical Expenses incurred by the Participant or his Dependents while he is an Employee, during the Plan Year for which the Participant's election is effective. These expenses must also be expenses which - (1) are not covered, paid or reimbursed from any other source; and (2) meet the criteria of tax-deductibility as a medical or dental expense under Section 213 of the Code, as amended and the regulations thereunder, and 10 yo AGE . , - - -~~__,._...-•_-_~,...._.-._..~zr_~,_~u__._-. ~c...-mss _.~,...-_~.n._._..,,... ~c.~.. ~ - - - • 1n _ Lr • . 1.. ~ - r (3) meet any limitations imposed by applicable regulations promulgated under Code • Section 125; and E (4) will not be taken as a deduction from income on the Participant's federal income tax return in any tax year; and i• t (5) do not exceed the lesser of (a) the maximum annual amount allocable to Medical Care Expense Reimbursement specified in the Adoption Agreement, or (b) the annual amount that the Employee has elected to have withheld for Medical Care Expense Reimbursement; less previous Medical Care Expense Reimbursements made during the Plan Year; and (6) are verified in writing to the satisfaction of the Administrator that a covered expense has occurred and the reimbursement for which meet the substantiation requirements F of Section 6.11. (c) Dependent Care Expense Reimbursement. If pursuant to the Adoption Agreement, the Employer has elected to maintain a Dependent Care Expense Reimbursement Plan, payment shall 'be made to the Participant in cash as reimbursement for Eligible Employment Related Expenses t incurred by him or her while an Employee, during the Plan Year for which the Participant's election is effective, provided that the substantiation requirements of Section 6.11 have been complied with. No payment otherwise due a Participant hereunder shall exceed the smallest of: (1) the Participant's Earned Income for the applicable month; or (2) the Earned Income of the Participant's Spouse for such month (Note: a Spouse of a Participant who is not employed during a month in which the Participant incurs Eligible Employment Related Expenses and who is either incapacitated or a Student shall be deemed to have Earned Income in the amount of $200 per month per ' Qualifying Individual for whom the Participant incurs Eligible Employment Related Expense(s), up to a maximum amount of $400 per month); or (3) the annual amount the Participant has elected to have withheld from his Compensation for Dependent Care Expense Reimbursement less any prior Dependent Care Expense Reimbursements during the Plan Year; or (4) Five Thousand Dollars ($5,000), or, if the Participant is married and files a separate tax return, Two Thousand Five Hundred Dollars ($2,500) (or any future aggregate limitations promulgated under Code Section 129) less any prior reimbursements during the Plan Year. I L : I 11 G VU ,w~ Z M :s lit ■ . II • [7 . l I! M1F 1 I Al 5.02 Cash Benefit. To the extent that a Participant does not elect under a Salary Redirection Agreement to have the maximum amount of his Compensation contributed as a Pre-tax Premium or After-tax Premium hereunder, such amount not elected shall be paid to the Participant in the form of normal Compensation payments; provided however, that Nonelective Contributions may not be received in the form of cash compensation. 5.03 Repayment of Excess Reimbursements. If, as of the end of any Plan Year, it is determined that a Participant has received payments under this Plan that exceed the amount of Eligible Reimbursement Expenses that have been substantiated by such Participant during the Plan Year, the Plan Administrator shall give the Participant prompt written notice of any such excess amount, and the Participant shall repay the amount of such excess to the Employer within sixty (60) days of receipt of such notification. 5.04 Termination of Reimbursement Benefits. Coverage under the Medical Care Expense Reimbursement and/or Dependent Care Expense Reimbursement Plan(s) shall cease as of the first day of the month immediately following the month in which a Participant is no longer employed by the Company or when a premium payment has not been made for any reason. Such Participant shall have the right to submit a Request for Reimbursement for any Eligible Medical or Employment-Related Expense arising during the Plan Year before the date of separation from service at any time until ninety (90) days after the end of the Plan Year for which the election had been in effect, and to receive reimbursement hereunder. The Participant shall = be entitled to receive reimbursement for expenses incurred after coverage ceases under this Section, and any unused reimbursement benefits at the expiration of the 90-day period following the close of the Plan Year shall be treated in accordance with Sections 4.05 or 4.06. 5.05 COBRA Coverage. Each Benefit Plan or Policy made available under Article V that is considered to be a "group health plan" under Code Sec. 162(1), because employees and their families are provided with health care benefits within the meaning of Code Sec. 212(d)(1), including the Medical Care Expense Reimbursement Benefit, shall contain the necessary provisions required by Code Sec. 4980B and ERISA § 601, to assure that such benefits may be continued on or after the occurrence of the qualifying events defined in Code Sec. 4980B(f)(3). 