88-042 Superior Resources, Inc., Coverage Agreement and Plan Trust Agreement, Resolution No. 7543RESOIVTION NO. 7543
A RESOIVTION OF THE ClT¥ COUNCIL OF THE CrrY OF aJPERI'mO
AVrHORIZING EXEalTION OF OOVERAGE AGREEMENT lIND
PIAN TRiJST AGREEMENT BEIWEEN THE CI'l'? OF aJPERl'mO
lIND SUPERIOR RESOURCES, INC.
WHEREAS, a Coverage Agreement and a Plan Trust Agreement between the
City of C\1pe:l:tino and SUperior Resources, Inc. outlining the terms and
conditions for administration of the program alla;.ling f.)r payment of
dependent care costs and :medical costs in excess of the employer I s
contribution to be paid with before-tax dollars has been presented to the
City council; and
WHEREAS, said agreement has been approved by the City Manager and the
City Attorney; ,
NOW, 'I'llEREFURE, BE IT RESOI1i1ED that the Mayor and the City Clerk are
hereby authorized to execute tha agreement herein referred to in behalf of
the City of Cupertino.
PASSED lIND AOOPrED at a regUlar meeting of the City Council of the
City of Cupertino this 5th day of July, 1988, by the following vote:
Vote ~ of the city Council
AYES: Johnson, I<bppel, Plungy, Rogers, Gatto
NOFS: None
ABSENT: None
ABS'l!AIN: None
ATrEST: APPROVED:
Is/ John M •. Gat."'to"'--...,-:-__ -:---::--_
Mayor, City of Cupertino
CAFETERIA PLAN
.CE
ADOPTION AGREEMENT
CAFETERIA PLAN
OF
The Employer rher.~b1 establishes a cafeteria plan for the benefit of
its employees rinJa'ccordance with the terms of this Adoption
Agreement a~d;:::.the' plan document. The Adoption Agreement is
established pur~,uar:l}\ to and is a part of the plan and trust, and the
plan and trudt '-are) incorporated herein by reference. Any term
defined in the plafl;::,or trust shall have the same meaning when used
in this Ad.OPtior6Aqr'eement, unless the term is defined differently
under this Aaogboh Agreement or unless the context clearly '-" v
indicates a dif(ecrD' meaning.
~ SPECIFICATIONS r-V -]
SECTION 1.Q1 G:ml:loyer: -_-'1.t:.(y QfL-'.Lf8~."rJ;'....1M-L.O'---
LAaarJS: I Q '30" To n:e.. /)vG" ..
b C4.<2e&:t:n..J0J Cb? '7S'dl'¥
~\ ~!:2. -~5aS' ~T~J!l~one No.: ("io.f)
'---/ 1.020 ~der~1 Employer ID No.: .. 9q· 6D2"L7""3..,,(.,.,,,-,,!~ __ _
1.03 ~e: Dwight H. Mensinger
@.
......2360PlazaDeIAmo,Suite200 ,0. '. Torrance, CA 90501 .' a . ~f'b4 ~'C3'r Adm'o'""",,, S'pec'" Re,o",ce,. 'oc.
l~~ ~~Si 2T306rrOanPcleaZaCADeglOASm010, Suite 200
II 1) ; .. ?j (213) 618-9929
HI. it J1, dls(2J'ff~. 'Ive Date of Plan: J"uL.y S·191JB ~ U J(}
1.06
1.07
1.08
(8~,Wl-y,,)ear (choose one):
vD) ,)l Calendar Year
rCil~ Employer's fiscal year,
\...J
(2) which is to ____ _
~~ E:lao:::N1 0.: L.,',,,
El.igibility Requirements: I,' /
~m Age: \'-J) ,
[lrtA~ of Service: I
Entr9 !Date: (Choose One) '--J i/
_-</:...18",,--_ (not over age 25)
(not over 36 months)
cal ~irst day following date eligibility requirements
,-----are met
/\7;1 r n~First day of month following or coinciding with ! W'-tre date eligibility requirements are met
n Other (1): ~"' ________ _
[>lnot later than first day of the Plan Year
~following or coinciding with the date eligibility to requirements are met) ~J o IExcJEjions:
hon-insured plans (medical reimbursement and
~cJ ,di3pendent care):
1" e Part-time employees
.I ~ g:?;....' '_' _ ~::~ret:::nt alie::urs/Week){2)
, .1 f;)
. 81 WJ1J '"he<
(b'lrlnsured plans: as contained in any policy or . rd D) policies of insurance incorporated under U0 the life, accident and health or /"".1 f\ disability insurance plans
( ClUJ
1.09 Beo.efrt Limitations(S):
(J~ ~axim~m annual dollar amount for deferral under
r:i1ediGal expense reimbursement plan: ~ ~ $ 10/000 (Not to exceed $10,000)
~---'
f "' --"l
1.1 0 Bfmef~ts: (check appropriate benefit) ~-1.
, .... _~ _ Medical Expense Reimbursement
( ClYl.\)' \ '-Dependent Care Reimbursement
'--:.../
()r-::\ Life Insurance Cov~rage
v:.)()
Cl'" Accident and Health Insurance Coverage (a 1\)
\l) Disability Insurance Coverage Gl? IN WITNESS~REREOF this Adoption Agreement, and the plan and
trust incorpOtttecnlErre~n, are executed by the Employer on (/ pert ,19J.L.
EMPLOYER: @
[11: 'j
~ . @,
~ ((5)
J ~ @R)
By: (Ti Ie) N'~·
By: '-:J Y)f:t~
(Titl e)
SUPERIOR RESOURCES, INC.
By:}j~ft~
(Title) PRESIDENT
([j)
(Gl\1
(1 ) If grOuJi1'1?c:dent and health insurance is included as a benefit
in the plan, oo~nsilf,lr selecting the policy year to facilitate plan
administration. ~~
(2) coVer~g~leS under Section 125 of the Code allow for
exclusions of [cerIaln classifications of employees, provided the
classification does __ r:lot discriminate in favor of officers, shareholders or
highly compensJted~-Jmployees. If the number of hours per week you
choose results (i'il'c:..tB-e exclusion of a substantial number of part-time
employees from t~e-plhn, the plan may be discriminatory. '-.....Y
(3) To insQ,&j;:at the plan does not provide impermissibly greater
medical benefitJ'-.to [j/ighly compensated employees than to non-highly
compensated emplo}e'es, it is recommended that you choose a flat dollar
deferral limitatio~ C\~?)medical benefits for all eligible employees.
~ r¥ ! :=J
D
@
[j .!::'~--'
ARTICLE
I[
CAFETERIA PLAN
CF
TABLE OF CONTENTS
"Accident and Health
Insurance Plan" ..................... .
"Ad .. t t " miniS ra or .................... .
"Adoption Agreement" ............... .
"C d " o e ............................ .
"C s t' " ompen a Ion .................... .
·Dependenr ........................ .
"Dependent Care Assistance Plan ..... .
"Dependent Care Expenses" ........... .
"Dependent Care Service Provider" .... .
"Disability Insurance Plan" ........... .
"E I " mp oyee ......................... .
"E I " mp oyer ......................... .
·ERISA" ............................ .
"F rf't " o el ure ........................ .
"K E I " ey mp oyee ..................... .
"Life Insurance Premium Plan ........ .
"Medical Dependent" ................. .
"Medical Reimbursement Plan" ....... .
i.
PAGE
1
2
2
2
2
2
2
3
3
3
3
4
4
4
4
4
4
4
4
5
ARTICLE
(][jj
t(10) Section~*\9 Sectionl1~2(,) {C Ll Sectiorl:" 22
Sect~0~C2.2~
Sectloo:.......~
"P rt" t" a IClpan ................. , ..... .
"Plan" ............................. .
"Qualifying Medical Care Expense" ..... .
"T t" rus ............................. .
"Trustee" ........................... .
PAGE
5
5
5
5
5
Sectiori.2.~ 2J
"Union Employee" ..................... ' 5
~. PARTl eE5"IPN .................................... .
S '~3"O)1 C t f t" : actlonl :. ommencemen 0 par IClpatlon ....... . SectiohoI3:-o~ Duration of participation ............. .
• \ . '~ ! • Sectlon~ .. 03 Failure to elect ..................... .
(a0;
BENt;~.9J!>.:f!ONS. ELECTIONS AND NOTICES ............ .
SedidnJ4~ Benefit options .................... .
Seclian-4,02" Election of optional benefits in
III
IV
V, . . lieu of cash ........................ .
Sectio(i'4:-0"31 Election procedure .................. .
sect~o~ Failure to elect. .................... .
Sectlon~.Q§' Changes by administrator ............ .
Sec~]>fl4""'()6j Irrevocability of election
O~ by the participant during
f·.· .. :::] the plan year ....................... .
sectiOt«67) . Funding benefits under the plan ....... .
n~ ,~V
J,/ ~ ! .'il MEDI~~~BURSEMENT PLAN ....................... . I ~..,."" . i.J r! . r(, 'b.'fiectlon"",!?~Oir
t,l I.'~.' ect~oh. -5:Q2;
I· • t~ectIoITo3! ~ ~W2)
Plan purpose ........................ .
Crediting of accounts ................ .
Debiting of accounts ................. .
Forfeiture of accounts ............... .
ii.
7
7
7
7
9
9
9
9
10
10
10
11
12
12
12
12
12
ARTICLE
VI
VII
'~I f!!i&
(~} 0 Secti06. $:'05
• ",' J Sectlo0::-'5:06 /1 f--"" Section! 5;OV
PAGE
Claims for reimburesement .......... . 13
Reimbursement of expenses .......... . 13
Continuation coverage ............... . 14 ~ DEP!~J~JlEjIr CARE ASSISTANCE PLAN.. ...... ............ 15
·h'~ Sectl?r1-6,01
Secti0n~6,02
Sectief6fG
Sectibn-6;lj,4 Secti9n/~O~ Secti?~ o/-9~
SectioQ....6!9¥
Plan purpose ........................ .
Maximum dependent care assistance .. .
Crediting of accounts ............... .
Debiting of accounts ................ .
Forfeiture of accounts ............... .
Claims for reimbursement. ........... .
Reimbursement 01 expenses .......... .
15
15
15
16
16
16
17
((]]')
lIFdNSLJJ3ANCE PREMIUM PLAN. . . . . . . . . . . . . . . . . . . . . . . 18 (nV,J
Se9tlon . ;Z.Ot Plan purpose. . . . . . . . . . . . . . . . . . . . . . . . . 18
Section_Z.02 Crediting of accounts ............... .
Secti0n\. 7.03 Debiting of accounts ................. .
Sectidn 7:0<1-Forfeiture of accounts ............... .
SectiOt-r7:0? Designation of beneficiary ........... .
secti~~3.',OJ Purchase of life insurance
~ policies .......... ',' ................ .
Seeti6i1::T.OV Submission to physical L-' (-. I
n examination ....................... , . . ;-" ,,---, Section ''A:OB Nonentitlement to insurance
18
18
19
19
19
20
\\\ /j ((ill) . ,m",ed, ..... : . . . . . . . . . . . . . . . . . . . . . . 20
~CCI~D HEAL TIj INSURANCE PLAN ............•.... 21
~ect~d!l:;:::8:0~::J Plan .~urpose ... , ... , .... , ... , . . . . . . . . 21
I 11 } t I: ',$ectld~B • .o2 Credlling of accounts. . . . . . . . . . . . . . . . 21 ~ I' [ ~eC,tiot?lr:Q.tJ Debiting of accounts ............... , . . 21
I 1'1 . III (}@iii. ~) U W()
ARTICLE
IX
X
IJ
Sectiim--8)08 r """'" ) -.I
Forfeiture of acco unts ............... .
Payment of accident and health
insurance premiums or dues .......... .
Submission to physical examination ... .
Nonentitlement to insurance
proceeds ........................... .
Continuation coverage ............... .
G~ DISA~~INSURANCE PLAN ................. , ..... ..
Sectia~'1 Plan purpose ......... , ......... , .... . t,~1:?j Secti0!l--,9~2 Crediting of accounts ............... .
Section-Sm3 Debiting of accounts ................. . Secti6.rQ§..,;~Of Forfeiture of accounts ...... .
S ectidA_9. 0'5 Payment of disability insurance GCJ proceeds ........................... .
SeGti!Ln~6 Submission to physical examination.
Sebtlon_9_0Y Nonentitlement to insurance
D-r '.:J
~
proceeds ........................... .
CON~~_t;tTION ..........•...........................
,-y
Secti(!)n~tO:01 Continuation of Coverage ............. . Li[_._:~ ... SectlOTli 1 0.02 Definitions ........................ .
S ,:::'''-"" T B' C ectl<tn1v.q3 ype of eneflt overage ............. .
Secti9J1-'fe~04, Period of Coverage .................. . ~~". 4. ?eecctt~100~~11~Q~~6 Notices ............................ .
I ~ V# "'--~u Elections .......................... . f: 11# Sectiifn)i~~7 Premium Requirements .............. .
I . f'-.-J :J ~ I .j Ul.j l:lrDM'~'S:J)~tT'ON OF PLAN ........................... .
Ij ur®~' Plan admii~~tffitinn ................ .
PAGE
22
22
22
23
23
24
24
24
24
24
25
25
25
27
27
27
28
28
29
31
31
33
33
ARTICLE
XII
XIII
(!iJ
@V
Sectia~1Sd2
SectitZn;:'n-:03
Section 11.04
eJ Sectio.o_1J ,05 I )
Examination of records .......... , ... .
Reliance on tables, etc ............... .
Nondiscriminatory exercise of
authority ... , ....................... .
Claim for benefits and review
of denial. .......................... .
Sectie3'Q6 Correction of administrative Secti~li-1"1~7 7~~~~~ifi~~ti~~ '~f '~d~i~i~t~~t~'r', " " " " " ' . , ,
SeCti®~8 ~~t7~~~,a,n,t ,a,p,p,Ii~~:i~~~ ,a,n,d, , , . , , , , , , , , ,
Sectiorl'11f09 Notice of change in employee ~ status,""""""', .. ,"""',.,"
,..-.." ?.::-:1 LlMIB1c.S ON BENEFITS, , , , , , , , , . , , , , , , , , , , , , , , , , , ,
se!CJi,oaJ.2.D1 Limitations on benefits for D certain employees, , .... , , , , , .. , , , , , . ,
AMEJ\JQtii1EJJT AND TERMINATION OF PLAN, , , , , . , , . , , , , , , ,
((J)
Sectio~G1 Amendment. , , . , ...... , , , ...... , , , , , ,
Sectil!m-13:02 No contractual obligation, , , . , , , .. , , , , se~titlr3-:~3 Procedure on. termination, , , , , , , , , ... ,
PAGE
33
34
34
34
36
37
37
38
39
39
40
40
40
40
XIV MIS~(Gl»)60US PROVIS,IONS .................... , ....... 41
I v,.#SectIOflJA.01 Information to be furnished ... , .... , , , 41 V Sectio'§'02 Limitation on participants' rights. , , , , 41
__ , Secti6n"14.0~J Receipt and release. , . , . . . . . . . . . . . . . . 41 Sectid,o::1:.4~flI4 Nonassignability .......... , . . . . . . . . . 41 ~ectidn-1.4rO\5 Incompetency ............. , ..... , , . . 42
SecHqn-1-4.S,6 No guarantee of tax consequences .... , . 42
r!RJ v.
ARTICLE PAGE
Indemnification of Employer by
participants. . . . . . . . . . . . . . . . . . . . . . . . 42
Soctio Trust fund sale source of
benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Gender. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Governing Law. . . . . . . . . . . . . . . . . . . . . . . 43
vi.
([if)
U;lf\
ARTICLE I ~ {~l?)
. . PURPOSE AND SPECIFICATIONS
The purpose of fhis~p[an is to provide employees of the Employer choices
among cash, ITr~ur6af reimbursement, dependent care assistance, life
insurance, accii:r~nt< and health insurance, and/or disability income
insurance ben~i~(rS, s,elected by the, Employer in ,the adoption
agreement), Thls--BLan IS Intended to qualify as a "cafetena plan" under
section 125 of tI:re'I'ntEjrnal Revenue Code of 1986, as amended, and shall
be interpreted ibOaJ(bianner consistent with the requirements of section
125. The SpeCifiGaiie'ns of this plan are contained in a separate adoption
agreement exec{ted~) the Employer. The adoption agreement constitutes
a part of this p~clnd its terms are incorporated by reference in this
plao. @5
D
@
01 ' I
~ rJ
Cll5'l '
I~ [02 1
i '11 [J ~ ~~
END OF ARTICLE I
-1-
((jj)
@D ARTICLE II
DEFINITIONS @
2.01 "Accidef')La~d Health Insurance Plan" means the accident and
health insuranc[-ElanJ set forth in Article VIII hereof.
2.02 "Admi~is;r1~r" means Superior Resources, Inc., or its duly
appointed agen7:wt:ri6h will administer the plan pursuant to a separate
contract between ctserl and the Employer. The plan administrator, within
the meaning of~edi0n 3(16) of ERISA, is the Employer or such other
person of comTifre'~/e, as may be appointed from time to time by the
Employer to su~Ei1fvi\Ie the administration of the plan.
U
2.03 "AdoPtirulAgreement" means the agreement executed by the
Employer Whicht~forth the specifications selected by the Employer
for this plan. (~?
2.04 "Coae!!l means the Internal Revenue Code of 1986, as amended
from time to tim~-~eference to any section or subsection of the Code
includes refereri.!:e __ to any comparable or succeeding provisions of any
legislation whio'Fi afliends, supplements or replaces such section or
subsection, and /to:ar,¥ regulations promulgated thereunder.
~OJ
2.05 "Compensation" means the full salary and wages paid to an
employee by [ffib Emdloyer for services rendered, including salary, wage,
bonuses and iQ~.e.r:.g(T1e compensation, and including all Employer
contributions to ithis-plan on behalf of the employee, whether for cash or ...,-,." non-cash beneHfh(but. cash benefits shall not be double-counted), but
r
rFiu\,di ~/j \ lJ lJ ) l n~I~) (R~bursement for expenses or allowances, including
.1. f;al:ttoflJobile ~walfqes and moving allowances;
1\ rr\~ IJ .. t! II ?)
JJJ ul ®2) -2-
~'?l ~UJ0
(2) @~mount contributed by the Employer to any pension
plan or plaryQfr~eferred compensation other than the contribution by
the Employer COla) plan intended to qualify under section 401 (k) of the
Code which ~re derived from employee salary reduction; and CC_
[I
(3) [MJ amount paid by the Employer for other fringe
benefits ou.tsidill of this plan, such as health and welfare, hosPitaJjzatibH."3)a~d group life insurance benefits, or prequisites.
(0 ~ .' 2.06 "Depenaeot" means, for purposes of the dependent care
assistance plan IQ1fA JtlICle :VI, (a) a dependent of the. ~artici?ant ~ho is
under the age of\i§J~lild with respect to whom the participant IS entitled to
an exemption underse'G:tion 151 (e) of the Code, or (b) a dependent or spouse
of the participa~t(}J~ol is physically or mentally incapable of caring for
himself. ",-..-J , Qrl
2,07 "De~friliernt Care Assistance Plan" means the dependent care
assistance plaliLset· forith in Article VI hereof.
2.08 "Dep~ent, Care Expenses' means expenses incurred by a
participant WhiChl-fa:~are incurred for the care of a dependent of the
participant or for0~~t~d household services, (b) are paid or payable to a
dependent care ~6e provider, and (c) are incurred to enable the
participant to bE1 rgalnfully employed tor any period tor which there are one
or more depetn'dtl'rfts-.Jwith respect to the participant. Dependent care
expenses shall rn'orJinclude expenses incurred for services outside
participant's hous7hOlld~ f,or the care of a dependent unless such dependent
is described in se.sti9nJ 2.06(a) or regularly spends at least eight (8) hours ~~day/~the ~articipant's household, Dependent care expenses shall be ~few~to be ip?ur?ed at the time the services to which the expenses r~la~are renderrO. ~ I ~lDepehdent~Care Service Provider" means a person who provides
I. rure'19r otle! se.7';cel)"Crlbed 10 Seclioo 2.08(a) abo'e, b,l 'hall 001 ~ J @J2) -~
(jj]j
include (a) a depfi!q:d1I1t care center (as defined in section 21 (b)(2)(D) of the
Code), unless th(rr,~~1i~ements of Code section 21 (b)(2)(C) are satisfied, or
(b) a related indi(aua/ described in section 129(c) of the Code. .
2.1 0 "Disarlil~9)Jsurance Plan" means the disability insurance plan
set forth in Arti~~~hereOf.
2.11 "Empldyee"1Peans any individual employed by the Employer. , ---,''\
2.12 "EmPlby,.:rJ means the sponsoring Employer indicated in the
adoption agreem(f}t-~iCh has adopted the plan and any affiliate or any
other employer th~clOPts the plan with the consent of the sponsoring
Employer. (07;1
2.13 "ERISA:"£ans the Employee Retirement Income Security Act of
1974, as amend,] ~fom time to time. Reference to any section or
subsection of ERIS!t>lJi2cludes reference to any comparable or succeeding
provisions of alw~egjSI.ation which amends, supplements, or replaces such
section or subs'ecti~n_~nd to any regulations promulgated thereunder. . I I r
2.14 "Falf~i~r~!l-Jneans any portion of a contribution on behalf of a
participant which,the participant has designated for benefits under the
medical reimbufrs~ept plan, dependent care assistance plan, life
insurance premium:-aCfident and health insurance, or disability insurance
plan and which is @ used to provide benefits under such plan for the year
to which the corltr:i~udon is attributable.
Oi I
2.15 "Key 1E[hQ.IQ.yee" means any person who is a key employee as
defined in sectionL4J .. 6(iJ)(1 ) of the Code.
~.16 )'iife I~~C~ Premium Plan" means the life insurance premium rrnlt~(h in {;j VII hereof.
! II ~~MediCal-l:)ePBndent" means, for purposes of and the medical r:ri b~~~t PI~--in.~. Article V, the participant's spouse and any I f llg L-...........,..;l II' a l= ~ @V -~
CW
dependent(s), withiMlittle meaning of section 152 of the Code, of the
participant (or, in {h~1 dake of a child to whom section 152(e) of the Code
applies. of the part~iPa:fu or his spouse). For purposes of the accident and
health insurance Plar1 tiJ)Articie VIII. "Medical Dependent" means the person
or persons define~~aependents in any policy or policies of insurance
maintained by the ~tQPIJer and incorporated into the plan.
2.18 "Medical~Reimbursement Plan" means the medical
reimbursement pla0-s~t forth in Article V hereof.
1"·0.1
2.19 "particip~means any individual who participates in the plan
in accordance wit~cle III.
I"~ 2.20 "Plan" I rrt'eJa:n~ the cafeteria plan of the Employer as set forth
herein. together witb~~# and all amendments and hereto.
2.21 "QUalif~~1~dical Care Expense" means an expense incurred by
a paticipant. or,(bYva::!medical dependent of such participant, for medical
care as defined {in sedtion 213 of the Code (including without limitation
amounts paid I fod hospital bills, doctor and dental bills, drugs and
premiums for aeeiGlentJand health insurance). but only to the extent that
the participant o~other person incurring their expense is not reimbursed
for the expense [th'rough insurance or otherwise (other than under the
medical reimbursrot) plan).
2.22 ·Trust"~ahs the trust established as part of this plan for the
purpose of prol{Lqii;ng6ej'lefits under the plan.
G-:l 2.23 "Truste~e'::"'JXleans the person named in the adoption agreement or
such other persor,(or~Organization from time to time acting as trustee of t~::r~~st. ~-jany ~ysor trustee duly appointed by the administrator.
II i l//, '<'~" ! I 12 2~ "Uniofj l'iirl1p'joyee" means any employee included in a unit of
the Secretary of Labor finds to
f I I I CJ
~ ~~ -5-
be a collective
and one or more
were the subj
representatives
agreement between employee representatives
ers, if there is evidence that retirement benefits
ood faith bargaining between such employee
employer or employers.
