Plan Documents - Flex Systems® FlexSystem°
Article I: Table of Contents
Article I
Table Of Contents
Article VI
Elections
6.01
Available Benefits
Article II
Purpose
6.02
Election Maximum Amounts
2.01
Creation and Title
6.03
Failure to Elect
2.02
Effective Date
6.04
Effective Periods for Elections
2.03
Purpose
6.05
Change in Status Events
6.06
Non - Discrimination
Article III
Definitions
3.01
Change in Status Event
Article VII
Contributions
3.02
Code
7.01
Employer Contributions
3.03
Compensation
7.02
Employee Salary Reductions
3.04
Dependent
7.03
Administrative Fees
3.05
Effective Date
7.04
Increases or Decreases in
3.06
Eligible Employee
Premium
3.07
Employee
3.08
Employer
Article VIII
Records and Reports
3.09
Enrollment Communication
8.01
Responsibility
3.10
Participant
8.02
Records
3.11
Plan Year
8.03
Examination of Records
3.12
Qualified Benefits Plan
3.13
Spouse
Article IX
Plan Termination
9.01
Plan Termination
Article IV
Administration
9.02
Rights to Terminate
4.01
Employer's Duties
4.02
Information to be Provided to
Article X
Plan Construction
the Employer
10.01
Taxation
4.03
Interpreting Plan Terms
10.02
Adoption by Related
4.04
Misstatements
Organizations
4.05
Review Procedures
10.03
Uniform Exercise of Powers
4.06
Rules Apply Uniformly
10.04
Construction
4.07
Facility of Payment
10.05
Entire Document
4.08
Information to be Furnished
10.06
Severability
4.09
Medical Child Support Orders
10.07
Benefits Provided through
Third Parties
Article V
Eligibility and Participation
10.08
Rights Against the Employer
5.01
Eligibility Requirements
10.09
Successor - Businesses
5.02
Current Employees at the Time
of Plan Inception
Article XI
Plan Adoption and Schedule
5.03
New Employees
11.01
Employer Adoption
5.04
Re- Employment of Former
11.02
Plan Year
Employees
11.03
Effective Date
5.05
Becoming a Participant
11.04
Eligible Employee
5.06
Notification to Employees
11.05
Commencement of Participa-
5.07
Termination of Participation
tion
5.08
Family Medical Leave Act
11.06
Qualified Benefits Plans
5.09
Uniformed Services Employ-
ment & Reemployment Rights
Act(USERRA)
5.10
Layoff, Leave of Absences and
Sabbaticals
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Plan Document
Article II: Purpose
2.01 Creation and Title. The Employer adopts
this Cafeteria Plan as indicated by the
Employer signature in Article XI - 11.01, and
creates this Cafeteria Plan under the terms
and conditions set forth in this Plan Docu-
ment as well as through the Enrollment
Communications that are expressly incor-
porated by reference into this Plan Docu-
ment and described in Article XI - 11.06.
2.02 Effective Date. The original Effective Date of
this Cafeteria Plan and the Effective Date of
this Plan Document are identified on the
Plan Schedule, see Article XI.
2.03 Purpose. The Plan allows Participants to
elect between cash Compensation or certain
nontaxable Qualified Benefits Plans main-
tained by the Employer as identified on the
Plan Schedule, see Article XI. The Employer
intends that this Plan qualify as a Cafeteria
Plan under Section 125 of the Internal Rev-
enue Code. Notwithstanding any term in
this Plan Document, if any term is found
to be in conflict with federal or state law, the
term will automatically be amended to
comply with the federal or state law.
3.01 Change in Status Event. A Change in
Status Event allows a Participant to revoke
or change his/her pre -tax election during
the Plan Year, and outside of the scheduled
open Enrollment period. The Employer al-
lows all of the Change in Status Events
published by the IRS for this type of Plan
under 26 CFR 1.123 -4, as amended. A
Participant who becomes eligible under
the Health Insurance Portability & Account-
ability Act of 1996 ( "HIPAA ") for coverage
under an accident or health benefit offered
by the Employer will be allowed to make a
consistent election, or election change
under this Plan.
3.02 Code. The Internal Revenue Code of 1986,
as amended from time to time.
