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CITY OF JEFFERSON
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CAFETERIA PLAN - SUMMARY PLAN DESCRIPTION
ELIGIBILITY (Q 1.)
CONTRIBUTIONS AND BENEFITS (Q 2. -Q 13.)
CONTINUATION OF MEDICAL COVERAGE (Q 14.)
DEPENDENT CARE ASSISTANCE PLAN (Q 15. -Q 25.)
k MEDICAL REIMBURSEMENT PLAN (Q 26. -Q 34.)
• ., PARTICIPANT RIGHTS (Q 35. -Q 36.)
^y '
ELIGIBILITY (Q 1.)
ss'
1. When am I eligible,le to join •he 1p an?
" Any permanent employee who customarily works at least 1500 hours per year is eligible to participate in the
Cafeteria Plan. .An employee will become a.participant in the plan on the later of(a)the effective date of the plan
or(b)the first day of the month following the date he or she becomes eligible to participate.
CONTRIBUTIONS AND BENEFITS (Q 2. - Q 13.)
2. What are the benefits available to me?
The City of Jefferson will make available to each Eligible Employee through the Cafeteria Plan
a Basic Benefits Package including:
(1) Basic Group Term Life Insurance(annual salary rounded up to the next even thousand dollars);
(2) Employee Health Insurance(provided by the Missouri Consolidated Health Care Plan);
(3) Employee Dental Insurance; and
ley
(4) Employee Vision Insurance.
The City of Jefferson will make an employer contribution on behalf of each Eligible Employee in the amount
of 200 per month which may be used by the emplo ee to purchase benefits through the Cafeteria Plan. Benefits
(1), (3)and (4) above will be provided at no coat. ach employee must select and purchase one of the health
insurance programs provided by the Missouri Consolidated Health Care Plan. If an employee fails to select a
health insurance plan,then the City of Jefferson will select a default plan for that employee.
If the cost of the selected health care plan is less than $200 per month, then the employee may, if he or she
wishes,use the remainder of the emplo er contribution to purchase additional benefits through the Cafeteria Plan.
"y If the total package of benefits selected by the employee is more than$200 per month,then the cost of the benefits
. in excess o $200 per month,known as the employee cost,will be paid by the employee through a salary redirection
agreement.
The employer contribution of$200 per month will be credited in the amount of$100 for each of the first two
regular payrolls in each month in which the employee is a participant in the Cafeteria Plan and receives
compensation. Theemployer contribute w of be treated as a portion of the full compensation due t
employee. A participant may choose to receive his or her full compensation for any plan year in cash or to have
a poreria of it applied toward the employee cost of the benefits which the employee has selected through the
CAFETERIA PLAN - SUMMARY PLAN DESCRIPTION - Page 1
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. .Z.N 1•? ' ` s$ yX".�' '�}'h,'6� �;Jy'. '"Yd 3 1 r .; �.*,, y, 'Y s?„p 4 t. , ��> � 4� :�N: 7 .�.��`�t '
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The optional benefits available through the Cafeteria Plan from which a participant may select are:
(1) Supplemental Group Term Life Insurance (up to double the volume of the Basic Life Insurance); +
(2) Optional Employee , Spouse, Children, or family Health Insurance;
(3) Dental Insurance for Spouse, Children, or family;
(4) Vision Insurance for Spouse, Children, or Family;
(5) Cancer Insurance for Spouse, Children, or Family;
:�,,
} ' (6) Hospital Intensive Care Insurance for Spouse, Children, or Family;
(7) Dependent Care Assistance Plan;
(8) Medical Reimbursement Plan.
t * Note: The IRS limits the total volume of Group Term Life Insurance which may be received tax-free to
$50 000. If the City of Jefferson provid
is eligibles a articipant with$20,000 of coverage,for example then that participant
^ � e to purchase upto an additional �40,00t�of coverage. However only the first$34,000 of supplemental
'
coverage an a purchased urchased tax-free. The remaining$10,000 of supplemental coverage must be purchased through t
a taxable deduction. d °
,y. The right is reserved for the Plan Administrator to terminate, suspend,withdraw or modify plan benefits in
6'. whole or in part at any time, subject to the applicable provisions of the insurance contracts providing benefits - k
( described above. Additionally,the insurance carrier may cancel insurance policies for underenrollment or non-
payment of premiums in certain circumstances. Any failure of insurance benefits, whether due to the City's
negligence,gross neglect or otherwise including but not limited to failure to enroll a participant or pay premiums, "' `fix"
. shall not result m any liability by tl e City to a participant. Your coverage shal terminate w en you leave x
?' employment,if you are no longer eligible under the terms of any insurance policies, or when insurance coverage
'w terminates,whichever happens first. `
Any benefits to be provided by insurance shall be provided only after(1) the participant has provided the Plan
Administrator the necessary information to apply for insurance, and (2) the insurance ;s in effect for such
participant.
3. Where can I obtain more information about the benefitg available,to me?
The City of Jefferson will provide separate information on the insurance benefits. The benefits of the Dependent
Care Assistance Plan and the Medical Reimbursement Plan will be explained later.
lP;
.; 4 Who makes contributions to the pan? '
fit
Technically,the City of Jefferson is the owner of the Cafeteria Plan and makes all contributions to the plan.
'. However, these contributions may be a combination of the employer contribution of$2100 per month plus an
Employee-Employer salary redirection agreement. Consider the following example.
r John Jones is an employee of the City of Jefferson and earns ,000 er month. He selects a benefits packaagge
which costs$350 per month. The City of Jefferson will pa the first$200 per month and Mr.Jones is responsible5
` for the remaining$150 per month. If he decides to enroll in the Cit of Jefferson Mt teria Plan he will elect to
' redirect$150 of his monthly salary,which will reduce his taxable salary to $1,850. The City of Jefferson,in turn, �{
will agree to ay the entire$350 per month to purchase Mr.Jones benefits package. The tax advantages of this
situation will become clear in Question 5.
If you select a benefits package which costs more than $200 per month and if you decide to participate in the
? Cafeteria Plan, you will have the option to enter into a compensation redirection agreement with the City of
Jefferson whereby you may irrevocably elect to redirect a portion of our compensation for the plan year, and have
this amount contributed by the City of Jefferson to provide benefits to you under these plans. once you have
signed the agreement,you will not be able to change the amount of salary redirected during the plan year unless 'a
you have a'change in family status." This is further explained in Question 12.
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CAFETERIA PLAN - SUMMARY PLAN DESCRIPTION - Page 2
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ti{-y,, �.. ct 11t: .. {i�. it+ t Y r y�1t`{t '�.: t'iS.n. F; t � r,3'r xti'•e.� i✓' 7 'aft �,! ,
) ,� �+ .u� k1 . �' {+A`i Xr3 r } a 1�•• `+'.1, i;.+ a +�- \i �s yr+'ti'
!r .� .,•., n i��^. .4' '�u4frst ti.) l�. .'ber viv,�:'t4'l �,..
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6. If I eleh++�••�.�•
This can best be shown by the following example:
John and Jane Jon s are married and have two children. John is 0111,P]o ee
` 32 000 per month, or 24,000 per year. John selects a benefits package wich of a City ofJefferson and earns
eerson will pay the first$200 er month and John is responsible for the remainin
decides to enroll in the City of Je#Ierson Cafeteria Plan, costs360 per month. The City of
'h g160 er month. John
his frill compensation into the plan to purchase his portion of tlise benefits package per month 01800 per,year)of
With the plan John is able to
Without the plan'John would have.y for his portion of the benefits package with dollars that are not taxed•
Plan is shown below. Pay with after-tax dollars. John's disposable income with and without a
With Without
Compensation Compensation
— Redirection — ---Redirection
Gross salary $24,000 $24,000
Pre-tax benefits package (1,800)
Taxable salary 2 200 24,000
Federal income tax ( 768 1,177
State income tax ( ) 1
{ Social security tax (1 862
698) 836
.; Salary after taxes 1$,827 26,136
�{ After-tax benefits package _—_-�(1,800)
DISPOSABLE INCOME $18,827 $18,335
NET SAVINGS WITH PLAN :x492
John Jones receives$492(18,827 minus l8 336)more per year in disposable income if he elects to purchase
portion of the benefits package through a 6afeteria Plan. P abe his
If I elect:to r_ eAir, rt my nTr,,,ahov�,do .s h,'
Selection of tax-free reimbursements under a Cafeteria Plan will normally result in your employer and yourself
making lower contributions to the federal social security system. This is likely to reduce your social spicurity
contributions and could reduce your benefits. The amount of any change in your social securit ben ill
depend on your social security employment history and the law and rules governing social security. efits �v""'
7
sation and havp;+flDDlied ntvarri+t,o ,. rte,_
a „ i on ton ?
Participant must specify which is the benefit e
C options he desires on the a ro Hate election form(s). These
forms should be provided to each participant approximately 30 days prior to the of each
plan year.
1LCan I r,�.direet?
Under the Dependent Care Assistance Plan and the Medical Reimbursement Plan,you determine
amount of your compensation redirection,subject to the limitations of the plans, the specific
For all the other optional benefit plans, the compensation redirection is equal to your share of the cost of each
optional benefit. The compensation redirection amount will be adjusted automatically in the event of a change
in your share of that coat. g
'�• Wha ie thA .tpfl.nt• .. 'for more of the
Each election form should be completed and returned to the Administrator before the b
(January 1)for which your election agreement will apply, beginning of the plan year
10 IfT
a.'._w narricin hen c an I el get one
e�.� ,d cnrtonal nay °..ruts?
The Administrator will provide you with the necessary election forms soon after you become elf 'ble to
`Participate, 'These forms must be completed and returned to the Administrator before the begins,rig of the firs
Pay period for which your agreement will apply, t
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CAFETERIA PLAN - SUMt4ARY PLAN DESCRIPTION - Page 3
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''�: �lY•3 t r�, 1+�^r r r�.. .i"(�t�tri'�� klarxaa
b,<
::. 11. .h»ADens if I fail to rP lrn a completed IPrtinn fnrn, � '12�d,Xllii1.
t6.trator by the dgg�jj�
If you do not submit an election form to the Administrator in the year in which you first become a participant
the City of Jefferson will provide you with the Basic Benefits Package described in Question 2, includul
:• :>�;-.:xti_
employee .,
p yee health insurance plan. You will be deemed to have elected to receive your full compensation g A default
In cash.
Ifyyou elect certain benefits in one plan year and if you do not submit an election form in subsequent
will be deemed to have elected to continuo all optional benefits that yyou elected
the benefits of the Medical Reimbursement Plan and the Dependent Care Assistance Plan.Plapreceding. ss you specifically
elect the benefits of the Medical Reimbursement Plan and the Dependent Care Assistance Ply except for
deemed to have elected cash compensation in lieu of these benefits, p
you will be
:)• 12 Can I Chang Qr revoke my Rlectiona nnr;na aho„ '
In general--no. However there is an exception for a change in family status. This includes change in marital
status,death of a spouse or child birth or adoption of a child,change of em loyment status of a spouse and other
events that the Administrator determines will gg
The IRS does not consider pregnancy or miscarprlagelto be a che�nge c famiony of an election during plan year,
effective at such time as the Administrator will prescribe, but not earlier than the first pay Period begginnin after
the election form is completed and returned to the Administrator. Chan gges mad y new election will be r�
' options must be on account of and consistent with the change in family status.
e In the Cafeteria Plan benefi
ne .o my jecti ms if I am no lo Weer eljgibl . .o narkic
n?
Elections made under this plan will automatically terminate on the date on which you cease to be a � t
in the plan.
� participant
—C_O_N_T_I—N—UA—T_I=O=N OF MEDICAL COVERAGE ��`��';a<:'3�r;;',i�s��, 'y�'• ',;
(Q 14.)