5.06 Coordination of Benefits Under Health FSA. The Health FSA is intended to pay benefits solely for otherwise unreimbursed medical expenses. Accordingly, it shall not be considered a group health plan for coordination of benefits purposes, and its benefits shall not be taken into account when determining benefits payable under any other plan. S a 4 1 f s t k . r ` 12 VO AGE S . ~ . a_~.. _a ~a_~.•..LJ,v..Y... - '-.i~ S.:- •-.rY...__a+a ~u_ --1[.u.r A..a.....i~. ia...a.+..yun+-u.... ~f x r, c c F. I to IV, • ARTICLE VI PLAN ADMINISTRATION 6.01 Allocatitm of Authority. Except as to those functions reserved within the Plan to the Employer, the Plan Administrator appointed pursuant to the Adoption Agreement shall control and manage the operation and administration of the Plan. The Plan Administrator shall have the exclusive right to interpret the Plan and to decide all matters arising thereunder, including the right to remedy possible ambiguities, inconsistencies, or omissions. All determinations of the Plan Administrator with respect to any matter hereunder shall be conclusive and binding on all persons. Without limiting the generality of the foregoing, the Plan Administrator shall have the following powers and duties: (a) To require any person to furnish such reasonable information as he may request for the purpose of the proper administration of the Plan as a condition to receiving any benefits under the Plan; (b) To make and enforce such rules and regulations and prescribe the use of such forms as he shall deem necessary for the efficient administration of the Plan; (c) To decide on questions concerning the Plan and the eligibility of any Employee to participate In the Plan and to make or revoke elections under the Plan, in accordance with the provisions of the Plan; (d) To determine the amount of benefits which shall be payable to any person In accordance with the provisions of the Plan; to inform the Employer, insurer or Trustee (if any), as appropriate, of the amount of such benefits; and to provide a full and fair review to any Participant whose claim for benefits has been denied in whole or in part; T (e) To designate other persons to carry out any duty or power which may or may not otherwise be a fiduciary responsibility of the Plan Administrator, under the terms of the Plan; (f) To keep records of all acts and determinations, and to keep all such records, books of account, data and other documents as may be necessary for the proper administration of the Plan; (g) To prepare and distribute to all Employees Information concerning the Plan and their rights under the Plan; (h) To do all things necessary to operate and administer, the Plan in accordance with its provisions; 6.02 Provision for Third-Party Plan Service Providers. The Plan Administrator, subject to approval of the Employer, may employ the services of such persons as it may deem necessary or desirable in connection with the operation of the Plan and to rely upon all tables, valuations, certificates, reports and opinions furnished thereby. Unless otherwise provided in the service agreement, obligations under this Plan shall remain the obligation of the Employer. 13 ]FwL.i.jlrlL. +l2 1.~~~J 1~~' 1711! v;(( VOL PAGF, r t V • • t • 1 6.03 Fiduciary Liability. To the extent permitted by law, neither the Plan Administrator nor any other person shall incur any liability for any acts or for failure to act except for their own willful misconduct or willful breach of this Plan. 6.04 Compensation of Plan Administrator. Unless otherwise determined by the Employer - and permitted by law, any Plan Administrator who is also an employee of the Employer shall serve without compensation for services rendered in such capacity, but all reasonable expenses incurred in the performance of their duties shall be paid by the Employer. 6.05 Bonding. Unless otherwise determined by the Employer, or unless required by any Federal or State law, the Plan Administrator shall not be required to give any bond or other security in any jurisdiction in connection with the administration of this Plan. 1 r 6.06 Payment of Administrative Expenses. Unless otherwise indicated in the Adoption Agreement, all reasonable expenses incurred in administering the Plan shall be paid by the Employer, provided, however that each Participant shall bear the monthly cost (if any) charged for the maintenance of any Reimbursement Account unless otherwise paid by the Employer. 6.07 Funding Policy. The Employer shall have the right to enter into a contract with one or more insurance companies for the purposes of providing any benefits under the Plan and to replace any of such insurance companies or contracts. Any dividends, retroactive rate adjustments or other refunds of any type which may become payable under any such insurance contract shall not be assets of the Plan but shall be the property of, and shall be retained by the Employer to provide future Benefit Plan or Policy benefits. 