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<br />© 2019 Hitesman & Wold, P.A. MEDSURETY, LLC <br />Cafeteria Plan 1-888-816-4234, www.medsurety.com <br />Basic Plan Document <br />8 <br />ARTICLE IV. <br />CONTRIBUTIONS <br />4.1 Salary Reduction Contributions. To the extent the Participant’s cost of an Optional Benefit <br />exceeds the Employer Contribution (if any), a Participant may ele ct in accordance with the <br />Election procedures described in Article V to receive his or her full Compensation in cash, or to <br />have a portion of such Compensation applied by the Employer toward the Participant’s cost of <br />Optional Benefits. If so elected, the Participant’s Compensation will be reduced, and an amount <br />equal to the reduction shall be allocated by the Employer to the Optional Benefits designated by <br />the Participant. A Participant’s Compensation shall be reduced by pro-rata amounts of the <br />Participant’s total salary reduction Election. Salary reduction is done on a pre-tax basis before <br />any withholdings have been made. The frequency of salary reduction co ntributions shall be as <br />specified in the Adoption Agreement. Notwithstanding the forgoing, if participation in an <br />Optional Benefit extends to the last day of the month in which a Participant’s employment <br />terminates, if necessary, additional salary reduction contributions shall be taken from the <br />Participant’s final pay check to pay for the coverage provided during the period of time following <br />the date on which the Participant’s employment terminates. <br />4.2 Imputation of Income. To the extent a Participant participates in an Optional Benefit that <br />covers a Dependent who is not the Participant’s Spouse or Tax Dependent, the entire cost of <br />coverage for which the Participant is responsible shall be paid pre-tax through this Plan and the <br />fair market value of the coverage for that Dependent shall be imputed as income to the <br />Participant as the coverage is provided (pursuant to Cafeteria Plan Regulations). This provision <br />applies regardless of whether the cost of coverage is paid by salary reduction or allocation of <br />available Employer Contributions, if any. <br />4.3 Employer Contribution. The Employer may make a fixed dollar contribution per Plan Year, or <br />portion of the Plan Year (e.g., month, pay period), per Participant. The amount of the Employer <br />Contribution and any restrictions on the use thereof shall be identified in the Adoption Agreement <br />and communicated to the Participants prior to the start of each Plan Year so that they may <br />consider it in making their Elections. The annual Employer Contribution amount shall be prorate d <br />and made available in equal monthly installments except that any Employer Contribution <br />allocated to the Health Flexible Spending Account or Limited Scope Health Flexible Spending <br />Account shall be made available on the first day of the Plan Year (or the P articipant’s Entry Date <br />if later than the first day of the Plan Year). The amount of the Employer Contribution may <br />change from year to year as announced by the Employer prior to the Plan Year start and <br />reflected in the Adoption Agreement. Unless otherwise specified in the Adoption Agreement, no <br />Employer Contribution shall be credited to any Employee during a period of leave of absence, <br />whether authorized or unauthorized, unless required by the Family Medical Leave Act (“FMLA”), if <br />applicable. Unless otherwise specified in the Adoption Agreement, Employees who are not <br />eligible for participation on the first day of the Plan Year shall have their annual Employer <br />Contribution pro-rated by multiplying the annual available Employer Contribution by a fraction, <br />the numerator of which is the number of months the Employee is eligible for participation for the <br />Plan Year, the denominator which is twelve. <br />4.4 Maximum Under the Plan. Under no circumstances may a Participant’s total salary reduction <br />exceed the sum of (a) the cost of benefits paid on a pre-tax basis provided through insurance or <br />insurance types of benefits plus (b) the maximum Election amounts permitted under the <br />reimbursement-type Optional Benefits plus (c) the maximum Election permitted under the HSA <br />Contribution Feature (if applicable) minus (d) the Employer Contribution, if any. <br />4.5 No Trust. Nothing in this Plan is intended to require the establishment of a trust. Employer <br />Contributions made to this Plan remain the Employer’s general assets until used to pay benefits <br />or purchase coverage through the Plan. Participant contributions to the Plan including, but not <br />limited to, salary reduction contributions, are Plan assets. To the extent ERISA applies, such Plan