Health plan continuation
t n must be made available for a period not to exceed eighteen (18)months if a loss of
benefits occurs because of termination of em to
3" ears for the other reasons iven below. Howe ernin certain reduction circumstances this this contnuatioe cexceed ehree 3) rt t
yy
terminated as provided by fe eral law for reasons such as failure to pay continuation cover ( k
coverage under another employer's plan (whether as an employee or otherwise ig may be t "
plan,or the beneficiary,becomes entitled to Medicare benefits. The cost of continuation coverage eligibility for t a
b ), the City terminates its health
Y the individual choosing the same however,such cost may not exceed 102%of the cost of the same coverage for
a"similarly situated employee or family member. ge shall be borne +;I
(a) A Participant who would otherwise lose his or her health plan coverage under this plan because
termination of emplo ment or reduction in hours, ma continue the health covers a providecn
y y g suss of a
However, this will not be a tax-deductible expense to the employee, absent unusual circumstances under this Plan. ,
(b) Spouses of Participants may choose continuation coverage for themselves,if they lose group health cover
for any of the following reasons: r death of the spouse; (ii)termination of the s Ouse's employment {` {
other than gross misconduct)or reduction in the spouse's hours of em l0 p yment(for reasons :
from the spouse; or(iv)the spouse becomes eligible for Medicare. p went; (iii)divorce or legal separation
(c) Dependent children of Participants may choose continuation coverage for themselves, if they lose group
health coverage for any of the following reasons: (i)death of a parent;Sii)termination of the
(for reasons other than hh
or legal separation; 00 thespaarrent becomes ellgib eofor Medicarenor(v)the depn dent teas gent's a dependent
went
child under the lan. It is the Participant's responsibility o notify employment; (iii)parents' diorce
g es to be a dependent
separation or other than a in marital status, than a in a e Ouse's adds ss o lg des endent' le al `
under the lan,within s' g y g
i�cty(60)da a of the event. It is the Cpty s responsiblhy to notify the PlanpAdminietrator
of an employee's death,termination of employment or reduction in hours, or 1Vledicare eligibili 1�
If the Plan is extended by the City to provide benefits after retirement,continuation coverage hall be available
if the City undergoes reorganization under federal bankruptcy law.
;i.
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CAFETERIA PLAN - SUMMARY PLAN DESCRIPTION - Page 4�
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DEPENDENT CARE ASSISTANCE PLAN (Q 16.- Q 25.)
t,Y•4� .
Y ;, A 15. Who_n�lifiQs as a dependent?
A"Dependent"means any individual that is
(a) your dependent who is under the age of 13 and
with respect to whom you are entitled to a
federal income tax exemption, or
(b) your dependent or spouse who is,physically or F'
mentally incapable of caring for himself.
Whict►d n at up expenses can I be reimbursed for under this plan?
The dependent care services expenses must be incurred for care and well-being (not for education, food or
#' transpok-tation) and must be necessary for you to be gainfully employed.
` Expenses for dependent care services are covered by the plan if the services are performed either in your
' household or outside our household for(1)the care of a dependent as described above,or(2)the care of any other
.� ,:.
vim,;{` y
qualifying individual who spends at least 8 hours a day in your household,
If the expenses are incurred for services that are performed by a dependent care center(that is, a facility which
provides care for more than six individuals not residing at the facility and for which services it receives a fee,pay-
ment or grant regardless of whether the facility is operated for a profit) then the dependent care center must
?" s comply with WA applicable state and local laws and regulations.
Please refer to IRS Publication 503 for further details on qualifying expenses.
�'C 5
v 17. May payments made to a relative qualify as dependent child-care expenses?
Payments to your relatives or to members of your household are covered by the plan only if the person to whom 'k
the payments were made is not your dependent,your spouse, or your child who is under the age of 19.
18. VVhat is amount that I ran receive per ear in D ndent Care Assistance?
{.
The most you can receive under this plan is the lesser of:
(a) your earned income(less all redirection amounts);
(b) your spouse's earned income;
(c) the Dependent Care Assistance Maximum ($5000.00).
In the case of a spouse who is a full-time student at an educational institution or is physically or mentally
y
;f incapable of caring for himself,such spouse shall be deemed to have earned income of$200 per month if you have
one dependent and $400 per month if you have two or more dependents. The following example illustrates the
maximum amount you can receive for dependent care:
Sf.
,sl John and Jane Jones have two children. John earns$24,000 per year and Jane is a full-time student. The most
John can receive under this plan is the lesser of:
�k
(a) John's salary of$24,000(less all compensation reduction elections);
.S�
h: (b) Jane's income,which is deemed to be$4,800 since she is a full-time student and they have two "r
children($400 x 12 months);
(c) the Dependent Care Assistance Maximum($5000.00).
19. Haw will I be reimbursed for myded ..pendent care exnen�?
The amount of your compensation redirection for each pay period during the year will be credited to a
De endent Care Assistance Account on the books of the City of Jefferson. You will be reimbursed u to the
balance in that account for our dependent care e p
�;-• y expenses incurred during the year. You agree to notify the City
of Jefferson if you have reason to believe that any expense for which you receive reimbursement is not a qualifying
expense. You also agree to indemnify and reimburse the City of Jefferson on demand for an y liability it may incur
+J` for failure to withhold federal,state or local income tax.or Social Security tax from any reimbursement you receive
of a nonqualifying expense,up to the amount of additional tax and/or penalty you actually owe. '
CAFETERIA PLAN - SUMMARY PLAN DESCRIPTION - Page 5
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iStF t`?.y;.'•yr'x,> " .��' 3T,F{ i. ix. 41 t ,)f i s 4 {Sx s' }": j.. j y i,' +;„ {f
5' E '1: � cif fN°�1S.�t �', 3',i ,..r�.k i" 'b• � 1 'S
f
E,
'{: 20 Wh+� .forms mnAt I subrni in orciPr to be reim> urs fo�mv,.�xnense�
` You must submit the Dependent Care Claim Form to the City of Jefferson. The Claim Form will ask questions
like when the expense was incurred,how 'hit f billwho oce it for, to ts x her statements from t h provider
Care Claim Form must be accompanied by d
y: showing the charges and dates for services ren Bred. However,�o�� also re�a�n hie docu� •atxon
in case �-
`� �.;— the Internal Revenue Service sliould over request it.
Sometimes babysitters do not provide receipts or invoices for their services. If you pay for their eorvices,you x..
`} are entitled to a receipt. If your provider does not provide a receipt, make up your own and have your provider '
s?; sign that services listed were provided.
C
x Starting in 1989 'you must obtain, for your records, an IRS Form ill have(Dependent Caro Provider's
Identification and CertificatioThlsodc isnodependent
penalizee you Teri any way,but merely allows the IRthis traclt umncolme
each ear on your tax p
which the dependent care providers should be reporting. '
The City will reimburse you from our Dependent Care Assistance Account for le pendent care expenses
incurred during the plan ear for which you submit documentation. The City may, at i option, pay any
�s y
dependent care expenses directly to the dependent care service provider in lieu of reimbursing you.
`° na in my Dependent G Asis .Ance�ecaunt_atth,�f 1 ,€ '
fw,
No. The amount credited to your Dependent;Care Assistance Account for any plan year will be used only y for w $`
d �f d
c
reimburse you for dependent care expenses incurred during such plan year an only if you apply ^;
reimbursement on or before the 90th day following the close of the plan year. iy valance remainingg at a en xf nt
of a lan ear will not be carried over to reimburse you for dependent care expenses in a subse ue timat year.
-
jr'I' t ft.
You will forfeit all rights with respect to such balance. For this reason,it is prudent to careful y estimate your
s„t
expenses. r
_�'.� ^„�ri, +� rnvPr the reimbursement � �' a
'j iniaYJ200 e atan=Accou nt is nogn ^' > i The unreimbursed expense will be carried over until the balance in the account permits reimbursement. The
unreimbursed expense will not be carried to a subsequent plan year.
fit;?
der�Pndent ac re as8i8taI1�CE dllrin� `'''
t
This report will also
Yes the Administrator will furnish a report to each partici ant in October and January. Yf
.t�
cover ftie insurance and medical reimbursement portions of he plan. 4
i
ome
Your compensation reduction agreement will terminate. You may continue to file reimbursement requests unto
t �- the funds on deposit in your Dependent Care Assistance account are depleted.
tr# 26. What a�m�t t P federal income ta° ^rpdit for deT�endent care erns•
You may be able to take a tax credit for amounts are eamilair to those explained eaalier dependents. The rules
regarding eligible dependents and qualifying expenses
g The amount of credit r lesare ulma be ab el take will claim a c edit of 30°Io of yogross ependent cAare and expense other If your ~}
M � If yyour AGI is$10 0
AtxI is over$28,060,you may be able to claim a credit of 20%of your dependent care expenses. g
r,
Whether it is more advantageous for you to redirect your compensation to pay for child care expenses i take
the income tax credit will a end on your individual factsyyand circumstances. Generally speakingLif your
individual income or combined end both income and without aOCafeteia Plan to determine which is better71:�1for your,
<4•i you m wish to compute your taxes b `t
particular situation. +.
C'r f
.Q O
«. CAFETERIA PLAN — SUMMARY PLAN DESCRIPTION — Page 6 ,ns
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MEDICAL REIMBURSEMENT PLAN (Q 26. -Q 34.)
ou $I parti adpy have
The Medical Reimbursement Plan offers reimbursement for medical care expenses not reimbursed by
x.t insurance. For example,expenses,including co-pa ments,for annual physicals, eye exams, prescribed medicine,
hospital care, dental work, etc., can be reimbursed through the plan.
t ;;z4r 27, Mat medical eav .nses ify for reimbursement?
Medical
'•�ts�� expenses incurred for you,your spouse or dependents that qualify for reimbursement are as follows:
�t.
u (a) Amounts incurred for diagnosis,cure mitigation treatment, or prevention of disease, or for the '
::;. purpose of affecting any structure or function of the body;
y (b) Expenses for prescribed drugs or insulin.
t
All of the above are c�ualifyin medical care expenses,but only to the extent that you or other persons incurrin
the expense are not reimburse for the expense through insurance or otherwise. These are the same o
expenses which you could normally deduct on your federal income tax return(assuming g you had met the minimum .
:' ;, percentage of
adjusted gross income limitation).Insurance premiums are ineligible for this category of the s
;.t cafeteria plan.
Please refer to IRS Publication 502 for further details on qualifying expenses.
t. 2S. at is the mamum amount+�,he I �n r 1v er year in Medical Care Reimbursements?�
The most you can receive under this plan is the lesser of
r,
x (a) your earned income (less all redirection amounts); or 'r
(b) the Medical Reimbursement Maximum($5000.00).
29. How will I be reimbursed for my medical expenses?
The amount of your compensation redirection for each pay period during the year will be credited to a Medical
Reimbursement Account on the books of the City of Jefferson. You will be reimbursed,up to the annual available i
' ty !'
�; a=q balance in that account,for our qualifying medical care expenses incurred during the year. You agree to notify
the City of Jefferson if you Piave reason to believe that any expense for which you have received reimbursement
is not a qualifying expense. You also a ee to indemnify and reimburse the City of Jefferson on demand for any '
F.:; y
t;_', . liability it may incur for failure to wi hold federal, state or local income tax or Social Security tax from any
reimbursement you receive of a nonqualifying expense,up to the amount of the additional tax and/or penalty you
actually owe. :
F 30, Vaiat forms must I submit in order to be reimbursed for my expenses?
.,< You must submit the Medical Expense Claim Form to the City. The Claim Form will ask questions like when
k"f the a Kpense was incurred,how much it was who was it for b whom was the service provided etc. The Medical
:. Ys: :
Expense Claim Form must be accom spied by copies of bills,invoices,receipts or other statements showing the
xP p ..z
.{, charges and dates for services rendered. However,you must also retain this documentation in case the Internal
Revenue Service should ever request it.
The City will reimburse you from your Medical Care Reimbursement Account for medical care expenses
incurred during the plan year for which you submit documentation. The City may, at its option, pay any such
medical care expenses directly to the person providing or supplying medical care in lieu of reimbursing you.
31. When are expenses incurred?
Expenses are considered to be incurred when services are provided,not when the bill is received or when
payment is made. ,
' Reimbursement Account at the end of the
plan year,
t
No. The amount credited to your Medical Reimbursement Account for any plan year will be used only to . p
reimburse you for medical care expenses incurred during such plan year,and only if you apply for reimbursement
on or before the 90th day following the close of the plan year. Any balance remaining at the end of a plan year will
CAFETERIA PLAN - SUMMARY PLAN DESCRIPTION - Page 7
�' R'('T�^ �* { '°•'i,,.s{� 1 siyy�� ; t��°r� ,t d A 1 r 1 t 1�a.•�`� t F �. ru�- t a }
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.,i. r .,� A�,�yGL;',�',+ x v�;tr{fs4?+l: .:t 1�. Z -1 r1 �.,,r .+ .. ..t n•Yy �,�Y { .'htr}.1 .a � ,{t� �. �.rr , 't .'�. t ^'��. �.�t':�1P�t'.
not be carried over to reimburse you for medical care expenses in a subsequent plan year. You will forfeit all rights
y with respect to such balance. For this reason,it is prudent to estimate your expenses carefully.
33. Gtlt�nt if the halence in my Medical lteimb era �n�n Ac o]n is 11D, .no h to cover . e-reiW urseme
".' You will be reimbursed for the total amount of qualifying expenses claimed up to your annual election amount.
Your Medical Reimbursement Plan contributions will continue thru the end of the lan year to fund these f
reimbursements. Your reimbursement may not at any time exceed your annual election. ,
fa
�,{,:..