6.08 Disbursement Reports. The Plan Administrator shall issue directions to the Employer concerning all benefits which are to be paid from the Employer's general assets pursuant to the provisions of the Plan. 6.09 Reporting and Disclosure Obligations. Unless specified otherwise, it shall be the Employer and Plan Administrator's sole responsibility to comply with all filing, reporting, and disclosure requirements, imposed by the Department of Labor and/or Internal Revenue Service , specifically including, but not limited to creating, filing and distributing Summary Annual Reports, Form 5500's, and Summary Plan Descriptions. Furthermore, the Employer and Plan Administrator shall be required to amend the Plan as is necessary to ensure compliance with applicable tax and other laws and regulations. 6.10 Indemnification. The Plan Administrator shall be indemnified by the Employer against claims, and the expenses of defending against such claims, resulting from any action or conduct relating to the administration of the Plan except claims arising from gross negligence, willful neglect, or willful misconduct. • 14 N t. t 11 . i VO AGE I~ i Ik t r f • r... ~ -fir . a • .•...••W. .d : '1 A i ' . • •i 6.11 Substantiation of Expenses. Each Participant must submit a written Request for Reimbursement form to the Plan Administrator to receive reimbursements from his Medical or Dependent Care Expense Reimbursement Account(s), on a form provided by the Plan Administrator accompanied by a written statement/bill from an independent third party stating that the expense has been incurred, and the amount thereof. The forms shall contain such evidence as the Plan Administrator shall deem necessary as to substantiate the nature, the amount, and timeliness of any expenses that may be reimbursed. 6.12 Reimbursement. Reimbursements shall be made as soon as administratively feasible after the required forms have been received by the Plan Administrator. Reimbursements of less than $15 may be carried forward and aggregated with future reimbursements until the reimbursable amount is greater than $15, provided, however, that the entire amount of reimbursable reimbursements outstanding at the end of the Plan Year shall be reimbursed without regard to the $15 threshold limit. Such forms and documentation must be submitted by the fourth (4th) Friday of the month in order to receive a reimbursement in the following month. Year-end expense reimbursements must be submitted to the Plan Administrator within 90 days of the close of the Plan Year for which the Salary Redirection Agreement is effective, and during which such expense was incurred, in order to be eligible for reimbursement. Likewise, if a Participant terminates participation in the Plan with a credit balance in any Reimbursement Account, such Participant shall be entitled to submit to the Plan Administrator any Requests for Reimbursement for reimbursable expenses incurred prior to such cessation of Participation at any time within 90 days after the close of the Plan Year for which the Salary Redirection Agreement is effective. 6.13 Annual Statements. The Plan Administrator shall furnish each Participant with an ' annual statement, showing the amounts paid or expenses incurred by the Employer in providing Medical and/or Dependent Care Expense Reimbursement during the previous calendar year and the respective Reimbursement Account balance(s) on or before January 31 following the close of the applicable Plan Year. ARTICLE VII FUNDING AGENT r 7.01 Funding of the Plan. The Plan shall be funded with amounts withheld from Compensation pursuant to Salary Redirection Agreements and by Nonelective Contributions by the Employer. 7.02 The Employer as Funding Agent. If the Employer is designated the Funding Agent in the Adoption Agreement, the Employer will immediately apply all such amounts, without regard to their source, to pay for the welfare benefits provided in the Adoption Agreement and shall comply with all applicable regulations promulgated by the Department of Labor ('D.O.L.•) taking into consideration any enforcement procedures adopted by the D.O.L. 7.03 Trust as Funding Agent. If a Trust is designated Funding Agent in the Adoption Agreement, an appropriate Trust Agreement shall be attached at the end of this Plan. 15 VO - AGE, ' _ .s.r •1"fir:` r ~A 'C - ~ I• < . r•Z r' `I ~i•. %f+~:' A ,7 cif • i. -i . . ,i • {I, t.ZJ r ~ • r. ' u It r . i • • • F t rA ' i ARTICLE VIII 1 CLAIMS PROCEDURES M 8.01 Application to Plan Benefits. The provisions of this Article do not apply to individual policies or group policies not subject to ERISA, and if applicable, apply to claims for benefits only to the extent that no claims procedure is specified for such benefit in the applicable Benefit Plan or Policy. If a claims procedure is otherwise available under the applicable Benefit Plan or Policy, this Article shall n21 apply to benefits under the component Benefit Plan or Policy, but shall only apply to issues germane to the pre-tax benefits available under this Plan (i.e., such as a determination of: a Change in Family Status; significant change in premiums charged; or eligibility and participation matters under this Flexible Benefits Plan document). This Article shall be the claims procedure applicable to the Medical Care Expense Reimbursement and the Dependent Care Expense . Reimbursement Plan(s). 