3.03 Compensation. All the earned income,
salary, wages and other earnings paid by the
Employer to a Participant during a Plan Year,
including any amounts contributed by the
Employer pursuant to a salary reduction
agreement which are not includable in gross
income under Sections 12S, 402(8)(3), 402(h),
403(6) or 457(b) of the Internal Revenue
Code.
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3.04 Dependent. For the purpose of the tax
advantages available under this Plan, a
Dependent is an individual who is a depen-
dent of a Participant within the meaning of
Section 152(a) of the Internal Revenue Code,
and any child of the Participant to whom
IRS Rev. Proc. 2008 -48 applies (regarding
certain children of divorced or separated
parents who receive more than half of their
support for the calendar year from one or
both parents and are in the custody of one
or both parents for more than half of the
calendar year). For the purposes of the tax
advantages available under Qualified Benefit
Plans that provide accident and health
benefits as defined under Sections 105 and
106 of the Code, a Dependent is determined
without regard to Subsections (b)(1), (b)(2),
and (d)(1)(B) thereof and includes any child
(as defined in Code § 152(f)(1)) of the Par-
ticipant who at the end of the taxable year
has not attained age 27.
3.05 Effective Date. The date specified in the
Plan Schedule, see Article XI, on which the
Plan was first effective, and the date that
this Plan Document is in effect.
3.06 Eligible Employee. An Employee who is
eligible to participate in the one or more
Qualified Benefits Plans sponsored by the
Employer, limited to Employees as defined
below who meet the additional require-
ments in the Plan Schedule, see Article XI,
and not including the following:
(a) Employees who are Non - Resident Aliens
(within the meaning of Section 7701(b)(1)(B)
of the Internal Revenue Code) who are de-
riving no earned income (within the mean
ing of Section 911(d)(2) of the Code) from
the Employer which constitutes income
from sources within the United States
(within the meaning of Section 861(a)(3) of
the Code); and,
(b) Employees who are self - employed indi-
viduals (as described in Section 401(c) of the
Internal Revenue Code) including sole pro-
prietors, partners in a partnership, or more
than 2% owners of subchapter "S" Corpora-
tions. This exclusion applies to the Spouse,
children, parents, and grandparents under
the Code Section 318 attribution rules.
An Eligible Employee will also meet any
additional conditions and terms as defined
in the Enrollment Communication.
If an Employee is not eligible Ito participate
in this Plan and allowed to participate under
any Qualified Benefits Plan, then the Em-
ployee cost will be paid with taxable in-
come, and the Compensation will not be
reduced by the Employer.
3.07 Employee. An Employee is a person who
is currently or hereafter employed by the
Employer, or by any other Employer aggre-
gated under Sections 414(b), (c), (m), (n), or
(o) of the Internal Revenue Code and the
regulations thereunder, including a leased
Employee subject to Section 414(n) of the
Code.
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3.08 Employer. The Employer adopting this
Plan under Article XI, and any affiliate or
subsidiary that, with the consent of the Em-
ployer becomes an Employer, by adopting
the Plan, or any successor business organi-
zation that assumes the obligations of the
Employer.
3.09 Enrollment Communication. The Employer
will provide a written Enrollment Commu-
nication at open Enrollment and during
the Plan Year for midyear enrollees. The
Enrollment Communication will provide
the specific process for Enrollment in the
Qualified Benefits Plans. The Enrollment
Communication is expressly incorporated
by reference into this Plan Document.
Enrolling in a Qualified Benefits Plan will
automatically enroll you in the Medical or
Medical - Related Premium Plan. There is no
separate Enrollment form for the Medical or
Medical - Related Premium Plan.
3.10 Participant. Any person who has been or is
an Eligible Employee and who qualifies to
participate and enrolls in a Qualified
Benefits Plan.
3.11 Plan Year. Commencing on the first day of
the Plan Year and each anniversary thereof,
except that the first Plan Year may include a
period of fewer than twelve (12) consecu-
tive months. The Plan Year is identified on
the Plan Schedule, see Article Xl.
3.12 Qualified Benefits Plan. Employer -spon-
sored plans that are allowed tax advantages
under this Plan pursuant to Section 125(f) of
the Internal Revenue Code.
3.13 Spouse. An individual who is legally mar-
ried to a Participant but is not separated
from a Participant or under a decree of legal
separation.