Your participation in the Medical Reimbursement Plan will cease and no further salary redirection
contributions will be contributed on your behalf. However, you will be a11e to submit claims for health care
expenses incurred prior to your date of termination, up to the amount of your annual election.
PARTICIPANT RIGHTS (Q 35. -Q 36.)
0 35. How do I claim my rights and r this plan,?,
4.
If you believe you are being denied any ri hts or benefits under the Clan,you may file a claim in writing with
the Administrator, If any such claim is wholly or parti�elly denied,the dministrator will notify you of its decision r ''
i in writing. Such notification will be written in a manner calculated to be understood by you and will contain the r$"' N .,. •.
F;> following:
1 '%A
a Specific reasons for the denial
b Specific reference to pertinent plan provisions '
c A description of any additional material or information necessary for you to perfect such claim and
explanation of why such material or information is necessary
(d) Information as to the steps to be taken if you wish to submit a request for review. °" tv
Such notification will be given within 90 days after the claim is received by the Administrator(or within 180
,try, days,if special circumstances require an extension of time for processing the claim and if written notice of such
extension and circumstances is given to you within the initial 90-day riod). If such notification
within such period,the claim will be considered denied as of the last da of such period and a request t a
review of your claim. y p y y i,
Within 60 days after the date on which you receive a written notice of a denied claim(or,if applicable within fP
60 days after the date on which such denial is considered to have occurred), you (or your duly authorized
representative)may
c (a) file a written request with the Administrator for a review of your denied claim and of pertinent
documents, and
(b) submit written issues and comments to the Administrator.
The Administrator will notify
to be understood b �'you of its decision in writing. Such notification will be written in a manner calcu-
lated
y you and will contain specific reasons for the decision as well as specific references to
` pertinent plan provisions. The decision on review will be made within 60 days after the request for review is
received by the Administrator (or within 120 days, if special circumstances require an extension of time for u='�
processing the request, such as an election by the Administrator to hold a hearing and if written notice of such
��� extension and circumstances is given to you within the initia160-day period). If the decision on review is not made
within such period,the claim will be considered denied.
36. What are my rights under the, lam?
' As a participant in the Medical Reimbursement Plan you are entitled to certain rights and protections under
the Employee Retirement Income Security Act of 1974 (hRISA). ERISA provides that all plan participants shall
be entitled to:
5 "Examine without charge,at the Plan Administrator's office and at other specified locations, such as worksites
and union halls,all plan documents,including insurance contracts collective bargaining agreements and copies
of all documents filed by the plan with the U. S. Department of Labor. Such documents would include detailed
annual reports and plan descriptions. However,you may not inspect materials containing confidential information
on other plan participants.
Obtain collies of all non-confidential plan documents and otherplan information upon written request to the
Plan Administrator. The Administrator may make a reasonable charge for the copies,
CAFETERIA PLAN — SUMMARY PLAN DESCRIPTION — Page 8 a
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'�.PrX`."�i. s %!: r "i' �. �t vF •ss.«. 'f, i t 'Ij.� 1r 1t��13+��.`�� i ( ��6 'i; M< § l
2*ax 426.
In addition to creating rights for plan participants,ERISA imposes duties upon the people who are responsible
for the o eration of the employee benefit plan.The people who operate your plan,called "fiduciaries"of the plan,
have a duty to do so prudently and in the interest of you and other plan participants and beneficiaries. No one,
including your employer your union, or any other person,may fire you or otherwise discriminate against you in
any way to prevent you f=rom obtaining a welfare benefit or exercismg your rights under ERIS& If our claim for
a welfare benefit is denied in whole or in partyou must receive a written explanation of the reason for the denial.
You have the right to have the plan reviewed and reconsider your claim.
Under ERISA,there are steps ou can take to enforce the above rights. For instance, if you request materials
from the plan and do not receive Zem within 30 days,you may file suit in a federal court. In such a case,the court
may require the plan administrator to provide the materials and pay you up to $100 a day until you receive the
materials,unless the materials were not sent because of reasons beyond the control of the Administrator.
If you have a claim for benefits which is denied or ignored in whole or in part,you may file suit in a state or
federal court. If it should happen that plan fiduciaries misuse the plan's money,or if you are discriminated against.
for asserting your rights,y_ou may seek assistance from the U. S. Department of Labor, or you may file suit in a
federal court The court vn decide who should pay court costs and legal fees.If you are successful,the court may
order the person you have sued to pay these costs and fees.
If you lose,the court may order you to pay these costs and fees for example,if it finds your claim is frivolous.
If you have any questions about your plan,you should contact the flan Administrator. If you have any uestions
about this statement or about your rights under ERISA,you should contact the nearest Area Office of the U.S.
Labor Management Services Administration,Department of Labor."
,E
a CAFETERIA PLAN — SUMMARY PLAN DESCRIPTION — Page 9
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1
7 J{ r
City of Jefferson
320 S . McCarty
Jefferson City MO 65101
(44-6000193)
i
* *
• * *
* CAFETERIA PLAN
* *
*
* DOCUMENTS
*
*
1 . - Plan Document
2 . - Dependent Care Assistance Plan
3 . - Medical Reimbursement Plan
4 . - Summary Plan Description
5 . - Claim Form & Log
r
01/01/95
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ARTICLE I - INTRODUCTION
1 . 1 . Purpose of Plan. The purpose of this Plan is to pro-
. ,;, . vide employees of City of Jefferson a choice between cash and
certain Benefits maintained by City of Jefferson. A complete }.
list of these Benefits is given in Section 4 . 1 of this document .
1 .2 . Cafeteria plan status . This Plan is intended to quali-
fy as a "cafeteria plan" under section 125 of the Internal Reve-
nue Code of 1986, as amended; and is to be interpreted in a man-
ner consistent with the requirements of section 125 .
Np
Y..J'
.ARTICLE II - DEFINITIONS
�1 Wherever used herein, the following terms have the following a$
meanings unless a different meaning is clearly required by the zr,
context:
2 . 1 . "Administrator" means the Company or such other person ' ` h ;•
or committee as may be appointed from time to time by the Company
t to supervise the administration of the Plan. k
S+
2 .2 . "Benefit" means each of the optional benefit choices
available to a Participant as listed in Section ' 4 . 1.
2 .3 . "Code" means the Internal Revenue Code of 1986 , as a.
amended from time to time. Reference to any section or subset-
` tion of the Code includes reference to any comparable or succeed-
` s" ing provisions of any legislation which amends, supplements or
replaces such section or subsection.
stir, 2 .4 . "Company" means City of Jefferson, of the State of
Missouri .
h';f
2 .5 . "Compensation" means the total cash remuneration re-
ceived by the Participant from the Company during a Plan Year rr
prior to any reductions pursuant to a salary redirection agree- +.
`3 ment (compensation reduction agreement) authorized hereunder.
2 .6 . "Effective Date" means 01/01/95 .
2 .7 . "Employee" means any individual employed by the Company
or by any other entity which is treated, along with the Company,
as a single employer, in accordance with the provisions of Sec-
tion 414 (b) , (c) or (m) of the Code.
2 .8. "Insurance Benefit" means any benefit option in Section a;
a' 4 . 1 guaranteed by an Insurance Contract. These might include
group term life insurance and/or health insurance.
a
2 .9 . "Insurance Contract" means any contract issued by any
insurance company that underwrites a Benefit under this Plan.
2. 10 . "Key Employee" means any person who is a key employee
as defined in section 416(1) ( 1) of the Code.
CAFETERIA PLAN DOCUMENT - Page 2
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1
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rn;.
i
2 , 11. "Participant" means any eligible Employee who elects to
participate in the Plan in accordance with Article III .
r
X.
2 . 12 .
"Plan" means the City of Jefferson Cafeteria Plan as set forth herein, together with any and all amendments and supple-
ments hereto.
r 2 . 13 . "Plan Year" means the period beginning on the Effective
Date and ending on December 31, and the 12-month period ending on
each December 31 thereafter.
2 . 14 . "Reimbursement Benefit" means any benefit option in
;y Section 4 . 1 for which a separate account is maintained for each
Participant for the purpose of the reimbursement of eligible
expenses incurred by that Participant. These might include depen-
dent care assistance and/or medical reimbursements .
A pronoun or adjective in the masculine gender includes the
feminine gender, and the singular includes the plural, unless the
°s context clearly indicates otherwise.
h •ARTICLE III - PARTICIPATION f
. 3 . 1 . Eligibility. Each permanent Employee whose customary
employment, excluding overtime work, is at least 1,500 hours per
year will be eligible to participate in the Plan on the first day
.3 t df the month following employment and enrollment in the Plan.
d� 3
%
3 .2 . Participation Date.
The Participation Date is the
later of (a) the Effective Date or (b) the first day of the month
following the date on which an Employee becomes eligible to par-
ticipate under Section 3 . 1 . If an Employee will have had fewer
than 30 days in which to decide whether to participate in the '
y` Plan, he may request an extension of an additional 30 days. An
Employee who chooses not to become a Participant on his Participa-
tion Date must wait until the next Plan Year.
3. 3 . Cessation of participation. A Participant will cease
to be a Participant as of the earlier of (a) the date on which
the Plan terminates or (b) the date on which he ceases to be an
;.
Employee eligible to participate under Section 3. 1.
3.4 . Reinstatement of former Participant. A former Partici-
pant will become a Participant again if and when he meets the
eligibility requirements of Section 3. 1 .
3.5 Employer Contribution.
able to each participant an Employer eContributionaequal ktoav200 II
per month, funded at $100 per pay period for each of the first
t' two regular pay periods of each month during the Plan Year. This
$200 is available only if the employee elects coverage under one
f of the Employer sponsored health plans. Any remaining funds in
excess of the insurance cost, up to $200, may be used to purchase `
h , other benefits available
Pursuant to Section 4 . 1. The Employer
.1
CAFETERIA PLAN DOCUMENT - Page 3
i
1 l
{ t
V
1
'.p! r'. 1.'' .°.. ikti +.. _r..>, S I ` !: tr .c.ars•4,ay-•..:
1
c4rip `-
.x �nx {n ,d '�`<� A��?;sf.s47,�N}. S}tl t,ct / yy} t r�-}q� Ser�k +y }`�"sf•�'
contribution is not considered as part of the employee' s full
compensation and is not available to the employee as cash.
-} 3 . 5 Salary Redirection. Each Participant may elect to have
his salary reduced pursuant to a Salary Redirection Agreement.
Such Salary Redirection Agreement must be executed during the
applicable Election Period. The amount of the Salary Redirection
a Participant may elect for each Plan Year shall be subject to
the limits as stated in Article IV of the respective documents .
These contributions shall be converted to Cafeteria Plan Benefit
Dollars and allocated to the funds or accounts established under
the Plan pursuant to the Participants ' elections made under Arti-
cle IV.
ARTICLE IV - OPTIONAL BENEFITS
4 . 1. Benefit options . A Participant may choose under this
Plan to receive his full compensation for any Plan Year in cash
or to have a portion of it applied by the Company toward the cost
of one or more of the following optional benefits :
Health/Dental/Vision Insurance Plans r
£N
Medical Reimbursement Plan
Dependent Care Assistance Plan
Group Term Life Insurance. Plan `
' 4 .2 . Description of benefits other than cash. While the
election to receive one or more of the optional benefits listed ^
a in Section 4 . 1 may be made under this Plan, the benefits will be
provided not by this Plan but by the Insurance Contract(s) guaran-
: 7 teeing the Insurance Benefit(s) , the Dependent Care Assistance r;
y Plan and/or the Medical Reimbursement Plan. The types and
amounts of benefits available under each option described in
Section 4 . 1, the requirements for participating in such option, ;
and the other terms and conditions of coverage and benefits under
such option are as set forth from time to time in the Insurance
Contract(s) , the Dependent Care Assistance Plan Document, and/or
r the Medical Reimbursement Plan Document. The benefit descrip-
tions in such plans and contracts, as in effect from time to
ZE time, are hereby incorporated by reference into this Plan. a
4.3. Election of optional benefits in lieu of cash. A Partic-
"' i ant may elect under this Plan to receive one or more of the
..., p y
4 optional benefits listed in Section 4 . 1 in accordance with the
procedure described in Section 4 .4 . Any remaining employer con-
tributions may be used to purchase these benefits . If employer
contributions are insufficient, then the Participant's cash com-
pensation will be reduced, and an amount equal to the reduction
will be credited by the Company to the options as elected in
Section 4 . 1.
