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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 />17 <br />an outside formal or informal arrangement under which the forfeited amounts are <br />allocated among Participants based (directly or indirectly) on their individual claims <br />experience under the Plan. This forfeiture requirement shall be applied separately for <br />each Optional Benefit and shall only apply with respect to Plan assets. <br />(b) Entities Not Subject to ERISA. Any amounts, whether obtained through salary <br />reduction, salary deduction, Employer Contributions, or otherwise, under this Plan which <br />cannot be distributed by the Plan Administrator to cover the cost of Optional Benefits for <br />the applicable Plan Year, shall be forfeited by the Participant. Forfeited amounts, in <br />accordance with the Cafeteria Plan Regulations, may be: (1) retained by the Employer, <br />(2) used to defray the reasonable administrative costs of the Plan, (3) used to reduce <br />required salary reduction amounts for the immediately following Plan Year on a <br />reasonable and uniform basis, and/or (4) returned to the Participants on a reasonable <br />and uniform basis. Under no circumstances shall the Plan Administrator establish an <br />outside formal or informal arrangement under which the forfeited amounts are allocated <br />among Participants based (directly or indirectly) on their individual claims experience <br />under the Plan. <br />5.8 Limitations on Benefits. Benefits shall be limited as determined by the Plan Administrator in <br />accordance with Section 6.16 for the purpose of ensuring compliance with any nondiscrimination <br />requirement applicable to the Plan or an Optional Benefit.