END QFARTICLE II
-6-
()fj{] \!J(J
((Oll~ \3 ARTICLE III
PARTICIPATION ()O"\
3.01 comm);{ment of participatjon. Each employee who has
satisfied the eligJbllity] requirements set forth in the adoption agreement
is eligible to part.iEl~~t~ in the plan and shall become a participant on the
entry date or datfs",setj forth in the adoption agreement. L.---"
3.02 Durati~)f oarticipation. A participant will cease to be a
participant as of \,h\-~arlier of (a) the date on which the plan terminates or
(b) the date on w~ich he or she ceases to be an employee eligible to
participant, exc~'btfr>t\o the extent the participant or a "qualified
beneficiary" with"-r.espesct to the participant (within the meaning of
section 162(k) Gl'llh'a Code) elects continuation coverage under the
accident and hedlth! li~~urance plan or the medical reimbursement plan, A
forrr:e.r part.iciP~.I'l~WK§ i~ reemployed or. o,therwise .becomes e!igible to
particIpate In the,plan will become a partIcIpant again on the first entry
date following It~el date he or she is reemployed or otherwise becomes
eligible. Any 'participdnt who ceases to be eligible to participate in the
plan shall contin~e~receive his or her benefits hereunder for a period
equal to the shC@er o,f (x) 60 days following termination of participation
or (y) the date 111-pte{iOusly unused credits to the benefit accounts have
been exhausted; p@d\3d, however, that nothing herein shall be deemed to
modify or abrogal~ .. /the forfeiture provisions of the several plans
hereunder. 0 C=:J
\\
3.03 Failu;'[ t~ect. A participant who has not otherwise ceased to
be a participant inrfti~)~p.lan as a whole will cease to be a participant in one
oymore benefit ~~£A~ ~s of the earlier of (a) the date on which he or she fil~:s)'~[%~~al eleGH~ form electing not to participate in such plans or
ib)1 t~ll?st date ft:r2i~h to file an annual election form under Section
~rfll[l ~ . lh ~I ®'~ -7-
4.03 if the
who is eligible to
subsequent plan
commencement a
election form.
failed to file such a form. A former participant
'es subsequently file an annual election form for a
II become ,a participant in such plans again on the
year following the filing of the new annual
END OF ARTICLE ,III
-8-
1r-\ ~v ARTICLE IV
fr,lC\
BENEFIT OPTIONS, ELECTIONS AND NOTICES
" 'J "'--/' /11'\ (( '1
4.01 Benefft Q~tiQns. Subject to specific eligibility requirements,
and the percent~~limitation and dollar limitation contained in the
adoption agreem~:iIDd to the other limitations set forth in this plan, a
participant may elect ,tg be paid his or her entire compensation in cash, or
to have a portion~,OLSUCh compensation applied for medical reimbursement,
dependent care a,ssJst<fnce, life insurance premium, accidental and health
insurance, and/or(d. iS~ ... ility insurance benefits. \L)J
4.02 Election;-o;,IoptiQnal benefits in lieu of cash. A participant may
elect to receive ~~~ for1 more of the optional benefits described in Section
4.01 in accordar\civLYvith the procedure described in Section 4.03. If
participant elects la~llced. and an amount equal to the reduction will be
contributed by thl?{Eh1p,~oyer to an account in accordance with the medical
reimbursement /~I~Jf~dependent care assistance plan. life insurance
premium plan, (apqloent and health insurance plan, or disability insurance
plan. as the eT:Plo¥~e_i'peCifies. .
.~
4.03 Electior:h procedure. Not less than 30 days, before the effective
" date of the plan ICbr.~ soon thereafter as possible). and not less than 30
days before the beginning of each subsequent plan year. the administrator
shall provide 0~e3r) more written election forms and compensation
reduction agreemt}l'l.tbto each participant and to each other employee who
is expected t0D>f3Co~ a participant during the plan year. The election
forms shall be eff.!lc~ as of the first day of the plan year or. if later. on
the date the enap,lo,YJ;l:e becomes a participant. Each participant who
chooses a non-c1aS'R (Illenefit for the plan year shall so specify on the . r11 . 1 appro.pnat~lectldn "fo.rm or forms and shall agree to a corresponding 1elGltretlon/fn~hjS o}'-f:H:l,f/cash compensation. The amount of the reduction in
tll1 i Ill/'/.>'" • /' h'" 'f h I f .1 {3 Pr%tle'lpant s c'1s , \ fompensatlon or t e p an year or each non-cash ge~t{t~n~1 be hht»amount elected by the participant. subject to the
II.; it~tlf~l. o,a;rjj""h;' p1ao. Each alaotloo to,m m"" ba oompla,ad
, 1 I! .' , u ~ (V2) -9-
r!iiJ fJ~ and returned to ~f:lbU7-dministrator on or before such date and the
adminisfrator shall spe~y, which date shall be no later than the beginning
of the first pay pttb~} for which the participant's compensation reduction
agreement will ap~
4.04 Failureh~~ect. A participant failing to return a completed
election form to tne adJninistrator on or before the specified due date for
the initial plan ye~r_oDthe plan, or for the plan year in which he became a
participant, shall 6e-ddemed to have elected to receive his or her full
compensation in C~A participant failing to return a completed election
form to the admlin~strator on or before the specified due date for an
subsequent plan y~rshal! be deemed to have made the same election as
was in effect just ~& the end of the preceding plan year.
4.05 Change'flOv administrator. If the administrator determines,
before .or during kMLpll:in year, that the plan may fail to satisfy for such \ ... 1 plan year any non'di.scrimination requirement imposed by the Code or any
limitation on be'nlefftS_drovided to key employees, the administrator shall
take such actibn_k~_the administrator deemed appropriate, under rules
uniformly appll.iGable.J to similarly situated participants, to assure
compliance with such requirement or limitation. Such action may include,
without limitation~ ,'a-rodification of elections by highly compensated
employees or ke·remployees without the need for consent of such
employees. (S)
4.06 IrreV06f!piliIY of election by the participant durin\! the plan
~. Elections rl:tade under the plan shall be irrevocable by the participant
during the plan yfiiat, except in the event of a change in family status. A
participant may re/~e"f' benefit election for the balance of a plan year and
file-a ne~electiorll B'hly on account of and consistent with a change in f,~frWl statifs. A~ch~nge in family status for this purpose includes
mi· arria~rtfivorce(deatl'il) of a spouse or child, birth or adoption of a child,
t il ur;/o f t (I 1 f d h h eI1mLnat'Qr:l~0 emp0ym~t a a spouse, an suc at er events that the A.mr~:l det,f,,,,,,.s wW p.,mit a chaogo 0, ,.vocaUoo of so el.ctioo
. . (jfj) ·10·
({jJ
election under this-:::S&"ction 4.06 shall be effective at such time as the
administrator shal~9JJ7.bbe, but not earlier than following the forty-five
(45) day period se.Prfor~h in Section 11.09 hereof (unless the administrator
waives this minimu~ .L90tice period).
4.07 Fundin~~fits under the plan. To fund the benefits under the
plan, the Employe'i'makes contributions to the trust in accordance with the
election containedi in ~he compensation reduction agreements completed by
the participants as-de~ribed in Section 4.03. In addition, the Employer
may make non-elbcti.v{ contributions on behalf of participants equal to a
specified amountG0r-.,percentage of compensation which may be made
available to particiban't~ for the selection or purchase of benefits under
the plan. Fundin~'m\ any benefits provided hereunder shall be derived
solely from such (g,o~tributions, and neither the administrator, its agents
or employees, nordli&)trustee shall be responsible for any failure of the
Employer to fund amJwch benefits. r;o~., L: L, END OF ARTICLE IV
b
@
IJ[ 1
b @}
(§1
-~ ~
rJ!jiJ -11-
rJ!iJ
G ARTICLE V
5.01 ~Iao P~. Th;s plan is intendad Jo q""lit, as a salt-ins",ed
medical reimbursefnent-plan under section' 105 of the Code, and is to be
interpreted in a rnann)e~ consistent with the requirements of section 105.
The purpose of tAe~pl'an is to enable participants to elect to receive r I reimbursements o!?qualifying medical care expenses that are excludable
from the participant's-!2l~SS income under section 105(b) of the Code. The
plan shall maintail\l CaJ ~edical reimbursement account fa r each participant
in order to accomp~n<'\hiS purpose.
5.02 CreditiJe l?JaccQunts. There shall be credited to a participant's
medical reimbUrs~M~1t account lor each plan year, as of each date
compensation is ~~id Ltc the participant in such plan year, an amount equal
to the reduction,,...if~n ~ to be made in such compensation and credited to
the medical reimbursement plan in accordance with the participant's
election pursuaAt l t6 Isection 4.03 hereof. .
t I
5.03 Debitin-gl of accounts. A participant's medical reimbursement
account for each~~nl year shall be debited from time to time in the
amount of any payfi1Emt hereunder to or for the benefit of the partiCipant
for qualifying me6i@dare expenses incurred during such plan year. No
payments may b\kmdde which would reduce the participant's account
balance below ~Fo (Q)J Amounts debited to such account shall be treated
as payments of f.F.)e earliest amounts credited to the account and not yet
treated as paid ili.ud-;;]this section, under a "first-in/first-out" approach.
~5.04 F,0rfeitGaLhl' accounts. The amount credited to a partiCipant's r~\1 /·F.b \.' I I h b TrulfaV'~ urs~e~ account or any p an year s all e used only to ryelrclJ:!r.s~ the parltleipant for qualifying medical care expenses incurred <iI~{i~~S,~h pl'an-''1ear, and only if the participant applies for 1~iimi:"urse~nt 01-ef ~efor~ th~ 60th day f?I.lowing the. close. of the plan
1e r. If an ba,aice) )emalOs In the partiCipant's medical reimbursement
(!!j2J -12-
(J!jO
account for a Plan~Jr\ after all reimbursements hereunder, such balance
shall not be carrieblov~r to reimburse the participant in any other form or
manner, but instea~h{!1 revert to the Employer to the extent permitted by
law, and the pa/tL6i~l)Jt shall forfeit all rights with respect to such
balance. . ~C::. . .
5.05 Claims Upr .Jelmbursement. A participant who has elected to
receive medical ca're_JeRnbursements for a plan year shall apply
to the adminisrr.atdr) for reimbursement of qualifying medical care
expenses incurred~~Ys:he participant during the plan year and while a
participant, by sy(mittfng an application in writing to the administrator,
in such form as t~lninistrator may prescribe, setting forth:
(a) the amo'~Vate incurred and nature of the expense with respect
to which a benefit\.isJr.e~uested;
(b) the nlr£'iL~ the person, organization of entity to which the
expense was or is-)b';;b~paid; ( v j .
(c) the n~rnr;) £t~e person for whom the expense was incurred and, if
such person is Lno t-the\ participant requesting the benefit, the relationship
of such person tOt. t~e jarticiPant; and '-l
(d) the amounl"{ecovered or expected to be recovered under any
insurance arrange~r other plan, with respect to the expense.
Such app:!rd:J.tioQ . Jshall be accompanied by copies of bills, invoices,
receipts or otheRlstatements showing the amounts of such expenses,
together with anf_addltional documentation which the administrator may
request. /J c<rJ}
. !'fllt,Ow.8'eimbu!:sement of expenses. The plan shall reimburse the
;~irti~ig;.ar1t from (the)\participant's medical reimbursement account for 'iI~an~~r:o.:dicar6areZ.e'fpenses incurred during a plan year, for which the p~tiSIp.ant'rS'Ubmi s-a~written application and documentation in accordance
1]1 [I . II . a ~ ~1@0 -13-
(({;j'l uD
with Section 5.05. tJf?{1eimbUrsement under this Section 5.06 of expenses
incurred during a R!~nLcyear shall any time exceed the balance remaining in
the participant's m\~'i<!al reimbursement account attributable to amounts
elected by the partf~rtJ to be credited to the account for that plan year.
5.07 CQntln~\(Po coverage. To the extent that the medical
reimbursement b~.elLtSJ provided hereunder are subject to the benefit
continuation provfSTonill of section 162(k) of the Code and sections
601-607 of ERISA ,...continued coverage under this plan will be provided in
accordance with t~j=~h,s. conditions and procedures contained in Article
X hereof. ( n )
tH~U .. ·.L~ \~.~ ,
e/
(~ END OF ARTICLE V
@
@5
-14-
(!!j GJS) ARTICLE VI ~RENDENT CARE ASSISTANCE PLAN
6.01 Rlaa P~' This plao is ioteoded 10 q"'ily as a depeodeol
care assistance p[ugIaril under section 129 of the Code and is to be
interpreted in a manned consistent with the requirements of section 129.
The purpose of the-plan is to enable participants to elect to receive
reimbursements of Lt:heir..Jdependent care expenses that are eXCludable from
the participant's gr?s'irrcome under section 129 of the Code. The plan
shall maintain a dlepeJdent care assistance account for each participant in
order to accomplis~hi~l purpose.
6.02 MaximJm /iependent care assjstance. The maximum amount
which the participant tmay receive in any plan year in the form of a
dependent care ds~~.ta~ce under this plan shall be the least of (a) the
participant's earn~?irlc:ome for the plan year (after all reductions in
compensation rncludidg the reduction related to dependent care
assistance), (b)/ (hJ rc"ctual or deemed earned income of the participant's
spouse for the (!Iran-yeal., (c) a maximum annual amount of $5,000 or $2,500
in the case of married participants filing a separate federal income tax
return, or (d) th~' 'aol\ar amount which the partiCipant has elected in
accordance with Arlitle IV hereof to have applied for dependent care
assistance benefi(s@)thePlanyear.lnthecaseofaspousewhois
full-time student atJl..o educational institution or is physically or mentally
incapable of ca[!pgfOr'llimself or herself, such spouse shall be deemed to
have earned incon:Je~of not less than $200 per month if the participant has
one dependent abd_$A!OO per month if the participant has two or more
dependents. (olD . ~;..o~editin~Of accounts. There shall be credited to a participant's
depe~~l'lr care a's(sisfilnce account for each plan year, as of each date Jdlng~sa~n is ~id ... t6-the participant in such plan year, an amount equal ~ollth~~ecJuetion, iif-crAy;-to be made in such compensation and credited to
th,lle &epen~~rt care-a~sistance plan in accordance with the participant's t~h p"~"a~'tioo 4.03 he::,
(}!jj)
6.04 Debiting I'Qfl .!i'ccounts. A participant's dependent care assistance
account for each \pllih) }ear shall be debited from time to time in the
amount of any payrner:ll hereunder to or for the benefit of the participant
for dependent carer ek6e~ses incurred during such plan year. No payments
may be made which'-w'06Id reduce the participant's account balance below
zero (0). Amounts~f:ioited to such account shall be treated as payments of
the earliest amountL~dited to the account and not yet treated as paid
under .this seCtiOn~der a "first-inllirst-out" approach.
6.05 Forfeiture-=Of) accounts. The amount credited to a participant's
dependent care asfistar1be account for any plan year shall be used only to
reimburse the part'i~ipahtl for dependent care expenses incurred during such
plan year, and oplYTi~ the participant applies for reimbursement on or
before the 60th day} ~dllowing the close of the plan year. If any balance
remains in the pahicip.~rit's dependent care assistance account for any plan
year after all reimi:lUrMi'rrents hereunder, such balance shall not be carried
over to reimbursJ CMe>participant for dependent care expenses incurred
during a sUbseque~tfPlan year. and shall not be available to the participant
in any other fofm~orrm!anner. but shall instead revert to the Employer to
the extent perfnihJd-ey law, and the participant shall forfeit all rights
with respect to 'such-balance.
6.06 Qlaim ~eimbursement. A participant who has elected to
receive dependenYCar-e assistance for a plan year shall apply to the
administrator for ~eJmptlrsement of dependent care expenses incurred by
the participant during ... :.I~e plan year by submitting an application in writing
to the adminis01:tor. i~ such form as the administrator may prescribe,
setting forth: ~
LJ
(a) the amo~~h. date incurred and nature of the expense with re(spe~ich ~Mit is requested; np)~e nef the person, organization or entity to which the
ex@eofe'!owas or isrto-cbeZpaid; and
f I 7 D) I
-16-
(J!i)
Such apPlica(~l~all be accompanied by copies of bills, invoices,
receipts or other 'srate'ments showing the amounts of such expenses,
together with any ab~iti'onal documentation which the administrator may
\.....J request.
6.07 ReimbuF~~nt of expenses. The plan shall reimburse the
participant from ttiLpa~ticipant's dependent care assistance account for
dependent care expertses incurered during a plan year for which the
participant submitsLde.eufuentation in accordance with Section 6,06. No
reimbursement und(r~thls Section 6.07 of expenses incurred during a plan
year shall at any \tlllle~bxceed the balance remaining in the participant's
dependent care asststance account which is attributable to amounts
elected by the par~d to be credited to the account for that plan year.
@ END OF ARTICLE VI
@5
b
@
o I I
b
(@}
@1
Sl ~)
, ()~ 17 ~~ --
(!!}j
@ ARTICLE VII
r---hlFE INSURANCE PREMIUM PLAN
7.01 Plan PUfPQs.e. This plan is intended to provide funding for
qualified g roup-tent Irf~ ~insurance coverage under section 79 of the Code
(and coverage in excess of the section 79 limits), and is to be interpreted ,
in a manner consiste~ with section 79. The plan shall maintain a life
insurance premiumraccpunt for each participant in order to accomplish this
purpose. If a ~ftiCibant elects life insuirance coverage, then the
participant's life in~13r!ance premium account shall be applied by the
Employer or the 'dJnini~trator to obtain and maintain qualified group term
life insurance cov~r,gdf)on the participant's life. Any policy or policies of
group life insurance-'. p~lchased by the Employer pursuant to a participant
election shall con~fftUt~j a part of this plan and the terms and conditions
of such policies s~~be incorporated by reference into this plan.
7.02 Cred(iQ ~accounts. There shall be credited to a participant's
life insurance premium' account for each plan year, as of each date
compensation is pe-ie. tO
j
the participant in such plan year, an amount equal
to the reduction, rany, to be made in such compensation and credited to
the life insurance.---plemium plan in accordance with the participant's
election pursuant ~tion 4.03 hereof.
7.03 OebiIi'rfOOfl accounts. A participant's life insurance premium
account for each:-l?lan year shall be debited from time to time in the
amount of any p£i>,me_olt hereunder to obtain and maintain qualified group
term life insurancer@{lerage on the participant's life. No payments may be made\whiCh/WOUI~ Qe~\ube the participant's life. No payments may be made ~~~ lJ'~d-. red~Ge~e participant's account balance below zero (0). tmounts,.....deblted~olsClCh account shall be treated as payments of the e,li~~a~unts rr~ditddl to the account and not yet treated as paid under
M, ,.Of'.o "":1"""'·iOlfi,,,.out" appcoa'h.
(!fi) ·18-
(}!jj
7.04 ForfeiturCt ('accounts. The amount credited to a participant's
life insurance premi~bcount for any plan year shall be used only to
obtain and maintainr:qoalified group term life insurance coverage on the
participant's life. I~ ~ ~alance remains in the participant's account for a
plan year after all s_uch./premium payments are made, such balance shall
not be carried ove~",\t0-p'ay premiums incurred during a subsequent plan
year, and shall nobb.e-~vailable to the participant in any other form or
manner, but shall i~ste;d1 revert to the Employer to the extent permitted by
law, and the particip~rit shall forfeit all rights with respect to such
I ./
balance. (Q)'
7.05 oeSionatQ ,of beneficiary. If the employer holds any policies
of insurance funde-Cl(hereunder on the life of a participant, and if the
participant desireJ tto?designate or change the beneficiary of the life
insurance, the pa~ei~laht shall notify the administrator in writing of the
desired change a?dlt'Hl~ administrator shall file such changed designation
with the company ~issued such policy. The participant shall complete
and execute any-TorffisJequired by the administrator which are helpful or
necessary to accompli'sn the deSignation of beneficiary. The designation or
change of desibn1ttio1r-shall not be effective until it is accepted by the
insurance company. IfJ a participant dies before it is accepted, the death
benefits shall be Baid...Jo the designated beneficiary shown on the records
of the insurance lcomphny at the time of the partiCipant's death. If a
participant fails tO~ignate a beneficiary, or if a designated beneficiary
shall not survive {0\.r.e6E1ive any or all payments due under any such policy,
then the benefici:ir.y,..;.s'hall be determined under the provisions of such Ul 1 policy. c-l
7.06 purch~sB=1f life insurance poljcies, If policies are to be,
purchased by th'CEH1~loyer or by the administrator in the name of the Efili:ilb¥e~Fl6'rsuaht W ~ participant election hereunder, the Employer shall ldfe~\ ~e9"admi~rstra:tor to purchase the poliCies from a specified in:~u~oc.e compa~Y,3rd pr?vide the ~dmi,nistra:or with ,the documents and !~fOrr~eCessary. 'tol file an application With the Insurance company. f~e 1(a'dministratofS~1 file the application with the insurance company
-19-
@frJ
application. An ina~death benefit is not in eff~ct, and the p'articipant
and/or his benefi6iMV Js not entitled to benefits thereunder, until the
insurance company /~a~es the policy in force.
7.07 SUbmiski'oO ,t physical examination. If a policy or policies
purchased by the ~E\mplqyer, and incorporated into the plan, require that
participants com~[Le.te~a medical questionnaire, submit to physical
examinations, or satisfy other requirements of the insurer, the
administrator shalil-noiit'y the participants' eligible for such benefits of
the requirement(s)'r.:=rf~a participant fails to satisfy such requirement(s),
after request from I t® administrator, the participant shall not be entitled
to such insurance coverabe or any insured benefits until such later time as --the participant cOl~RJwith the requirement.
7.08 Nonentitlement to insurance proceeds. If, ,due to the
participant's breach( ~fllcbnditions, covenants or other requirements of the
insurance contract(~), 31. if the participant's death is excepted under the
terms of the in~llrapc~ contra6t(s) for any reason (including, but not
limited to, death lot1the participant due to suicide, while sane or insane).
and if, as a result~tffelinsurance proceeds will not be paid, neither the
plan, the Emplo~er northe administrator shall bear any responsibility to
the participant or fiis~or her beneficiaries for any amounts by reason of
such failure of the i5sur~ce proceeds to be paid.
@ END OF ARTie," VII 01 i
~l L-~
10lJ"'
ik~ (0) r~1 ~~~ I \ II ~-1.
! II' I il (Jr;~ ~ II \ lj /J J \:~/ U ,-_J LJ
-20-
nQ SV ARTICLE VIII
[(1);
ACCIDENT AND HEALTH INSURANCE Pl.AN
O~
\ '--' I 8.01 plan purpose. This plan is intended to provide funding for
qualified accident,~ health and hospitalization insurance coverage under
sections 105 and 1:06=of, the Code, and is intended to be interpreted in a
manner consistent 'With) sections 105 and 106. The plan shall maintain an
accident and heal~nins\urance premium account for each participant in
order to accomplish/thiS" purpose. The Employer may, from time to time,
maintain one or rho'fe) ~ealth, hospitalization, or dental insurance plans,
including health nialDlim'ance organization ("HMO") pre-paid plans. If a
participant elects 0r~fof\the insuirance coverages offered by the Employer,
then the participant's'l6cident and health insurance premium account shall
be applied by the '''lirriployer or the administrator to obtain and maintain
such accident and {he~itH coverage for the participant and, if selected, the
partiCipant's medicar d~pendents. Any policy or policies of insurance ~ purchased by the-Employer under this Article pursuant to a participant
election, shall cdnS1itut~ a part of this plan and the terms and conditions
of such policies ~IiaI'1 'Del incorporated by reference into this plan.
8.02 Creditingr:'of accounts. There shall be credited to a participant's
accident and health-insu~ance premium account for each plan year, as of
each date compensatlo(l\is paid to the participant in such year, an amount
equal to the redu~tion~)if any, to be made in such compensation and
credited to the a,cciCienLand health insurance plan in accordance with the
participant's electidb~r~uant to Section 4.03 hereof.
8.03 DebjtjnJ--:Qf~accQunts. A participant's accident and health
insurance premium (aedel,tint for each plan year shall be debited from time
to Itisn~\,in ;h~ amou~t~f any payment hereunder to obtain and maintain
qUalifi'tiI'd Laceident and-health insurance plan coverage for the participant
d'/'j , h ~ .. I 't;'\ \ d' I d d an, .or I:!,e partlclpant~me Ica epen ents, No payments may be made
h' ill [!r ~I'" d " ::th . , b I w !qy Il(lql:!.~\ re !!J~-J' e partICipants account a ance below zero (0):
~ If 'I :=jj lUI J Jy~ -21-
G!iiJ
Amounts debited fo---::lostih accounts shall be treated as payments of the
\ L,/ J earliest amounts credited to the account and not yet treated as paid under ---~ this section, under'25'\~irst-inlfirst-out" approach.