4.4 . Election procedure. Approximately 30 days prior to the
r commencement of each Plan Year, the Administrator shall provide
one or more written election forms and compensation reduction
agreements to each Participant and to each other Employee who is
expected to become a Participant at the beginning of the Plan
CAFETERIA PLAN DOCUMENT - Page 4 .�
^+y � '�..rj�+ 'jj.,y'S;C 'vrjl �i„"{jie.�'��f-'`tt,�s�,>,��h�.y*��5��'hr.�'i�`�` M�•'�' ��2f'*` 7
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t
I
Year. The election forms shall be effective as of the first day
of the Plan Year. Each Participant who desires one or more op-
tional benefit coverages listed in Section 4 . 1 for the Plan Year
shall. so .specify on the appropriate election form or forms and
shall agree to a reduction in his compensation for the amount of
the election in excess of the employer contributions . The amount
of the reduction in the Participant 's compensation for the Plan
Year for each optional Insurance Benefit that is elected by the h
' Participant shall equal the Participant 's share of the cost of '
such optional benefit, and shall be adjusted automatically in the
event of a change in such cost. The amount, if any, of the reduc-
tion in the Participant' s compensation for the Plan Year for each
optional Reimbursement Benefit shall be the amount elected by the
4i Participant, less any employer contributions, subject to the w
limitations of the Dependent Care Assistance Plan and the Medical
Reimbursement Plan. Existing Participants in the Plan must com-
plete and return their election forms to the Administrator on or '
' before such date as the Administrator shall specify, which date
shall in no event be later than the beginning of the Plan Year to
5,s
'. which the election relates . New Participants in the Plan must
y=4.
complete and return their election forms to the Administrator onr4k:. .
or before such date as the Administrator shall specify,
�. P Y. which
y, date shall be no later than the beginning of the first pay period `" f N
for which the Participant' s compensation reduction agreement will � �;P{
apply• '" •t;r
As soon as practicable before an
4 . 5 . New Participants .
Employee becomes a Participant under Section 3 . 1 or 3 4 the
,. Administrator shall provide the written election forms and compen-
sation reduction agreements described in Section 4 .4 to the Em- g�
k ployee. If the Employee desires one or more optional benefit
4 � coverages listed in Section 4 . 1 for the balance of the Plan Year,
he shall so specify on the election forms and shall agree to a ,
reduction in his compensation as provided in Section 4 .4 . The
election forms must be completed and returned to the Administra-
tor on or before such date as the Administrator shall specify, ; '
which date shall be no later than the beginning of the first pay ,
period for which the Participant's compensation reduction agree-
_ ments will apply.
4 . 6 . Failure to elect. A Participant failing to return a
s completed election form 'to the Administrator on or before the
r3 specified due date for the initial Plan Year of the Plan, or for
the Plan Year in which he became a Participant, shall be deemed
to have elected to receive his full compensation in cash. A
' Participant failing to return a completed election form to the
Administrator relating to an optional Insurance Benefit listed in t•
Section 4 . 1 on or before the specified due date for any subse-
quent Plan Year shall be deemed to have made the same election as f!
was in effect as to such optional benefits just prior to the end
of the preceding Plan Year. The Participant shall also be deemed
„,•. to have agreed to a reduction in his compensation as specified in
Section 4 .4 for the subsequent Plan Year equal to the Partici-
pant's share of the cost (less employer contributions) from time
� + to time during such Plan Year of each such optional benefit he is
deemed to have elected for such Plan Year. A Participant failing
CAF"ETERIA PLAN DOCUMENT - Page 5
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u 6Yt� 1.S Jsr�3lr�'?y4i <J JT'��'tl Y y f J' i: Iil A t .} 12.11} ' fr k 2 �.. t.i J. i t .i,,.�:.•7r,�,i 5l � }^��'".i�" 7` k
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t,•` !."�% ir (^)r r>C 7.{ i4>, �3 +`'f J2 { S1 � . .. f t o r 4 {..�7 �j{' 1 f�i tj}'�ht
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q'$.• S� J�3� E Y? 'x1 r 1 �,� .$�X,u�j yli d.t:r�;a�,+ t Fi<,�'i>t k`t�. �kt ;.�', tH. t
17
t ¢}!' k' s TYz,•: tFi tccaxr •� � r * J trL e z
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t' S� ,:`t[��h i• i n'�:s tc;'��'},� r��f r:>• f'ab nx is Y . Ea i {ri�r i tai'
r ®. sj•" �+�ffil
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i
loom lim
, .. -
m _5L
to return a completed election form to the Administrator relating
to an optional Reimbursement Benefit listed in Section 4 . 1 on or
before the specified due date for any subsequent Plan Year shall
be deemed to have elected cash compensation in lieu of such op-
g, ti.onal benefit, regardless of the election in effect during the
preceding Plan Year.
4 . 7 . Changes by Administrator. if the Administrator deter-
:4A mines, before or during any Plan Year, that the Plan may fail to
satisfy for such Plan Year any nondiscrimination requirement
imposed by the Code or any limitation on benefits provided to Key
Employees, the Administrator shall take such action as the Admin-
istrator deems appropriate, under rules uniformly applicable to
similarly situated participants, to assure compliance with such
requirement or limitation. Such action may include, without
limitation, a modification of elections by highly compensated
Employees or Key Employees with or without the consent of such
Employees .
4. 8 . Irrevocability of election by the Participant during
the Plan Year. Elections made under the Plan (or deemed to be
made under Section 4 . 6) shall be irrevocable by the Participant
during the Plan Year, subject to a change in family status . A
Participant may revoke a benefit election for the balance of a
Plan Year and- file a new election only if both the revocation and
the new election are on account of and consistent with a change
in family status . A change in family status for this purpose
includes changes in marital status , death of a spouse or child,
birth or adoption of a child, change in employment . of,.a F;po11r_,C
and such other events that the Administrator determines will
permit a change or revocation of an election during a Plan Year
under regulations and rulings of the Internal Revenue Service.
Decreases in the Unreimbursed Medical portion of the Cafeteria
Plan shall be limited to those required due only to the death of
a spouse or dependent, changes in marital status or if required
due to your taking a leave without pay (LWOP) from your job. Any
new election under this Section 4 . 8 shall be effective at such
time as the Administrator shall prescribe, but not earlier than
the first pay period beginning after the election form is complet-
ed and returned to the Administrator.
4 . 9. Automatic termination of election. Elections made
under this Plan (or deemed to be made under Section 4 . 6) shall
automatically terminate on the date on which the Participant
ceases to be a Participant in the Plan, although coverage or
benefits under the optional benefit plans listed in Section 4 . 1
may continue if and to the extent provided by such Plans .
t.
4 . 10. Maximum contributions . The maximum amount of contribu-
tions under the Plan for any Participant shall be the sum of (a)
the maximum amounts which the Participant may receive in the form
of dependent care assistance under the Dependent Care Assistance
Plan and as medical reimbursements under the Medical Reimburse-
ment Plan, as set forth in such Plans, and (b) the costs from
time to time of the most expensive benefits available to the
CAFETERIA PLAN DOCUMENT Page 6
MH
_vf
nhn.�o-.t..
*� ` ��"��f'Y� ry�K�"y'y`'� '�km�Y,,.;' ' ��+��G r.� �r`.e".,f.; .�� ,,F T�<a.`� �.�,. t•r M �z,
4t.
Participant under the Insurance Benefits (including the portion
of such costs payable with nonelective Company contributions) .
ARTICLE V - ADMINISTRATION OF PLAN
5. 1. Plan Administrator. The administration of the Plan .
shall be under the supervision of the Administrator. It shall be ,
a principal duty of the Administrator to see that the Plan is
carried out, in accordance with its terms, for the exclusive
benefit of persons entitled to participate in the Plan without
discrimination among them. The Administrator will have full
power to administer the Plan in all of its details, subject to
applicable requirements of law. For this purpose, the Administra-
tor's powers will include, but will not be limited to, the follow-
ing authority, in addition to all other powers provided by this
Plan:
(a) To make and enforce such rules and regulations as t . '
} it deems necessary or proper for the efficient '
>`
administration of the Plan, including the 4
establishment of any claims procedures that may
be required by applicable provisions of the law.
(b) To appoint such agents, counsel, accountants,
consultants and other persons as may be required
to assist in administering the Plan; and rzol ol
Si.
(c) To allocate and delegate its responsibilities under
the Plan and to designate other persons to carry
out any of its responsibilities under the Plan,
any such allocation, delegation or designation to ;.
f be in writing.
Notwithstanding the foregoing, any claim which arises under the
optional benefit plans as listed in Section 4 . 1 shall not be
subject to review under this Plan, and the Administrator' s author-
' ` ity under this Section 5. 1 shall not extend to any matter as to
which an administrator under any such other plan is empowered to
make determinations under such plan.
�s.
5.2 . Examination of records. The Administrator will make
available to each Participant such of his records under the Plan ,
a� 'pert'ain to him, for examination at reasonable times during
'J normal business hours .
5.3. Reliance on tables, etc. In administering the Plan,
the Administrator will be entitled to the extent permitted by law
to rely conclusively on all tables, valuations, certificates ,
opinions and reports which are furnished by, or in accordance
with the instructions of, the administrators of the optional
benefit plans as listed in Section 4 . 1, or by accountants, coun-
, ,f sel or other experts employed or engaged by the Administrator.
5.4 . Nondiscriminatory exercise of authority_. Whenever, in
CAFETERIA PLAN DOCUMENT - Page 7
r
, r
Y
t t
,t hr., a .i+. '.'; ,ti' ..,{`� .Ir s 'S M�} t,�Y'�' +Y�� !�R4� � ..r�i.x'+45"!Pr • +f�3"k rt'vj"!'l7� , ,•�.1 5. "sµ. y t Y.
-l` +.` . ..w:,i' ..J t . k,. ;j• r .}a 5+i •t t. ',}.'� r�k,.`�� C Wjif' 'tJf.
Y �"^�4�?�'Tdn Qp ty Y,S'N,x'{ll,y�r,� c �y.3^c�i�k'r+��:._tf�i'�j XF�:.m•,'P�'.r_}`?z• "n�15K)�`' -�"�`:s,:� tai-t5,y{S,, �Y+n.�r'��,� C.fi .h T ,a
iwyd•. .� L+ �y� �5 c,. .,r �:kc�I�;u,'� +*'F'�yr�1.:p`}��..�t .`t,jj f• _„l:, i tyt�'�t*•s7'j �'a'i'�• i
} e* the administration of the Plan, any discretionary action by the
Administrator is required, the Administrator shall exercise its
,;,.. authority in a nondiscriminatory manner so that all persons simi-
larly situated will receive substantially the same treatment.
5. 5 . Indemnification of Administrator. The Company agrees
<;< to indemnify and to defend to the fullest extent permitted by law
t}AI
',.. any Employee serving as the Administrator_ or as a member of a
1j,-': l
_ 'W committee designated as Administrator (including any Employee or
former Employee who formerly served as Administrator or as a
member of such committee) against all liabilities, damages, costs
and expenses ( including attorneys ' fees and amounts paid in set-
tlement of any claims approved by the Company) occasioned by any
1 act or omission to act in connection with the Plan, if such act }
or omission is in good faith.
ARTICLE VI - INSURANCE ,
,rr••� y
sy7f, 6 . 1 . ,
- ; Responsibility for implementing Plan. Once an Employee
A:YIY.�I.I• is eligible to be a Participant,9 pant, it shall be the Participant's
responsibility to apply to any insurance carrier for any insur-
ance contemplated by the Plan. sl
6 .2, Limit on obligation to obtain coverage. Upon the fail-
ure ok either the Participant or the Company to obtain the insur-
ance contemplated by the Plan (whether as a result of circumstanc-
' ;#q es, negligence, gross neglect, or otherwise) , the Participant' s
benefit shall be limited to the insurance premium, if any, unpaid
P
, .� for the period in question and the actual insurance proceeds, if t
rany, received by the Company or the Participant as a result of
the Participant's claim. t
6 .3. Receipt of benefit by Company. The Company' s liability
to the Participant shall only extend to and shall be limited to
any payment actually .received by the Company from the insurance fit”
company. In the event that the full insurance benefit contemplat-
ed is not promptly received by the Com p an within a reasonable
time after submission of a claim, then the Company shall notify
the Participant of such facts and the Company shall no longer
have any legal obligation whatsoever (except to execute any docu- ,
ment called for by a settlement reached by the Participant) . The
Participant shall be free to settle, compromise or refuse to
pursue the claim as the Participant, in his sole discretion,
shall see fit.
h;X •
6.4. Limit on duty to maintain policies. The Company shall
not be liable for any loss or obligation with respect to any
insurance coverage. Such limitation shall include, but not be
x limited to, losses or obligations which pertain to the following:
rr
(a) Once insurance is applied for or obtained, the Company
shall not be liable for any loss which may result from
the failure to pay premiums to the extent premium
notices are not received by the Company.