Article IV: Administration
4.01 Employer's Duties. In addition to any
rights, duties or powers specified in this
Plan Document, the Employer will have the
following rights, duties, and powers:
(a) to interpret the Plan, to determine the
amount, manner and time for payment of
any benefits under the Plan, and to construe
or remedy any ambiguities, inconsistencies
or omissions under the Plan;
(b) to adopt and apply any rules or proce-
dures to ensure the orderly and efficient 4.03
administration of the Plan, and from time to
time, amend or supplement such rules and
regulations;
(c) to determine the rights of any Partici-
pant, Spouse, or Dependent to benefits
under the Qualified Benefit Plans;
(d) to develop appellate and review pro-
cedures for any Participant, Spouse, or
Dependent denied benefits under the Plan;
(e) to maintain records it may require in
connection with the proper administration
of the Plan;
(f) to employ any agents, attorneys, accoun-
tants or other parties (who may also be
employed by the Employer) and to allocate
or delegate to them such powers or duties
as is necessary to assist in the proper and
efficient administration of the Plan, pro-
vided that such allocation or delegation and
the acceptance thereof is in writing;
(g) to correct any defect, supply any omis-
sion, or reconcile any inconsistency in the
Plan in such a manner and to such extent as
it shall be deemed expedient to administer
the Plan;
(h) to amend or terminate this Plan.
4.02 Information to be Provided to the Employ-
er. The Employer, or any of its agents, will
collect employment records of Participants
under the Plan. These records will include,
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but will not be limited to, any information
regarding period of employment, leaves of
absence, salary history, termination of
employment, or any other information the
Employer may need for the proper admin-
istration of the Plan. A Participant will fur-
nish the Employer the data the Employer
reasonably requests to ensure the proper
and efficient administration of the Plan,
with documentation for items such as proof
of relationship as needed.
Interpreting Plan Terms. Any interpretation
of any provision of this Plan made in good
faith by the Employer as to the terms of this
Plan is final and will be binding upon the
parties.
4.04 Misstatements. Any misstatement or other
mistake of fact will be corrected as soon as
reasonably possible upon notification to the
Employer and any adjustment or correction
attributable to such misstatement or
mistake of fact will be made by the Employ-
er as he considers equitable and practicable.
4.05 Review Procedures. An Employee or his/
her authorized representative can appeal
a decision made to deny Enrollment in a
Qualified Benefits Plan or a decision to disal-
low an election change by sending a written
request for an appeal to the Employer
within 60 days of the decision to deny
Enrollment or an election change. The ap
peal will be performed in a manner that
does not afford deference to the initial de-
termination and will be conducted by the
Employer or designee. A Participant can
request, free of charge, reasonable access to,
and copies of, all documents and records
relevant to the decision. Benefit appeals for
denied claims are addressed in the Qualified
Benefits Plan descriptions provided by the
Employer.
4.06 Rules Apply Uniformly. The Employer will
perform assigned duties in a reasonable
manner and on a nondiscriminatory basis,
and will apply uniform rules to all Partici-
pants similarly situated under the Plan.
4.07 Facility of Payment. whenever a Partici-
pant who is entitled to receive a benefit
under this Plan is under legal disability
or is incapacitated to be unable to manage
his/her financial affairs, the Employer may
make payments to the Participant's legal
representative, relative, or for the benefit
of such Participant in such manner as the
Employer considers advisable. Any such
payment of a benefit in accordance with
the provisions of this document shall be a
complete discharge of any liability for the
making of such payment under the provi-
sions of this Plan.
4.08 Information to be Furnished. Participants
shall provide the Employer with such in-
formation and evidence, and shall sign such
documents, as may be requested reasonably
from time to time for the purpose of admin-
istering the Plan.
4.09 Medical Child Support orders. The Em-
ployer will adhere to the terms of any judg-
ment, decree, or court order (including a
court's approval of a domestic relations
settlement agreement) which complies with
federal or applicable state law. The Employer
will comply with the administrative require-
ments described under 29 USC Sec. 1169
relating to Qualified Medical Child Support
Orders (QMCSO), including any federal
regulations or state laws relating to the
same. On the date coverage is provided
as directed by a QMCSO the Employee -par-
ent will become eligible to participate in
this Plan in order to pay his/her share of the
cost of the coverage on a pre -tax basis.