8.02 Procedure if Benefits are Denied Under the Plan. Any Employee, beneficiary, or ; his duly authorized representative may file a claim for a benefit to which the claimant believes that he is entitled, but that has been previously denied by the Plan Administrator. Such a claim must be in writing and delivered to the Plan Administrator in person or by mail, postage paid. Within ninety (90) days after receipt of such claim, the Plan Administrator shall send to the claimant, by mail, postage prepaid, notice of the granting or denying, in whole or in part, of such claim, unless special circumstances require an extension of time for processing the claim. In no event may the extension exceed ninety (90) days from the end of the initial period. If such extension is necessary, the claimant will be given a written notice to this effect prior to the expiration of the initial 90-day ' period. The Plan Administrator shall have full discretion to deny or grant a claim in whole or in part. If notice of the denial of a claim is not furnished in accordance with this Section 8.02, the claim shall be deemed denied and the claimant shall be permitted to exercise his right to review pursuant to Sections 8.04 and 8.05. 8.03 Requirement for Written Notice of Claim Denial. The Plan Administrator shall provide a written notice to every claimant who is denied a claim for benefits under this Article. Such written notice shall set forth in a manner calculated to be understood by the claimant, the following information: (a) The specific reason or reasons for the denial; ' (b) Specific reference to pertinent Plan provisions on which the denial is based; (c) A description of any additional material or information necessary for the claimant to perfect the claim and an explanation of why such material is necessary, and (d) An explanation of the Plan's claim review procedure. ti• 16 v0 , ao s - _ '....'.~n~ .•..~.e..._..yL..i:...-..e_......._._-i~..i.........._a..-.t.ai.~.....u.... JL1u.. _---.L..s-~..i.. u+tv. u+e 1 • ! Y• 1. . 1 f 8.04 Right to Request Hearing on Benefit Denial. Within sixty (60) days after the receipt by the claimant of written notification of the denia'. (in whole or in part) of his claim, the claimant ` or his duly authorized representative may make a written application to the Plan Administrator, in person or by certified mail, postage prepaid, to be afforded a review of such denial; may review pertinent documents; and may submit issues and comments in writing. ' 8.05 Disposition of Disputed Claims. Upon receipt of a request for review, the Plan Administrator shall make a prompt decision on the review matter. The decision on such review shall be written in a manner calculated to be understood by the claimant and shall include specific reasons for the decision and specific references to the pertinent plan or insurance policy provisions on which the decision was based. The decision upon review shall be made not later than sixty (60) days after ' the Plan Administrator's receipt of a request for a review, unless special circumstances require an extension of time for processing, in which case a decision shall be rendered not later than one hundred twenty (120) days after receipt of a request for review. If an extension is necessary, the claimant shall be given written notice of the extension prior to the expiration of the initial sixty (60) day period. If notice of the decision on the review is not furnished in accordance with this Section 8.05, the claim shall be deemed denied and the Claimant shall be permitted to exercise his right to a legal remedy. a, r, L, . ARTICLE IX AMENDMENT OR TERMINATION OF PLAN 9.01 Permanency. While the Employer fully expects that this Plan will continue Indefinitely, due to unforeseen, future business contingencies, permanency of the Plan will be subject to the Employer's right to amend or terminate the Plan, as provided In Sections 9.02 and 9.03, below. Nothing in this Plan Is Intended to be or shall be construed to entitle any Participant, retired ' or otherwise, to vested or nonterminable benefits. 9.02 Employer's Right to Amend. The Employer reserves the right to amend the Plan at any time and from time-to-time, and retroactively if deemed necessary or appropriate to meet the requirements of Code Section 125, or any similar provisions of subsequent revenue or other laws, to modify or amend in whole or in part any or all of the provisions of the Plan. All amendments shall be made in writing and shall be approved by the Board of Directors (or a duly authorized officer of the Employer) in accordance with its normal procedures for transacting business. Each Benefit Plan or Policy shall be amended in accordance with the terms specified therein, or, if no amendment procedure is prescribed, in accordance with this section. Any amendment made by the Employer shall be deemed to be approved and adopted by any Affiliated Employer. 