CAFETERIA PLAN DOCUMENT - Page 8
'.�"'"�: . ' `� :. .'�iai i^rt,;�i i r�Po[«),`.`+ iii•S�;d�'r'J 1 rq`f`�S'.".:'�>.t �y��� D
i r r a r)�•,,. r 7.1t •a e i z`xr� ..�f}i�S�S �i+'�i + ,�`�r .ai .�.
tiy' f
f(� •1 k. ���^i F+i 11 k 1
{�'L.+M.t
r �
''` �k '$ yi5•V :A,
{, `�`��.
�4x +; f�'YJtt►axw,:.._,...,.C,x... .na_. _ ...,,,.,...x..e...,.u.dt4t.. X' i aw .a �,wkb .�4 .s hr+,a.:�k+ " _. 'r ._ ,.:,.1,.w:..+ .s,..,..' ..
}
(b) To the extent premium notices are received by the
Company, the Company' s liability for the payment of
h,xal w such premiums shall be limited to the amount of such
premiums and shall not include liability for any other
loss which may result from failure to pay such premiums.
(c) The Company shall not be liable for the payment of any
insurance premium or any loss which may result from the
failure to pay an insurance premium if the benefits
available under this Plan are insufficient to
provide for the amount of such premium cost at the time
it is duel In such circumstances the Participant shall
. be responsible for and to see to the payment of such
premiums . The Company shall undertake to notify a
Participant if available benefits under this Plan
+" r are insufficient to provide for an insurance premium
�t but shall not be liable for any failure to make such
n notification.
d Upon termination of employment by a Participant, the
Company shall have no liability to take any step to
maintain any policy in force. The Company shall not be
liable for or responsible to see to the payment of any :arfr
premium after termination of employment.
f z'
6 .5 . Selection of beneficiaries . In the case of any insur-
ance policy which permits or requires the naming of a beneficia-
a` ry, it shall be the responsibility of the Participant to see that
at, r&
, ,,; ,#.:r°� this is done. The Company shall not be liable for any loss or
.: w >� cost which may result from such failure. The Company' s responsi-
' ; bility shall be limited to joining in the execution of any docu-
ments as requested by a Participant or insurance carrier in order
' to carry out the purposes of this Plan.
6 . 6 . Master insurance agreement controls . A Participant
shall not be eligible for an insured benefit under this Plan
rf
until the insurance contemplated by this Plan is actually ob-
tained. In the event of a conflict between the terms of this
Plan and the terms of the olio of a particular insurance compa-
ny, j
policy
e=
=,•k; if any, whose product is then being used in conjunction with
this Plan, the terms of the insurance policy master agreement .
'.•ra 4s
shall control as to those Participants receiving coverage under
such master agreement in defining the persons eligible for insur- �
ance, the dates of their eligibility, the conditions which must
be satisfied to become insured, if any, and the benefits and
circumstances under which insurance terminates .
`y!
ARTICLE VII - HEALTH PLAN CONTINUATION COVERAGE (COBRA)
7 . 1 . General requirements on continuation coverage. Pursuant
to the Consolidated Omnibus Budget. Reconciliation Act (COBRA) , if
the Company had twenty (20) or more Employees on a typical busi-
ness day during the preceding calendar year, the Company is re-
quired to make available continuation coverage, at group rates,
CAFETERIA PLAN DOCUMENT - Page 9
N-7)(,��
tu'�etrMN- ,N
d )t: •erva E�rpp a'tu�'+Y'i�'3�rG;�.y•4" h;rt��p. �i a.. Y#'�+�, 5`�, ,+,,
.}}'4th .r,x � litF;, �1fY• 4���..t�� I ,a fi fi
,•{ -�. .,.r i}d{F`i!' sn'y,i6y�frC� t}ii, ? }:
rr'.e c
W x .�s
u
{.�.LS 'e ,3I.Y1'tha
't .:.t. {�a ..:ta'• ,qh n,rak
{r if a Participant loses group health coverage because of reduction
in hours of employment or the termination of their employment
( for reasons other than gross misconduct on their part) . To
determine the twenty (20) Employee test, Employees of all employ-
ers
in a controlled group or affiliated service group are count
ed. Spouses of Employees covered by such plans have the right to
choose continuation coverage for themselves if they lose grou
health coverage for any of the following four reasons: (i) Death
of the spouse; (ii) Termination of the spouse' s employment ( for 4
reasons other than gross misconduct) or reduction in the spouse 's {'
hours of employment; t
(iii) Divorce or legal separation from the
, < spouse; or (iv) the spouse becomes eligible for Medicare. Depen-
dent children of a covered Employee have the right to continua-
tion coverage if group health coverage under the plan is lost for 4
" } any of the following reasons: (i) Death of a parent; (ii) Termi-
nation of a parent' s employment (for reasons other than gross
ltd': - ,
misconduct) or reduction of a parent's hours of employment with s
+'u the covered employer; (iii) Parents ' divorce or legal separation; r. F '��
( iv) A parent becomes eligible for Medicare; or (v) the dependent �.
ceases to be a dependent child under the Plan. ';';;':
If the Plan is extended b the employer to
Y provide benefits
....: ,t•,F, ayt::
after retirement continuation coverage shall be available if the •�t, ,�
{ Company undergoes reorganization under federal bankruptcy law.
Notification requirements. When the Plan is notified r:
that one o€ the events described in e
5 ction 7 . 1 has happened, it
will in turn notify the covered person(s). of the right to choose
continuation coverage. The law allows at least sixty (60) days
from the date you would lose coverage because of one of the
events described above to inform -the Plan Administrator that you
want continuation coverage. The Employee or a family member has
<' the responsibility to inform the Plan of a divorce, legal separa-
tion,: ;y
Y tion, or a child losing dependent status under the plan, within
<' sixty ( 60) days of that event. The Company has a responsibility
to notify the Plan of the Employee's death, termination of employ-
ment or reduction in hours, or Medicare eligibility. If, covered .
' individuals change their marital status, or their spouses have
changed addresses, they should notify the Plan Administrator. i
7 . 3 . Cost of continuation coverage. Any person electing r
continuation coverage may be required to bear the cost of such "t
J
coverage; however, the cost of coverage may not exceed 102 of ,$
the cost of the Plan for "similarly situated" Employees or family
members .
coverage
7 .4 . Termination of continuation . The right to
r:
continuation coverage shall continue for eighteen ( 18) months for
a a Participant who has lost coverage because of termination
employment or reduction of hours . Spouses or dependents who
f
y+i would otherwise lose coverage because of any of the events listed
in Section 7 . 1 above, may continue coverage for a period
" (3) years. However, this continuation coverage may beterminated,
as provided by federal law, for reasons such as failure to pay
continuation coverage cost, eligibility for coverage under anoth-
er employer's
plan (whether as an Employee y ee o r otherwise) , this
CAFETERIA PLAN DOCUMENT - Page 10 n
sa
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Company terminates its health plan, or the beneficiary becomes
entitled to Medicare benefits.
ARTICLE VIII - AMENDMENT OR TERMINATION OF PLAN
The Plan may at any time be amended or terminated by a writ-
ten instrument signed by the County commissioner.
ARTICLE IX - MISCELLANEOUS PROVISIONS
9. 1 . Information to be furnished. Participants shall pro-
vide the Company and Administrator with such information and
evidence, and shall sign such documents, as may reasonably be
requested from time to time for the purpose of administration of
the Plan.
'9.2 . Limitation of r 2hts. Neither the establishment of the
Plan nor any amendment thereof, nor the payment of any benefits,
will be construed as giving to any Participant or other person
any legal or equitable right against the Company or Administra-
tor, except as provided herein.
9. 3 . Governingilaw. This Plan shall be construed, adminis-
tered and enforced according to the laws of the County of Boone
in the State of Misf3ouri.
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CAFETERIA PLAN DOCUMENT - Page it
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ARTICLE I - INTRODUCTION
This Plan is intended to qualify as a dependent care assis-
tance program under section 129 of the Internal Revenue Code of
1986, as amended, and is to be interpreted in a manner consistent
with the requirements of section 129 . The purpose of the Plan is
to enable Participants to elect to receive payments or reimburse-
ments of their dependent care expenses that are excludable from y
f
the Participants ' gross income under section 129 of the Code.
i
ARTICLE II - DEFINITIONS
?k Wherever used herein, the following terms have the following s�
meanings unless a different meaning is clearly required by the
context: �a
2 . 1 . "Administrator" means the Company or such other person ?,
or committee as may be appointed from time to time by the Company
to supervise the administration of the Plan.
1. 2 .2 . "Cafeteria Plan" means the City of Jefferson Cafeteria
Plan, effective 01/01/95, as amended from time to time.
< 2 .3. "Code" means the. Internal Revenue Code of 1986, as
amended from time to time. Reference to any section or subsec-
tion of the Code includes reference to any comparable or succeed-
', r`•. ing provisions of any legislation which amends, supplements or
replaces such section or subsection. :K
' 2 .4 . "Company" means City of Jefferson, of the State of
Missouri.?
2.5. "Compensation" means the total cash remuneration re-
ceived by the Participant from the Company during a Plan Year
prior to any reductions pursuant to a salary redirection agree-
4
ment (compensation reduction agreement) authorized hereunder. S
2.6 . "Dependent" means an individual who is
y (a) a dependent
of the Participant who is under the age of 13 and with respect to
{
whom the Participant is entitled to an exemption under section
151(c) of the Code, or (b) a dependent or spouse of the Partici-
pant who is physically or mentally incapable of caring for him-
self.
2 .7. "Dependent- Care Assistance Account" means the account
described. in Article V hereof.
' 2 .8. "Dependent Care Expenses" mean expenses incurred by a
ii Participant which (a) are incurred for the care of a Dependent of
1 .the Participant or for related household services, (b) are paid
or payable to a Dependent Care Service Provider, and (c) are
incurred to enable the Participant to be gainfully employed for
any period for which there are one or more Dependents with re-
spect to the Participant. "Dependent Care Expenses" shall not
CAFETERIA PLAN - DEPENDENT CARE ASSISTANCE PLAN - Page 2
{
1
.� }� 7� � 1: . ''/ 4 t:5 '9Yr 1. .i S. ;} •, Sur•. ,1LLii b ''1 x 1. t ,y, � }. f:g v Y i� V�iijid {'�"sr1 f'�i, r•r';us
..;,� ��. ,i}'�rp,'fi,�� �`�.. '?#1•,.�my�. '6kky'$ti n'M1..MnY.'o i.,�,++N�jyS,� ! 4i' r�.r kt4t "� ",t 2t'6�•' x fR';lr�EdJ. .j1�rrk F�eaw#c.a' .'0'• _
".% x'•yrU: {>.} �?,'y.����"' ;.pt xn.i ri�'� t+ , r�1i ' """{�z� rk'.,' �, �.
include expenses incurred for services outside the Participant's
household for the care of a Dependent unless such Dependent is
described in Section 2 . 6 (a) or regularly spends at least 8 hours
,t each day in the Participant's household. Dependent Care Expenses
shall be deemed to be incurred at the time the services to which
the related expenses are rendered.
2 . 9 . "Dependent Care Service Provider" means a person who
provides care or other services described in Section 2 . 7 (a)
above, but shall not include (a) a dependent care center (as {
defined in section 21 (b) (2) (D) of the Code) , unless the require-
ments of Code section 21(b) (2) (C) are satisfied, or (b) a related
individual described in section 129 (c) of the Code.
2 . 10 . "Effective Date" means 01/01/95 .
,a
2 . 11 . "Employee" means any individual employed by the Company
or by any other entity which is treated, along with the Company, '
as a single employer, in accordance with the provisions of sec- a
tion 414 (b) , (c) , or (m) of the Code.
t.;
i 2 . 12 . "Participant" means each Employee who participates in
i the Plan in accordance with Article III . ,
2 . 13 . "Plan" means the City of Jefferson Dependent Care Assis-
tance Plan as set forth herein, together with any and all amend- >;
ments and supplements hereto.
P
2 . 14 . "Plan Year" means the period beginning on the Effective
Date and ending on December 31, and the 12-month period ending on r,
each December 31, thereafter. �_<{
A pronoun or adjective in the masculine gender includes the
feminine gender, and the singular includes the plural, unless the :f
context clearly indicates otherwise.
ARTICLE III - PARTICIPATION
3 . 1 . Eligibility. Each permanent Employee whose customary
employment, excluding overtime work, is at least 1,500 hours per z#
year will be eligible to participate in the Plan after no initial
waiting. period.