8.04 EorfeitSe~(;)/ accounts. The amount credited to a participant's
accident and healt~ insurance premium account for any plan year shall be
used only to obtain~arra:::-lmaintain accident and health insurance or HMO plan
coverage for the participant andlor the participant's medical dependents.
If any balance rem~~~ the participant's account for a plan year after all
such pre~ium payn;e~:~re ma~e, such balance shall not be carried over to
pay premIums or cos~mcurred m a subsequent plan year, and shall not be
available to the pa~til;;](JJnt in any other form or manner, but shall instead
revert to the Empl~er-to the extent permitted by law, and the participant
shall forfeit all rig~M)Cith respect to such balance. \.....1./
8.05 paymentr;;lMcident and health insujrance premiums or dues .. If
premiums or dues \~tb be paid by the Employer or the administrator
pursuant to the ,partiCIpant election hereunder, the Employer shall direct
the administrator I to'paysuch premiums or dues to the specified insurance
companies or Htv10~ aralshall provide the administrator with the documents
and information necessary to file an application with the insurance
companies or HM0'F'--:r:hr administrator shall file the application with the
insurance company 'oI';::I:!MO within a reasonable period of time after receipt
of the completed aP.pIiCiition. An insured accident and health or HMO
benefit is not in ~f.!.'ectVand neither the participant nor the participant's
dependents are entitlEfd~to benefits thereunder, until the HMO enrolls the
participant or the Lih~yrande company places the policy in force. rJ 8.06 Sybmissi~ physical examination. If any policy or policies
which are purchased' oYI t, Employer and incorporated into this plan, or any H~(~~hic~~es \~)aid b~ ~he Employer and which .is incorpor~ted i~to
thIS rtpi'an,jeqUlfed(that",partlcIPants complete a medical questionnaire, ~U~'1iit Ilt~~YSiCal~ exam!.9~tions, or satis~y other re~~irement~ .of the msu~er lr-HMO, the_admlfllstrator shall notIfy the participants eligible for
subh !,be.h(fi~ ~I the~gui~ement(s). If a participant fails to satisfy such
I r! II -,,,
III HI ~) ~ 1I1~ -22-
~rm
requirement(s) aft~e'iuest from the administrator. the participant shall
not be entitled to ~udl+.Iirisurance coverage or any insured or HMO benefits
until such later tirT}e~\the participant complies with the requirement.
. I r--'.) I
8.07 Nonentill9ment to insurance proceeds. If, due to a covered
participant's breac~> bf~conditions, or covenants or other requirements of
the insurance cont~acJ(s)J or HMO for any reason, and if, as a result, the
insurance proceedt-wi)l~ not be paid. or HMO benefits or services not
rendered then neitQer-th!3 plan, the Employer, nor the administrator shall
bear any responsibility-tCl the participant (or the spouse or dependents) for
any amounts not pa'i«;l-by'reason of such failure of the insurance proceeds to
be paid or HMO beh~6r services to be rendered.
8.08 continukib'Dlcoverage. To the extent that the health benefits
provided hereunder~afl~< subject to the benefit continuation provisions of
section 162(k) of Ith~llCode and sections 601-607 of ERISA, continued
coverage under this \.pl~d will be provided in accordance with the terms.
conditions and procedirre's contained in Article X hereof.
f O·S
END OF ARTICLE VIII
b
@
IJL~
b
@D ?"---. ~clL.
! . I
I ] ~, r-"')
~ .. ......,~~ (,~/~ -23-
@R)
@~ ARTICLE IX
G [PISABILITY INSURANCE PLAN
LJ I
J
9.01 Plan ptrlfroTe. This plan is intended to provide funding for
disability insurance runde~ section 106 of the Code, and is intended to be
interpreted in a maM,er) consistent with Section 106. The plan shall
maintain a disabilitLl.!lj3urance premium account for each participant in
order to accomplisntnis purpose. If a participant elects one of the
disability insurance( 6QY:erkges which the Employer may offer from time to
time, then the partlcip,arft's disability insurance premium account shall be
applied by the E~io~r of the administrator to obtain and maintain
disability insurance\~0l0he participant. .
9.02 creditj09(~ ~ccouots.· There shall be credited to a participant's
t ~J ... j disability insurance \p~mium account for each plan year, as of each date
compensation is pliJd'/f~)he participant in such year, an amount equal to
the reduction, if ~n~ t6 be made in such compensation and credited to the
disability insuraMce ~ium plan in accordance with the participant's
election pursuant to~Section 4.03 hereof.
9.03 Debitjngt~ccounts. The participant's disability insurance
premium account fof (ea<::h plan year shall be debited from time to time in
the amount of any\£ay'p\ent hereunder to obtain and maintain disability
insurance for th~lpar:ticipant. No payments may be made which would
reduce the participa'nt's-abcount balance below zero (0). Amounts debited
to such accounts ~h~U--be treated as payments of the earliest amounts L ,
credited to the account"and not yet treated as paid under this section,
under a "fir~1in/fir~~:::d!I~Jtl· J approach.
fri0 4. ~~.
1.[ffipJv(offeiture,-Ql'aOCQunts. The amount credited to a participant"s disabilit~~iKsurance 'p.{emiuml account for any plan year shall be used only
to !o'~tai/n~\. maintain-.disability insurance for the participant. If any b ,'I~ /I r .. ~, . ~h J ", f a ~n.0~,i rem~l~s 10:..-1 ~ \partlolpant s acoount or a plan year after all
premi'u1 I payt:n~nts rare-! made for the plan year, such balance shall not be
I II ~: ! / i I ill ! rl ,f_""", ~J L ~(() -24-
GfiJ
carried over to pay~~iums incurred in a subsequent plan year, and shall
not be available to~))articipant in any other form or manner, but shall
inst~~d revert to \h~. ~~pl~yer to, the extent permitted by law, and the
participant shall forfeit all rights with respect to such balance. \.~~
Any policy &Cpolicies of disability insurance purchased by the
Employer under t:tJis_~rtiCle pursuant to a participant election shall
constitute part of this-p'It:tn and the terms and conditions of such policies
shall be incorporat~d~by \eference into this plan . .... ..-".....:.../
9.05 PaymenWisability insurance premiums. If premiums are to
be paid by the ErhR.@Y..e~ or the administrator pursuant to the participant
election hereunder. (t~,e-:Employer shall direct the administrator to pay such
premium to the speCine'd )insurance company or companies and provide the
administrator with 'the', ~documents and information necessary to file an
application with sulh~1 tb?npany or companies. The administrator shall file
the application within l{) reasonable period of time after receipt of the
completed apPlicatio~tn insured disability benefit is not in effect, and
the participant i1 nqt re-ntitled to benefits thereunder, until the insurance
company places th~-policY' in force. t !
9.06 SubmisSiOn to physical examination, If a policy or policies
purchased by the Emplo.Yer. and incorporated into the plan. require that
participants complete'a medical questionnaire. submit to physical
examinations, or tGtlsjy other requirements of the insurer. the
administrator shall 'notifY. the participants eligible for such benefits of
the requirement(sf)1 CIL~ participant fails to satisfy such requirement(s).
after request from ;tHe-administrator. the participant shall not be entitled
to such insurance cO\ler<i\de or any insured benefits until such later time as
the participant compJies\\vith the requirement.
f(ii'gtO\? 'd~~ t'tl (~LVt t . d If d t t" t' I 11.-' : ;!'lQnen ( amano IDsurance procee s. • ue 0 a par IClpan s
breabh Ilofj(5onditior1sico~enants or other requirements of the insurance co~tf~ct(§)~Q~~f thet 'p~rtiapant's claims are excepted under the terms of
I i r---)1 i 2 J
I I ! (;l (\ -25-~~) U 1~!Jr~
rJ!jjj
the insurance cont~£l) for any reason, and if, as a result, the insurance
proceeds will not Ibuaid, then neither the plan, the Employer, nor the
administrator shalVbear any responsibility to the participant for any
amounts not paid tiy~r:§!.\~on of such failure of the insurance proceeds to be
paid. ~C
[ . §3 ENOOEABTICLE IX
@
(!i)
@
@5
D
(~)
DL_J
PI
@
(;~ f'-~
~3 (j!m ·26·
11/~ c)c)
@ ARTICLE X
(?~C0CQNTINUATIQN CQVERAGE ~C,l
10.01 Contitmf~n of Coverage. A person who is a qualified
beneficiary with respe9t, to a participant in the medical reimbursement
plan is entitled to fc)i11i'1uation coverage under the plan in accordance with
the terms and the toi~ons of this Article.
10.02 Definitions) For purposes of this Article, the following terms
shall have the fOliowiflgjeanings:
(a) "CQntinW,fan Coverage" means the right of a qualified
beneficiary to rec6i~e\)8enefits provided by the medical reimbursement
plan to similarly Jit~~e~ participants and beneficiaries, with respect to
whom a qualifyingev'eilt has not occurred, as limited by the terms and
conditions set fdrtfl1 irlthis Article. I c.J '~
(b) "GrQup Health Plan" means any plan of, or contributed to by, the
Employer to providJ~medical care (as that term is defined in section 213(d)
of the Code) to Jl}}plQyiees, former employees, or their families, either
directly or through (insurance, reimbursement, or, otherwise.
(c) "Qua!jfje~~Lefjciary.. means any individual who, with respect
to an employee 'whoriS-a participant is attributable to a period in which
such individual was'" a-nonresident alien who received no earned income
(within the meaning'?ifffection 911 (d)(2) of the Code) from the Employer
which constituted in~?rTJ~ from sources within the United States (within the(~~ning/~ sedti~':861 (a)(3) of the Code). If an individual is not a qualifi~d tt{eneficiary""-pur-suant to the previous sentence, a spouse or dePJrd~~hild of~ suchLindividual shall not be considered a qualified berlJficiar:f1)Y'~irtUlLoLthel relationship to the individual. , I fir\.' '-1 ,I Il ~," (d) I "Qualifyine-Event" means an event described below, but for the conti~u~tion Mil cov.erage: provided under this Article, would result in the los~ 19d1bbver~ge bt)a' qualified beneficiary: \,~ UI ~::J[) -27-
CcfJiJ
(1 ) 1~e~dleath of a participant.
(2) 'i(JiVtermination (other than by reason of an
employee-par-ticipant's gross misconduct), or reduction of hours
(where sUCh( tea'u~tion causes the participant to be ineligible for
coverage undecthe medical reimbursement plan), of the participant's employment.L~ ,
I 1 (3) q:~divorce or legal separation of the participant from
the participaQ"t's saouse.
~-
(4) ~artiCiPant becoming entitled to benefits under
Title XVIII of\t~Social Security Act.
(5) QQ.ndent child ceasing to be a dependent child under
'-• / I / the medical relmqursement plan. r
10.03 Type (p ~~tfit Coveraoe. The type of coverage to which a
person is entitle9"1Jna~this Article' is identical to the coverage available
to similarly situated-\plan participants and beneficiaries on the date of the
qualifying event, ;witl1 respect to whom a qualifying event has not occurred. ,
If coverage uhder_the medical reimbursement plan is modified for any I ,
group of participant?or:~beneficiaries, the coverage shall also be modified
in the same manneJ rfOs)all individuals who are similarly situated qualified
beneficiaries under~~Article.
Coverage mWfnot-Je conditioned upon, or discriminate on the basis of
lack of, evidence 0t \ins~ra:bility.
10.04 periOdrJ t'Coverage. The coverage to which a qualified
beneficiary is/~ntitl~d~' LInder this Article extends for a maximum period of
thi{t>filk 1'(36f month's~beginning on the date of the qualifying event; howellv~{..::;i;r the followi'n'g) situations, the period will end the earliest of: \ IF....· r '-'I
! (t~teen~C(8il ~onths from the date of a termination of
described
-28-
l0V
unless a SUbSeqUe~~~IifYing event occurs with such eighteen (18) month
period; \J
(b) the datQo£),hiCh the Employer terminates this plan and ceases
to provide any othet..>gro6p health plan to any employee;
" C.:]
(c) the datk-ol1,whiCh coverage ceases by reason of a failure to
make timely paymbnt-of; any premium required under Section 10.07 with
respect to a quali(iea~eneficiary;
(d) the dat~r the date of the election, on which the qualified
beneficiary first b~come's
()(;;]
(1) covered under any other group health plan, as an
employee or atn'Jr.~ise; or
(0 \) J
(2) eQ!!!Lea to benefits under Title VIII of the Social
Security Act:-\?
10.05 NoliQs~ To the extent they are not inconsistent with
regulations hereinafter prescribed by law, the following notices are
required: f' 1 .
(a) To presef~he option to elect continuation coverage provided
under this Article,\' a-pArticipant or a qualified beneficiary who would
otherwise lose CoJv,er.a(ej must notify the administrator in writing within
sixty (60) days of (he-following events:
r~ (1) di,vor,ce or legal separation of the participant from the
t·· t' t Ii \ par IClpan s spouse,;
11-r;d '~'J ~"j2r a/oapendent child ceasing to be a dependent child under
U:i€,;?p'lan; ~ Cl ) v~_" r --1 II (((3~ de~lli,l)f a participant, if occurring after an election by I th6i qu~lified beneficiary for continuation coverage by reason of a p~frp~na~Ji~ln r01jthe\particiPantls employ or reduction of hours of
lllrr,cel ~')?J ·29·
~rv
(4) !fhilS~rticiPant being entitled to benefits under Title
VIII of the So@Security Act, if occurring after an election by the
qualifying ben-efibiary for continuation coverage by reason of a
termination bfj,l1e\ participant's employ or reduction of hours of
service. ~\::;
(b) To pre£e~e+he right to receive benefits provided under this
Article, a qualifiedLl:ler:leficiary who is a participant by reason of having
elected continuatj@.J cbverage under this section must notify the
administrator in writing<within thirty (30) days of the date, after the date
of the election, on~ the qualified beneficiary:
(1) fifst'O'ecomes covered under any other group health plan,
I I rT r I I h . as an emp oY~':_l{pt erwlse; or
(2) ~I~ to benefits under Title VIII of the Social
Security Act\~j
(c) The (E~~r will give notice to the administrator of the
following qualifYi,n~ e~ts within thirty (30) days of the date of such '---_~~J event:
(1) ~ of a participant as described in Section
10.02(d)(1); Cc=?)
(2) ntermination of participant's employment or reduction of
hours, as des~r;n'ledl in Section 10.02(d)(2}; "-,
(3) the~rticipant becoming entitled to Social Security
benefits, as d'scribed in Section 10.02(d)(4}. ~ <:J \._1 t) )
I (r.~)L.~h1; ad~i~!st\a~or will send written notice to each qualified ber;Jr,fI911~-y;;:.at such >b@etc1ary's last known address:
I ~ V' ,~~, I :J ".. -" '----': (( ((1, 'I 01 t~eJ option to elect continuation coverage under this
~~ticle py rea?on-05 a. qualifying event, or ~ II ) I r' ~ U @)~ ~O·
@ffi
(2) Q&'l termination of coverage under this Article due to
a failure of a\timely payment of an applicable premium or of a plan
termination, r_Sl
within fourteen (14)'cda~s of the administrator receipt of notice of such
qualifying event orrtermiration of coverage.
(e) A notic~-se!,lt\ to an individual who is a qualified beneficiary as
the spouse of a parti q,i pant will constitute notice to all other qualified
beneficiaries residinl:fvJith such spouse at the time the notice is sent.
(0)
10.06 EleQtjon.--""To become eligible for the continuation coverage
provided under this? Mcle. a qualified beneficiary must file an election
with the administrJ~~ithin the election period.
The election~h6d begins on or before the date a qualified
beneficiary would losuo~erage in the plan by reason of a qualifying event,
and ends sixty (60)vaays after the later of (a) the date the qualified
beneficiary WOUld[ I€e (cOverage by reason of the qualifying event or (b) the
date that a notic~ of f§l option to elect continuation coverage is given by
the administrator pursuant to Section 10.05.
G
An election f6r-~tinuation coverage by a qualified beneficiary will
be considered an f?1ecti~ by other qualified beneficiaries who would lose
coverage by reasol( I....o~the same qualifying event, except as otherwise
specified by a qualified-beneficiary in the election. UL-....!
. An election. a~in~~ continu~tion co.verage by a qualified beneficiary
Will not be consld~rea['(in election agamst coverage by other qualified
beneficiaries ~ro wo.91~J lose coverage by reason of the same qualifying evenrrl~ ~
( if 1',9;« premiJm;~equirements. The applicable premium for any
indill,idual~bting c'ontinuation coverage shall be equal to the amount last J I (Ii /F " "\ r--""1
def
1
e1rep I by \t~e eropl.oY"ee with respect to which the qualifying event OCC;JOlr~~ prior Ito thFl--qda!ifying event. , f 1\ 1 __ ., l uJ i (YjJ) -31-L \:--' G
(!!iJ
A qualifying Qrtificiary electing continuation coverage under this
Section must pay \gvalnount equal to the applicable premium for such "'---"' coverage to the administrator upon making the election.
(() 'I
If the electio,n,isJmade after the qualifying event, payment of the
applicable premium\' for-the period preceding the election must be received
by the employer Jithin-forty-five (45) days after the election.
The payor m~y ~~ke payment for the applicable premium in monthly
installments, in t acc6dance with procedures determined by the
administrator. pa~~t) of any premium or installment will be deemed
made in a· timely 'n:@IJ.ner if received by the Employer within thirty (30)
days of the date such'l¥emium or installment is due. \!!JrJ \ @ END OF ARTICLE X
@5
D
@
O~! ~
D
@
~
~ )3
rw -32-
CfJJ
(~ ARTICLE XI
/1 l'ADMlf:;:IISTRATION OF PLAf:;:I
(U)
11.01 Plan k[rr;ioistratioo, The administration of the plan shall be
under the supervi~i(:fh-6f the Employer, which shall see that the plan is
carried out, in adcordahce with its terms, for the exclusive benefit of , \
persons entitled teparticipate in the plan without discrimination among 1.--__ ......
them. The administrator will have full power to administer the plan in all
of its details, subje§.[)d supervision by the Employer and to applicable
requirements of lavk._r;dr this purpose, the Employer's powers will include,
but will not be Iimit6'Cito, the following authority, in addition to all other I (' f) I powers provided by, this lilian:
'-../ [./
(a) To makGJd} enforce such rules and regulations as it deems
necessary or propJr~the efficient administration of the plan;
(b) To ioG'~he plan, its interpretatio~ thereof in good faith to
be final and con6lusive-on all persons claiming benefits under the plan; '---------'
(c) To deci~-alll questions concerning the plan and the eligibility
of any person to p~rticiRate in the plan;
((:1)
(d) To apPQlnt~such agents, counsel accountants, consultants and
other persons as Cf~.::~ required to assist in administering the plan; and
(~) To allocF~.=~d delegate its responsibil!ties under ,t~~. plan and
to deSignate other persons to carry out any of ItS responSibIlitIes under
the plan. any such ra~lplda:'tion. delegation or designation to be in writing. ----"'. /J ~ l.i ) ~rll1 !o2:::EfxaminatiQ~' of records. The administrator or the Employer
will mJke%v~ilable (to'-eadh participant such of his or her records under the p'~n;i a'~~1t~Jn to Ltil; __ Pa:rticipant, for examination at reasonable times
duiing tJOrmal 'businbss hours.
i '\ I ~-)', ! \ . C) ~ II I I (--lW (J!riJ -33-
~('Q)
'-..Jl ........ -1,...
11.03 Reliahcei \ 6n tables. etc. In administering the plan, the
administrator will ~~ntitled to the extent permitted by law to rely
conclusively on aH1 tables, valuations, certificates, opinions and reports
which are furnish/eCi 'oyl, or in accordance with, the instructions of the \ -J Employer or by accountants, counselor other experts employed or engaged
\ I
by the Employer. t ':=J
11.04 Nondircrj;ibatory exercise of authority. Whenever, in the
administration of the-pl~n, any discretionary action by the Employer is
t_~ required, the Empleyer\shall exercise its authority in a nondiscriminatory
manner so that £II"--':-!yensons similarly situated will receive substantially i '----'-' the same treatment.
1 05 CI ' (J/~b"\ f' d . f d . I 1. a!(n "ot ~ene Its aD reYlew oenla.
\JV'
(a) SubmisCl\ of claim. A participant may file a claim for
benefits uinder tKe \J Piin by writing a letter to the Employer or the ~ administrator whiCh f7~quests the determination of the participant's
entitlement to b~nelit and which states the basis for the claim, The claim
I I' I i.
must be dated and-signed by the claimant, and must contain the claimant's L __ --'
address and telephone number. n \" ,-
The administFatQ~.Jas the Employer's designated agent, shall review
and determine clainfs-submitted under the medical reimbursement plan and I ( \, the dependent care, assi~tance plan. The Employer hereby designates any
insurance company ~r-60mpanies whose policies are incorporated into the
life insurance pt.e'mi\Jm-plan, the accident and health insurance, or the
disability insurancJ" 'planl as its agent to review and determine claims
submitted under subh:::p:olicies.
/---:(b) Denial !tChl~il. If a claim is wholly or partially denied, the ErriRiS~'e~<~dffiinistr,ator~,or designated insurance company or companies
shall\ witl:lTh ninety( (9'0) )days after receipt of the claim, provide written nO~i6~ l!f~~e.\Claim~~T!~~ng forth the fallowing in a manner calculated
to be ul'lderstd'od bYI the claimant:
\
1 I\i i;:I! 1\ r--'. ~
!: ij! II L_../
ll.Ui ! ILl ()/7;\, ~v j ",-/[J
-34-
C(})
(1 ) (~~pecific reason or reasons for the denial; C J
(2) Specific reference to pertinent plan provisions on which
h d . I . (b) L. d' t e enta IS ase: \ '----~
(3) liCdescription of any additional material or information
necessary fof,::tbe-tlaimant to perfect the claim and an explanation of
why such material)or information is necessary; and
.--) )
(4) k-p-prc(priate information as to the steps to be taken if
the claimant ~ to submit his claim for review.
If special circumstances require an extension of time for processing
the claim, the Emp'tbyer\ administrator, or designated insurance company
or companies may \exf~(l'd the period for an additional ninety (90) days by
furnishing written /hqt!6ej of the extension to the claimant prior to the
termination of the \!hiti~1 ninety (90)-day period. i'Y1
If notice of denial.Jof the claim is not furnished to a claimant within
these periods, arldLthJ-claim has not been granted within these periods, the , I
claims shall be deemed-denied for the purpose of review.
(c) Appeal ~enial of claim. A claimant shall appeal the denial
of a claim to the EfilQlbyer or administrator by delivering to the Employer
or administrator al wdtt~n appplication for review within sixty (60) days'
after receipt by the.-claimant of written notification of denial of the
claim, or such lo~~ pe1riod as the Employer or administrator may, in its
discretion, permit. $the written application shall be dated and signed by
the claimant or hiSL~l;Jthdrized representative and shall request a review of
the prior denial of the I blaim. The claimant shall be entitled to a full and
fairr:rev:iew of) the CdJni)~1 of his claim. including the opportunity for the claim~~/or~niS authorized representative to review pertinent documents
and \to~limit iSSU~s~~.d~mments in writing. I Tj~inistrator, ~f! the Employer's designated agent, shall review andd~felrmin~ I appe~rom denials if claims submitted under the medical
:UI Ii! . (/l?!iiJ1 ;:
~) . ~ /.-' " . ......./
-35-
C&8 .
reimbursement Plan~I:!J~he dependent care assistance plan. The Employer
hereby designates ~QLin'surance company or companies whose policies are
incorporated into t~~ IQe\ insurance premium plan. the accident and health
insurance, or the disability insurance plan to review and determine appeals
from denials of claz~s~s'ubmitted under such policies.