5.01 Eligibility Requirements. Each Employee
who enrolls in a Qualified Benefits Plan
must be eligible to participate in this Plan to
receive the tax advantages made available
under this Plan. The eligibility for this Plan
is set forth in the Plan Schedule, see Article XI.
5.02 Current Employees at the time of Plan
inception. At the time of Plan adoption, all
non - excluded Employees who meet the
eligibility requirements may participate.
5.03 New Employees. New Employees engaged
for employment after the Plan adoption,
who meet the eligibility requirements, may
participate in the Plan the next following
entry date as indicated in the Plan Schedule,
see Article Xi.
5.04 Re- employment of Former Employees. A
Participant whose employment terminates
and is subsequently re- employed within 30
days of his /her separation of service and
within the same Plan Year will immedi-
ately rejoin the Plan with the same Ben-
efit elections. Should the Participant return
within 30 days of his /her separation of ser-
OFlex5yst2m Plan Pocu;xent
vice during the following Plan Year, the Par-
ticipant will be allowed to change elections
through the Plan Enrollment process. A
Participant whose employment terminates
and who is subsequently re- employed with
more than 30 days separation of service will
need to re- satisfy Plan eligibility require-
ments to rejoin the Plan. Any unused re-
imbursement Benefits Account balance
prior to the initial separation of service date
will be forfeited.
5.05 Becoming a Participant. To become a Par-
ticipant, an Eligible Employee shall enroll in
a Qualified Benefits Plan by any application,
agreements, or process as may be required
by the Employer at the time of Enrollment.
The Enrollment Communication provided
by the Employer at the time of Enrollment
will define the process for becoming a
Participant. By completing the Enrollment
process, the Employee shall be deemed for
all purposes to have agreed to participate
and to conform to the Plan requirements.
An Employee, electing to participate in the
Plan, is choosing to participate for the entire
Plan Year. The annualized sum of salary
reduction benefit elections shall constitute
a current obligation of the Employee to
the Employer. Such obligation may be
revoked or changed only when the Em-
ployee has experienced and documents a
Change in Status Event, when the request is
consistent with the event, and notice is
provided to the Plan within 30 days.
5.06 Notification to Employees. The Employer
will communicate (in writing) to all Partici-
pants the terms and conditions of this Plan
through administrative communications
at the time of Enrollment and as needed
during the Plan Year. These communications
are expressly incorporated by reference into
this Plan Document.
5.07 Termination of Participation. A Participant
will automatically cease to be a Participant
on the earliest of the following dates:
(a) the date on which this Plan or any Quali-
fied Benefits Plan is terminated by the
Employer;
(b) the end of the Plan Year, unless the
Participant enrolls in a Qualified Benefits
Plan for the next Plan Year;
(c) the date on which the Participant fails
to pay any required premium (including
payment by salary reduction);
(d) when the Participant's employment
with Plan Sponsor is terminated this Plan
will terminate on the earlier of the day of
the termination or the day using the rule
stated in the SPD, whether termination
is initiated by the Participant or the Plan
Sponsor, however the Participants election
can continue to be used for one or more of
the Qualified Benefit Plans for the specified
period of time communicated in the SPD.
Participation under each Qualified Benefit
Plan is described in the materials provided
by the Employer; see Article XI Section 11.6
for a list of plans and literature available
from the Employer.
5.08 Family Medical Leave Act. The Family &
Medical Leave Act of 1993 (29 U.S.C. 2611)
as amended, is referred to as FMLA. FMLA
Leave will not be available to Employees for
Plan Years in which the Employer has 50
or fewer Employees as counted in that Act.
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For Plan Years in which the Employer has
more than 50 Employees, the Employer is
required to make FMLA Leave available to
Eligible Employees under circumstances
that are prescribed by applicable federal law,
including a period in which an Employee is
off due to the FMLA shall be treated in
accordance with the rules for a layoff or a
leave of absence and provided to the ex-
tent required by the FMLA (e.g., the Employ-
er will continue to pay its share of the
contribution to the extent the Participant
opts to continue coverage). If the Employer
is subject to the FMLA, a Participant may
revoke or continue an election through
the Plan upon commencement of the FMLA
Leave, whether such leave is paid or unpaid.
