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© Hitesman & Wold, P.A. 2019 Cafeteria Plan Summary Description (3-11) 23 PART IV. DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT 4.1 What benefits are provided? The Plan permits you to elect to receive reimbursement for some or all of your work related dependent care expenses under the Dependent Care Flexible Spending Account ("Dependent Care FSA"). Under the Dependent Care FSA, you provide a source of pre-tax dollars by entering into a salary reduction arrangement with your Employer. You may also use any available Employer contributions. Those pre-tax dollars will be used to reimburse you for your eligible expenses. You save Social Security and income taxes on the amount of your salary reduction for dependent care expenses. NOTE: Participation in the Dependent Care FSA will impact your ability to receive the dependent care tax credit with respect to your federal income taxes. Additional information is provided below regarding this tax credit. 4.2 How do I become a Participant in the Dependent Care FSA? To become a Participant in the Dependent Care FSA, you must first become a Participant in the Cafeteria Plan. You must also satisfy the eligibility requirements for the Dependent Care FSA. The Dependent Care FSA’s eligibility requirements are the same as the eligibility requirements for the Cafeteria Plan as described in Section 1.4. If you satisfy those requirements, you become a Participant in the Dependent Care FSA by electing benefits under the Dependent Care FSA during your initial or subsequent annual enrollment periods. 4.3 What is my account? If you elect benefits under the Dependent Care FSA, an account will be established in your name to keep a record of the benefits to which you are entitled. When you complete the election form, you specify the amount of benefits you wish to receive. These benefits may be funded by allocation of any available Employer contribution and, to the extent the Employer contribution is insufficient, with pre-tax dollars through salary reduction contributions. A pro-rated portion of your election will be credited to your account according to the schedule described in Section 1.14. The amount that is available in your account at any particular time will be whatever has been credited to such account less any reimbursements. The account is a bookkeeping account only. The Employer pays benefits under the Dependent Care FSA from its general assets. There is no trust. 4.4 What are the maximum benefits I may receive? The maximum amount of benefits you may receive under the Dependent Care FSA is $5,000 per calendar year if you: (a) are married and file a joint return; (b) are married, but you furnish more than one-half the cost of maintaining those dependents for whom you are eligible to receive tax-free reimbursements under the Dependent Care FSA, your spouse maintains a separate residence for the last six (6) months of the calendar year, and you file a separate tax return; or (c) are single, or a head of household for tax purposes.