3. 2 . Participation Date. The Participation Date is the
later of (a) the Effective Date or (b) the first day of the month �
following the date on which the Employee becomes eligible to
? participate under the preceding sentence. If an Employee will
have had fewer than 30 days in which to decide whether to partici-
pate in the Plan, he may request the Participation Date be extend.-
ed one time for an additional 30 days. The Employee must com-
plete an election under the City of Jefferson Cafeteria Plan to
receive Dependent Care Assistance under this Plan. An Employee y
who chooses not to become a Participant on his Participation Date. ,
must wait until the next Plan Year.
CAFETERIA PLAN - DEPENDENT CARE ASSISTANCE PLAN - Page 3
; vS ' E4u'
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L
�� i. .; i '��s.:` r ,.+ � ,e .t;'x -:t,. tc f.��f lt��kG'�e 7��� f 7�•u.4 d.t. �t•Si t i {?�%,cs�r...�,
3 . 3 . Cessation of participation. A Participant will cease
to be a Participant as of the earliest of (a) the date on which
the Plan terminates or (b) the date on which his election to
} receive Dependent Care Assistance expires or is terminated under
} the City of Jefferson Cafeteria Plan.
3 . 4 . Reinstatement of former Participant . . If a former Par-
ticipant who is eligible under Section 3 . 1 elects again under the
µari City of Jefferson Cafeteria Plan to receive Dependent Care Assis-
tance under this Plan he will again become a Participant in this
Plan on the effective date of such election.
, r
ARTICLE IV - ELECTION TO RECEIVE DEPENDENT CARE ASSISTANCE
h4T1 4 . 1 . Election procedure. A Participant may elect to receive
Dependent Care Assistance under. this Plan by filing an election '
and compensation reduction agreement in accordance with the prose- ,a$, :y
dures established under the City of Jefferson Cafeteria Plan. An
'' election to receive Dependent Care Assistance shall be irrevoca-
ble during the Plan Year, subject to a change in family status,
as provided in the City of Jefferson Cafeteria Plan.
4 .2 Maximum dependent care assistance. The maximum amount � t
'ft which the Participant may receive in any taxable year in the form
of dependent care assistance under this Plan shall be the least zss.t
'. of (a) the Participant's earned income for the taxable year (af-
ter all reductions in compensation) (b) the actual or deemed
,} earned income of the Participant' s spouse for the taxable year, .
jx or (c) $5,000 or $2,500 if married filing separately. In the
case of a spouse who is a full-time student at an educational
' 4y institution or is physically or mentally incapable of caring for
himself, such spouse shall be deemed to have earned income of not
less than $200 per month if the Participant has one Dependent and
$400 per month if the Participant has two or more Dependents.
ARTICLE V - DEPENDENT CARE ASSISTANCE ACCOUNTS
5 . 1 . Establishment of accounts. The Company will establish ail
4 and maintain on its books a Dependent Care Assistance Account for kr=
each Plan Year with respect to each Participant who has elected
to receive Dependent Care Assistance for the Plan Year.
5 .2 . Crediting of accounts. There shall be credited to a
Participant's Dependent Care Assistance Account for each Plan
Year, as of the first two regular pay dates per month of the
Participant in such Plan Year, an amount equal to the election
amount, if any, in accordance with the Participant ' s election and
compensation reduction agreement under the City of Jefferson M
Cafeteria Plan. All amounts credited to each such Dependent
Care Assistance Account shall be the property of the Company
4c until paid out pursuant to Article VI .
i'
l�x
CAFETERIA PLAN - DEPENDENT CARE ASSISTANCE PLAN - Page 4 {{
rr Rn f.
cis y't• 1 t1 f it h YP.1+v' $ 't�° r > �..;x !C a'+ t 5 1�,.,fUC$S'.•.v�r^'t75',R'! �'
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5 . 3 . _Debiting of accounts . A Participant's Dependent Care .,
Assistance Account for each Plan Year shall be debited from time
to time in the amount of any payment under. Article VI to or for
the benefit of the Participant for Dependent Care Expenses in-
curred during such Plan Year. Amounts debited to each such Depen-
dent Care .Assistance Account shall be treated as payments of the ` • ^%�.
earliest amounts credited to the Account and not yet treated as
paid under this sentence, under a "first-in/first-out" approach. k'
+ai, y 5. 4 . Forfeiture of accounts . The amount credited to a Par-
} ticipant' s Dependent Care Assistance Account for any Plan Year
shall be used only to reimburse the Participant for Dependent ;
Care Expenses incurred, during such Plan Year, and only if the 5.
Participant applies for reimbursement on or before the 90th day
following the close of the Plan Year. If any balance remains in
the Participant' s Dependent Care Assistance Account for any Plan
d
h
t
b
i
all Year after a reimbursements ereuner, h balance shall t
such sa no
a
` be carried over to reimburse the Participant for Dependent CareF" ;w,
Expenses incurred during a subsequent Plan Year, and shall not beYsyS{=
available to the Participant in any other form or manner, but
shall remain the property .of the Company, and the Partici pant
shall forfeit all rights with respect to such balance.
vtry�,{fi;4. ARTICLE VI - PAYMENT OF DEPENDENT CARE ASSISTANCE
so
6 . 1 . Claims for reimbursement. A Participant who has elect-
ma apply
aa ,
ed to receive Dependent Care Assistance for a Plan Year
P Y
to the Company for reimbursement of Dependent Care Expenses in- `
' -;' curred b the Participant pant during the Plan Year by submitting any
i application in writing to the Company, in such form as the Compa-
ny may prescribe, setting forth: "
(a) the amount, date and nature of the expense with
respect to which a benefit is requested; ,
b the name of the person,( ) p , organization or entity to ,
which the expense was or is to be paid; and
(c) such other information as the Company may from time
;ak to time require. r;
Such application must be accompanied by bills, invoices, re- r
ceipts or other statements showing the amounts of such expenses,
together with any additional documentation which the Company may
request.
;£4
6 .2 . Reimbursement or payment of expenses . The Company
shall reimburse the Participant from the Participant's Dependent
Care Assistance Account for Dependent Care Expenses incurred
during the Plan Year, for which the Participant submits documenta-
tion in accordance with Section 6 . 1 . No reimbursement or payment
tiY±S under this Section 6 .2 of expenses incurred during a Plan Year
t, shall at any time exceed the balance of the Participant's Depen-
Jn
CAFETERIA PLAN - DEPENDENT CARE ASSISTANCE PLAN - Page 5
4•
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�'".. }..�: <}; '%rz'1!,�'.tWi h���'11. � r.,. � l�,i.t,•' �, t�t'�G r t' e,{ {.r. ,?> *. i.y "
, ' .. S- �r,.;x :� '%; �,1� .t � �� t1+ l +h ��v .rt .r. :s �R` T •i�}'..: rY rf ; �f;4(��
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f
dent Care Assistance Account for the Plan Year at the time of the
[ nk reimbursement or payment
6 . 3 . Report to Participants . On or before January 31 of '
each year, the Administrator shall furnish to each Participant
who has received Dependent Care Assistance during he
dar year a written statement showing t g h ass calen-
dar he amount of such assts- -?
tance paid during such year with respect to the Participant. Kx
ARTICLE V_ I_I_TERMINATION OF PARTICIPATION r
` N
In the event that a Participant ceases to be a Participant in p`
..i; this Plan for any reason, the Participant ' s election and compensa- :A
tion reduction agreement relating o Dependent Care Assistance
t shall terminate. The Participant (or his estate) shall be enti-
tled
tl to reimbursement only for Dependent Care Expenses incurred
,r within the same Plan. Year and for which �
h a reimbursement request
will have been filed on or before 90 days after the end of the Plan Year. No such reimbursement shall exceed the
'ttr ` remainin
balance, if any, in the participant's Dependent Care Assistance
3r } Account for the Plan Year in which the expenses were incurred. Wj
Any remaining balance after. r the final reimbursement request has
°y been paid, shall revert to the Company which shall treat these ; '
funds as provided in Section 5. 4 of this document.
ment.
RTICLE VIII ADMINISTRATION OF PLAN
8. 1• Plan Administrator. The administration of the Plan
shall be under the supervision of the Administrator. It shall be a principal duty of the Administrator to see that the Plan is ;r
carried out, in accordance with its terms, for the exclusive
benefit of persons entitled to
participate in the Plan without
discrimination among them. The Administrator will have full
Power to administer the Plan in all of its details, subject to
applicable requirements of law. For this purpose, the Administra-
tor's powers will include, but will not be limited to, the follow-
ing authority, in addition to all other powers
• P provided by this
Plan.
(a) To make and enforce such rules and regulations as it y
deems necessary or proper for the efficient administration of the
Plan, including the establishment of an claims '
may be. required by applicable provisions procedures that
of law;
r�
(b) To interpret the Plan, its interpretation thereof in
good faith to be final and conclusive on all persons claiming
benefits under the Plan;
c
( ) To decide all questions concerning the Plan and the
eligibility of any person to participate in the Plan;
CAFETERIA PLAN - DEPENDENT CARE ASSISTANCE PLAN - Page 6
Rill
�. Sf
-
�
.. 7; ; 4.; .� ."^S t'y��,f ynTTT644=t+, fK{ 1 tx,.t1 l ,n, = 1'R��2t fl fir•.. '�' r ., i.,. t
+ r" :.f. 4 r -•y a 1,!'�r r..�_. v' .i r l�:r. a :V=r} `�'•r
n
} ! pp .
s,"),:r7�:' t,,.a `�5 r.o-hf�Ll K( .ei�. •:t.tip..,.�r t a""` '.. o h y '"fry Y xr�G`4.vs`5:�?'� f .u
(d) To compute the amount of benefits which will be payable
any or other
Y Partici ant p person in accordance with the provi- �•,,
sions of the Plan, and to determine the person or persons to whom .
Y' such benefits will be paid;
(e) To authorize the payment of benefits;
kqj
' ( f) To appoint such Administrative Firm, agents, counsel,
: 4 accountants, consultants and other persons as may be required to y
a:
assist in administering the Plan; and
(g) To allocate and delegate its responsibilities under the
Plan and to designate other persons to carry out any of its re-
sponsibilities under the Plan, any such allocation, delegation or f
` designation to be by written instrument and in accordance with
applicable requirements of law.
` 8 .2 . Examination of records . The Administrator will make
available to each Participant such of its e
p records under_ the Plan �;-
` as pertain to him, for examination at reasonable times during
normal business
hours .
r �y 8 .3 . Reliance on tables, etc. In administering the Plan,
permitted y
p ;'"' • .`+;
r , the Administrator will be entitled to the extent b law
,
to rely conclusively on all tables valuations, certificates, :RX
"{ z
ri., opinions and reports which are furnished by accountants, counsel �..>
or other experts employed or engaged by the Administrator.
8 .4 Indemnification of Administrator. The Company pany agrees
to indemnify and to defend to the :dullest extent permitted by law
' any Employee serving as the Administrator or as a member of a
committee designated as Administrator (including any Employee or i
former Employee who formerly served as Administrator or as a f
member of such committee) against all liabilities, damages, costs
and expenses ( including attorneys ' fees and amounts paid in set- '
tlement of any claims approved by the Company) occasioned by any
act or omission to act in connection with the Plan, if such act
or omission is in good faith.
t ,
ARTICLE IX - AMENDMENT OR TERMINATION OF PLAN x`
9 . 1 . Amendment of Plan. The Company reserves the power at
any time or times to amend the provisions of the Plan to any
1 extent and in any manner that it may deem advisable, by a written
Utz; instrument signed by the County commissioner.
`.' 9 .2 . Termination of Plan. The Company has established the
Plan with the bona fide intention and expectation that it will be
continued indefinitely, but the Company will have no obligation
whatsoever to maintain the Plan for any given length of time and
may discontinue or terminate the Plan at any time without liabili-
ty. Upon termination or discontinuance of the Plan, all elec-
tions and reductions in compensation relating to the Plan shall
CAFETERIA PLAN - DEPENDENT CARE ASSISTANCE PLAN - Page 7
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�'. y�.'�'�2'�' q, .. ''s ! }r 'tt•t5 � .t th.u„ Y; t,'. t r.: L
� i' [ x..11 '{ r•'t
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Y`
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� [ � 4?�'ti � u i iy i$ r'1;. F .th 'F=. i 4 .'Y, t frI i ��y�'e¢} .< r•r.� a. i"fYS,. ..L
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s S y .Y1j�'*H, i iv.'a3. id. t .t .�1N�i1'"i�`•.}Y�t���r•�4� �t�+yiy �"t .
terminate, and reimbursements shall be made only in accordance
with Article VII .
;# a x
K. ARTICLE X - MISCELLANEOUS PROVISIONS }
10 . f5'
� 1 . Communication to Employees . Promptly after the Plan
is adopted, the Company will notify all Employees of the avail-
ability and terms of the Plan.