This provision applies in addition to any
other right to revoke and reelect benefits
under the Plan. Upon return from FMLA
Leave, a Participant may be reinstated to all
pre -leave elections.
5.09 Uniformed Services Employment & Reem
ployment Rights Act (USERRA). The Em-
ployer shall permit Participants to continue
benefits elections as required under the
Uniformed Services Employment & Reem-
ployment Rights Act and shall provide such
reinstatement rights as required by such
law.
5.10 Layoff, Leave of Absences, and Sabbaticals.
Continuation under the Plan may occur in
one of the following ways:
(a) In the case of a planned layoff, an
Employee may be able to pre -fund a Quali-
fied Benefits Plan through the end of the
planned leave or the end of the Plan Year.
(b) During the period which the Employee
is off and receiving a salary, the pre -tax
deductions may continue. If the Employee is
not receiving a salary, he /she may continue
to fund his /her election with after -tax dol-
lars while on leave. (Payment schedule to
be agreed upon between the Employer and
Employee prior to the commencement of
the leave.)
Article VI: Elections
6.01
Available Benefits. The Qualified Benefits
the Plan will be allowed to alter or discon-
Plans offered under this Plan are listed on
tine the Participant's benefits elections
the Plan Schedule; see Article XI. The option
during a Plan Year except when due to and
for an Employee to make after -tax contri-
consistent with a Change in Status Event.
butions for certain Qualified Benefits Plans
Enrollment requests must be made within
will be communicated by the Employer at
30 days of the Change in Status Event and
the time of Enrollment.
be consistent with the event. Notwithstand-
ing, an Employee can make a prospective
6.02
Election Maximum Amounts. Each Par-
change to a Health Savings Account (HSA)
ticipant shall elect any combination of the
election under this Plan during the Plan
benefits made available. No Participant
Year without having a Change in Status
may choose available benefits costing more
Event.
than the maximum amount, if any, as indi-
cated in the Qualified Benefits Plan. The
A Change in Status Event allows a Partici-
maximum election amounts will be in-
pant to change his/her contribution election
cluded in the Enrollment Communication
during the Plan Year, and outside of the
and the literature available for each Quali-
scheduled open Enrollment period. The
fied Benefits Plan.
Employer has elected to allow all of the
Change in Status Events published by the
6.03
Failure to Elect. A Participant failing to
IRS for this type of plan. An unpermitted
complete the Enrollment process on or
election change will cause the elected ben -
before the specified due date for the Plan
efit to be included in a Participant's gross in-
Year, or a midyear enrollee during the Plan
come and can disqualify the Plan from tax
Year, shall be deemed to have elected to
preferred status.
receive his full Compensation in cash. The
Employer will communicate any applicable
Upon the occurrence of a Change in Status
Enrollment deadlines in writing at the time
Event, the Participant will notify the
of Enrollment.
Employer within 30 days and complete the
forms provided by the Employer. The Em-
6.04
Effective Periods for Elections. The election
ployer can require additional documenta-
must be made by each Participant prior to
tion for evidence of the event. The new
the commencement of each Plan Year,
election will be effective prospectively and
and shall be irrevocable except as provided
will apply only to those benefits accruing to
for in a Change in Status Event that would
the Participant, the Participant's Spouse,
allow an election change. Participants may
or the Participant's Dependents after the
not carry over any unused contributions or
effective date of the election change. With
available benefits from one Plan Year to
respect to an election change under the spe-
a subsequent Plan Year unless the Plan
cial Enrollment period provisions of HIPAA,
Schedule indicates that the Plan has incor-
"timely submitted" will mean submitted no
porated the Grace Period. Further, Partici-
later than the last day of such special En-
pants may not use any contributions from
rollment period.
one Plan Year to purchase any available ben-
efits that will be provided in a subsequent
6.06 Non - Discrimination. The Plan is not
Plan Year,
intended to discriminate in favor of highly
compensated individuals or key Employees
6.05
Change in Status Events. No Participant in
as to eligibility to participate or contribu-
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tions and benefits as required by the Code.