9.03 Employer's Right to Terminate. The Employer reserves the right to discontinue or terminate the Plan without prejudice at any time and for any reason without prior notice. Such decision to terminate the Plan shall be made in writing and shall be approved by the Board of Directors (or a duly authorized officer of the Employer) in accordance with its normal procedures for transacting business. Affiliated Employers may withdraw from participation in the plan, but may not terminate it. 17 N i A VOLE, AU ~ r • C r~ J 6 k(( 1} 1 • 7 9.04 Determination of Effective Date of Amendment or Termination. Any such amendment, discontinuance or termination shall be effective as of such date as the Employer shall determine. Subject to Sections 4.05(a) and 4.06(a) (if applicable), no amendment, discontinuance d or termination shall allow the return to any Employer of any Reimbursement Account balance nor t its use for any purpose other than for the exclusive benefit of the Participants and their beneficiaries. a ARTICLE X GENERAL PROVISIONS F 10.01 Not an Employment Contract. Neither this Plan nor any action taken with respect to it shall confer upon any person the right to continue employment with any Employer. t 10.02 Applicable Laws. The provisions of the Plan shall be construed, administered and enforced according to applicable Federal law and the laws of the State of the principal place of r business of the Employer. 10.03 Post-Mortem Payments. Any benefit payable under the Plan after the death of a Participant shall be paid to his surviving spouse (if any), otherwise, to his estate. If there is doubt as to the right of any beneficiary to receive any amount, the Plan Administrator may retain such amount until the rights thereto are determined, without liability for any interest thereon. 10.04 Nonalienation of Benefits. Except as expressly provided by the Administrator, no F benefit under the Plan shall be subject in any manner to anticipation, alienation, sale, transfer, : assignment, pledge, encumbrance or charge, and any attempt to do so shall be void. No benefit under the Plan shall in any manner be liable for or subject to the debts, contracts, liabilities, ' engagements or torts of any person. 10.05 Mental or Physical Incompetency. Every person receiving or claiming benefits under the Plan shall be presumed to be mentally and physically competent and of age until the Plan Administrator receives a written notice, in a form and manner acceptable to it, that such person is mentally or physically incompetent or a minor, and that a guardian, conservator or other person legally vested with the care of his estate has been appointed. f 10.06 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 he cannot ascertain the identity or whereabouts of such Participants or other person after reasonable efforts have been made to identify or locate such person such payment and all subsequent payments otherwise due to such Participant or other person shall be forfeited seven (I) years after the date any such payment first became due. 18 VOL PAGE~~Z: ' P, ter, • r.,.. ..,........,,.....-.~,+.i:.....:..-~ -.a._.:.~..u.~..+~«~-a_....~:v sip - -~..L.~w...._L...... r , t 10.07 Requirement for Props Forma: All communications in connection with the Plan made by a Participant shall become effective only when duly executed on any forms as may be required and furnished by, and filed with, the Plan Administrator. r" rr•-I h • • 1 1 ,w 10.08 Source of Payments. The Employer, the Trust fund (if selected as Funding Agent), and any insurance company contracts purchased or held by the Employer or funded pursuant to this Plan shall be the sole sources of benefits under the Plan. No Employee or beneficiary shall have any right to, or interest in, any assets of the Employer upon termination of employment or otherwise, except as provided from time to time under the Plan, and then only to the extent of the benefits payable under the Plan to such Employee or beneficiary, 10.09 Multiple Functions. Any person or group of persons may serve in more than one fiduciary capacity with respect to the Plan. 10.10 Tax Effects. Neither the Employer, its agents, the Plan Administrator, nor the Trustee makes any warranty or other representation as to whether any Pre-tax Premiums made to or on behalf of any Participant hereunder will be treated as excludable from gross income for local, state, or federal income tax purposes. If for any reason it is determined that any amount paid for the benefit of a Participant or Beneficiary are includable in an Employee's gross income for local, federal, or state income tax purposes, then under no circumstances shall the recipient have any recourse against the Plan Administrator or the Employer with respect to any increased taxes or other losses or damages suffered by the Employees as a result thereof. The Plan is designed and is intended to be operated as a "cafeteria plan' under Section 125 of the Code. 10.11 Gender and Number. Masculine pronouns include the feminine as well as the neuter , genders, and the singular shall include the plural, unless indicated otherwise by the context. 10.12 Headings. The Article and Section headings contained herein are for convenience of reference only, and shall not be construed as defining or limiting the matter contained thereunder. 