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© Hitesman & Wold, P.A. 2019 Cafeteria Plan Summary Description (3-11) 43 Example: If you become eligible to make HSA contributions on July 1st and you remain eligible through December 1st, you may begin making contributions to your HSA through this Plan on July 1st at a rate pursuant to which the full annual contribution will have been made by the end of the taxable year. Caution: The fact that you are participating in the HSA Contribution Feature does not necessarily mean you are eligible to contribute to an HSA. Other requirements apply. If you are ineligible for HSA contributions for reasons unknown to your Employer, your contributions under this HSA Contribution Feature may exceed the amount of contributions you are allowed to make to an HSA. You are responsible for determining whether you are eligible for HSA contributions and the limit on your contributions for any given year. Please contact your personal tax advisor for additional information. 6.6 What happens if my contributions exceed the contribution limit? If the contributions to your HSA exceed the applicable maximum contribution limit for a year, the excess contributions typically will be included in your income and an excise tax will be imposed upon them. You will also be taxed on any earnings earned on the excess amounts. However, you can avoid the excess tax if you take a distribution of the excess contributions (and the net income attributable to the excess contribution) before the last day (including extensions) for filing your federal income tax ret urn. 6.7 What are the tax consequences of the HSA Contribution Feature? The contributions made under this HSA Contribution Feature will not be included in your gross income, unless they exceed the applicable maximum contribution limit as discussed above. 6.8 What are the rules regarding distributions from my HSA? Your Employer has no control over or involvement with distributions made from your HSA. Your Employer does not substantiate expenses for which such distributions are made. Information regarding the procedure for obtaining distributions and the consequences of taking distributions is available from the trustee/custodian of your HSA. 6.9 When does my participation end? Participation in the HSA Contribution Feature ends upon the earlier of the date your part icipation in Plan ceases or the date you no longer satisfy the eligibility requirements described above. However, you need not be a participant in the HSA Contribution Feature (or be employed by the Employer) in order to obtain distributions from your HSA. In addition, you may make contributions to your HSA outside this Cafeteria Plan, provided you are eligible to do so under IRS rules, after you have left employment with the Employer or have ceased to be a participant in the Cafeteria Plan. NOTE: This HSA Contribution Feature is not a group health plan for purposes of the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (COBRA), the Family and Medical Leave Act (FMLA), and the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA). COBRA, FMLA, and USERRA do not apply to this HSA Contribution Feature. However, COBRA, FMLA, and USERRA may apply to the Qualifying High Deductible Health Plan. 6.10 Can the contributions made to my HSA be forfeited? No, once the contributions have been deposited in your HSA, you will have a nonforfeitable interest in the funds. You will be free to request a distribution of the funds or to move them to another provider of HSAs, to the extent allowed by law.