The Employer may exclude or limit certain
highly compensated individuals from par-
ticipation in the Plan, in the Employer's
judgment, such actions serve to assure that
the Plan does not violate applicable nondis-
Article VII: Contributions
7.01 Employer Contributions. The Employer
will contribute out of its general assets the
amounts necessary to meet its obligations
under the Plan. Unless the Employer pro-
vides differently in the Enrollment Commu-
nication or separate Plan Documents for
the various Qualified Benefits Plans, there
are no segregated funds established to col-
lect or maintain the contributions. Contri-
butions to the Plan for any Plan Year will
be limited to the amounts necessary to pay
for the Qualified Benefits Plans elected by
the Participants.
The Employer may provide additional con-
tributions in the way of cash or spending
credits that can be used for any Quali-
fied Benefits Plan, or used in a limited man-
ner as defined by the Employer. The
Employer may make defined contributions
to specific Qualified Benefit Plans. The
Enrollment Communications will include
the amount of any Employer contribution,
the rules defining how the Employer con-
tributions can be used by the Participants,
and any limitations on the use of Employer
contributions. Employer contributions will
continue to be provided while on approved
FMLA Leave to the same extent provided to
an Employee actively at work.
7.02 Employee Salary Reductions. The Partici-
pant shall agree to reduce his/her Com-
pensation from the Employer by such
amounts as are necessary to provide for
those Qualified Benefits Plans which the
Participant has elected. "Employee" salary
reduction amounts are "Employer" contribu-
tions for purposes of Internal Revenue Code
Section 125 and its applicable regulations.
No Participant shall have, by virtue of the
Plan, any interest in any specific asset or
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crimination rules. The Employer can make
necessary adjustments to Employee contri-
butions during the Plan Year to assure that
the Plan passes the required discrimination
tests.
assets of the Employer. A Participant has
only an unsecured contractual right to
receive the benefits defined and limited by
the Qualified Benefits Plans.
7.03 Administrative Fees. The Employer may
charge the Employee reasonable cafeteria
plan administrative fees. If any administra-
tive fees are required, the Enrollment Com-
munication will include the amount of the
administrative fee and whether it is with
held from the Employee's salary reduction.
7.04 Increases or Decreases in Premium. The
Employer reserves the right to increase the
Participant's share of any Premiums and
decrease the Employer's share by a like
amount. The Employer will notify Partici-
pants prior to raising the Participant's
obligations. If the premium or required
contribution for any Qualified Benefits
Plan increases or decreases during the Plan
Year, a Participant's contributions will
increase or decrease automatically in
an amount sufficient to pay for such
increase or decrease. However, in the case of
an increase in premium, if a similar benefit
is offered under the Plan at the time of said
increase, the Participant may select such
similar benefit rather than pay the increase.
The Employer reserves the right to reduce
the Participant's share of any Premiums
and increase the Employer's share by a like
amount. The duration of this "Premium
Holiday" is at the Employer's discretion and
will be communicated by the Employer. As
this is considered to be temporary, Partici-
pants are not considered to have incurred
a Change in Status should the Employer
invoke this option.
WA
Article VIII: Records and Reports
8.01 Responsibility. The Employer shall exercise
authority and responsibility to comply with
the Plan relating to Participant records,
balances, and benefits payable under this
Plan. The Employer also shall be respon-
sible for all Plan reporting and disclosure
requirements.
8.02 Records. The Employer will process claims
and maintain Employer account records,
which shall record "deposits" and check
"balances" prior to each reimbursement.
An information report will be provided
periodically to Plan Participants showing
previous balances, deposits, payments,
reimbursements, and current balances.
8.03 Examination of Records. The Employer will
make each Participant's records under the
Plan available for his/her examination at
reasonable times and during normal busi-
ness hours.
i,
Article IX: Plan Termination
V
9.01 Plan Termination. The Plan or any portion
of the Plan shall be subject to termination
at any time by the Employer, provided how-
ever, that such termination shall not affect
any right or claim arising under the Plan
prior to termination. Any unclaimed funds
shall become payable as the Employer may
direct. Such direction may include, but not
be limited to a continuation of the Plan in
order to pay balances in accordance with
elected benefits.
9.02 Rights to Terminate. In accordance with
the procedures set forth in this section, the
Employer may terminate the Plan at any
time. In the event of a dissolution, merger
consolidation, or reorganization of the
Employer, the Plan shall terminate unless
the Plan is adopted and continued by a
successor to. the Employer in accordance
with the resolution of its Board of Directors.