(d) Review Go~peal. The Employer or administrator shall make
its decision on t~e-apReal within sixty (60) days after receipt of the
request for review .1 unl~s special circumstances (such as the need to hold
a hearing, if in th9rEmployer's or administrator's determination a hearing
is necessary or advigble) require an extension of time, in which case a
decision shall be fende/ed as soon as possible, but not later than one
hundred and twenty1(f20) days after receipt of the request for review. If
such an extension~~l( f.ime for review is required because of special
circumstances. writtenl rfl'otice of the extension shall be furnished to the
claimant prior to th'eJq9~mencement of the extension. If the decision on
review is not furhished within these time limits, the claim shall be
deemed denied on7e~iewJ
The decisidn gn ~iew shall be in writing and shall include specific
reasons for the deCision, written in a manner calculated to be understood
by the claimant. an~spe9ific references to the pertinent plan provisions on
which the decision j~based.
f,r) )
The administ}~tor~as the Employer's designated agent, shall review
and determine revliews~of appeals under the medical reimbursement plan
and dependent c~rJ=~ssidtance plan. The Employer hereby designates any
insurance company [or-companies whose policies are incorporated into the
life insurance premjunrl"Plan; the accident and health, or the disability
insurance pial'), to ~lre~liew and determine reviews of appeals submitted
d ----... h Jf" \.. / ! un er-s.uc po ICles. ./
, rn1f1110/;#6/~C"; tr:~fJ d .. t' If . d' h II ~L.~ _Qrrec :Qn Q a mlOlstra Ive ermrs. an error IS ma e 10 t e
administ!~Of tf:le-e.!~n.1 the administrator shall promptly correct the errb~l ~'p'on lits di§:Qovejy. For this purpose, "administration" shall enddm~~ss thf enltire~ o'peration of the plan, including but not limited to, IIU I I ~_J Iii I I (JYJ") -36-
I ~ :) Ll' I L:J \ ._'// \ '--_/ ,-
r1Q ~/L.)
00' eligibility, partiCiPati~ and benefit calculation and distribution. If a
participant has (~lr J denied a benefit distribution due to such
administrative oveJ;sIght, the administrator shall determine the correct
interest of the p~rt\cjpant and shall direct the Employer to disburse an
amount to the p~rticip~nt (or his beneficiary) as is necessary to rectify
the error. If arl-exc~ssive distribution has been made to or for a
participant or ben'efiCi~fy, the administrator shall advise the party who
received the distri5u'fiOrl' of the error and shall take such actions on the
plan's behalf as a~jssary to retrieve the excessive payment.
11.07 IndemrntrCation of administrator. The Employer agrees to
indemnify and tolldere~d, to the fullest extent permitted by law, the
administrator. its ag~lht~ and employees against all liabilities, damages,
costs and expen£es )(inCluding attorneys' fees and amounts paid in
settlement of any ~llJimsl approved by the employer) occasioned by any act
or omission is irv-gO:oCl::::faith and not a result of gross negligence or willful
neglect. lor
11.08 pJtiCiQ;J apolication and notices. Any participant
applications or notige.s required to be made to the administrator hereunder
shall be made to ithe_fJJlowing address. and shall be deemed made upon
personal delivery, tWo "(2) days following posting by express mail (postage
prepaid). Federal ~fuPi7~s or similar overnight carrier, or five (5) days
after sending by OTdiDarl mail, postage prepaid to:
CC"---superior Resources I . ----c/o Bruce Fox ~(Jll'5118 East Clinton Way ~\ /1 \. U Fresno, California 93727 ,f)]~ .. //.~ /:':""<Attention: Cafeteria Account of I Il~ \ 0 Wame of Employer)
I 'Ii"~tti dd L --=:]th d" t t h II .. .. Of! sue I'omer.l a ~ess, as e a miniS ra or s a communicate m wntmg to
I II 1 ::: the Em1loyer. r) )
JUJ I (?U2) -37-
Superior Resources .
@R)
11.09 Noticet;;] Cihange in employee status. Participants shall be
required to notifi~J Employer, and the Employer shall notify the
administrator in wrifin9 \ in accordance with the provisions of Section
11.08 hereof, at 1~'~f9rtY-five (45) days prior to the effective date of. a
change of election\by...Ahe participants as a result of a change in family
status (unless the Fa~mi?istrator waives this minimum notice period).
a
@
(j!iJ
@)
1,r--\7j
·Oi .. ~
b
@
o !::::;! ----' F---]
~ /J rOl~ 1 ~. \'::.~ ~ (?)j
rrT a
1r!Jij
END OF ARTICLE XI
-38-
r[jiJ
@ ARTICLE XII
C~ LIMITATIONS ON BENEFITS
12.01 Limitati~ns-on benefits for certain employees. Nor more than
twenty-five perce~t=('25,%) of the total non-cash benefits (i.e., medical
reimbursement behefit~~ dependent care assistance benefits, accident and
health insurancerdisability insurance, and life insurance premium
benefits) provided 'nereGnder for or during any plan year shall be to or for { \ key employees of th~ Employer, and their spouses and dependents. In
addition, not mor~~nJ twenty-five percent (25%) of the total dependent
care assistance (benefits provided hereunder shall be to or for
more-than-five per'deFft I (5%) shareholders of the employer, and their
spouses and depehdJnt~. The administrator shall make any adjustments in
benefit elections tec~~'Sary, as provided in Section 4.05, to comply with
this Section. ~~
(O? END OF ARTICLE XII
!
0J7J
@) ARTICLE XIII
AMENDMENT AND TERMINATION OF PLAN
'.
C~ ,
13.01 Amen'dment. The Employer shall have the right to amend this
plan from time· td-time~ and to amend or cancel any such amendments.
Employer amend~ents ~shall be stated in an instrument executed by the
Employer in the sam-~manner as this plan, and this plan shall be deemed to
have been amendfcl=rn\this manner and at the time therein set forth and all
participants shall ~bEl'effective which shall attempt to cause any of the .'-..." I assets of the plan tDe used for or diverted to purposes other than for the
exclusive benefitCofparticipants or their beneficiaries, or effect or
create any discri~in1fion in favor of participants who are officers.
shareholders or hi~.hI1160mpensated employees.
13.02 No (Qnilctual obligati~n. It is the expectation of the
Employer that it-will'::continue the plan indefinitely. but the continuation
thereof is not ~sSDmErd.J as a contractual obligation by the Employer. The
plan may be l:li~'c'brl@ued or terminated at any time by action of the
Employer. DisContinuahce or termination of the plan shall not have the
effect of depriving~anLparticipant of any benefit owed by the plan on the
date of terminatioiLoLt~e plan.
13.03 proce~on termination. On or before the effective date of
termination. the ~mpJP'yer shall direct the administrator to proceed as
soon as possibl';1 Lbuud any event within one (1) year from such effective
date, to pay all bQefits owed by the plan, after first reserving such sums
as it may dee~-to-be reasonably necessary for its expenses and ~~~ for ~~abU;tles, absol"to or contingent, chargeable to the
~ LO --l END OF ARTICLE XIII r~ CJ
I II a
ij ~ csv -40-
(}!iJ @Y ARTICLE XIV I~MISCELLANEOWS PROVISIONS
14.01 I,j.r~ t. be fuml'hed. Participant, ,hall provide the
Employer and adrbioistrator with such information and evidence, and shall
sign such documJnts" ~s may reasonably be requested from time to time
for the purpose !Of-Jgh,inistration of the plan. The administrator, its
agents and employees-q;ay reasonably rely on the accuracy of, and have no
duty to investigate-the validity of, any such information provided by
participants. ~)
14.02 Limit.QQon participants' rights. PartiCipation in the plan
shall not give any?~~ployee the right to be retained in the Employer's
employ, or any rig'ht, fr~interest in the plan other than as herein provided.
The Employer or\!~IJ~tee reserves the right to dismiss any employee
without any liability,/ffuJ any claim either against the plan, except to the
extent herein drovided, or against the Employer. All benefits provided
herunder shall bJ~~did-Jfrom the trust and no person claiming an interest
under the plan LSh"EiII-h-ave any recourse toward satisfaction of his benefits
from the Employe'r,'QLJ,he administrator. Any amounts transferred by the
Employer to the cfdroinistrator for the payment of benefits hereunder shall
be paid on a ufirafirst-outU basis.
14.03 ReceiPt-a~ releas~. Any payment to any participant or his
legal represent~ti":"e_orJ beneficiary in accordance with the provisions of
this plan shall bef1to_the extent thereof, in full satisfaction of all claims
against the trustee,theJadministrator and the Employer; and the Employer,
administrator o(;:;tr~stee may require such participant, legal
representative10r beriMic'iary, as a condition precedent to such payment, to
I ~ \ ~,.. b . " .... /1 f exeouteL. a ~eoelpt an ... "'re ease to such ef ect.
[II t~Nonas~r;{a~ility. None of the benefits, payments, proceeds or chiims(ofi:lTi~ participant shall be subject to any claim of any creditor of ah~1 participzmt E:2J )in particular, the same shall not be subject to
UI ®2J -41-
(!iJ
attachment or gafn:Mri'ent or other legal process by any creditor of any
participant, nor st\~III~dy participant have any right to alienate, anticipate,
commute, pledge, (~Q1ber or assign any of the benefits or payments or
proceeds which he\ ~~xpect to receive under this plan.
14.05 Incorh[etency. Every person receiving or claiming benefits
'J • under the plan sh[all=b~ conclusively presumed to be mentally competent
and of age until the-Aate on which the administrator receives a written
notice, in a form Land manner acceptable to the administrator, that such
person is incompetent~or a minor, for whom a guardian or other person
legally vested Wit~ l!.h~ care of such person or estate has been appointed;
provided, howeVer)~e if the administrator shall find that any person to
whom a benefit isrp,ayable under the plan is unable to care for his affairs
because of incomlp~~'f'rldy, or is a minor, any payment due (unless a prior
claim therefor s'hanVhave been made by a duly appointed legal
representative) maY(b~\'paid to the spouse, a child, a parent or a brother or
sister, or to any ~eidonl or institution deemed by the administrator to have
incurred expens,e-faFS"och person otherwise entitled to payment. To the
extent permitted p~ la~, any such payment so made shall be a complete
discharge of Ii~bilit~ "th'erefor under the plan. L-.
14.06 No gi:iarantee of tax consequences. Neither the administrator
nor the Employer[make~ any commitment of guarantee that any non-cash
benefits paid to or~,the benefit of a participant will be excludable from
the participant's g~oQi9come for federal or state income tax purposes, or
that any other federai/or state tax treatment will apply to or be available
to any participr;;triL_I.i shall be the obligation of each participant to
determine whethef.:'eachj payment is excludable from the partiCipant's gross
income for feder~l-an(!j state income tax purposes, and to notify the
Employer if the paftlc'i~nt has reason to believe that any such payment is
nQt-so) exclu~able.~ ~)
r ffi~dem.-;;i~~ion of Employer by participants. If any participant receivEfs~one or m6-re' ilon-cash benefit payments or reimbursements that ~rb: rf6i"'-fbD~ldepe'naen~are or medical care or otherwise non-taxable e~he~~~s, Is'uch p'lITticipant shall indemnify and reimburse the Employer for
II I ..., UI!! c:J II u ~rv -42-
(!!}j
any liability it mayG11D for failure to withhold federal or state income
tax or Social Se9lTriw\ tax from such payments or reimbursements.
However, such inde~nification and reimbursement shall not exceed the
amount of addition'al federal and state income tax that the participant
would have owed if~he-payments or reimbursements had been made to the
participant as regular.::cakh compensation, plus the participant's share of
any Social Security Ltaxj that would have been paid on such compensation,
less any such additonal-irlcome and Social Security tax actually paid by the
f ,/
participant. ~
(OJ 14.08 Trust fund ,sale !:l0urce of benefits. The benefits provided
hereunder will be p'~(s9IeIY from the trust fund created pursuant to the
trust, or from amoLhts~~p.'aid by the trustee to the administrator, or from
the insurers. No p1:rti~iR'ant or other person shall have any claim against,
right to, or security( ?5Ib~er interest in, any fund, account or asset of the
Employer or the administrator from which any payment under the plan may ~
be made. ~~ ,
14.09 ~. LJI! pronoun or adjective in the masculine gender ............ !
includes the feminine gender, and the singular includes the plural, unless
the context clearly Ci7[indicates otherwise. _--.1
14.10 GQverni~~. This plan shall be construed, administered and
enforced according 'td-th'o/ laws of the state in which the principal place of
business of the Employer1 is located, except to the extent the law of such
I I L state is superceded_by-federal statute. r~
~0 (OL rr-" l~_J
I I 9 ,d
I ~!J2)
END OF PLAN
-43-
OF
:s
G) CAFETERIA PLAN TRUST
IJ:Cf
t& fy d f Cl) Ee:t/l\J 0 a. · o I-I.
G)
~ :s
In
Article/Section
@RJ (Ol ~ TABLE OF CONTENTS ~0 Subiect
"
ARTICLE I CS)NCORPORATION OF PLAN ............... .
ARTICLE II. C::TRUSTFUND
Section 2.01 I pomposition of Trust Fund ............. .
Section 2.02 t ) )SUb-Funds ............................ .
ARTICLE III @DUTlESANDPOWERSOFTRUSTEE
Section 3.01 0 Receipt of Moneys in Trust. ............. .
Section 3.02 Disbursement on Direction of Administrator
Section 3.03 (~rnFower to Invest. ..... , ................. .
Section 3.04 v[ Records Required ....................... .
Section 3.05@L(ReportingRequirements ................. .
Section 3.06 Q I) f\uthorization Must be in Writing ......... .
Section 3.07 ;Investigation .......................... .
Section 3.0~/--"'V::~Taxes ................................. .
Section 3.0~ 0 I_Compensation of the Trustee ............. .
Section 3.1 It payments by the Trustee ................ .
Section 3.11 No Responsibility for Payments .......... .
V'----]
ARTICLE IV [ RECORDS OF TRUSTEE
Section 4.01 r;=;'{\CCOunting ............................ .
Section 4.02 eAnnual Report of Trustee ................ .
ARTICLE V 0 ~ ~ENERAL PROVISIONS APPLICABLE TO THE
L 1 TRUSTEE
Section 5.01 r::l f"-"Trustee Acts Conclusive ................ .
Section 5.02 \ 0 J) !Duties, Responsibilities, Liabilities and ~\\ /<"d ,~C:J Disabilities of Trustee ............... .
I . Sectiow5.03 r-No Liability ............................ .
I Kecti6'n 5.04 l C) ~itations on Trustee Responsibilities ... .
S1;Cti0i'r:,5.05 L_Jndemnification of the Trustee ........... .
Q, ~~,\ ~-
I 9,eftion ~r06 Jrustee's Rights Where Controversy ....... .
I" slection 5iD7 ,equest for Instructions ................. . l~j J @m i.
1
1
1
2
2
2
3
3
3
3
3
4
4
4
4
5
5
6
6
6
7
7
7
C0rv '
Articl.e1Section 'GlS~SUbiect ~
ARTICLE VI 6RESIGNATION. REMOVAL AND SUBSTITUTION
Section 6.01 (J S'\Resignation by the Trustee .............. .
Section 6.02 \'=:.;Removal of Trustee ..................... .
Section 6.03 \"1 Procedure upon Resignation or Removal. .. .
ARTICLE VII f' . jAMENDMENT AND TERMINATION
Section 7.01 ) "'f'-mendment by Mutual Agreement. ........ .
Section 7.02 f ./Termination ............................ .
Section 7.03 ~Disposition of Funds Upon Termination .... .
Section 7.04 eNO Violation of Rules Against Perpetuities ..
7
8
8
8
9
9
9
ARTICLE VI/I rJr13ENERAL PROVISIONS
Section 8.01 ~t./GOverned by This Trust Agreement. . . . . . . . . 9
Section 8.02 @ 1\Lim!tation of Participant Claims. . . . . . . . . . . 9
Section 8.03 (] \) Notice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Section 8.04 _",,/Choice of Law. . .. . . .. . . . . . . . . . . . .. . . .. . 10
Section 8.05~r-'Useof Courts. . . . . . . . . . . . . . . . . . . . . . . . . . 10
Section 8.06 0 (--Severability........................... 10
l ---, Section 8.07 Confidential Nature of Records. . . . . . . . . . . 10
Section 8.08 ~rbitration............................ 10
L_' SIG NA TU RES. . • • . (§r . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11
01 1
D
I~CJ ~) \~~
(~-=:; ~~ .----J ~~) L._. __ '
/l (..--,\
I ~JV J Ii.
({ii) @ CAFETERIA PLAN TRUST
THIS CAFEt2R~1 PLAN TRUST (hereinafter referred to as the "Trust
Agreement" or "Ag1r.eiIDent") is entered into by the Employer and the Trustee
for the purpose of" ~roviding benefits to employees under the cafeteria plan
established by the ~Emplbyer.
2) ARTICLE I
@ INCORPORATION OF PLAN
This trust agreement is established pursuant to and is a part of the
plan, and the plari li~ jm60rporated herein by reference. Any term defined in
the plan shall hav~t~e' same meaning when used in this trust agreement,
unless the conte\.~IY indicates a different meaning.
C05 ARTICLE II
TRUST FUND
~
Section 2.01 rCQm~Qsjtjon of Tryst Fund. The trust fund shall consist of
all contributions madelJnder the plan, investments made on property of any
kind acquired witb(;rti such contributions,. and all income, profits and
proceeds derived therefrom. D[-~J
Section 2.02 $1yb-Funds. The trust fund may be held, administered, and
invested as a sing'l~funld, or it may be divided into such sub-funds as the
administrator may dirett:\ The assets of each sub-fund shall be held in trust
as la-portio%f thb q6fal trust fund. In the event the administrator divides
the qt7'y~!/fU'n6' into)"suo~undsl the administrator may designate a separate trJs'te~lJc5'/serve asrtrustee of that portion of the trust fund constituting a
I r-L __ ~ 11\ ~~ , ',--,' ::.-
I. /(1 r--j I!llil 2) I~J (jjj) -1-
" (~RJ
single sub-fund. Ibthk\event that sub-funds are set up and the administrator
designates a sepa'rat~) trustee for each such sub-fund, then the trustee of
each such sub-furil,l~ha'1l furnish such information concerning the investment -----of the assets of its)s~b\fund as the administrator may require for the proper
administration of the tr!,lst fund. The plan administrator may also require \ -, that all expenses related to the operation of any sub-fund be charged against
the assets of suc5' bb-fund. The trust fund may be held by the trustee in
such custodial a6countl or accounts with such banks or other financial
institutions the ac~()unt~ of which are insured by an instrumentality of the
United States as the ~d'ministrator may from time to time select.
! .J
@ ARTICLE III
~~TIES AND POWERS OF TRUSTEE
Section 3.01 (§f;[eiPt of Moneys in Trust. The trustee shall receive all
contributions and m'-d~-eys paid by the Employer to it under the terms and
conditions of thefl1a;( in trust, for the purpose and uses set forth in said
Plan. and with ther:lovrers and duties hereinafter set forth. 'u 1 L: __ ~
Section 3.02 Disbursement on Direction of Administrator. The trustee
shall hold and adnJi'nister the trust fund subject to the following provisions:
(a) The tru~shall hold and administer the trust fund subject to
the proper written ldireclUbn of the administrator or its designated agent, and
the trustee shall be=t50und by and may act in reliance upon the written
instructions of t~J\adrrlinistrator. or its deSignated agent. insofar as the
trust fund is conc~rnedd.
I J
/i" (b) When SO'I idifected in writing by the administrator, the trustee
shall:J3egregate portibrfs) of the trust fund, create speCial accounts, andlor
• f 11'"'1,\' ./ /f!, '--, /, . dlsburs&./~ertrust fund-In such amounts and to such persons as directed by
thb adlnihfutrator, brnrs :designated agent. I ~'.r ' "'--/,
/
' ~\ L ____ J
'I S~btioh \3.03 [fower to Inyest. The trustee shall conserve and protect
th? \' prihbipal af th~~friJS~ funds. The trustee shall have the power to invest
alW of 1" ®~USf funds in _2~VingS accounts at banks, savings and
r!iJ
loan associationS:~rh6ney market accounts, Treasury bills, banker's
acceptances, insdr~iY contracts or other property of a like kind, that a
prudent man wouldlllse under like circumstances with due regard for the
purpose of the PI~und trust fund and its need for liquidity. The trustee
shall have the poweLta' transfer any part of all of the money or property of
the trust fund to 'clAy-common or collective trust fund or pooled investment
fund maintained tiY. th.el trustee. The trustee may, directly or through the
administrator, em~IOY) sluch investment adviser or advisers, with power to'
direct the investm~nt-df )all or any part of the trust funds, as the trustee may
select, and such inve-stment adviser or advisers shall direct the investment
of such trust fund~ (con'sistent with the terms hereof.
\:J Section 3.04 "R@rds Required. The trustee shall maintain suitable and
adequate records 60 and for the administration of the trust.
Ul)
Section 3.05~e"ltortjng ReQujrements. The trustee shall make all
reports required bY~A and any other applicable law or laws.
Section 3~QorjZation Must be in Writing. All checks, drafts,
vouchers or oth~rL~ithdrawals of money from the trust shall be authorized in
writing by the ladminist~ator.
Section 3.0~stjgatjon. The trustee shall not be required to
determine or to IT)a~any investigation to determine the identity or mailing
address of any p~rsdrl entitled to benefits hereunder and shall have
discharged its obllg~li9_O:in that respect when it shall have sent or caused to
be sent checks lah'd_other papers by first class mail to such persons at their
respective address~,-as] may be certified to it by the administrator. L_
. "'--q", Section 3.0BfT-axes. If the whole or any part of the trust fund or the
proceeds t.heAreof ~hal!i become liable for the payment of any estate, inhfrlt)~ce~~iH'comel'or~ny other tax, charge or assessment which the trustee
'I"I V ".#' ' \ shall b~/reqUired to\'paYI the trustee shall have the full power and authority I II I;': " ---' ' tOI pay lUch~tax, cnarge 0r1 assessment out of any moneys or other property in
its i haridsb~IOngi~:--toJthe trust fund for the account of the person whose
I ! ! ~ cJ
II II i ®. /-'\ Iy) (j?) ~-../ l~
-3-
Inte,ests he,e""de~1Vllable lor Ihe payment the'eol, but ~t least ten (10)
days prior to the 1f1a~i~~ of any such payment the trustee shall give notice in
writing to the admi~ator of its intention to make such payment. Prior to
making any transf~ ~r\ distributions of any portion of the trust fund, the
trustee may requlre_sych releases or documents from any legal taxing
authority as it sha~",\deem necessary.
Section 3.09~c~ensatiQn of the Trustee. The trustee shall receive
such compensatio~-for) i~s services rendered hereunder as may from time to
time be agreed uFWn-by separate agreement between the administrator and ! ... the trustee. So long as the trustee is Dwight H. Mensinger, the trustee shall
not receive any co~pen~ation for services hereunder. \'J
Section 3.1pl(f1wments by the Trustee. As directed by the
administrator, the tr'ustd~ shall make payments from the trust to an account
established to pay \addqnaintain plan benefits. In addition, the trustee shall
make payments frp'~ &e trust to a separate account established to pay all
expenses of the pla~ a~d trust, including plan and trust administration fees.
The trustee shall-r91mburse to the Employer any amounts remaining in the
fund or in suc~ ,aqcptffits after all liabilities for the plan year have been
satisfied, but not incluaing any earnings thereon.
t:;;;;,\ /1
I (r lil l/<?
I iff
• < v:
! !