10.13 Incorporation by Reference. Except for the Medical and Dependent Care Expense Reimbursement Plan(s), the actual terms and conditions of the separate component Benefit Plans or Policies offered under this Plan are contained in separate, written documents governing each respective benefit, and shall govern in the event of a conflict between the individual plan document, and this Plan as to substantive content. To that end, each such separate document, as amended or subsequently replaced, is hereby incorporated by reference as if fully recited herein. The provisions of the Medical and Dependent Care Expense Reimbursement Plan(s) are reproduced herein, but shall constitute separate plans for purposes of all applicable Code and ERISA provisions. 10.14 Severability. Should any part of this Plan subsequently be invalidated by a court of competent jurisdiction, the remainder thereof shall be given effect to the maximum extent possible. 19 VO - PAGE SS~„r it i • • • I 1 tl t' r.~J • r 10.15 Effect of Mistake. In the event of a mistake as to the eligibility or participation of an Employee, or the allocations made to the account of any Participant, or the amount of distributions made or to be made to a Participant or other person, the Plan Administrator shall, to the extent it deems possible, cause to be allocated or cause to be withheld or accelerated, or otherwise make adjustment of, such amounts as will in its judgment accord to such Participant or { other person the credits to the account or distributions to which he is properly entitled under the w Plan. Such action by the Administrator may include withholding of any amounts due the Plan or the t ; Employer from Compensation paid by the Employer. ♦ Y t I= 10.16 Provisions Relating to Insurers. No insurer shall be required or permitted to issue an insurance policy or contract that is inconsistent with the purposes of this Plan, nor be bound to take any action not in accordance with the terms of any policy or contract with this Plan. The insurer shall not be deemed to be a party to this Plan, nor shall it be bound to interpret the construction or validity of the Plan. The insurer shall be protected from its good faith reliance on the written representations and instructions of the Trustee and the Plan Administrator, and shall not be responsible for the initial or continued qualified status of the Plan. ARTICLE XI CONTINUATION COVERAGE UNDER COBRA E The following provisions shall be applicable to any group health plan (as defined by Code 4980B and 5000(b)(1) and the regulations promulgated thereunder) subject to COBRA that does not otherwise contain COBRA provisions. s ' 11.01 Continuation Coverage after Termination of Normal Participation. During any Plan Year during which the Employer is subject to Code Section 4980B, each person who is a Qualified Beneficiary shall have the right to elect to continue coverage under any group health plan subject to COBRA upon the occurrence of a Qualifying Event that would otherwise result in such person losing coverage hereunder. Such extended coverage under the plan is known as 'Continuation Coverage.' 11.02 Who is a "Qualified Beneficiary". A "Qualified Beneficiary' is any person who is, as of the day before a Qualifying Event, (a) an Employee of the Employer (including persons who 1 are considered to be 'employees' within Code Sec. 401(c), directors and independent contractors) covered under the Plan as of such day (such persons are called 'Covered Employees"), (b) the Spouse of the Covered Employee, or (c) a Dependent of the Covered Employee. A Covered Employee can be a Qualified Beneficiary only if the Qualifying Event consists of termination of employment (for any reason other than gross misconduct) or reduction of hours of the Covered Employee's employment. A retiree or other former Employee actively participating in the Plan by reason of a previous period of employment will be treated as a 'Qualified Beneficiary'. 20 { n VOL' 44.~'aGE, Y/ r i 1J . -a.: f 11.03 Who Is not a "Qualified Beneficiary" 'A person is not a Qualified Benefici if • arY as of such day, either the individual is covered under the group health plan by virtue of the election of Continuation Coverage by another person and is not already a Qualified Beneficiary by reason of a prior Qualifying Event, or is entitled to Medicare coverage under Title XVIII of the Social Security Act. Furthermore, an individual who fails to elect Continuation Coverage within the election period provided in Section 11.07, below, shall not be considered to be a Qualified Beneficiary. 11.04 What Is a "Qualifying Event". Any of the following shall be considered as a 'Qualifying Event% (a) death of a Covered Employee; (b) termination (other than by reason of gross misconduct) of the Covered Employee's employment or reduction of hours of employment; (c) divorce or legal separation of a Covered Employee from the employee's spouse; (d) a Covered Employee's becoming eligible to receive Medicare benefits under Title XVIII of the Social Security Act; or (e) a dependent child of a Covered Employee ceasing to be a Dependent. In the case of any person treated as a Covered 'Employee' but who is not a common-law employee, termination of 'employment' means termination of the relationship that originally gave rise to eligibility to participate in the group health plan subject to COBRA. 