FIN—
Article X: Plan Construction
10.01 Taxation. The Employer intends that this
Plan be in compliance with Section 12S of
the Internal Revenue Code, and therefore,
the Employer may deduct the amount paid
for the benefits provided from federal in-
come and employment taxes. This Plan has
not been submitted to the Internal Rev-
enue Service, and there is no assurance
that the intended tax benefit under this
Plan will be realized. Neither the Employer
nor its designated representatives makes
any commitment or guarantee that any
amounts elected or paid for the benefit of a
Participant will be excludable from the
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Participant's gross income for federal or
state income tax purposes, or that any other
federal or state tax treatment will apply
to or be available to any Participant. It shall
be the obligation of each Participant to
determine whether each payment is exclud-
able from the Participant's gross income for
federal and state income tax purposes, and
to notify the Employer if the Participant has
reason to believe that any such payment
is not so excludable. Any Participant, by
accepting a benefit under this Plan, agrees
to be liable for any tax penalties and inter-
est which may be imposed by the Internal
Revenue Service with respect to these
benefits.
10.02 Adoption by Related Organizations. Upon
the approval of the Employer, this Plan may
be adopted by any organization in affiliation
with the Employer. For the purpose of this
Plan affiliated organizations are described
in Section 414(b), (c) or (m) of the Internal
Revenue Code. The adopting organizations
shall execute and deliver to the Employer a
supplemental agreement providing for the
adoption of this Plan and such other docu-
ments as the Employer deems necessary or
desirable. The provisions of this Plan shall
be applicable to such organization to the
extent provided in the supplemental agree-
ment.
10.03 Uniform Exercise of Powers. In the exercise
of any of its powers, duties and discretion
under this Plan, and within the scope of its
authority, and in all of its acts, decisions,
and determinations hereunder, the Employ-
er shall at all times act in good faith and
in a non - discriminatory manner and shall
follow a consistent policy on comparable is-
sues. All Employer actions and determi-
nations shall be duly recorded. All such
records, together with such other docu-
ments as maybe necessary for the admin-
istration of this Plan, shall be preserved. De-
cisions regarding any Employer- disputed
questions relative to the rights of a Par-
ticipant hereunder and upon all matters
within the scope of its authority shall be
final and binding on all parries in interest.
10.04 Construction. No provision of this Plan
shall be construed to conflict with any
Treasury Department, Department of Labor,
or Internal Revenue Service Regulation, Rul-
ing, Release, or Proposed Regulation or
other order which affect, or could affect, the
terms of the Plan. This Plan will be in
compliance with any changes related to the
Internal Revenue Code. This 125 Plan is not
subject to the Employee Retirement Income
Security Act of 1974 (ERISA); however the
0 FiexSystem Plan Document
Qualified Benefits Plans offered by the Em-
ployer can be subject to ERISA. Refer to the
Qualified Benefits Plan for details.
10.05 Entire Document. This document, including
any appendices or supplements thereto,
shall constitute the entire and complete
document, and as such shall govem the
rights, liabilities and obligations of the Plan,
except as the Plan may be modified.
10.06 Severability. In the event any provisions
of this document shall be held illegal or
invalid for any reason by law or a court of
competent jurisdiction, said illegality or
invalidity shall not affect the remaining
provisions included herein either initially,
or beyond the date said provisions are first
held to be illegal or invalid, provided the
basic purposes hereof can be affected
through the remaining valid and legal provi-
sions.
10.07 Benefits Provided through Third Parties.
In the case of any benefit provided through
a third party, such as an insurance com-
pany, pursuant to a contract or policy with
such third party, if any conflict or inconsis-
tency exists between the description of
benefits contained in this Plan and such
contract or policy, then the terms of such
contract or policy shall control.
10.08 Rights Against the Employer. Neither the
establishment of the Plan, nor any modifica-
tion thereof, nor any distribution hereunder,
shall be construed as giving to any Partici-
pant or any person whomsoever any legal or
equitable rights against the Employer, its
shareholders, directors, or officers, as such,
or as giving any person the right to be
retained in the employ of the Employer.
10.09 Successor - Businesses. Unless this Plan be
sooner terminated, a successor to the busi-
ness of the Employer, by whatever form or
manner resulting, may continue this Plan by
appropriate supplemental agreement.