ARTICLE IV
l~ I SElction ~~.01 'l\QcoUntjng. The trustee shall keep or cause to be kept by
on'el at): fnarel IllcustadianS'1 appointed pursuant to Section 2.02, complete and II I I L-"
lW ~ (02) -4-
aceu,,'e cecocds a~couots of its receipts aod disbursemeots. The books
and records of th'ltrIJ~tee shall be available for inspection at all reasonable
I \..; 1 I J • times and places b.y~e duly authorized representatives of the Employer of
the administratof.(J J)
Section 4.02\~nnlJal Report of Trystee. Within thirty (30) days after
the close of each~ Planl year of the receipt of a written request from the
administrator, or Jpon-termination of the duties of the trustee, the trustee
shall file with the-abministrator a written accou nt setting forth all
investments, receip,t~d!~bursements and other transactions effected by the
trustee during such/plaA\ year. Such account may consist of written accounts
of custodians and (!!1vestment advisers appointed hereunder which are
provided to the tru~t~dr the administrator. Such account shall also contain
an exact descriPtiolj@all securities and other investments purchased and
sold, the cost or (netfrproceeds of sale and shall show the securities and
investments held a~of-"the date of such account and the cost of each item
th.ereof as car~ie~ (~~ I ~e books of the trustee. The tru~tee s~all also file
With the admlnlstratc:Y' a monthly report on the receipts, Investments,
disbursements and-'Otlie~ transactions related to the investment funds in that
same month. !AII\a,ccounts so filed shall be open to inspection during
business hours pY--:the--a;dministrator.
h ARTICLE V ~ GENERAl'PRaVISIaNS APPICABLE TaTHE TRUSTEE '----../ .
Section 5.0r;J fi:~e Acts Conclusive-; . No third party dealing with the
trustee shall be oblig\ated to see to the application of any monies or property
of the trust, or to~see~Jthat the terms of this trust agreement have been comp~ied with, < or tp c.i~~uire as to the necessity or expediency of. any, act, of
the/trustee . ./ Every Instrument executed by the trustee or by hiS direction r r<",,:,\\' ./ _,:;,. ~-Shall De 1 conGlusive in-favor of every person who
I ~~ (ciL I ~ ('a}Fat\ the tim~...QLthe delivery of the instrument, this plan and trust agreem't\in1W~f.e in ffulnorce and effect; ill ~) ~ .1 (2) -5-
((i)
(b) the insi~1 ~t was executed in accordance with the terms and
\ '-' -' I conditions of this pl<!Q....and trust agreement; and
(c) the trul~<eS"was duly authorized to execute the instrument or
direct its executioe~~
Section 5.02~DQtils. Responsibilities, Liabilities and Disabilities of
Trustee. The dUtiesr responsibilities, liabilities and disabilities of the
trustee under this pran'ahd trust agreement shall be determined solely by the , ,/
express provisions (h~~re~f. No further duties, responsibilities, liabilities or
disabilities shall be, i@JiEtd or imposed. The trustee may delegate any of his
ministerial powers or-.,Quties to any of its agents or employees,
Section 5.03 (~~iabjljtY, The trustee shall incur no liability for acting
upon the papers, d6c6rh~lnts, data or information believed by the trustee to be
genuine and accu~atv 'and to have been made, executed, delivered or
assembled by the \p'rbpe~ parties. The trustee shall incur no liability for any ~ act taken by the ,trusteein reliance upon the advice of legal counsel.
S ' 5014°[1, C , T R 'b'l' 'Th h II b ectlon ,ImitatIon on rust esponsllll!es. e trustee s a e '---= ~ responsible only for the property actually received by it as trustee
~ ,
hereunder. It shall, Rave no duty or authority to compute any amount to be
paid to it by, the ElnplQyJr or to bring any action or proceeding to enforce the
collection from thEf(E~ployer of any contribution to the trust fund, The
trustee shall have ~no-aJthority or responsibility with respect to any part of
the trust fund as Oof:J.vhi1 it does not serve as trustee.
The trustee ~y-concluSively rely upon any directive which purports to
have been authoritedlbyl, and executed on behalf of, the administrator, and
shall not be under l~nYI'd'uty to question any such direction, The trustee shall hav~~no duty/Jo revje'w) dr make recommendations with regard to the making, reMntiori/6~;f(fispoSiti~\of any investment subject to the direction of the
I tll.~! 4.'" ( ,...-... J adlm~ln!~yator. ~ L_> '_,
I ~\ L-==,--1
t I 1r~ truNee s~n~t be liable nor responsible for losses or unfavorable
resultsll arising ~ from""") the trustee's compliance with directions of the
lUll 1\1 II .J-,;=::) , I II I ! J \ I IU) II I I 0 j~1 J ~/ J! ~/ L/
-6-
@;?J
administrator whictf(J~made in accordance with the terms of the plan and
trust. If applickl:ilJ~' )neither the Employer nor the trustee shall be '--_/
responsible or liablej tor\ the failure of any insurance company, HMO, health
services provider, (d~effindent care assistance service provider, or other third
party contractor to"rpa! or provide any benefits due the participant as a
result of premiumJ" paidl on behalf of that participant. ~-'
Section 5.05C1nd-;h,nificatjon of the Trustee. The administrator shall
indemnify and ho'la~thJ trustee harmless from all liabilities and claims, L---./ including reasonable-attorneys' fees and costs in defending against such
liabilities and clairhs;-asl a result of: \. "--' )
'---' (a) Any actrir:laction of the administrator; or
(b) Any a~t4} inaction of the trustee resulting from acting in
accordance with ahYl ~irections from the administrator, or resulting from the
absence of directi6(l~Jm the administrator where the trustee is entitled to
direction. ~'7J
( (I r
Section 5.0a-TrYstee's Rights Where Controversy. If a controversy
arises concernin1i-Uleperson entitled to a distribution, the trustee m~y,
without liability, retaio_the funds or property involved pending settlement of
the controversy 6r--[)ehding an adjudication by a court of competent
jurisdiction. (0)
Section 5p7~ReQuest for Instructions. The trustee may request
instruction or cl~r~fi.catidn of instruction from the administrator and may
delay acting pursulantl to instruction until the clarification request is . . d l __ :-:-, __ receive . rI ['.
/1 ~!J I (rf1~ (( ~ ARTICLE VI
',II ~ R~)?~AnQN. REMOVAL AND sUBSTlruIlQ~
II slebn! 6.01 ReSIgnation by the Trustee. The trustee may resign at any
time b~ givi~dl thidy-(30) days wirtten notice to the administrator.
I tU. r 11 ~(I?') -7-~ U -)!-)
·,
(!!i)
Section 6.02~J~oval of Trustee. The trustee and any successor
trustee hereunder ~~ble removed by the administrator upon delivery by the
administrator of arwtitten notice of removal to the trustee, to become
effective in not le'si.J:h~n thirty (30) days after delivery thereof, unless an
earlier date or a \l:!-terJ date is agreed upon by the administrator and the
trustee. Howeve~~ \nal removal shall become effective until a successor
trustee appointed by.-the administrator has accepted in writing, in trust, the
trust fund. A s~cces~or trustee shall have all of the powers. without
exception, conferre~-ap3h its predecessor trustee.
Section 6.03 (G~ure upon Resignation or Remoyal. The trustee who
has resigned or De~femoved as trustee shall endorse, transfer, assign,
convey and deliver)ltfi9\ trust fund to the successor trustee, together with
true copies of all bfl iQ Jrecords relating to the trust fund so transferred and
delivered. The re~igriihg trustee shall also execute all documents necessary
to vest title as tfust~b )of the trust fund in the successor trustee as may be ! I 1 ! J ' necessary or desir~!Vin order that the successor trustee may properly
administer the Tro-stvfrereunder.
In the evehtQf (:ah removal or resignation of any trustee hereunder, it
shall, within thihY--(30)..J days from the effective date of such removal or
resignation, file ~tb~the administrator a statement and report of its
accounts and proc~edif.lgls covering the period from and containing the items
of its last statemer1t~port in this respect to the effective date of such
removal or resignitibn))ln the absence of any objection made within ninety
(90) days of the, ~J:~ipt of such written account by the administrator. the
account shall be ldJemedJ approved by the administrator. CL L ___ .J
. (;,(J I ~ ARTICLE VII ~.~ / ,,-' J { ~n11.,~;J ~MENPMENTANPTERMINAT!QN ~on~.01 A~~kent by Agreement. Any provision of this plan and truis~ (g'reeIT1~~t m~y-?~ amended or modified at any time, in writing by
agreuem;eot of Ithe Employ~r, the administrator, and the trustee. II , II \1 I " ~ ~CV2J ~
(!!j)
Section 7.oi"J~ination. This agreement may be terminated by the
Employer or the abmjni~trator and the trustee by an instrument in writing at
any time. ((5)
Section 7.0:f\:.DjSPositjon of Funds Upon Termination. Upon the
termination of the'" trrrst, any and all monies remaining in the trust after
payment of all b~nefit='claims, administrative fees and charges shall revert
to the Employer td-th-e. {xtent permitted by law. In no event shall any funds
of this trust be usgd fOf
i any purpose other than as provided for in this plan
and trust agreememnor returned to a participant except in the form of
benefits preViOUSIY\~d in accordance with the plan.
Section 7.04(f.!6\r,jOlation of Rule Against Perpetuities. Unless sooner
terminated, this truSt' Sh~1I in any event terminate upon the death of the last
survivor of such p¥s6r1's who are living at the time of the creation of this
trust, who are enfitle~\l fa receive benefits hereunder. However, if, as, and
I \.J v} when the trust witQQ).,lJ benefit of this provision shall not violate the rule
against perpetuiV~\f~ provision shall be of no further force or effect, and
this trust shall co'ntil'lue in perpetuity unless otherwise terminated. L ___ J
ARTICLE VIII
(OJ GENERAL PROVISIQNS
Section 8.0'11 :-Eroferned by This Trust Aoreement. The rights and duties
of all parties, ihcluding..J the Employer, the participants, other beneficiaries, " the administrator and-tne trustee, shall be governed by the provisions of this L-.~J plan and trust agreem·ent.
( II \ ~. f5SE!ctio~,l02 ~m1t~tion of Participant Claims. All benefits provided by
thisll Plkn;;fnall be (limft'ed to the funds contributed by the Employer to the tr~~teJ~o;r behalf ofGheLparticipants. II~I I
I I slcili;~ \18.03 iNOtlcl Any notice required to be given under the terms of
! 11/! \ ~ \ this
l
plan and trust-agreement shall be deemed to have been duly served jf
lltJ ®~ ·9·
r!iJ
delivered persona'l~ the person notified in writing, or if mailed in a
sealed envelope, p~stage prepaid, to such person at his last known address as
shown on the recofds~of the trust, or if sent by wire to such person at his
last known addres~.C~ 1 \. .J
Section 8.0~-C;;hQice of Law. All questions pertaining to the trust
agreement, the tfusfc>r the plan and their validity, administration and
construction, shall Ibe-de~termined in accordance with the laws of the State of
California, except rtOt!Je extent California law is superseded by federal
statute. (Q)
Section 8.05\S;;, of Courts. All reference in this instrument to courts
will mean courts f1~.llmpetent jurisdiction located in the State of California.
Section 8.oci/'$~e rab i I ity. If any provision of this plan and trust
I II' . • agreement, the rulel?] af;1d regulations made pursuant hereto, or any' act In the
administration of tHe Riah is held to be illegal or invalid for any reason, such
illegality or invalidit{' shall not affect the remaining portions of this plan
and trust agreefnertt (clod its rules and regulations unless such illegality or
invalidity will prh'eOt .~ accomplishment of the objectives and purposes of
this plan and trust ~greement. or the rules and regulations, as the case may
require shall be mfdifiedj to remedy such defect.
Section 8.07~fidential Nature of Records. Except to the extent
necessary for thEf\ \pro'p~r administration of the plan, all books, records,
papers, reports.! d1oaarnents, or other information obtained with respect to
the plan shall beJ Fcmfid~ntial and shall not be made public or used for any oth~r . purposes. lN~thi~9 in this Secti~n shall prohibit the preparation of
statistical data and",summary reports With respect to the operations of the
plan if aut~J,zed (b~ll~h1 administrator.
I~r""""ns\ ·t' '4808>''''='/6't t' A t I . . . f ec Ion . I 0 r 'ua 10 n. ny con roversy or calm anslng out 0 or
relatink(O" this phin@all be settled by arbitration in accordance with rules
of II i~e>rl\mer.ican ~r.bitratidn Association then in effect. Judgment upon the I! \ \ L i I -" I---.J )
U @k) -10-
@JiJ
award rendered b~~arbitrator or arbitrators may. be entered in any
state or federal court... . ..Iiaving jurisdiction. The fee of the arbitrator or
arbitrators shall ber1lorn. by each of the parties in accordance with the
rules of the Americ~n)Arbitration Association.
b
~. )) ENDOFTRUsr
IN WITNESS/WH~REOF, this trust agreement, and the plan and
adoption agreemen~ mgorporated herein, are executed by the trustee and
employer on J $"" , 19f.i.
TRUSTEE:
EMPLOYER:
r!J~
@
rn? l 0 ".]
By:
-11-
CAFETERIA PLAN
.CE
ADOPTION AGREEMENT
CAFETERIA PLAN
The Employer ~er.eby'J establishes a cafeteria plan for the benefit of
its employees rin-&dcordance with the terms of this Adoption
Agreement and/the/ plan document. The Adoption Agreement is
established pursuant'to and is a part of the plan and trust, and the
plan and trust\...kfe) i'ncorporated herein by reference. Any term
defined in the plan::"tir trust shall have the same meaning when used
in this Adoption( &greoement, unless the term is defined differently
under this Adoptrdnl Agreement or unless the context clearly
indicates a diffeffintmeaning. ~ SPECIFICATIONS
SECTION 1.01~~e" ~ of Cu.pe.-tJ},J-",o,--_ Aaa~esl /0.300 7'Orl"'c.. AIle.NUr: ..
b ~u.per .. t.INoJ (2R.. 9,OIL/-
T@ne No.: (~) 252." J.l.50~
1.02 [Fiecferalj Employer ID No.:
~-1 .03 ljrustee;: Dwight H. Mensinger
2360 Plaza Del Amo; Suite 200
Torrance. CA 90501 /r2 @
r
nj#A{&. (ayct Administrator: Superior Resources, Inc.
n r'~-;] 2360 PI",. Del Amo, S,'te 200 Torrance, CA 90501
(213) 618-9929 'm ~~e Date of Plan, ..;r"/:1 I, 1~8e
1.06 PJ~9-Yfar (choose one):
( ,,/ II' t'-J l( 'j Calendar Year
Employer's fiscal year,
which is :it",tl .. y I to J,.,N6 flo
Other: to ____ _
~f "
;';L..-,
1.07 Rlan_No.: _-L/...:o::...=tlI=-r;..? _____ _
r---'J
1.08 EUgi6f1ity Requirements: I· J re§)m Age: IB (not over age 25)'
Mantas of Service: I (not over 36 months) {](~J
Entryrljate: (Choose One) ~ ... v ~ ~lTirst day following date eligibility requirements
~re met
~I'st day 0' moo.h '01l0wl09 0' COlncldl09 wl.h
'. ,Ll Lthe date eligibility requirements are met
-..:....~
n Other (1):
t-=-j]lot later than first day of the Plan Year
@., . f~lIowing or coinciding with the date eligibility
• Qrequirements are met) .. -y
rExclusi.ons: u [ , 1
(~-I\jon-insured plans (medical reimbursement and
@Tf. c~pendent care): Nollli!!'
(IV] V .' .. / Union employees
I (I ~ is .~ Noo-""Idoo' alleos
Other
Ill} Ll~J
(b\ ~Insured plans: as contained in any policy or ((f n I policies of insurance incorporated under
\ lr) the life. accident and health or
(~\J disability insurance plans
1.09 B~~J Limitations(3):
1'"" f'\ Ma5cimu'm annual dollar amount for deferral under
\ '--~""" j m~dic.al expense reimbursement plan: lS $/tI •. eDO (Not to exceed $10.000)
1.10 ~enefiJs: (check appropriate benefit) J1 CJ Medical Expense Reimbursement -T"'-(c0' Dependent Care Reimbursement
'-..../
(1(""'\ Life Insurance Coverage Dr; _1" Accident and Health Insurance Coverage
( ;] ~ ) Disability Insurance Coverage
'~-~
IN WITNESS WHERE<:?F this Adoption Agreement. and the plan and
trust incorpor~d-herein. are executed 9,Yn the Employer on
Q a&j ::::> r::' "---1 • 1 9...K.L.
(J () [ I
EMPLOYER: @ e 9' &>..£._~..l'.rJ.AJ.I) __
D:=--...J
By:
(Ti Ie) Mayor. City of Cupertino
By: (~
SUPERIOR RESOURCES. INC,
By: ~//./?l~ i::~~lec..)---PR-E-S-ID-E-N-T-"'=;""::
(Jfj~
((ili~
(1) If grou~;aGci8ent and health insurance is included as a benefit
in the plan, CQ1\:si?a.r selecting the policy year to facilitate plan
administration. ~U)
\,".-:../
(2) CoveraghUles under Section 125 of the Code allow for
exclusions of ~eftaiT. classifications of employees, provided the
classification dOe1s-n'iJt'\ discriminate in favor of officers, shareholders or
highly compensa~eJ'l1ployees. If the number of hours per week you
choose results ir:r1Ii"e\ exclusion of a substantial number of part-time
employees from {~n, the plan may be discriminatory.
(3) To insu'r~'J(t,?at the plan does not provide impermissibly greater
medical benefitS\~!9bhIY compensated employees than to non-highly
compensated emp,loyeet, it is recommended that you choose a flat dollar
deferral limitation'~medical benefits for all eligible employees.
0 rj
l35
L"=J
(O.~ ,,_/
01_=
\;.\ r--,
@D'
1ft.· LV~ ~
i l I A ,,01
I k;;; . [.-' -:J rr=-~ I 1 III d U J @2)
ARTICLE
II
CViJ
fnO·.llt:\ ~ ~ CAFETE~A PLAN
CJ~6U f2~ ~i:";!/~ ~c:,
I _J
r-~ TABLE OF CqNTENTS
~'\ L_J
@
rl~ PURPOPO 1JP SPECIFICATIONS, , . , .................. . UV
w\;\ DEFINITIO,NS ............. , .... , , .................. . ~
SectiC"n2:otJ "Accident and Health I U T Insurance Plan" ............ , .. , . , , . , , Secti<:LlL_-,2~Q_2j "Administrator" . , , , ...... , .... , .... .
Sectionr .2.03 "Adoption Agreement", ..... , .. , ..... .
S . ;:> \2 0 "C d " ectlon L;"4] 0 e .......................... , ..
Section /,2~Q5 "Compensation" .................... .
Section (~:o .. ,6) 6 "Dependent", . , , . , .. , . , . , ... , , ...... .
Section ~2~ "Dependent Care Assistance Plan. , ... ,
Section 12:08] "Dependent Care Expenses" .......... , , I l! SecMnC?:09 "Dependent Care Service Provider" .... .
Section r 2"]'0] "Disability Insurance Plan", ....... , , , .
Section j"'2;pl\. "Employee" , .. , , ... , ................ .
Section ( 19.[,2) "Employer" ..... , ...... , .... , , ...... .
rr. nnMi 11 ~~~;~~ )§.:L.:t!. ) :~:~~~~~~I: : : : : '. " '. ' ... ', .......... ' .' : : : : : ' .. , ... .
LJ ~ect~on ~B5~ "Key Employee" ... , , , ............... . II f~9~~t~on L2.·16 "Life Insurance Premium Plan ........ .
i \ ' .1 S\el~t~on G ..... 1.1~ "Medical Dependent" ................. . L 'I Sr tlon c:~~'V.. "Medical Reimbursement Plan" ....... .
~ ~ (92) I.
PAGE
1
2
2
2
2
2
2
3
3
3
3
4
4
4
4
4
4
4
4
5
ARTICLE
@;v
(a~
Section "-2.£1'9 /j I,
Sectionl ·2120
"P rt" t" a IClpan ....................... .
"Plan" ............................. .
PAGE
"Qualifying Medical Care Expense" ..... .
"T t" rus ........ " .................... .
"T t " rus ee .. " ........................ .
sect~orl" (2&))
SectlOn;:,'lJ2:22
Section; 2.2~
Sectionr-2:~~ L)
"U' E I " mon mp oyee .........•...........
5
5
5
5
5
5
III
IV
~ PARTICfPArrON .................................... . ! ( 1 J
S . \..."--'a 0/:1 C f" t' ect~on 11/ \ om~encemen: ~ p.artlclpa Ion ....... .
sectlont (;a.~2j Duration of participation ............. .
Section. 3103 Faifure to elect ..................... . 721~ .. \ . ))
BENE,flJ~"(\ONS. ELECTIONS AND NOTICES ............ .
S ct· [ I 4'\ 0··~1 B t't t' . . e 19~' 7:1 ene I op Ions .... " ........ " ..... " .
SectiGlD_4.02-l Election of optional benefits in
Section R03]
sect~on~~
Section 4~
Sectio~~~
~~.l l_:-J
lieu of cash ....................... " .
Elec;tion procedure. " ................ .
Failure to elect ..................... .
Changes by administrator. ........... .
Irrevocability of election
by the participant during
the plan year ....................... .
Funding benefits under the plan ....... . Section (oI})
rrn4 ~ I ~IV1E~ICA~ t:~~~URSEMENT PLAN ....................... .
7
7
7
7
9
9
9
9
10
10
10
11
12
12 I f S)d. lion 5. 'O~~·. . . Crediting of accounts. .. . . . . . . . . . . . . . . 12
t ' .. \ Se~tion p:oa.l . Debiting of .accounts. . . . • . . . . . . . . . . . . • 12 ~ S~lw FO"'iM':faCCO"~...... 12
ARTICkE (J!Ji) PAGE
VI
VII
1::1[\
Section: 5JO~)
Section '5.06
Claims for reimburesement .......... .
Reimbursement of expenses .......... .
Continuation coverage ............... .
13
13
14 Sectionrg
t'C -5 DEPENDENT CARE ASSISTANCE PLAN. . . . . . . . . . . . . . . . . . .. 1 '-,~
~--J
Section L6:01 '\ Section[6~(2)
Section!%
SectiOn\ 6.04 )
Section 6,Q!5/ seCtion(6(op~
Section~JU
Plan purpose, , ...... , . , ..... , ....... .
Maximum dependent care assistance, ..
Crediting of accounts ........ " .... , ..
Debiting of accounts ........ , ...... , .
Forfeiture of acco unts ............... .
Claims for reimbursement. ........... .
Reimbursement of expenses .......... .
15
15
15
16
16
16
17
(dl~~
LIFE INSURANCE PREMIUM PLAN. . .. . .. . .. . . . . . . . .. .. .. 18
Q':J
Section 7.til1 Plan purpose .................. , ..... .
Sectib;;-7 ,-Q~J Crediting of accounts ............... .
Sect~on\:~\ 03 Debit~ng of accou nts ................. .
Section tf .. 04] Forfeiture of accounts ............... .
Section~;'Q5 Designation of beneficiary ........... .
Section(1~ Purchase of life insurance
, poliCies ............................ .
18
18
18
19
19
19
Secti~ r:O'll Submission to physical
C"\. examination. . . . . . . . . • . . . . . . . . . . . . . . . 20
Section r.?::.(JS=:J Nonentitlement to insurance
proceeds ............ , ............ , .. 20 «ill\ (~~/4 ,,~/
IVUI I ~KcCIDEjtIT AND HEALTH INSURANCE PLAN ................. 21 ~ "O··L
• ~'~fion ~.tQ.;~ J Plan purpose ............... ,', ... , ... , 21 (If ~:!,ction t8.0~1.\ Crediting of accounts, . , .... , ... , , . . . 21
iii.
ARTICLE
IX
X
fl r ,
\ J y) ,,-)L
.--, '" I(lll,\ i '.~j ) J
Section \8.04)
SectiOn(1il.~\ l L... I
Section2'8:0E/ Section~~~
r-:-J
Section ;8:Q?'\
L_.~ . ..I
~~ / '\ f ,r-, '>
Forfeiture of accounts ............... .
Payment of accident and health
insurance premiums or dues .......... .
Submission to physical examination ... .
Nonentitlement to insurance
proceeds ........................... .
Continuation coverage ............... .
DISABILltLY_INSURANCE PLAN ........................ .
\,---~j
section(~J6M
Section 9.021
} '-• ./ V Section ,9:03\
section( ~O~ )
Section 9 .. Q5/ rv'l I (-. / . .J
Section 9.06
Sectibn"g.07 1
t:_=:J
~
Plan purpose ........................ .
Crediting of accounts ............... .
Debiting of accounts ................. .
Forfeiture of accounts ...... .
Payment of disability insurance
proceeds ........................... .
Submission to physical examination.
Nonentitlement to insurance
proceeds ........................... .
CONTIN~U~9N ..................................... .