10.2 . Limitation of rights . Neither the establishment of
the Plan nor any amendment thereof will be construed as giving to
any Participant or other person any legal or equitable right
against the Administrator or the Company, except as expressly kq
y provided herein, and in no event will the terms of employment or
service of any Participant be modified or in any way be affected
IT hereby.
10 . 3 . Benefits solely from general assets . The benefits
provided hereunder will be paid solely from the general assets of
the Company. Nothing herein will be construed to require the
Company or the Administrator to maintain any fund or segregate
any amount for the benefit of any Participant, and no Participant
or other person shall have any claim against, right to, or securi-
ty or other interest in, any fund, account or asset of the Compa-
ny from which any payment under the Plan may be made.
10 .4 . Nonassignability of rights . The right of any Partici-
pant to receive any reimbursement under the Plan shall not be
i alienable by the Participant by assignment or any other method,
and will not be subject to be taken b his creditors b an
„> j Y Y Y pro-
£ cess whatsoever, and any attempt to cause such right to be so
x subjected will not be recognized, except to such extent as may be
required by law. K.
10.5. No guarantee of tax consequences. Neither the Adminis-
trator nor the Company makes any commitment or guarantee that any
amounts paid to or for the benefit of a Participant under Article is
"x VI will be excludable from the Participant's
` gross income
federal or state income tax purposes, or that any other federal ,t
or state tax treatment will apply to or be available to any Par-
ticipant. It shall be the obligation of each Participant to
determine whether each payment under Article VI is excludable
' from the Participant's gross income for federal and state income
tax purposes, and to notify the Company if the Participant has
reason to believe that any such payment is not so excludable.
10.6. Indemnification of Company by Participants. If any
participant receives one or more payments or reimbursements under
f Article VI that are not for Dependent Care Expenses, such Partici-
pant shall indemnify and reimburse the Company for any liability
it may incur for failure to withhold federal or state income tax
or Social Security tax from such payments or reimbursements.
{ However, such indemnification and reimbursement shall not exceed
the amount of additional federal and state income tax that the
CAFETERIA PLAN - DEPENDENT CARE ASSISTANCE PLAN - Page 8
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ARTICLE I - INTRODUCTION
This Plan is intended to qualify as a medical reimbursement
u, y plan under section 105(b) of the Internal Revenue Code of 1986,
y. as amended, and is to be interpreted in a manner consistent with
the requirements of section 105(b) . The purpose of the Plan is
"? to enable Participants to elect to receive
payments or reimburse-
;. ' ments of Qualifying Medical Care Expenses that are excludable '
from the Participants ' gross income under section 105(b) of the t,
3;ry
Code.
ARTICLE IT - DEFINl'TIONS r"
iy
x. Wherever used herein, the following terms have the following
meanings unless a different meaning is clearly required by the
context:
2 . 1• "Administrator" means the Company or such other person t!
' or mmttee as may! coi Y be appointed from time to time b the Co `
to supervise the administration of the Plan. Y Company
2 .2• "Cafeteria Plan" means the City of Jefferson Cafeteria
Plan, effective 01/01/95, as amended from time to time .
2 .3• "Code" means the Internal Revenue Code of 1986, as
amended from time to time. Reference to any section or subsec-
tion of the Code includes reference to any comparable or succeed-
ing provisions of an le hr;
replaces such section or subsection. amends, supplements or
2,4 • "Company" means City of Jefferson, of the State of
Missouri . —`—`
2.5 . "Compensation" means the total cash remuneration re-
ceived by the Participant from the Company during a Plan Year
prior to any reductions pursuant to a salary redirection agree-
nuent (compensation reduction agreement) authorized hereunder. '>
2. 6 . "Dependent" means any person who falls within the
definition of dependent provided in Section 152 of the Code.
2. 7 • "Effective Date" means 01/01/95.
2 . 8• "Employee" means any individual employed by the Compa-
ny or by any ot�entity which is treated, along with the Compa-
ny, as a single employer, in accordance with the provisions of i
section 414 (b) , (c) , or (m) of the Code.
2 .9• "ERISA" means the Employee Retirement Income Security
Act of 1974 . y
2 . 10. "Medical Reimbursement Account"
described in Article V hereof. means the account
AFETERIA PLAN - MEDICAL REIMBURSEMENT PLAN - Page 2
' 3
I
.., t ti t
)" .%
4
x
i
�
2,J r^hktl�••,t'l^'•{
f�r(,(��i.}3,JRy�e�t/'� }' 2?.�"�+}?sr .}` >�;>•, at+. '�''`�,'sa re r,Y"hi�n�{a��j�+��,C�4f� �,!r¢�r ,} �+.
tSJf'6+,'s
' €:�± 2 . 11 • "Participant" means each Employee who
participates in
the Plan in accordance with Article
c
ie III.
r. 2 . 12 . "Plan" means the City of Jefferson Medical Reimburse- n
ment Plan as see forth herein, together with any and all amend-
} : ments and supplements hereto.
2 . 13 • "Plan year" means the period beginning on the Effec-
tive Date and ending on December 31, and the 12-month period
ending on each December 31, thereafter.
2 . 14 • ,QuaLifyinq Medical Care Expense" means
incurred by a Participant, or by the spousF or Dependentxefnsuch 3
Participant, for medical care as defined in Section 213 of the
Code (including without limitation amounts paid for hospital
bills, doctor and dental bills and drugs) , but only to the extent )
that the Participant or other person incurring the expense is not }
reimbursed for the expense through insurance or otherwise other
than under t ( t
he Plan) .
A pronoun or adjective in the masculine gender includes the
feminine gender, and the singular includes the plural, unless the
context clearly indicates otherwise.
t H,
y ` ,y ARTICLE III - PARTICIPATION :x
i t:+ytr.
} `CP
3. 1. Eligibility. Each permanent Employee whose customary
tf
,�. employment, excluding overtime work, is at least 1,500 hours per
year will be eligible able to
waiting period. Partici P ate in the Plan after no initial
3.2 . Participation Date. The Participation Date is the
later of (a) the Effective Date or (b) the first day of the month 1`
following the date on which the Employee becomes eligible to
participate under the p recedin sentence.
' have had fewer than 30 days in which to decideawhetheryto will
particl-
pate in the Plan, he may request the Participation Date beextend-
ed one time for an additional 30 days. The Employee must com-
plete an election under the City of Jefferson Cafeteria Plan to
receive medical care expense reimbursements under this Plan. An
Employee who chooses not to become a Participant on his Participa-
tion Date must wait until the next Plan Year.
,
3 .3 . Cessation of participation.
to be a Participant as of the earliest ofP(a)itheadateion which
the Plan terminates or (b) the date on which his election to
receive medical care expense reimbursements expires or is termi-
nated under the City of Jefferson Cafeteria Plan.
3.4. Reinstatement of former Participant. If a former Par-
ticipant who is eligible under Section 3, 1 elects again under the
City of Jefferson Cafeteria Plan to receive medical care expense
CAFETERIA PLAN - MEDICAL REIMBURSEMENT PLAN - Page 3
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+ ..R!y tfr.: +L4 i
v��. • "`i ,�:� ' ;• i,1-1' .-t ✓t .}.• � N. '�. r j" t}f.�t i r�` .l Yt ¢ ,t .r� ><F: rt. .38t i x '�'� 4 t'�r
♦ r,, f m <t.w .I{� ,j �r S: i;r�.J.^t.� ��. iy I.
rP
i4^.�, r �'�9A�.a ...Y.Lti.1.,.b4krk�fnr!it+S'$�t%A . f..��✓;+$`.:...Y�'_. 1.9P '-.+n.r+».rdM1a.............,..i a t., t.. 'Y °5
f
reimbursements under this Plan, he will again become a Partici-
pant in this Plan on the effective date of such election.
t
..u._
ARTICLE IV - ELECTION TO RECEIVE MEDICAL CARE
z EXPENSE REIMBURSEMENTS ks
z 4. 1 . Election procedure. A Participant may elect to receive
payments or reimbursements of his Qualifying Medical Care Expens-
es under this Plan by filing an election and compensation reduc-
tion agreement in accordance with the procedures established
under the City of Jefferson Cafeteria Plan. An election to re-
ceive payments or reimbursements of Qualifying Medical Care Ex-
penses shall be irrevocable during the Plan Year, subject to a
change in family status, as provided in the City of Jefferson
Cafeteria Plan.
4. 2 . Medical reimbursements . The maximum amount which the
— Participant may receive under this Plan in the form of payments
or reimbursements for. Qualifying Medical ;
,r Q Y g Care Expenses incurred �
, 5
Yi iY3 f Y.
in any Plan Year shall be $5000 .
.� ARTICLE V - MEDICAL, REIMBURSEMENT ACCOUNTS
5 . 1 . Establishment of accounts . The Company will establish ,
tt, and maintain on its books a Medical Reimbursement Account for
each Plan Year with respect to each Participant who has elected
to
receive reimbursement of Qualifying Medical Care Expenses
incurred during the Plan Year.
5 .2 . Crediting of accounts. There shall be credited to a
r: ;
Participant' s Medical Reimbursement Account for each Plan Year,
as of the first two regular pay dates per month compensation is
r,. paid to the Participant in such Plan Year, an amount equal to the
election amount, if any, in accordance with the Participant' s #.
election and compensation reduction agreement under the City of
Jefferson Cafeteria Plan. All a
mounts credited to each such
Medical Reimbursement Account shall be the property of the Compa-
ny until paid out pursuant to Article VI . r
5 . 3 . Debiting of accounts. A Participant' s Medical Reim-
bursement Account for each Plan Year shall be •debited from time
to time in the amount of any payment under Article VI to or for
the benefit of the Participant for Qualifying Medical Care Expens-
es incurred during such Plan Year. Amounts debited to each such
Medical Reimbursement Account shall be treated as payments of the <'
earliest amounts .credited to the Account and not yet treated as
paid under this sentence, under a "first-in/first-out" approach.
5 .4 . Forfeiture of accounts. The amount credited to a Par-
ticipant's Medical Reimbursement Account for any Plan Year shall
be used only to reimburse the Participant for Qualifying Medical
Care Expenses incurred during such Plan Year, and only if the f,
CAFETERIA PLAN - MEDICAL REIMBURSEMENT PLAN - Page 4
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�" .'�� .� n., � 9 r.�a ? g � ,rtiy.�ar . 'd.� 1� <, Y i.. , �. t FS� ;v.9,•� '7s3•t � y.
'! ,�L t�' �, t' � r N ,�S :S: 2i�F 1.• 41 J J�.�tl�{ �.. '..� �.'• r 4 ,
.a*.t Y�' Y y �t`' 7 `, + : t �,. .�ln .,Y.�{ d, 'Fil'L a S�` et.:/F';,fi�7�.•t
IN
4
,� t i' '4 } .i. U�.4; ..�, ' k'��J s e5 y�'�YA`I`1'.S�aY. Tt h°.. �?'q r....���t.7�'1,.4�Jx.'.�, j. k r s t t 1 x.,ti"'S'„.'�`:!!�,i+'� y. �.a��-f..ww+� Y+`3•l .
'�. e}'"!W' ��"`i��'�'�att��`I`�4'�uf��# `` z'.,y *'tr'�"i;' ztJ ��z= e4...�€��•. �tm� ,(�,`�� �s:�`S"
I
Participant applies for reimbursement on or before the 90th day x.
following the close of the Plan Year. If any balance remains in
the Participant 's Medical Reimbursement Account for a Plan Year
after all reimbursements hereunder, such balance shall not be carried over to reimburse the Participant for
p Qualifying Medical �.
Care Expenses incurred during a subsequent Plan Year, and shall }
not be available to the Participant in any other form or manner,
but shall remain the property of the Company,; p y, and the Participant
, p shall forfeit all rights with respect to such balance.
4:
ARTICLE VI - PAYMENT OF MEDICAL CARE EXPENSE REIMBURSEMENTS
a° 4 6 . 1 . Claims for reimbursement. A Participant who has elect- `!
ed to receive medical care reimbursements for a Plan Year ma y
apply to the Company for reimbursement of Qualifying Medical Care
Expenses incurred by the Participant during the Plan Year by
submitting an application in writing to the Company, in such form
as the Company may prescribe, setting forth:
(a) the amount, date and nature of the expense
with respect to which a benefit is requested; . 7r.;
(b) the name of the person, organization or entity
to which the expense was or is to be paid; 1`
;, (c) the name of the person for whom the expense
:- was incurred and, if such person is not the
Participant requesting the benefit, the ;
relationship of such person to the Participant; x
' 4 (d) and the amount recovered or expected to be recovered, under any insurance arrangement or other plan, with respect to the expense.
' < Such application must be accompanied by bills, invoices, receipts
or other statements showing the amounts of such expenses, togeth-
er with any additional documentation which the Administrator may
request.