11.03 What Benefit Is Available under Continuation Coverage. Each person who is eligible to elect to continue coverage under Article XI shall have the right to continue the level of coverage in effect for the Covered Employee on the day before the Qualifying Event (or a lesser level of coverage). A premium for Continuation Coverage shall be charged to Employees and Qualified Beneficiaries in such amounts and shall be payable at such times as are established by the Plan Administrator and permitted by applicable law. 11.06 Notice Requirements. (a) When an Employee becomes covered under a group health plan subject to COBRA, the Plan Administrator must inform the Participant (and spouse, if any) in writing of the rights to continued coverage, as described in Article XI. (b) The Employer shall give the Plan Administrator written notice of a Qualifying Event within thirty (30) days of the occurrence thereof. 21 VU AGE ' r r.••.', ~'ff ~ ~ =rte } N • r i (c) Within fourteen (14) days of receipt of the Employer's notice, the Plan Administrator shall furnish each Qualifying Beneficiary with written notification of the termination of regular coverage under any group health plan subject to COBRA, as well as a recital of the rights of any such Beneficiary to elect Continuation Coverage, as required by Code Sec. 4980B and ERISA § 601, j in accordance with the terms of this Plan. 5 (d) In the case of a Qualifying Event described in Section 11.04(c) or (e), a Covered R ! Employee or a Qualified Beneficiary who is a Spouse or Dependent of such Employee must notify the Plan Administrator within sixty (60) days of the occurrence thereof. The Plan Administrator shall give written notification of Conversion Coverage rights to any other affected Qualified Beneficiaries within fourteen (14) days of receipt of the notice described in this Section 11.06(d). i Notwithstanding any of the foregoing, notification to a Qualified Beneficiary who is a spouse of a Covered Employee is treated as notification to all other Qualified Beneficiaries residing with that person at the time notification is made. 11.07 Election Period. Any Qualified Beneficiary entitled to Continuation Coverage shall have 60 days from the date of the notice required by Section 11.06, in the case of occurrence of a Qualifying Event, in which to return a signed election to the Plan Administrator indicating the choice to continue benefits under this Plan. • is 11.08 Duration of Continuation Coverage. Continuation Coverage shall extend for a period 4 of 18 months after the date that regular coverage ceased due to occurrence of a Qualifying Event, t unless during such 18-month period a subsequent, Qualifying Event occurs, in which case, another election to extend coverage for 18 months shall be available to the Beneficiary. In the event a Covered Employee becomes entitled to Medicare coverage, the period of Continuation Coverage for a Qualified Beneficiary, other than the Covered Employee for such Qualifying Event or any E subsequent Qualifying Event, shall not terminate for a period of 36 months from the date the ' Covered Employee becomes entitled to Medicare benefits. In no event, however, shall Continuation Coverage extend more than 36 months beyond the date of the original Qualifying Event. 11.09 Automatic Termination of Continuation Coverage. Continuation Coverage shall automatically cease if (a) the Employer no longer offers group health coverage to any of its employees (b) the required premium for Continuation Coverage is not paid within 30 days of the date j due or within 45 days after the initial election of Continuation Coverage made pursuant to Section 11.07 (whichever is later), (c) an electing Qualified Beneficiary becomes covered under another group health plan other than a group health plan which may limit a Qualified Beneficiary's coverage because it involves a pre-existing condition, or (d) an electing Qualified Beneficiary becomes eligible to receive benefits under Medicare. IN WITNESS WHEREOF, the Employer has executed this Flexible Benefits Plan, Medical Care Expense Reimbursement Plan, and/or Dependent Care Expense Reimbursement Plan (as noted in the Adoption Agreement), the date and year first written below, to be effective as set forth in the Adoption Agreement. 22 VO AGES r4 a~~ lj~ I F r, r ' t ' ATTEST „ E 4Emplo er: By: t r Title: W Date: -T)15 L. s VO AGE SS r • . ry. - i I ONE" PLAN D6CUMENT CHECKLIST FOR EMPLOYERS 't • ~~'f1ZL's AccouN-r NAME AND AccouNr Nu, BER f • • J j i Please check the items listed below as they are completed and attach the white copy t9 the signed Plan Documents (see bottom of form for distribution instructions) and returt~w FLEX ONE®. (The checklist must be returned with the signed documents before they will he .assigned an -executed" status in our database.) O CANCELLATION - Employer has"decided not to implement the Plan at this time. Explanation for cancellation written below. E • fa SAMPLE FLEXIBLE BENEFITS PLAN. DOCUMENT - Containing the Adoption Agreement and Table of Contents. Each separate document is signed and (one copy) will be mailed to FLEX ONE® (in the postage-paid envelope provided) within two weeks after the effective date. SAMPLE CORPORATE RESOLUTION - Resolutions have been signed (if applicable); one copy will be mailed to FLEX ONE® along with the plan document and adoption agreement in the postage-paid envelope provided. Ell" SAMPLE SUMMARY PLAN DESCRIPTION - One copy has been sent to the Department of Labor in the self- addressed envelope provided, complete with Plan ]Identification Number (PIN). (This should be completed within 120 days after the plan becomes effective.) Employer has been made aware that a copy must be distributed to each eligible employee within 120 days of the effective date of the initial plan year and within 90 days of the effective date of coverage for. all subsequent plan years. 