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CAFETERIA PLAN <br />ADOPTION AGREEMENT FOR City of Orono <br />© 2020 Hitesman & Wold, P.A. MEDSURETY, LLC <br />Cafeteria Plan Adoption Agreement 1-888-816-4234, www.medsurety.com <br />6 <br />ACKNOWLEDGEMENTS <br />1. This Plan has been duly adopted or authorized to be adopted by the Employer’s Managing Body. <br />2. Portions of this Plan are intended to be a “covered entity” for purposes of the Health Insurance Portability and Accountability Act (HIPAA). <br /> <br /> EMPLOYER: City of Orono <br />Date: August 31, 2022 Signature: <br /> Print Name: <br /> Title: <br />