C 6.2 . Disbursement or payment of expenses . The Company shall
reimburse the Participant from the Participant's Medical Reim- v
bursement Account for Qualifying Medical Care Expenses incurred
'r during the Plan Year, for which the Participant submits a written
application and documentation in accordance with Section 6 . 1 . No <$
reimbursement or payment under this Section 6.2 of expenses in-
curred during a Plan Year shall at any time exceed the annual
election of the Participant's Medical Reimbursement Account for
the Plan Year.
!
CAFETERIA PLAN - MEDICAL REIMBURSEMENT PLAN - Page 5
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,� �rb },SF"� }t. •'i�G.t 4.4 !;'?:n''.t:' i.;.r;:s,..:){;.•' `.•,i>f�;J,tO�`q"3t�7iy {�ti..• C,�, i' „1.
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! .a � tit. `�°S� #�+����Ar'� ������ �e��µ°{`�A � %��'fvl }i •
4�..i k "•�i.7v t:t�t, Y t� ..,��, �#~� �7P� F���yt�t Y �'p� a�}�yy���5f ,�Ea F, 3;i; '�J v I F I 4�,,�. .
A� '6
ARTICLE VII TERMINATION OF PARTICIPATION
In the event that a Participant ceases to be a Participant
for any reason, any election to receive reimbursements for Quali-
fying Medical Care Expenses and any related election and cOinpensa-
tion reduction agreement made under the City of Jefferson Cafete-
ria Plan shall terminate. The Participant (or his estate) shall kr
be entitled to reimbursement only for Qualifying Medical Care
Expenses incurred while a Participant was in the Plan and for
which a reimbursement request will have been filed on or before
90 days after the end of the Plan Year. No such reimbursement
shall exceed the remaining balance, if any, in the Participant 's
Medical Reimbursement Account for the Plan Year in which the
expenses were incurred. Any remaining balance, after the final
reimbursement request has been paid, shall revert to the Company
which shall treat these funds as provided in Section 5 .4 of this
document. 3 .
ARTICLE VIII ADMINISTRATION OF PLAN
8 . 1. Plan Administrator. The administration of the Plan
shall be under the supervision of the Administrator. It shall be
a principal duty of the Administrator to see that the Plan is
carried out, in accordance with its terms, for the exclusive bene-
fit of persons entitled to participate in the Plan without dis-
crimination among them. The Administrator will have full power
to administer the Plan in all of its details subject, however, to
the requirements of ERISA. For this purpose, the Administrator's
powers will include, but will not be limited to the following
authority, in addition to all other powers provided by this Plan:
(a) To make and enforce such rules and regulations as it
deems necessary or proper for the efficient administration of the
Plan;
(b) To interpret the Plan, its interpretation thereof in
good faith to be final and conclusive on all persons claiming
benefits under the Plan;
(c) To decide all questions concerning the Plan and the
el,igibility of any person to participate in the Plan;
(d) To compute the amount of benefits which will be payable '
to any Participant or other person in accordance with the provi-
sions of the Plan, and to determine the person or persons to whom
such benefits will be paid;
(e) To authorize the payment of benefits;
(f) To appoint such Administrative Firm, agents, counsel,
accountants, consultants and actuaries as may be required to
assist in administering the Plan; and
(g) To allocate and delegate its responsibilities under the
CAFETERIA PLAN - MEDICAL REIMBURSEMENT PLAN Page 6
W(
IWO, 9"911,
ya 6
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17 7
Plan and to designate other persons to carry out any of its re-
^r, sponsibilities under the Plan, any such allocation, delegation or
designation to be by written instrument and in accordance with
section 405 of ERISA.
8. 2 • Examination of records . The Administrator will make rz
available to each Participant such of its records under the Plan
as pertain to him, for examination at reasonable times during
normal business hours.
8 . 3 . Reliance on tables/ etc . In administering the Plan,
the Administrator will be entitled, to the extent permitted by
law, to rely conclusively on all tables, valuations, certifi-
cates, opinions and reports which are furnished by any accoun-
tant, counsel or 'other expert who is employed or engaged by the s .
Administrator.
8 .4 . Named fiduciary. The Administrator will be a "named
fiduciary"-7—or purposes of section 402 (a) ( 1) of ERISA with author-
ity to control and manage the operation and administration of the
Plan, and will be responsible for complying with all of the re-
porting and disclosure requirements of Part 1 of Subtitle B of
Title I Of ERISA. ;.�X W,
M
8 .5. Claims and review procedures.
(a) Claims procedure. If any person believes fie is being
denied any rights or benefits under the Plan, such person may
file a claim in writing with the Administrator. If any such
claim is wholly or Partially denied, the Administrator will noti-
,H fy such person of its decision in writing. Such notification
will be written in a mariner calculated to be understood by such
person and will contain (i) specific reasons for the denial, ( ii)
specific reference to pertinent Plan provisions, (iii) a descrip-
tion of any additional material or information necessary for such
person to perfect such claim and an explanation of why such mate-
rial or information is necessary and (iv) information as to the
steps to be taken if the person wishes to submit a request for
review. Such notification will be given within 90 days after the
claim is received by the Administrator (or within 180 days, if
special circumstances require an extension of time for processing hi
the claim, and if written notice of such extension and circum-
stances is given to such person within the initial 90-day peri-
od) . If. such notification is not given within such period, the
claim will be considered denied as of the last -day of such period
and such person may request a review of his claim.
(b) Review procedure. Within 60 days after the date on
which a person receives a written notice of a denied claim (or,
if applicable, within 60 days after the date on which such denial
is considered to have occurred) such person (or his duly author-
ized representative)ntative) may (j) file a written request with the
Administrator for a review of his denied claim and of pertinent
documents and (ii) submit written issues and comments to the
Administrator. The Administrator will notify such erson of
decision in writing. Such notification will be writpten in a its
CAFETERIA PLAN MEDICAL REIMBURSEMENT PLAN Page 7
IN
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no,
t tr
-���`�ld'.IYY1t�S���fJZ,,y�}�' .��� V�„i}�3rt,l���fi { M1 Y s i• .4 .7
vTJ lki zt �.n:t�' ",ti�`r��t��3'r,''�S',�iA�r T • f ` t '' s : �. r t: 4
,.et' rvy� t`x'1✓ ;}> =f6-?°''mil,.i'i t r Jftt �tlY 7 k'i
J�iU Yl 4
j '� +��1' �t��ty�.r�l�z-^�tr;=>�x�lt' r�^ rr ??Y.,i t f l t, ' ° a...�`�-`•�Ki"t';145`a'�t'S'i�I��iStA"�iM1tt's!L`kUlffiHPz4fs �•n,iz.«+.v«..aie•.awwkrilbacu�F+itAfi3
manner calculated to be understood by such person and will con-
` tain specific reasons for the decision as well as specific .refer-
ences to pertinent Plan provisions . The decision on review will
be made within 60 days after the request for review is received
5. by the Administrator (or within 120 days, if special circumstanc-
es require an extension of time for processing the request, such
as an election by the Administrator to hold a hearing, and if
written notice of such extension and circumstances is given to a
eh.'...
such person within the initial 60-day period) . If the decision
on review is not made within such period, the claim will be con-
t
�r, s
sidered denied.
8 . 6 . Nondiscriminatory exercise of authority. Whenever, in
the administration of the Plan, any discretionary action by the x ,
Administrator is required, the Administrator shall exercise itse. `
authority in a nondiscriminatory manner so that all persons simi-
i y • a. ,xt'rR•
larly situated will receive substantially the same treatment. �•t�Y"•t
.z r��•,��t{{ytfi
8 .7 . Indemnification of Administrator. The Company agrees
to indemnify and to defend to the fullest extent permitted by law
an Employee to ee s the Administrator or as a member of a t ` Nft
committee
designated as Administrator (including any Employee or
former Employee who formerly served as Administrator or as ass:;:.;
member of such committee) against all liabilities, damages, costs
,tx
and expenses (including attorneys ' fees and amounts paid in set-
occasioned by any
tlement of any claims approved by the Company)
act or omission to act in connection with the Plan, if such acti ?
;+ or omission is in good faith. �z #
4tr
ARTICLE IX - AMENDMENT OR TERMINATION OF PLAN
The Company reserves the power at #°
9 . 1 . Amendment of Plan. P Y
any time or times to amend the provisions of the Plan toawritten 1`"}?`
x .�"
that it may deem advisable, by a
extent and in any manner
.r
instrument signed by the County commissioner. ;
Company
9 .2 . Termination of Plan The Com an has established the
;.
Plan with the bona fide intention and expectation that it will e
continued indefinitely, but the Company will have no obligation
=h5'' whatsoever to maintain the Plan for any given length of time and
may discontinue or terminate the Plan at any time without liabili-
"•,tl ty. Upon termination or discontinuance of the Plan, all elec-
':;leti:':R• r:v
tions and reductions in compensation related to the Plan shall
f;'<wSf terminate, and reimbursements shall be made only in accordance
with Article VII . '
i'
ARTICLE X - MISCELLANEOUS PROVISIONS ,
10 . 1 . Communication to Employees . Promptly after the Plan
is ado
opted, the Company will notif all Employees of the avail- ,cA
1` P P' Y Y
''3• �`* ability and terms of the Plan.
+di
CAFETERIA PLAN •- MEDICAL REIMBURSEMENT PLAN - Page 8
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'6t. y�°. .iNr'�r .. �. ,•i` .. /.." 1Y„i ,. .y” ',f,, .. .. <S..t s� H#FS .� �+��!`y(5� e�� � r_
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1 4+
R, '��y1.Fy���'r�`Y�y�J��'f�t�T j,Fr� ir�t kX. I 4?�,i, 6 I' 4 .:! i ., ';, �•5' '+�,
.}.•r•.,umr) .h,,}•.ia' •zi.i�i`ra`� 1�161fr% :'\\""'R„! "ti..,l; ta'k'E`Ys-r"..Y::"a1'R,y47,;y)T1tHYkit4` 5vws.:7.......,
10 . 2 . Limitation of rights. Neither the establishment of
the Plan nor any amendment thereof will be construed as giving to
any Participant or other person any legal or equitable right '
against the Administrator or the Company, except as expressly
provided herein, and in no event will the terms of employment or '
service of any Participant be modified or in any way be affected
hereby.
10 . 3 . Benefits solely from general assets. The benefits
rr,;ry provided hereunder will be paid solely from the general assets of
the Company. Nothing herein will be construed to require the
Company or the Administrator to maintain any fund or segregate ;r
any amount for the benefit of any Participant, and no Participant {? N
or other_ person shall have any claim against, right to or securi-
ty or other interest in, any fund, account or asset of the Compa-
ny from which any payment under the Plan may be made.
' 10 .4 Partici-
pant ;t•.;.;°••.fr+'t..: 1
Nonassignability of rights . The right of any zr'?
to receive any reimbursement under the Plan shall not be
s alienable by the -Participant by assignment or any other method, '`°:
s...•: and will not be subject to be taken by his creditors by any pro-
cess whatsoever, and an attempt to cause such right to be so
'`Y t
subjected will not be Y P e
j recognized, except to such extent as may be r
t�
required by law.
10.5 . No guarantee of tax consequences . Neither the Adminis-
trator nor the Company makes any commitment or guarantee that any ; �` s
amounts paid to or for the benefit of a Participant under Article
VI will be excludable from the Participant's gross income for P
federal or state income tax
purposes, or that any other federal rn���t,;•�. .
or state tax treatment will apply to or be available to any Par-
ticipant. It shall be the obligation of each Participant to
1 determine whether each payment under Article VI is excludable1 ;
y t, p y
from the Participant' s gross income for federal and state income ; 4y ;•.
i
tax purposes, and to notify the Company if the Participant has
reason to believe that any such payment is not so excludable.
k 10 .6 . Indemnification of Company by Participants . If any
participant receives one or more payments or reimbursements under
Article VI that are not for Qualifying Medical Care Expenses,
,,;;5•. ,
such Participant shall indemnify and reimburse the Company for
any liability it may incur for failure to withhold federal or '
Art'.
state income tax or Social Security tax from such payment or
reimbursements . However, such indemnification and reimbursement
shall not exceed the amount of additional federal and state in-
b:
come tax that the Participant would have owed if the payments or
reimbursements had been made to the Participant as regular cash
compensation, plus the Participant 's share of any Social Security
= •tV tax that would have been paid on such compensation, less any such a
YS.. 4
additional income and Social Security tax actually paid by the
Participant.
A ° 10. 7 . Governing law. The Plan will be construed adminis-
tered and enforced according to the laws of the County of Boone
in the State of Missouri .
tSr CAFETERIA PLAN - MEDICAL REIMBURSEMENT PLAN - Page 9 '
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