, )
• .#' Seclien rO;(:)1] Continuation of Coverage ............. .
Sectl'ol'nl ,'o,'02' D f' 't' ~ \;I e Inl Ions ........................ .
Section ~03] Type of Benefit Coverage ............. .
Sect~on }O:O:'t\ Period of Coverage .................. .
__ . S~8t,on r QPt~; Notices ..... , .... , ................. . (rrn'\ /Section lO.06) Elections .......................... . !! II ~S'ction ~'~~ Premium Requirements .............. .
'!! ~~ L:_-=:J l~ ~ , I ~l I I ADMINlSIEI~T-10N OF PLAN ........................... . [ U I JI4tior:F~ ~ Ul \!!J{J
Plan administration ............•.....
iv.
PAGE
22
22
22
23
23
24
24
24
24
24
25
25
25
27
27
27
28
28
29
31
31
33
33
..
ARTICLE
nr;:l vLJ
@V
O~ Section'(11~02 /
, /
Section"H:03 ~ '---_-t Sectionf11.04 !
r'-J L_. Section~ . ..o5)
L-_ ---section(1('L.Q~1
~I
Section 1"LO:Z
Sectio nfi~(o~\ '01(,'< . j L¥
Section )'1:09\ \ a L))
'~
Examination of records .............. .
Reliance on tables, etc ............... .
Nondiscriminatory exercise of
authority ........................... .
Claim for benefits and review
of denial. .......................... .
Correction of administrative
errors ............................. .
Indemnification of administrator ..... .
Participant applications and
notices ............................ .
Notice of change in employee
status ............................. .
PAGE
33
34
34
34
36
37
37
38
".-.. ::r::::1 LlMl1'A(I()N,~ON BENEFITS. . . . . . . . . . . . . . . . . . . . . . .. . . .. 39
! r' I
XII
. I L...., .I~rHI Sect1QlLt2.0JJ Limitations on benefits for
~ certain employees ................... .
AMENDMEtiI:rJAND TERMINATION OF PLAN ............... . ( '-")\ . C, j
Section iQ~ Amendment. ........................ .
XIII
Sect~PJ l13~02J No contractual obli~ati?n ............ .
SectlonQ'3~_ Procedure on terminatIOn ............ .
L_,..J
39
40
40
40
40
XIV MISCELkAl"JEOUS PROVISIONS ........................... 41
fl' ) __ /j \G!)
( n~/S.jction 14",0.1/ Information to be furnished .......... .
III ~~ection (1~) Limitation on participants' rights .... .
I I ~~ S,ect~on [14.03 'l Receipt and release ................. . : i ~~~c, liOn 2-,4".OA:::::;-J Nonassignability ................... . II 'I'! SJ'ction M.05) Incompetency ...................... .
i I I SJbuon 114:06 No guarantee of tax consequences ... , ..
UJ ul~· v.
41
41
41
41
42
42
PAGE
Indemnification of Employer by
participants. . . . . . . . . . . . . . . . . . . . . . . . 42
Trust fund sole source of
benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Gender. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Governing Law. . . . . . . . . . . . . . . . . . . . . . . 43
vi.
010 \~JLJ ~~ '(::!) /) C\ ARTICLE I
I "-...J I
\ PURPOSE AND SPECIFICATIONS
r'{-
;", "----]
The purpose of tbiS~RI~n is to provide employees of the Employer choices
among cash, medical) reimbursement, dependent care assistance, life
insurance, accid~nt~nd health insurance, and/or disability income
insurance benef1its--(as selected by the Employer in the adoption
l ' agreement). Thisplcinl is intended to qualify as a "cafeteria plan" under
section 125 of the)!ln(er\nal Revenue Code of 1986, as amended, and shall
be interpreted in( iii /na,.nner consistent with the requirements of section
125. The specificati.{ns of this plan are contained in a separate adoption
agreement executed, ~Yjthe Employer. The adoption agreement constitutes
a part of this pl~h,lland its terms are incorporated by reference in this
plan. Io~
1,0 ~
END OF ARTICLE I
(1Jr;;J
U()
(olD
"---/
ARTICLE II
PEFINITIONS
(J0j
2.01 "ACCide~tan? Health Insurance Plan" means the accident and
health insurance [plalLl'et forth in Article VIII hereof. ,..----, l ' . ..l
2.02 "Administtalo'r" means Superior Resources, Inc., or its duly
appointed agent, [;,;,hic~ will administer the plan pursuant to a separate
contract between (its.eff,and the Employer. The plan administrator, within
the meaning of s~ctibn 3(16) of ERISA, is the Employer or such other
person of commhte;,e<as may be appointed from time to time by the
Employer to SUP~()he administration of the plan.
2.03 "AdoptionrlP,.'greement" means the agreement executed, by the
Employer whiCh (sifi:t~Xforth the specifications selected by the Employer
for this plan. c:;~
2.04 "Code{d,~rls the Internal Revenue Code of 1986, as amended
from time to tiine._, 8e~erence to any section or subsection of the Code
includes reference., to any comparable or succeeding provisions of any
legislation whiCh~~mel1ds, supplements or replaces such section or
subsection, and tcya~regUlations promulgated thereunder.
2.05 "compJn~ok means the full salary and wages paid to an
employee by th,3 rEmplbyer for services rendered, including salary. wage,
bonuses and o~erfim'e compensation, and including all Employer
contributions to thls'.Q.I5ln on behalf of the employee, whether for cash or
non-ca.sh benefits@~Ljt\ cash benefits shall not be dOUble-counted), but
eXCludm~g':/:J G ,) , ~"'\/AtK J ! 11 I :r;cfl I'!e-ri~ursement for expenses or allowances, including "-;.v ,'\ J
I, r u 23 ~ ~I @)2)
-2-
(!!jj)
rlr'
(2) (A'Q~)ahlOunt contributed by the Employer to any pension
plan or plan \cOeferred compensation other than the contribution by
the EmployerrtP Ic0plan intended to qualify under section 401 (k) of the
Code which a(b-dkrived from employee salary reduction; and .~
(3) f"ny~amount paid by the Employer for other fringe
benefits oufsicfe )Of this plan, such as health and welfare,
hospitalizatior,--';ID.d group life insurance benefits, or prequisites.
(0' 2.06 "Depena~J means, for purposes of the dependent care
assistance plan inr::A1tlCle VI, (a) a dependent of the participant who is
under the age of 1(J~~d) with respect to whom the participant is entitled to
an exemption under sect~n 151 (e) of the Code, or (b) a dependent or spouse
of the participant \fvvjV is physically or mentally incapable of caring for
himself. ~ ,
2.07 "Dep~dare Assistance Plan" means the dependent care
assistance plan Ferfbrt~ in Article VI hereof. .
2.08 "Depenaent~Care Expenses· means expenses incurred by a
participant which fa)· ~rk incurred for the care of a dependent of the
participant or for re1ate~\ household services, (b) are paid or payable to a
dependent care Si~~vic~ provider, and (c) are incurred to enable the
participant to beJgaihfuHY, employed for any period for which there are one
or more depen e17,t~-1With respect to the participant. Dependent care
expenses shall nfot'-;include expenses incurred for services outside
participant's houseHold-fair the care of a dependent unless such dependent
is described in sec~(yt ~\06(a) or regularly spends at least eight (8) hours eac'F~,ay i~~Ii1l pa~~p~r\t's household. Dependent care expenses shall be de~rR9 b.~ inc~fr .. ~'(j ... ~. at the time the services to which the expenses
relate i~ue?Fendered.r)
1.1H ~ r-'I~ . I ~lq9 "D~~end@'L~~re Service Provider" means a person who provides
\~) !. >, .... 0
l~rv
include (a) a dependenf'care center (as defined in section 21 (b)(2)(O) of the
Code), unless the h5q~~Jments of Code section 21 (b)(2)(C) are satisfied, or
\ J (b) a related individy.alr~escribed in section 129(c) of the Code.
r I l \
2.1 0 "Oisabilit~-I~s)urance Plan" means the disability insurance plan " , set forth in Article-"IX""·hereof. C __ J
2.11 "Employe-e"-means any individual employed by the Employer.
L--_) ~
2.12 "Emplo~.er" ~~eans the sponsoring Employer indicated in the
adoption agreement"Which has adopted the plan and any affiliate or any
other employer th~tCaao\pts the plan with the consent of the sponsoring
Employer. 0~
2.13 "ERISA"~~~ls the Employee Retirement Income Security Act of
1974, as amended"'-fhSm time to time. Reference to any section or
I ,~' subsection of ERlqAJ ipc}udes reference to any comparable or succeeding
provisions of any lE!gisl~tion which amends, supplements, or replaces such
section or sUbsectirrfod to any regulations promulgated thereunder.
2.14 "Forfjiture~;kans any portion of a contribution on behalf of a
participant which tl:le participant has designated for benefits under the
medical reimburs~rrl-entJ plan, dependent care assistance plan. life
insurance premium;,...aceiaent and health insurance, or disability insurance
plan and which is r:\ot-us1d to provide benefits under such plan for the year
to which the contiib'ufi~ri is attributable. -------DL_J
2.15 "Key ErllpLoyee" means any person who is a key employee as
defined in section {16(1Hl) of the Code.
,_~.16 "L~~ Ins~~feJ Premium Plan" means the life insurance premium
Planr;fsr~in A~~~II hereof.
J1"7..=::Medical' Qependent" means, for purposes of and the medical
. '" .,. r--..'-I [. A I. I V h .. relmuursement p an,-JO= rtlc e • t e participant's spouse and any
f I ~) ll'@R) +
(7!iJ
dependent(s), witl'\if('tFl'e meaning of section 152 of the Code, of the
participant (or, in thQ bk~e of a child to whom section 152(e) of the Code
applies, of the partitipi1lo1 or his spouse). For purposes of the accident and
health insurance pl6:'nl in \.Article VJlI, "Medical Dependent" means the person
or persons defined "as) ~ependents in any policy or policies of insurance " / maintained by the ~f:t1Plorer and incorporated into the plan.
L_
2.18 "MedicaJ~Reimbursement Plan" means the medical
reimbursement Pla~ )orth in Article V hereof.
2.19 "Particip,~'l(1eans any individual who participates in the plan
in accordance witli {AFticle II f. ~
2.20 "Plan" ;Q(a~ the cafeteria plan of the Employer as set forth • .i v /,,-, herein, together with_allyl and all amendments and hereto.
2.21 "QUalifYiQfy1~ical Care Expense" means an expense incurred by
a paticipant, or b~a-ciedical dependent of such participant, for medical
care as defined(Jn" §edon 213 of the Code (including without limitation
amounts paid fO~-1 h(ospital bills, doctor and dental bills, drugs and
premiums for aclcidenLcind health insurance), but only to the extent that
the participant or ,other person incurring their expense is not reimbursed
for the expense t:h?o-tJ9h insurance or otherwise (other than under the
medical reimbursemenl~lan).
2.22 "Trust" ~.J the trust established as part of this plan for the
purpose of provillling-b-enefits under the plan. LJ 1---1
2.23 "Trustee~s the person named in the adoption agreement or
such other person !ollor.ganization from time to time acting as trustee of
the tr.~~, :.9ny s~~or trustee duly appointed by the administrator.
(n'3-y'union (EmpiO.yee" means any employee included in a unit of emp.lo~~es=covered ,by-~nLagreement which the Secretary of Labor finds to .. I I
23
(J!ij -5-
([;~
(J~
be a collective ba'r~~in0g agreement between employee representatives
and one or more imRlqyers, if there is evidence that retirement benefits
were the subject (Jf L)900d faith bargaining between such employee
representatives and\. suCh) employer or employers.
'r-" ~'I
"----'
[ ,~ END OF ARTICLE II
, ,
~-) L __ ,
@)
!LID)"
\ ' I '--" L.-(al~)
'--' (-"'\/----l
I I' (-IU~ L ____ J
~ I~~
I ( I
-6-
C!iJ
@ ARTICLE III
PARTICI PATION (]~
3 01 C \. ~-) f t" t' E h I h h .0mmeQcement 0 par IClpa Ion. ac emp oyee w. a as
satisfied the eligibill!yrequirements set forth in the adoption agreement
is eligible to partic\'P'are~in the plan and shall become a participant on the
entry date or dates' sef)f~rth in the adoption agreement. C~J ---3.02 Duration" of\ participatjon. A participant will cease to be a
participant as of th~{ea~lihr of (a) the date on which the plan terminates or
(b) the date on w~ich::::tle or she ceases to be an employee eligible to
participant. exceP,td tql the extent fhe participant or a "qualified
beneficiary· with \~~sct to the participant (within the meaning of
section 162(k) of (t~~\Code) elects continuation coverage under the
accident and healtti Cihsur:ance plan or the medical reimbursement plan. A
former participan;,-\vho4s reemployec! or otherwise becomes eligible to
participate in the' pi¥~vilill become a participant again on the first entry
date following t~eL.date'1he or she is reemployed or otherwise becomes
eligible. Any participant who ceases to be eligible to participate in the
plan shall continuecto receive his or her b,enefits ~ere~nder for ~ ,per~od
equal to the shortrr"-ofJ(X) 60 days followmg termmatlon of partiCipation
or (y) the date all previously unused credits to the benefit accounts have
been exhausted; prfVi~d\ however. that nothing herein shall be deemed to
modify or abrogatUt:le forfeiture provisions of the several plans
hereunder. rl r--~ L.l l-.-.--..J
3.03 Failure t~leQt. A participant who has not otherwise ceased to
be a participant in ~hEf'Rlan as a whole will cease to be a participant in one
or "PJ~ benefif PJa~{l~~lof the earlier of (a) the date on which he or she
fil,Si1aCl ,aol1.t.Ial electi0C!:.. form electing not to participate in such plans or (b)i~rneIW.· t1ifate on~i~. h to file an annual election form under Section
I ~ L~
II II I .. (2;r ~ UI ~'!Jr!J
-7-
@R)
4.03 if the participafiflt1as failed to file such a form. A former participant
who is eligible to ~rfd lddes subsequently tile an annual election form for a
subsequent plan ye\t~-wirl become a participant in such plans again on the
commencement ot(piJ,lflan year following the filing of the new annual
election form. \' _l)
CL L:J
END OF ARTICLE III
-8-
(!!jJ ARTICLE IV
/-J "" BENE~hr\OPTIONS, ELECTIONS AND NOTICES .'-....J
(J ~
4.01 Benefit( bp(idns. Subject to specific eligibility requirements,
and the percentage-'-Ilmitation and dollar limitation contained in the
adoption agreemerff. 'a@ to the other limitations set forth in this plan, a
participant may elecCto~:be paid his or her entire compensation in cash,or
to have a portion ~f.iUa~ compensation applied for medical reimbursement,
dependent care aJsistance, life insurance premium, accidental and health
insurance, and/or d~ility insurance benefits.
4.02 Election ~Of~o~tional benefits in lieu of cash. .A participant may
elect to receive or(eHor1l:nore of the optional benefits described in Section
4.01 in accordande· .,!.tith the procedure described in Section 4.03. If '-' v participant elects a~re(jjj)ced, and an amount equal to the reduction, will be
contributed by the E!h~ldyer to an account in accordance with the medical reiillbursementplan,..-:d~pendent care assistance plan, life insurance
premium plan, a~er1Ll:!.nd health insurance plan, or disability insurance
plan, as the em~lqyj' s~ecifjes.
l : I
4.03 Election procedure. Not less than 30 days, before the effective
date of the plan (ot 'as-soon thereafter as possible), and not less than 30
days before the belg'iilffirrg of each subsequent plan year, the administrator
shall provide one( e.-,)'inore written election forms and compensation
reduction agreement~~ach participant and to each other employee who
is expected to b:ecome-:-a participant during the plan year. The election
forms shall be eff~EtiiiEi'i.s of the first day of the plan year or, if later, on " "-the date the empr~yeeJ becomes a participant. Each participant who
chooses a non-cash'-p~enefit for the plan year shall so specify on the
appropriate e)ectio~ (JOyrrl or forms and shall agree to a corresponding
redCiOti;)n1 iQji~ or fiEN""C~Sh .compensation. The amount of the reduction in th~'lh~tt1c~?nt's cash_qQmpensation for the plan year for each non-cash berefit~baJl be ttil""'iihio~nt elected by the participant, subject to the H't\fr.'~.rnt.~~hiS plan. Each election form must be completed
Ii. J
'1 III r ()ff0 -9-
~:::v u 'UrJJ
'/"j (""""'\
( II fJ ) \...J L;
Q,i\
and returned to the: 'aI:Jministrator on or before such date and the
administrator shall ~Qe?i~, which date shall be no later than the beginning
of the first pay peridd, for which the participant's compensation reduction
agreement will app~; ))
r'~---" \ 4.04 Failure Ito ~erect. A participant failing to return a completed
election form to the -administrator on or before the specified due date for
the initial plan year~Ctl,.~ plan, or for the plan year in which he became a
participant, shall b:e __ de~med to have elected to receive his or her full
compensation in casll.:''A participant failing to return a completed election
form to the admi~i~tr~t~h on or before the specified due date for an
subsequent plan year.-sh~1I be deemed to have made the same election as
was in effect just 110/,I,Y» the end of the preceding plan year.
\"../L ...
4.05 ChangeV-O£,' administrator. If the administrator determines,
before or during a&fl ~'ian year, that the plan may fail to satisfy for such
plan year any n09piscrir:f,ination requirement imposed by the Code or any
limitation on ben'efit1prbvided to key employees, the administrator shall
take such actiob (ak Ctbe administrator deemed appropriate, under rules
uniformly applibabJe __ tb similarly situated participants, to assure
compliance with such requirement or limitation. Such action may include,
without limitation, ral.....-modification of elections by highly compensated
employees or keYr:emrjlOyeeS without the need for consent of such
employees. ~ 0 )
'------4.06 I rreyocabilitY' of election by the participant during the plan
~. Elections h,IEtdi:nrftder the plan shall be irrevocable by the participant
during the plan ye¥,' ~ept in the event of a change in family status. A
participant may rev~kel'\i':'ibenefit election for the balance of a plan year and
file a new el.9ction @1)~Y) on account of and consistent with a change in faTi~tat~iJ A ~h=~ge in family sta~us f~r this pur~ose inclu~es marr~ageY:cllvorce, death of a spouse or child, birth or adoption of a child,
t I' " • !t.// f II r~ I f d h ermJn~'~ emp,oymer.1t1 a a spouse, an suc other events that the adhiini~tr~tleterrbines:;will permit a change or revocation of an election
duhfg $ plan! )~ear~) any applicable regulations and rulings. Any new
, '1 'ilJ -10-II I ( CJ n \~ \:Je/
@RJ
election under this;"'Section 4.06 shall be effective at such time as the
administrator shall( p}~~dribe, but not earlier than following the forty-five
(45) day period se'Kfor-t~ in Section 11.09 hereof (unless the administrator
. thO ., "'I I"t' , d) waives IS minimum no Ice peno .
4.07 Funding ~~Jts under the plan. To fund the benefits under the . .... ""-pian. the Employer[make;s contributions to the trust in accordance with the
election contained in th'~ compensation reduction agreements completed by
the participants as ~jiSc[ibed in Section 4.03. In addition, the Employer
may make non-elebtiv.e .... bontributions on behalf of participants equal to a
specified amount lq:=Rercentage of compensation which may be made
available to particiPan~ for the selection or purchase of benefits under
the plan. Funding~~f-any benefits provided hereunder shall be derived
solely from such cdntriti,utions, and neither the administrator, its agents Ill.I' or employees. nor \!l1e [trustee shall be responsible for any failure of the
Employer to fund anysuch benefits. ~~ . ros END OF ARTICLE IV
, ,
b
@
Oi 1 2_:J
\ @)
· n 23 U (]!Jij -11-
"-/r" (8 n) Cll! rr::l l\ ARTICLE V \ (] G )
',-MEDICAL REIMBURSEMENT PLAN III '\ I ( 'I
\ ',-e_e
l I
5.01 plan purpose: This plan is intended to qualify as a self-insured
medical reimburserrfenfJ:llan under section 105 of the Code, and is to be ~-~
interpreted in a mann'er jconsistent with the requirements of section 105.
The purpose of th~ plan is to enable participants to elect to receive
reimbursements of [qualif~tjng medical care expenses that are excludable
from the participant'sgross income under section 105(b) of the Code. The
plan shall maintain\ ~_~Jdical reimbursement account for each participant
in order to accomplish-C'tKis purpose. (' ( , J _ I
5.02 Creditind, ~fl(abcounts. There shall be credited to a participant's
---~ ..... medical reimbursemerit:',account for each plan year, as of each date
f ... I ~ ~ compensation is paid:j@)t,he participant in such plan year, an amount equal
to the reduction, if 'a.n~,~'io be made in such compensation and credited to
the medical reir.n~~~crlent plan in accordance with the participant's
I I I • election pursuant l t@_se.cii1on 4.03 hereof.
5.03 Debiting of accounts. A participant's medical reimbursement
account for each pl~n-~ear shall be debited from time to time in the
amount of any payfflent,\hereunder to or for the benefit of the participant
for qualifying medi{al-c~re expenses incurred during such plan year. No
payments may be \~J which would reduce the participant's account
balance below zero ~)~Amounts debited to such account shall be treated
as payments of itfe-earli~st amounts credited to the account and not yet '" '-,.-treated as paid unQE:r this section, under a "first-inlfirst-out" approach.
r:li\ 5.04 Forfeiture ('of ~ accounts. The amount credited to a partiCipant's ~ /, \._/ medical, re~m5ursemenLaccount for any plan year shall be used only to reirhpU~~~4t1ffi' partic!ii@t'l for qualifying medical care expenses incurred du~i~lg l~s6ch Plan~ ly.e'at.'l and only if the partiCipant applies for reim~Ur~~\\on or--b.e.f.ore the 60th day following the close of the plan ye~, J Iflsny r~1 anj '~jal", In the partlcipanr, medl",' mlmb""ement
,~, JI (Cjjj -12-
@RJ
account for a plan(Ye'ar\ after all reimbursements hereunder, such balance
shall not be carrie~ (M~ry to reimburse the participant in any other form or
manner, but instead"-shall revert to the Employer to the extent permitted by
law, and the parlt1dip~t shall forfeit all rights with respect to such
balance. . ~~ ~
5.05 Claims nor reimbursement. A participant who has elected to
receive medical car;e rei~bursements for a plan year shall apply
to the administcatQ) ')for reimbursement of qualifying medical care
expenses incurred Lb}/_tne participant during the plan year and while a
participant, by subfDitt!ng an application in writing to the administrator,
in such form as t~e\.-adn'linistrator may prescribe, setting forth:
'-./
(a) the amodri<~te incurred and nature of the expense with respect
to which a benefit \igr re'g'uested;
'-' V"
(b) the na~9~ the person, organization of entity to which the
expense was or is to-be"paid; (\r-.
(c) the nah,rbf~e person for whom the expense was incurred and, if
such person is hOLtheJparticipant requesting the benefit, the relationship
of such person to the participant; and
L"-j
(d) the amount--r{lcovered or expected to be recovered under any
insurance arrange~ other plan, with respect to the expense.
Such applic-atic)ll~Srall be accompanied by copies of bills, invoices, . W L------> • receipts or other ,",statements showmg the amounts of such expenses,
together with any [adamonal documentation which the administrator may
re~. ~. (ol~ .
(~5.0~Helmbursement of expenses. The plan shall reimburse the partici~~nt?1rom the_r>articipant's medical reimbursement account for I 11"f ,I // d' I \ ( ) I • d d' I . h h qua I Y/p9 p me Ica care exp,enses mcurre unng a p an year, for whlc t e
I i
rJ!RJ
with Section 5.05. (rfpl ~eimbursement under this Section 5.06 of expenses
incurred during a plahl ¥ear shall any time exceed the balance remaining in
the partiCipant's m~dica( reimbursement account attributable to amounts
elected by the partiPi,Pd~~to be credited to the account for that plan year.