11.01
Article XI Plan Adoption and Schedule
Employer Adoption. By signing this Plan
Document, the Employer identified below
represents that it has formally adopted this
Cafeteria Plan.
11.02 Plan Year. The Plan Year is from
Jan 2011 to
,20.IH_.
There is a short Plan Year beginning
20 and ending
20
(if left blank, there is no short Plan Year.)
11.03 Effective Date. This Cafeteria Plan was
originally effective on
20 9. This Cafeteria Plan has been
created or restated by this Plan Document
effective o q L, 20 A5—.
11.04 Eligible Employee. An Employee who meets
the definition of an Eligible Employee, 3.06,
and the requirements in this part 11.04, can
enroll in this Plan by completing the process
outlined in the Enrollment Communica-
tions.
An Eligible Employee must be regularly
scheduled to work _(,� hours
per week in order to enroll in this Plan. Part -
time Employees working fewer hours are
not Eligible Employees.
® PlexSystem Plan Document
Description of Excluded Employees
Union. Employees who are included in the unit of
Employees covered by a collective bargaining agree-
ment between the Employer and Employee represen-
tatives, provided benefits were the subject of good
faith bargaining and two percent or less of the Em-
ployees of the Employer who are covered pursuant
to that agreement are professionals (as defined in
Treasury regulation Section 1.410(b) -9). For this pur-
pose, the term "Employee Representatives" does not
include any organization more than half of whose
members are Employees who are owners, officers, or
executives of the Employer.
_ Excluded
Eligible
Not applicable
Seasonal Employees regularly working less than
months within a year.
Excluded
Eligible
Not applicable
Employees under years of age.
Excluded
Eligible
Not applicable
11.05 Commencement of Participation. An Eli-
gible Employee can enroll in this Plan at the
annual open Enrollment period or upon
completion of the employment requirement
identified below:
No wait, on the date of hire
30 days after the date of hire
60 days after the date of hire
90 days after the date of hire
First of the month after the date of hire
First of the month after 30 days of con-
tinuous employment
First of the month after 60 days of con-
tinuous employment
First of the month after 90 days of con-
tinuous employment (not allowed for
plans that are new or renewing January
1, 2014)
Other
11.06 Qualified Benefits Plans. The Plan Docu-
ments and Summary Plan Descriptions
identified in the chart below are expressly
incorporated by reference into this Plan
Document and provide specific description
of each of the benefits available through the
plan, including the periods during which
the benefits are provided (the periods of
coverage if different from the Plan Year for
this Plan), and the Plan's rules governing
participation.
The following Plans are offered under this
Cafeteria Plan:
Check if offered
under this Plan: Qualified Benefits Plans
Available Plan Documents or Summary
Plan Description (SPD)
Medical or Medical - Related Premium for A Medical or Medical- Related Premium SPD
a group health plan. (This can include an will be provided by the Employer within 90
imbedded or standalone dental/vision plan.) days of Enrollment and upon request.
Health Savings Account (HSA)'
Non - Employer- Sponsored Premium Account
Plan for individual health plans (NESP).
Medical or Medical - Related Expense Reim-
bursement Benefit (Health FSA).
Dependent Care Benefit.
Supplemental insurance (Voluntary Indem-
nity Plans).
Disability Insurance Premium (Employee
Only) - Pre - taxing Employee contributions
will make benefits paid taxable compensa-
tion.
Voluntary/Group Term Life insurance "
NOTES
' A Participant is required to make an election
before the start of the Plan Year, or before the
first day of his/her coverage, showing the
amount contributed to an HSA tax free under
this Plan. A Participant will be able to change
his/her HSA election for any month in the Plan
® Flex$ystem Plan Document
Details will be provided in the Enrollment
Communication.
See Appendix A.
See Appendix B. A Medical or Medical- Relat-
ed Expense Reimbursement Benefit SPD will
be provided by the Employer within 90 days
of Enrollment and upon request.
See Appendix C.
Details will be provided in the Enrollment
Communication.
Details will be provided in the Enrollment
Communication.
Details will be provided in the Enrollment
Communication.
Year regardless of whether the Employee can
show a Change in Status Event.
"The cost of excess coverage as determined in
Table I, published by the IRS, a will be imputed
income. Excess coverage is any amount over a
$50,000 benefit.