1,i/ 5500's AND SUMMARY ANNUAL REPORT - Employer has been made aware that accounts with more than 100 participants will be required to file a Form 5500 (with schedules) within seven months after the end of the plan year, and to distribute a summary Annual Report to plan participants within nine months after the close of the plan year. Employers with fewer than 100 participants need only file a Form 5500-C or 5500-R (with applicable schedules) and are not required to distribute summary Annual Reports if their plan is unfunded or fully insured • l~ONCE THE PLAN 1S IN OPERATION - This section is attached to the welcome letter and has been reviewed and left ` with the employer. EY/NON-DISCRINIINAT10N TESTING - Employer has been made aware that non-discrimination tests (including the Eligibility Test, the Contributions And Benefits Tests and the Concentration of Benefits Test) must be performed. In the case of a Full Plan, the employer has also been made aware that non-discrimination tests must be performed for each Flexible Spending Account. D' AFFILIATED COMPANIC - Employer has been made aware that 9, as described in 1RC section 414 (b), (c), or (m), . L, he is affiliated with any other company, there could be additional plan requirements dependent upon relationships with r these companies. f>ri' pf.AN IDENTIFICATION NUMBER INFORMATION (PIN) - The employer has been made aware that the Department of Labor (DOL) regulations require that welfare benefit plan sponsors assign athree-digit "Plan Number" to their wel- fare Mans (including Cafeteria plans) for identification pyrposes. Numbering for welfare plans should start at "501"`` and proceed consecutively. This number should be assigned to the Summary Plan Description pik to submission to the Department of Labor. , Questions g dds~checklist s Tye directed to FLEX ONE® (1-800-323-5391), option 1. AMC AssW - avr Form M-0392 Revised area Distribution Instructions: WHITE - FLEX ONE • YELLOW - Associate • PINK - Employer 44 PAGE SS' . VO 1 . i ' r tl • . r 1•• , w.. r.. . . et 1 / t t• y l t5 ' 'r • e 44 •:.~1. ~ T I XX Tn CONXISSIONM COQBT„~Z gi' ~:7u:tt E OF B BRUOS COUMTO Uns On this the 19TH day of December, 1994, the Commissioners Court of Brazos County, Texas, convened in Regular Session at the term of the Court, at the Brazos County Courthouse, in the City of Bryan, Texas, with the following members present, to-wit: R. J. Holmgreen, County Judge Gary Norton, County Commissioner, Precinct No. 1 Walter Wilcox, County Commissioner, Precinct No. 2 Randy Sims, County Commissioner, Precinct No. 3 Milton Turner, County Commissioner, Precinct No. 4 Among other proceedings held, the following proposed order was submitted: WHEREAS, The Honorable Claude D. Davis, Judge of the County Court at Law No. 1 of Brazos County, Texas, that on December 20TH, 21ST, 22ND, 27TH, 28TH, 29TH and 30TH, 1994 will be absent from the bench due to vacation time. WHEREAS, he has requested the appointment of James A. Amis to sit as Special Judge of the County Court at Law No. i of Brazos County, Texas when needed on the above mentioned dates in all matters that are, or may be, docketed on the Court's dockets for this day, and to have and exercise all powers of a Special Judge in relation to matters involved, it is, thereforet ORDERED, ADJUDGED AND DECREED, pursuant to authority of Article 30.03, Section 2, Code of Criminal Procedure, that James A. Amis, a former Judge of County Court at Law of Brazos County, Texas, to sit and hear all matters that are, or may be, docketed on any of the Court's dockets on the above-mentioned days and shall s R have and exercise all powers of such Special Judge in relation to f the matters involvedi VOL_ -PAGEZ574. • CA WHEREAS, the Court having considered the proposed order and deeming that it sould be approved; it is; therefore; ORDERED, ADJUDGED AND DECREED by,the Commissioners Court of Brazos County, Texas, that the order as submitted having been read, it was moved and seconded that same should be approved. Thereupon, the question being called for, the following members of the Court voted AYE: and the following voted NO: • u ■ i R. J HOLMGRIIEN County Judge i ' ATTEST: A i MARY WARD County Clerk Pursuant to Article 30.05, Code of Criminal Procedure, the Clerk entered in the minutes as a part of the proceedings a record showing that the oath of office prescribed by law as duly administered to James A. Amis as such Special Judge. W R. J LMGRE i COUNTY JUDGE ATTEST: i ~ + Y WARD ` i County Clerk ~ AGE sS 7 . vp