5.07 CQntinQ~;/n coverage. To the extent that the medical
reimbursement ben'efffs'lprovided hereunder are subject to the benefit
continuation provis~ Jof section 162(k) of the Code and sections
601-607 of ERISA'rcontinued coverage under this plan will be provided in
accordance with the-temis, conditions and procedures contained in Article
X hereof. @ .
rJ!RJ END OF ARTICLE V
(cIlj)
ro? I ~
-14-
Of~[)) . '_...J "1 ~\ ARTICLE VI
((]I.) )
8EPENDENT CARE ASSISTANCE PLAN
/f I l \
6.01 Plan pu~~ This plan is intended to qualify as a dependent
care a~sistance program under section 129 of the Code and is to be
interpreted in a manner, consistent with the requirements of section 129.
The purpose of t~e~_PJ~n is to enable participants to elect to receive
reimbursements of their_dependent care expenses that are excludable from
the participant's groSs::rncome under section 129 of the Code. The plan
shall maintain a d~{eode\nt care assistance account for each participant in
order to accomplis?w~(purpose.
6 02 M . I rYd'j 1 d t . t Th· t .axlmum ~epen en care assls anee. e maximum amoun
which the participanll iTIay receive in any plan year in the form of a
dependent care as'si§t~nbe under this plan shall be the least of (a) the
participant's earn~~-Jndome for the plan year (after all reductions in
compensation Vlcl0'6lD.d the reduction related to dependent care
aSSistance), (b) th~J aQ.tu.al or deemed earned income of the participant's
spouse for the plan_y.ear.,J(c} a maximum annual amount of $5,000 or $2,500
in the case of m~r.1ied participants filing a separate federal income tax
return, or (d) thetdollar amount which the participant has elected in
accordance with A:[.ticle\ IV hereof to have applied for dependent care
assistance benefits( (or)l~e plan year. In the case of a spouse who is
full-time student at~educational institution or is physically or mentally
incapable of cari~g rfor"himself or herself, such spouse shall be deemed to
have earned inconlE(-pfn-bt less than $200 per month jf the participant has
one dependent ancf $400 per month if the participant has two or more
dependents. II C\ i 0 I) . ~03 oreJHting\of f ahcounts. There shall be credited to a participant's
I 1(, 'I I " "',;' _., depe~nden~dare as~istanqe account for each plan year, as of each date
eomlP,1e8sation is pai,El(to) the participant in such plan year, an amount equal
to It~e j~ualon, if lany.;:::toJbe made in such compensation and credited to
the ItlJ~Jnde),tl care-assi~tance plan in accordance with the participant's I I~ H I I I~ JI .\
eleCfUlorl pursrart tOls·:~on 4.03 hereof.
~ l. (}!jrJ -15-
OQ \':JU
6.04 Debiting ol'a'Ccounts. A participant's dependent care assistance
account for each p(~ri)year shall be debited from time to time in the
amount of any payi1)erW/hereunder to or for the benefit of the participant
for dependent care (e~pe;:rses incurred during such plan year. No payments
may be made which l'w6uld reduce the participant's account balance below " ,; zero (0). Amounts r~Eitiiled to such account shall be treated as payments of
the earliest amount'S Credited to the account and not yet treated as paid
under .this section,[I!na~r a "first-in/first-out" approach.
6.05 FQrfeitur~-"'~ccounts. The amount credited to a participant's
dependent care assi§tande account for any plan year shall be used only to
reimburse the partidi~an~for dependent care expenses incurred during such
plan year, and onl~jlif~he participant applies for reimbursement on or
before the 60th day c,tollowing the close of the plan year. If any balance
remains in the particiQ~6tis dependent care assistance account for any plan
year after all reimbwrSements hereunder, such balance shall not be carried
over to reimburse ~~b!)~krticiPant for dependent care expenses incurred
during a subsequent~p.lanl year, and shall not be available to the participant
in any other forrrl1or'/ manner, but shall instead revert to the Employer to
t I ~ the extent permitted bYl law, and the participant shall forfeit all rights
with respect to s~Gh-l:lalance,
6.06 Claim fi5~reimbursement. A participant who has elected to
receive dependent I.care< assistance for a plan year shall apply to the
administrator for reimoursement of dependent care expenses incurred by
the participant durirlg:}6e' plan year by submitting an application in writing
to the administn[fo;r.-riilsuch form as the administrator may prescribe,
settjng forth: b
(a) the amount,f',date incurred and nature of the expense with resP~'\;~h a ~~ is requested; n~~t1'le ~a~~~fJt.he person, organization or entity to which the
eXp'ensepwas~ IS to" be~pald; and I rr;:y~ r I
I (e/~~dh ot~er-inJormation as the administrator may from time to r DI I . s~ [j )
,mWJ""" (c!J2J -16-
(jjjj
Such apPlicatW~all be accompanied by copies of bills, invoices,
receipts or other ~tat~ents showing the amounts of such expenses,
together with any (.:tdciiti6nal documentation which the administrator may
request. \. '---..-' I c-~
6.07 Reimbur:Se~t of expenses. The plan shall reimburse the
participant from the p'a~iicipant's dependent' care assistance account for
dependent care expe01es incurered during a plan year for which the
participant submits tdocu~entation in accordance with Section 6.06. No
reimbursement undlr'(thi~ Section 6.07 of expenses incurred during a plan
year shall at any time) exceed the balance remaining in the participant's
dependent care a~is(ance account which is attributable to amounts
elected by the parti~V to be credited to the account for that plan year.
@') END OF 'ARTICLE VI
@S
b
@
01 I
b
@liJ.
S
2)
(}!i) -17-
/11:.-r C: n)
\JL· F·~r·,
F " ( Cl :J) ARTICLE VII
(1iJF'E INSURANCE PREMIUM PLAN ~ __ )/'
r'·....-/ '-~ 1,,--
7.01 Plan plfmoS@. This plan is intended to provide funding for
qualified group-termrlifeinsurance coverage under section 79 of the Code '----(and coverage in excess 'of the section 79 limits), and is to be interpreted
in a manner consi~tent-J..ith section 79. Tlie plan shall maintain a life
insurance premium aCco'LJ9t for each participant in order to accomplish this
purpose. If a pbfticipant elects life insuirance coverage, then the
participant's life in~l,lr.arlce premium account shall be applied by the
Employer or the adn.:'jhist~ator to obtain and maintain qualified group term
life insurance coverkg5J'Lon the participant's life. Any policy or policies of
group life insurance/j:iurohased by the Employer pursuant to a participant
election shall constlt6tJ)~ part of this plan and the terms and conditions
of such policies sp.~\;9jncorporated by reference into this plan.
7.02 CreditibJ bfl accounts. There shall be credited to a participant's
life insurance pt.emium_~ccount for each plan year, as of each date
compensation is paid.,to the participant in such plan year, an amount equal
to the reduction, if ~ny;-to be made in such compensation and credited to
the life insurance )PTemium plan in accordance with the participant'S
election pursuant to'eSectibn 4.03 hereof.
'----' I I
7.03 Debiting rof-accounts. A participant's life insurance premium
~"--~ account for each plan year shall be debited from time to time in the -~ amount of any payment hereunder to obtain and maintain qualified group
term life insurance cOVe~age on the participant's life. No payments may be
mad.9_which ~ould ~eqUbe)the participant's life. No payments may be made WhiICIQ")foUI:!;;/educ~t~ participant's account balance below zero (0).
Amoants L:geoited to such account shall be treated as payments of the
I lfi II /P \ ( \ / earliest~%pounts cre,dited tal the account and not yet treated as paid under
thiJ ~eciti~nder ra--ufirst-in/first-outU approach.
I [ ~)
, L~
~ (!!jj -18-
rtrv
7.04 Forfeiturebf\accounts. The amount credited to a participant's
life insurance pren1iuhVciccount for any plan year shall be used only to
obtain and maintai11qu~lified group term life insurance coverage on the
participant's life. If anY, 'palance remains in the participant's account for a
plan year after all \sbcti ;'premium payments are made. such balance shall '--not be carried avec \}o ray premiums incurred during a subsequent plan
year, and shall nol b~_available to the participant in any other form or
manner. but shall insteaa; revert to the Employer to the extent permitted by '-----law, and the participant shall forfeit all rights with respect to such
balance. LJ
7 05 0 . (;~ f b f" If h I h Id I' . .esIQnatlon~ (!Jene IClary. t e emp oyer a s any po ICles
of insurance fundedi?he'{eUnder on the life of a participant, and if the
participant desires( e.o ;,:~fesignate or change the beneficiary of the life
insurance, the partiQiP~dt shall notify the administrator in writing of the
desired change and"'1h~ administrator shall file such changed designation
with the company -i,hid~ issued such policy. The participant shall complete
and execute any /cirms6equired by the administrator which are helpful or
necessary to accomp,l1sh...!the designation of beneficiary. The designation or
change of desigln~tibfLs,hall not be effective until it is accepted by the
insurance compahy.--If-a participant dies before it is accepted, the death
benefits shall be paid to the designated beneficiary shown on the records
of the insurance c"o~y at the time of the participant's death. If a L .. ~
participant fails to (de-signate a beneficiary, or if a designated benefic.lary
shall not survive to r@?~i~e any or all payments due under any such policy,
then the beneficiarYJhhll be determined under the provisions of such
policy. DL~
7.06 purcha~ life insurance policies. If policies are to be
purchased by the EmP,leyer or by the administrator in the name of the Emp.loy~r pu!-spant (t61l~ 'participant election hereunder, the Employer shall
dir.lelcftthe~aElminiS![atdr to purchase the policies from a specified
. I HI 1/ ~ (d:". 'd th d" . h h d d IOsmao., c~eompany an provi e e a mlDistrator Wit t e ocuments an
. f! 1ft It'" { tl I f'l I' t' . h h . 10 Frm~ ~~cessrrY-:-0-:.1 e an app ~ca ~on w~t t e I.nsurance company.
Thiel!! adrplOlstr\ator FRail-tile the application With the Insurance company
within a rkJsonable, 'period of time after receipt of the completed
I ~ (j[j) -19-
(J!iJ
application. An in~~death benefit is not in effect, and the p'articipant
and/or his beneficiafY~S not entitled to benefits thereunder, until the
insurance company(pi~ces the policy in force.
7 07 S b . ~~ )1 h' I . t' If I' I' . .u mlssJOnQ P YSlca examlna Ion. a po ICY or po ICles
purchased by the i..EmR.t9yer, and incorporated into the plan, require that
participants comrlTete]a medical questionnaire, submit to physical
examinations, or ~sa:ti)fY other requirements of the insurer, the
administrator shallc::...nj:)tify the participants' eligible for such benefits of
the requirement(s)f,It'a participant fails to satisfy such requirement{s),
after request from\the) Administrator, the participant shall not be entitled
to such insurance co,:\efage or any insured benefits until such later time as
the participant Co~Vwith the requirement.
7.08 Nonentifiement to insurance proceeds. If, .due to the
participant's breac~ (dfL'cbnditions, covenants or other requirements of the
insurance contract(~)-yo{l if the participant's death is excepted under the
terms of the in~ur~f}ce contract(s) for any reason (including, but not
limited to, deathi dtJtlie-participant due to suicide, while sane or insane),
and if, as a result,-theJ insurance proceeds will not be paid, neither the
plan, the Employer-nor the administrator shall bear any responsibility to
the participant or ri~: her beneficiaries for any amounts by reason of
such failure of the insurance proceeds to be paid. ~) o r~ END OF ARTICLE VII
b
@~) ~ (OJ I [ ~
t 'l a
(J[R) -20-
®V t:::l c\ ARTICLE VIII
\GU) , -
AGGI8ENT AND HEALTH INSURANCE Pl.AN
8.D1 plan p~~)... This plan is inlended to p,,,lde funding for
qualified accident, r' health and hospitalization insurance coverage under
sections 105 and 1~6 0] the Code. and is intended to be interpreted in a
manner consistent wjTIi) sections 105 and 106. The plan shall maintain an
accident and health~iniurance premium account for each participant in
order to accomplish~ purpose. The Employer may. from time to time,
maintain one or ~6re) Iiealth, hospitalization, or dental insurance plans,
including health mai!}te-6ance organization ("HMO") pre-paid plans. If a
participant elects oh~! of \jthe insuirance coverages offered by the Employer,
then the participant~ci:9.eidentand health insurance premium account shall
be applied by the(Employer or the administrator to obtain and maintain
such accident and \h'flJlt~ coverage for the participant and, if selected, the
participant's medica!~dlpendents. Any policy or policies of insurance
purchased by th~ rEf);Plbyer under this Article pursuant to a participant
election, shall c6nstitu'te,a part of this plan and the terms and conditions
of such policies khalLbeJ incorporated by reference into this plan.
8.02 Crediting\\f-a'ccounts. There shall be credited to a participant's
accident and healttY,iiTsUfance premium account for each plan year, as of
each date compen~atio'1 is paid to the participant in such year, an amount
equal to the reduct~jit any, to be made in such compensation and
credited to the accidl:rnrand health insurance plan in accordance with the
partiCipant's electi6fnpurSuant to Section 4.03 hereof. [.~
8.03 DebitjnorP'ff"-accounts. A participant's accident and health
insu;aqce premium \a9diluht for each plan year shall be debited from time
to rtirne~in/t~~ amounJ...-o't any payment hereunder to obtain and maintain qUalifj~la L-aeti'dent £d:---)health insurance plan coverage for the participant I'll I q .. \ ( 1 . and/lor the_Rarbclpant!s medical dependents. No payments may be made
h' h! :;'--I""a d I hi .. W IC [WOU \ ,a ;; j e part,~pants account balance below ,aro CO).
~ (!Ii) ·2t·
r?Q vu
Amounts debited fo@u~ accounts shall be treated as payments of the
earliest amounts cr~aitetl to the account and not yet treated as paid under
this section, unde( ~'~~irst-inlfirst-out" approach.
8.04 Eorfeiture.o( accounts. The amount credited to a participant's
accident and healtLinsutance premium account for any plan year shall be
used only to obtain[jnd maintain accident and health insurance or HMO plan
coverage for the pa-':ili:i),ant and/or the participant's medical dependents.
If any balance rem'ains1n the participant's account for a plan year aiter all
such premium payofents are made, such balance shall not be carried over to
pay premiums or cb~ts..-lnburred in a subsequent plan year, and shall not be
available to the pa~ici{ant in any other form or manner, but shall instead
revert to the Emplb~,~~~t~ the extent permitted by law, and the participant
shall forfeit all rig~tv~i{h respect to such balance.
8.05 paymenrQl~cident and health insuirance premiums or dues. If
premiums or dues2;ate/to be paid by the Employer or the administrator
pursuant to the [/J:1articiP~nt election hereunder, the Employer shall direct
the administrator t6Jpky such premiums or dues to the specified insurance
companies or HMG,-andl shall provide the administrator with the documents
and information rnecessary to file an application with the insurance
companies or HMc!. '-T~e administrator shall file the application with the
insurance company loTHMO within a reasonable period of time after receipt
of the completed ~~f2licktion. An insured accident and health or HMO
benefit is not in eff~ct/ and neither the participant nor the participant's
dependents are [nmrEld]o benefits thereunder, until the HMO enrolls the
participant or the i¥u3ce company places the policy in force.
8.06 $ubmjssjOO1ito physical examination. If any policy or policies
wh~ch-are purehase~lby)the Employer and incorporated into this plan, or any
H¥Gi9'o '),I:l(pt:i;:dues :ar.e:::6aid by the Employer and which is incorporated into
thi;sll Pl~J}ffequireq /tha~ participants complete a medical questionnaire,
submif!);:to!':!physical' 'exhminations, or satisfy other requirements of the inJ4~eif6'r-H~Mp, t~e-aaTij,istrator shall notify the participants eligible for sub~ oehefit~ af th~-reliltiirement(s). If a participant fails to satisfy such U @0 '-22-
(!i)
requirement(s) aft?GJ~~uest from the administrator, the participant shall
not be entitled to ~uch/(nsurance coverage or any insured or HMO benefits
until such later tirr~ the participant complies with the requirement.
B.07 Nonent~lem{nt to insurance proceeds. If, due to a covered
participant's breac& or90nditions, or covenants or other requirements of
the insurance contract(s1 or HMO for any reason, and if, as a result, the
insurance prOCee?~ill) not be paid, or HMO benefits or, ~ervices not
rendered then neltb.!'u_tt:ie plan, the Employer, nor the admlOistrator shall
bear any responsibility to the participant (or the spouse or dependents) for
any amounts not pki~j;'y) reason of such failure of the insurance proceeds to
be paid or HMO be~efits or services to be rendered.
B.OB Contin uC~(q J coverage. To the extent that the health benefits
~ ~ provided hereunder/ifre\ subject to the benefit continuation provisions of
section 162(k) of (ttiJjCode and sections 601-607 of ERISA, continued
coverage under this_pla'n will be provided in accordance with the terms,
cond;ti,n, and pr15d~k c,nla;nod ;n Art;clo X ho''''.
END OF ARTICLE VIII
-23-
(J!ffi
@~ ARTICLE IX
('2JjSABILITY INSURANCE PLAN
,r
9.01 Plan DU rQ"OSe , This plan is intended to provide funding for
disability insurance [pndelj section 106 of the Code, and is intended to be
interpreted in a rrrann'e~ consistent with Section 106. The plan shall
maintain a disability-ir.lsurance premium account for each participant in
order to accomplispis purpose. If a participant elects one of the
disability insurancel'f0v~~kges which the Employer may offer from time to
time. then the participant's disability insurance premium account shall be
applied by the Eh,~loy~r of the administrator to obtain and maintain
disability insuranc~~fGthe participant. .
9.02 creditingf@ ~bcounts. There shall be credited to a participant's
disability insurance~p."em'ium account for each plan year, as of each date
compensation is (paid',toJthe participant in such year, an amount equal to
the reduction, it arl}',! to_be made in such compensation and credited to the
disability insurahce_pr.einium plan in accordance with the participant's
election pursuant to-Section 4.03 hereof. ~'-~
9.03 Debiting /ohaccounts. The participant's disability insurance
premium account f~rceach plan year shall be debited from time to time in
the amount of an~,payrhent hereunder to obtain and maintain disability
insurance for tht] parti~ant. No payments may be made which would
reduce the participanTs account balance below zero (0), Amounts debited
r"'!l '------. to such accounts shall be treated as payments of the earliest amounts
credited to the acc~t\and not yet treated as paid under this section, unde.~ "fjr~in/fife~' ,approach. «(1)d~ejture?accounts. The amount credited to a participant"s dis'a~iIi~Y~insurance rpired!iu~ account for any plan year shall be used only
to fAbtain-::::ru:l1l, maintain-Jdisability insurance for the participant. If any bal~~cU (rem'ains i~-the\ participant's account for a plan year after all
I ", ~i ! in t ___ I d f h I h b I h II premium paymen s [are ma e or t e p an year, suc a ance s a not be
lU ~ C0?J -24-
r!iJ
carried over to pay(91~iums incurred in a subsequent plan year, and shall
not be available to ;the( participant in any other form or manner, but shall
instead revert to rh~ LEmployer to the extent permitted by law, and the
participant shall fodeit) ~II rights with respect to such balance.
Any policy ~Iicies of disability insurance purchased by the
Employer under Uiis ffirticle pursuant to a participant election shall
constitute part of this]plan and the terms and conditions of such policies
shall be incorporatbd:::l1/ reference into this plan.
9.05 payme{C;Jbjsabjljty insurance premiums. If premiums are to
be paid by the Emplcryer or the administrator pursuant to the participant {1' , election hereunder, '(l,he) Employer shall direct the administrator to pay such
premium to the speQjti~d insurance company or companies and provide the
administrator with (f~~dOcuments and information necessary to file an
application with such! 'co/npany or companies. The administrator shall file
the application within:::::'~ reasonable period of time after receipt of the
completed applicatioiL..JAn insured disability benefit is not in effect, and
the participant ils LnbLentitled to benefits thereunder, until the insurance
company places lthe-polidy in force.
9.06 $Ubmis~to physical examination. If a policy or policies '--.. ~ purchased by the lmployer. and incorporated into the plan, require that
participants cOmp.l~l;a medical questionnaire, submit to physical
examinations, or~Jisfy other requirements of the insurer, the
administrator sh~!I~fif.y the participants eligible for such benefits of
the requirement(s)C';J!-,a participant fails to satisfy such requirement(s),
after request from [tD5l_administrator, the participant shall not be entitled
to such insurance cOvera~e or any insured benefits until such later time as
the particip~~ CO~P1i~~ )with the requirement. rrn)fenentit!~t to insurance proceeds. If, due to a participant's breac~~conditioM;--b6venants or other requirements of the insurance
co'nt}act'(S);6r, if th~-fl-CijtidiPant's claims are excepted under the terms of
I a @J2) -25-
([jj)
the insurance cont~~ for any reason, and if, as a result, the insurance
proceeds will not be_paid, then neither the plan, the Employer, nor the
administrator shalr';:bb';:\r any responsibility to the participant for any
amounts not paid ~y~rek~on of such failure of the insurance proceeds to be
paid. ~
L'=J 23 END OF ARTlel E IX
eJ
([jj)
@~ .-----" rrl~ ~~
(:-J
,r-\
10\ \:::/ o .!::::-_--'
(J!i)
@ ARTICLE X ~mNTINUAnoN COVERAGE
10.01 .Q.Q.ntifilfiUiQ'n of Coverage. A person who is a qualified
beneficiary with respect, to a participant in the medical reimbursement
plan is entitled to !contin~ation coverage under the plan in accordance with
the terms and the~itions of this Article.
10.02 Definjti~)\ For purposes of this Article, the following terms
shall have the fol16~ing meanings: vU
(a) "Contin{iatlbn Coverage" means the right of a qualified
beneficiary to redefJ~) fuenefits provided by the medical reimbursement
plan to similarly 7iituat~d participants and beneficiaries, with respect to
whom a qualifying .... ){vent has not occurred, as limited by the terms and
conditions set f6rthJ i~l-this Article. I !
(b) "GrQup .-Health Plan" means any plan of, or contributed to by, the
Employer to provid~m~ical care (as that term is defined in section 21S(d)
of the Code) to emple,yees, former employees, or their families, either
directly or thrOUgh~Jnce, reimbursement. or otherwise.
(c) "Qualifiea:-Seneficiary" means any individual who. with respect '-" ~ to an employee wQ'o is a participant is attributable to a period in which
such individual was 'a ,nonresident alien who received no earned income
(within the meaning-'OfCsection 911 (d)(2) of the Code) from the Employer Which~onstitujted rin'ddm~ from sources within the United States (within
the(;rfieaninif";of se6tio~,/861 (a)(3) of the Code). If an individual is not a
I I·f·ild'/.b/-I' f' . .....------., t t th . qUlali Ir, u. en~ IClarYcp,~)s~an. ,0 e prevIous senten,ce. a spous~. or
dePlen~eQt;:!~g.~~dd of> sucA1lndlvidual shall not be conSidered a qualified
behrfif1F1Y)] virtu:e_of~~he relationship to the individual.
II ~1~)I' "QNalify~svent" ,means an eve,nt de~cribed below, but ~or the contJn~atJon 101~ co-,erage\ prOVided under thiS Article, would result 10 the 10d(~overUr~Ualified beneficiary:
-27-
(}!]j
(1) IT'CjhJlaeath of a participant. \[~
(2) lhE(,\ termination (other than by reason of an
employee-parH'cipant's gross misconduct), or reduction of hours
(where suc~0e9.u'ction causes the participant to be ineligible for
coverage ungectne medical reimbursement plan), of the participant's
employment.! I .
(3) ~T-he) iivorce or legal separation of the participant from
the partjcipant:s:::::s~ouse.
(4) ~0artiCiPant becOl:ning entitled to benefits under
Title XVIII 0r:fhe-.,Social Security Act. \y \
(5) :/Ld~dendent child ceaSing to be a dependent child under
the medical .r~rhifursement plan. ,yU)
10.03 TypeAlf-eBenefjt Coverage. The type of coverage to which a
person is entitle'drunderJ this Article is identical to the coverage available
to similarly situdtedJ plan participants and beneficiaries on the date of the
qualifying event,Lwith-re~pect to whom a qualifying event has not occurred.
\~ If coverage tfnder the medical reimbursement plan is modified for any
group of participantsorJbeneficiaries, the coverage shall also be modified
in the same mann'eITor) all individuals who are similarly situated qualified
beneficiaries undekthis Article.
Dc-J
Coverage maY,lnoLbe conditioned upon, or discriminate on the basis of
lack of, evidence bf-.ir.lsLrability.
CtO.04 p'erio{@f~·CQyera!Je. The coverage to which a qualified
benEffici'ary-1's:;;;entitle-d=u'Ftder this Article extends for a maximum period of 'Ib OJ v /J' / ~ thirt;y-s'iy,('36) months) beginning on the date of the qualifying event; hdJI~V~~im~e follo'wing-situations, the period will end the earliest of: r I t(! ),1\ I I
I I oani9nhteeh--{18i) months from the date of a termination of
'110IJn, 61 ~ of hOU~2J>-as d"e,",ed ;n S,eHon 10.02(d)(2)
(!!iJ
unless a SUbSeqUeQq~lifYing event occurs with such eighteen (18) month
period; ~
(b) the dat~ ~lNhich the Employer terminates this plan and ceases
to provide any oth~r\group health plan to any employee;
r~
(c) the date onJwhich coverage ceases by reason of a failure to
make timely paymentJof any premium required under Section 10.07 with
respect to a quallfied-b'eneficiary;
(d) the daeer the date of the election, on which the qualified
beneficiary first b~CO~S
((f()1
(1) ICC?Y?Jed under any other group health plan, as an
employee or (ofl~TiSe; or
(2) centitl.ed to benefits under Title VI II of the Social
Security ACG~
10.05 Not ice s~ To the extent they are not inconsistent with
regulations herei/ilafter prescribed by law, the following notices are , d \.,'---..., . require : [.
(a) To pre£~the _ option to elect continuation coverage provided
under this Article~'J!../~articipant or a qualified beneficiary who would
otherwise lose 8'pera~ must notify the administrator in writing within
sixty (60) days of \the following events: r:=J
(1) c:liVofce or legal separation of the participant from the
t" • (sed~s\ R.,ar ICIPJ'lnt s ete;
n ~ rCd;pendent child ceasing to be a dependent child under
toe ~~; ~ ) j [, rr~t 6eath<of a participant. if occurring after an election by
Uha quallified [l5e~e.fiCiary for continuation coverage by reason of a ~~imin~Non00f(the participant's employ or reduction of hours of
I Alelrvic~:~ CJ nl ~ U :JU -29-
(!!jj)
(4) ~articiPant being entitled to benefits under Title
VIII of the Social:! Security Act, if occurring after an election by the
qualifying b6nJefi~iary for continuation coverage by reason of a
termination 'af~t~J participant's employ or reduction of hours of
service. '--../ ~ [ i
(b) To preserve] the right to receive benefits provided under this
Article, a qualified beneficiary who is a participant by reason of having
elected continuaiion-60verage under this section must notify the
administrator in writ!n9'within thirty (30) days of the date, after the date
of the election, ori~~ the qualified beneficiary:
Clu (1) (fl!:,st{,.,becomes covered under any other group health plan,
as an employe,&}i:l.rJ otherwise; or
(2) Gtlt~d to benefits under Title VIII of the Social
Security Actg
(c) The ~Qplo.yer will give notice to the administrator of the
following qualify,ing-L.evehts within thirty (30) days of the date of such
event: 2 ]
(1) de-ath of a participant as described in Section
1 0.02(d)(1); (:?)
(2) 0 rerrriin;ation of participant's employment or reduction of
hours, as derc~ in Section 10.02(d)(2);
(3) th~ [participant becoming entitled to Social Security tR~~~ as ~ed in Section 10.02(d)(4).
I rn:d)~rhe ad~trator will send written notice to each qualified be~efi~Y~SUCh~beMfi9iary'S last known address:
I '.II 0 1.11)~ bf-thet option to elect continuation coverage under this I ~r(cI. 0, ~ a quallfy;ng event, or
~ -30-
(J!i)
(2) GJlh~ termination of coverage under this Article due to
a failure of a)timely payment of an applicable premium or of a plan
termination'lo \
within fourteen (14)Ca~s of the administrator receipt of notice of such
qualifying event o{termi'nation of coverage.
(e) A noticbn~ to an individual who is a qualified beneficiary as
the spouse of a [partidpant will constitute notice to all other qualified
beneficiaries reSidi?Git)h such spouse at the time the notice is sent. \i~
10.06 EleQti9n~To become eligible for the continuation coverage
provided under thisJArltible, a qualified beneficiary must file an election
with the administrk!g.p/lvJithin the election period.
The election~e~od begins on or before the date a qualified
beneficiary would lci'se;;:e6verage in the plan by reason of a qualifying event,
and ends sixty (60)' d~ys after the later of (a) the date the qualified
beneficiary would {o~e(c~verage by reason of the qualifying event or (b) the
date that a notide-of-the option to elect continuation coverage is given by
the administrator p'l:Irsuant to Section 10.05. I..\.....~ [ .
An election for continuation coverage by a qualified beneficiary will
be considered an ~I§id,n by other qualified beneficiaries who would lose
coverage by reasor:t ..... .9.fJ the same qualifying event, except as otherwise
specified by a qlTalifiecCbeneficiary in the election. '--J L~ __ ---'
~ .
An election ;igal(\~t continuation coverage by a qualified beneficiary
will not be considero;d,\an election against coverage by other qualified ~:,,~hO ~ '0'. o".ra,. by rea,"" at the sam. qualifyl",
I tQ.07~remiCO Requirements. The applicable premium for any indilvidl:lfl~cting tontinuation coverage shall be equal to the amount last
f • Kr f 1 " I I . deferred by the employee With respect to which the qualifying event
I II ,Id' ,\ ..--' \I'f ' oclcurre pnorl to tf~ qu/a I ymg event.
lUJ ~ GCV ·31·
(!!jj
A qUalifYing(QJSJficiary electing continuation coverage under this
Section must pay /.an~mount equal to the applicable premium for such
coverage to the adrrlinistrator upon making the election.
If the electi~ /1 made after the qualifying event, payment of the
applicable premium" fOrthe period preceding the election must be received
by the employer wiffiii1JfortY-five (45) days after the election.
The payor ~m}ke payment for the applicable premium in monthly
installments, in r:a~rdance with procedures determined by the
administrator. Pa{meht of any premium or installment will be deemed
made in a timely f'mainer if received by the Employer within thirty (30)
days of the date sluSh r.p~emium or installment is due.
v[, , @J) END Of ARTICLE X
(rl/2
iLl
b
@
01 J
h
rw~ . [-"J
'I r ~ lw (j!iiJ ·3~
([i)
C1(:"~ ~ ARTICLE XI
~~ADMINISTRATIQN OF PLAN
-'--11.01 Plan admin'istration. The administration of the plan shall be
under the superviSion-of the Employer. which shall see that the plan is
carried out. in acicora~nce with its terms. for the exclusive benefit of
persons entitled tbpar.t'icipate in the plan without discrimination among
them. The administrator will have full power to administer the plan in all
of its details, sub1{c"tJt6 supervision by the Employer and to applicable
requirements of law~E9r this purpose, the Employer's powers will include,
but will not be lirriifed) to, the following authority, in addition to all other
powers provided b}j;itrblan:
(~! (\. (a) To ma~e_ ~nd enforce such rules and regulations as it deems
necessary or prog.~-\;f9j the efficient administration of the plan;
(b) To i{t£~r~.Uhe plan, its interpretation thereof in good faith to
be final and conclusiv.e_dn all persons claiming benefits under the plan;
(c) To dec\d1--all questions concerning the plan and the eligibility
of any person to p~ici[ate in the plan;
(d) To app(02duch agents, counsel accountants, consultants and
other persons a~-may-b'e required to assist in administering the plan: and ~ L. __ • .-l
\I
(e) To allopateand delegate its responsibilities under the plan and
to designate other "'-persons to carry out any of its responsibilities under the/pl.~n, ~SUCh~b~tion, delegation or designation to be in writing. ( 0 ~~o~xamin~, of records. The administrator or the Employer willllm~~ailable}{o-~a!Ch participant such of his or her records under the pl~n ~s~rtain to th.e-:l p~rticipant, for examination at reasonable times
dJrih1 "orm",bUS;~.'S 50urs.
~ (Jfij -33-
r1/' tlJ
11.03 Relia~l~n tables. etc. In administering the plan, the
administrator will 'ber.:Eintitled to the extent permitted by law to rely
conclusively on all (Itabl'es, valuations, certificates, opinions and reports
which are furnish~d-O~' or in accordance with, the instructions of the "-Employer or by acc9l!!:llants, counselor other experts employed or engaged
by the Employer. LJ
~J
11.04 NondiSCrTOiibatory exercjse of authority. Whenever, in the
administration of th}!,=pl~n, any discretionary action by the Employer is
required, the EmpI6,yer,;'l;ihall exercise its authority in a nondiscriminatory
manner so that ~JI\.-perisons similarly situated will receive substantially
the same treatmenJJ(~
! U J) I
11.05 Clajm for ,pebefits and review of denial.
~lr'
(a) SUbmi(srohJ) of claim. A participant may file a claim for
benefits uinder Ih'e-plan by writing a letter to the Employer or the
administrator whic~/ rrelquests the determination of the participant's
entitlement to bJn~fi't 'and which states the basis for the claim, The claim
must be dated ~nd-signdd by the claimant, and must contain the claimant's
address and telephone number. " '---r l L ,
The administrator;-,.as the Employer's designated agent, shall review
and determine claih,ssubmitted under the medical reimbursement plan and
the dependent carJ,~i~tance plan. The Employer hereby designates any
insurance compCVfYLo!_~mpanies whose policies are incorporated into the
life insurance premi"l,lm plan, the accident and health insurance, or the
disability insurance" RTiiD as its agent to review and determine claims
submitted under suchl~'olicies. l J I) , I/~fth /D1nial oLclai}m. If a claim is wholly or partially denied, the
E IU'I_·I 1./ /"d .. t/ t" d' d' . mR, oye;.~a miniS ra or'lor eSlgnate tnsurance company or companies sh~lI, ~~ifbio ninet~I' (f90)Ldays after receipt of the claim, provide written
't·1I ·~th~ I . 1. f h h f II . . no Ice ItO,..-13, c aimant=sletttng ort teo oWing tn a manner calculated II If f , I! . to be understood by-the ,claimant:
'UI! II d I
J
t flO
[I fCJUi -34-
U \:....J ()
(J(,,\ u I ~ l \,_,.,)LI
/-"l i"',
['1]1\ .. (1) ::[he,,;peclflc reason or reasons for the denial;
,---"'" /1 [", (2) iSpecific reference to pertinent plan provisions on which , l' the denial is i.based i
" " c'c:-/
(3) !~L<!~~cription of any additional material or information
necessary for-me-claimant to perfect the claim and an explanation of
why such ma~(i:al jor information is necessary; and
I ' -----
(4 ) APPropriate information as to the steps to be taken if
the claimant \wish'e,s to submit his claim for review,
"----".
If special cir;Qi~~t~nces require an extension of time for processing
the claim, the EniRI.9.Y~;', administrator, or designated insurance company
or companies may ;6x\~nd the period for an additional ninety (90) days by
furnishing written (, n9ttc~ of the extension to the claimant prior to the
termination of th,~~tlall ninety (90)-day period.
If notice olf rd~ni;I-~of the claim is not furnished to a claimant within
these periods, ahd_the_claim has not been granted within these periods, the
claims shall be deE(m,ed denied for the purpose of review.
"-r
(c) Appeal Lfrom:-Jdenial of clajm, A claimant shall appeal the denial
of a claim to the IEmpl,dyer or administrator by delivering to the Employer
or administrator a\ ~iften appplication for review within sixty (60) days
"''-....-r'''' after receipt by! the-:-cl,aimant of written notification of denial of the
claim, or such Ibn6Efr-period as the Employer or administrator may, in its
discretion, permit. L!fi~Jwritten application shall be dated and signed by
the claimant or his/authorized representative and shall request a review of
the Plior deni'!.l of (tB~: I,ciaim, The claimant shall be entitled to a full and
fai~7f,e~iew/@ the \d:e,Dial of his claim, including the opportunity for the cl~ir~d~f/orJ'his authorized representative to review pertinent documents I" ilL /1( \ --, \ and ~ t0t. ... s~bmit issueskanELcomments in writing. I ~~ L ____ J
l( r--\.\\ ~--. I Tih'e administrator., <as the Employer's designated agent, shall review
and d~:t~rmiriel appeals~frpm denials if claims submitted under the medical
I!I !J (10J~) -35-\~) U[
@fD
~['
reimbursement Pial Qnb\ ~he dependent care assistance plan. The Employer
hereby designates anYfi~surance company or companies whose policies are
incorporated into tfiel lif~ insurance premium plan, the accident and health
insurance, or the di~abiliiy insurance plan to review and determine appeals '-./ from denials of claim-s submitted under such policies. L-=:J
(d) ReviewlOTappeal. The Employer or administrator shall make
its decision on the-appeal within Sixty (60) days after receipt of the
request for review, Lynleds special circumstances (such as the need to hold
a hearing, if in th8cEqip.IOyer's or administrator's determination a hearing
is necessary or a~,visa~I~) require an extension of time, in which case a
decision shall be r.endered as soon as possible, but not later than one
hundred and twen{yOh20) days after receipt of the request for review. If
such an extensioh_d{)ime for review is required because of special
circumstances. writteri ~notice of the extension shall be furnished to the
claimant prior to thel bo~mencement of the extension. If the decision on
review is not fur.hish/d within these time limits, the claim shall be
d dd ·d/\I'·I eeme eme on .,.evlew. I ' I r I I •
The decision-on:Jview shall be in writing and shall include specific
reasons for the decision, written in a manner calculated to be understood
by the claimant, a~l"specific references to the pertinent plan provisions on L_-"-' which the decision is~based.
(0)
The administbtor/as the Employer's designated agent, shall review
and determine reviews0f appeals under the medical reimbursement plan I...-J L.------l
and dependent car~'assistance plan. The Employer hereby designates any
insurance companY=-Qrc:ompanies whose poliCies are incorporated into the
life insurance pre7"i~"\'P!an: the accident and health, or the disability
insyraQ.,ce pia? .to~ l1~ie,w and determine reviews of appeals submitted
unCl9?lsu.ch/R61Ic,es.......... ../
I II ; v /t' r-""" , A i ~
11 J1~correc)ibn~jJf-,administrative errQrs. If an error is made in the adminitt;:~~ of the=p'la~, the administrator shall promptly correct the
Ii" (I I \ t d'· I F h' " d ... II error upon IS Iscovery. or t IS purpose, a ministration" sha
-36-
~ @~
eligibility, particip{tfoh'\and benefit calculation and distribution. If a
participant has Ib'eeri) denied a benefit distribution due to such
administrative ove~!ght, the administrator shall determine the correct
interest of the pa'rticip!!ht and shall direct the Employer to disburse an
amount to the patticip-ant (or his beneficiary) as is necessary to rectify
the error. If an~bElssive distribution has been made to or for a
participant or benhlidia!y, the administrator shall advise the party who
received the distriblJtlOn\ of the error and shall take such actions on the
plan's behalf as arle Cnetessary to retrieve the excessive payment. .'-....-/
'1~ 11.07 Indem'njfication of administrator. The Employer agrees to
indemnify and to ~fe~d. to the fullest extent permitted by law, the
administrator, its agents and employees against all liabilities, damages,
costs and expen~~sD(fncIUding attorneys' fees and amounts paid in
settlement of any)laimsl approved by the employer) occasioned by any act
or omission is ir;( 9~fu.ith and not a result of gross negligence or willful
neg lect. , U '---,
I I
11.08 Participant application and notices. Any participant
applications or noticEls-required to be made to the administrator hereunder
shall be made to Itne-::f5110wing address, and shall be deemed made upon
personal delivery, Itwo'~(2) days following posting by express mail (postage
prepaid), Federal \E~eks or similar overnight carrier, or five (5) days
after sending bYf-ordinaryj mail, postage prepaid to: _JL--~ \I,
L----,Superior Resources a I'c/o Bruce Fox
,------. /' \ (J I) ~118 East Clinton Way
r
~~.~ ,,/ :1 ',-__ /'Fresno, California 93727
II
1-::;>9' (."{\ttention: ca,feteria Account of r 0 (Name of Employer) .
II~ -'
orl kU1~ (ofu~~ addr~)~ the administrator shall communicate in writing to
thf E1Ployer. C ) lW (J!i) -37-
~r;v
11.09 NQtice~ \;hange in employee status. Participants shall be
required to notify\-thel Employer, and the Employer shall notify the
administrator in w'fi1i~\ in accordance with the provisions of Section
11.08 hereof. at l~ast)f~rtY-five (45) days prior to the effective date of, a
change of electiot']~by ..... the participants as a result of a change in family
status (unless the[a'ami~istrator waives this minimum notice period),
L)
, ) l_ ./ END OF ARTICLE XI
~ '0 1 ~./ (]/"---. , a I) I
'()[)
rQl~\l
\._:/ (~/I
I 0 ,,---J
I ~
-38-
·!
e[J2)
/Jl\ . ( Cl U j ARTICLE XII
\'-..-J r? r;\ LIMITATIONS ON BENEFITS l '~.' ) " . C{-·~
12.01 Limitatio~bn benefits for certain employees. Nor more than
twenty-five percet;lt~(2~%) of the total non-cash benefits (i.e., medical
reimbursement benefits;l dependent care assistance benefits, accident and
health insurance', disability insurance, and life insurance premium
benefits) provided /t1'6re'tmder for or during any plan year shall be to or for
key employees of ethel Employer, and their spouses and dependents. In
addition, not mor~thah twenty-five percent (25%) of the total dependent
care assistancer;j{er.l~fits provided hereunder shall be to or for
more-than-five peJ5~1t} (5%) shareholders of the employer, and their
spouses and depend~?ts. The administrator shall make any adjustments in
benefit elections ~t1F~sJary, as provided in Section 4.05, to comply with
this Section. '_-' r~'v ;:;'--1 IO~
END OF ARTICLE XII
f~
! r
! -39-
I ~
(fjj
@) ARTICLE XIII
~£r\JDMENT AND TERMINATION OF PLAN
~
13.01 Amenra~. The Employer shall have the right to amend this
plan from time tQtirnel and to amend or cancel any such amendments.
Employer amendnr.e.ots ~shall be stated in an instrument executed by the
Employer in the same_manner as this plan, and this plan shall be deemed to
have been amendepn"this manner and at the time therein set forth and all
participants shall \Oe~\ffective which shall attempt to cause any of the
assets of the plan tOlb' used for or diverted to purposes other than for the
exclusive benefit(ef D~larticipants or their beneficiaries, or effect or
create any disct~~tion in favor of participants who are officers,
shareholders or hi91ilY0COmpensated employees.
13.02 No (c~nt)actual obligation. It is the expectation of the
Employer that ,if WilT c'ontinue the plan indefinitely> but the continuation
thereof is not asWm'6d as a contractual obligation by the Employer. The
plan may be ~is.c_ontjD_Led or terminated at any time by action of the
Employer. Discontinuance or termination of the plan shall not have the
effect of depriving'~~ny-partiCipant of any benefit owed by the plan on the
date of terminati0tcaf;;::the plan.
13.03 procedQ Jon termination. On or before the effective date of
termination, the] EmpToyer shall direct the administrator to proceed as
soon as possible, tb~-irl any event within one (1) year from such effective
date, to pay all b:enefit~ owed by the plan, after first reserving such sums
as it may deem to be reasonably necessary for its expenses and
0J""] END QF ARTIQLE ~'"
2J
(}[ij -40-
rJ!jj
@ ARTICLE XIV
C,,-~MISCELLANEOUS PROVISIONS
14.01 IOfO"~ 10 be lumlsh,d. Partlclp"" shall provide lhe . ' Employer and administrator with such information and evidence, and shall
sign such docum~nls-;)a!s may reasonably be requested from time to time
for the purpose of adfninistration of the plan. The administrator, its
agents and emploY,ees may reasonably rely on the accuracy of, and have no
duty to investiga~e~J validity of, any such information provided by
participants. ''6
14.02 LimitiJLp bn participants' rjghts. Participation in the plan
shall not give any/8-mp.loyee the right to be retained in the Employer's
employ, or any riQh~ gr )interest in the plan other than as herein provided.
The Employer or'trustee reserves the right to dismiss any employee
without any liabiTftY'~ any claim either against the plan, except to the
extent herein 8r@ded, or against the Employer. All benefits provided
herunder shall be f:l~id ifrom the trust and no person claiming an interest
under the plan shall have any recourse toward satisfaction of his benefits
from the Employej.~ ~r-the administrator. Any amounts transferred by the
Employer to the J5fmin~~trator for the payment of benefits hereunder shall
be paid on a "first-in/first-out" basis.
14.03 ReGei~dd release. Any payment to any participant or his
legal represent~ttive\orJ beneficiary in accordance with the provisions of
this plan shall be~to-the extent thereof, in full satisfaction of all claims
against the trustee,A~e~,administrator and the Employer; and the Employer,
administrator of 0 tf,ustee may require such participant. legal re~entativ$ or I:H~~diary, as a condition precedent to such payment, to r1r~c~tJ/~~ceiPt aricnelease to such effect. I ~:::;Nona}s~akitY. None of the benefits, payments, proceeds or
claims" (of ~,n\~ partlciQa[lt shall be subject to any claim of any creditor of
r!})
attachment or gar~~~ent or other legal process by any creditor of any
participant, nor shalLan'y participant have any right to alienate, anticipate,
commute, pledge, ~Elcrumber or assign any of the benefits or payments or
proceeds which he, fnay ,kxpect to receive under this plan.
~/
14.05 Inco~p'erency. Every person receiving or claiming benefits
under the plan shall-be conclusively presumed to be mentally competent
and of age until lffje"id~te on which the administrator receives a written
notice, in a form Laod..-'lnanner acceptable to the administrator, that such
person is incompefen00r a minor, for whom a guardian or other person
legally vested wit~~) ~are of such person or estate has been appointed;
provided, however>--tha/ if the administrator shall find that any person to
whom a benefit is'i{ayable under the plan is unable to care for his affairs
b f · '''tlll .. td (I . ecause 0 mcomRe ency, or IS a mmor, any paymen ue un ess a prior '---" LV claim therefor shalll\have been made· by a duly appointed legal
representative) ma~G>!:) Raid to the spouse, a child, a parent or a brother or
sister, or to any ~eEfLoAI or institution deemed by the administrator to have
incurred expen!ie""lOr sJch person otherwise entitled to payment. To the . n ,...-extent permitted by,law, any such payment so made shall be a complete
discharge of li~biTfiy~th~refor under the plan.
14.06 No gSiirantee of tax consequences. Neither the administrator
nor the Employer L!J1akek any commitment of guarantee that any non-cash
benefits paid to of(f05'the benefit of a participant will be excludable from
the participant's g!r~ss i~come for federal or state income tax purposes, or
that any other f~Qeral:::'or state tax treatment will apply to or be available
to any participan't~lt shall be the obligation of each participant to
determine whethert~achl payment is excludable from the participant's gross
income for federal~?ra. state income tax purposes, and to notify the
Employer if the pa'r,ticip.~nt has reason to believe that any such payment is _~ ..<l i ~J 1/ I n0k!\~ ,excludable. ~ !frll:l~0'7?' d r.f~\t· f E lb" t If .. ! I Jl;l'::"" n emEll Ica Ion 0 mp oyer v partlclpan s. any participant r~c.,e. i~e.~.e~ or rhore •.. noh-cash benefit payments or reimbursements that I I, iiI. r '\ 'l,' r'-~ an~ ~N for I depeJJg~~fJ care or medical care or otherwise non-taxable
eXRelises. s.luCh .par-tiGiP'ant shall indemnify and reimburse the Employer for
t .liU. ' . .1 JI 1 (J. L I. ()\ -42-~~; ~~/U
(!!jj
((ill]
any liability it may,-jnc.ur for failure to withhold federal or state income
tax or Social SeftJ'rit'b tax from such payments or reimbursements.
However, such indehmlfication and reimbursement shall not exceed the
amount of addition'al-fe{jeral and state income tax that the participant
would have owed ifh~e-PFyments or reimbursements had been made to the
participant as regular cash compensation, plus the participant's share of
any Social security~taX)t~at would have been paid on such compensation,
less any such addit9nal irlcome and Social Security tax actually paid by the
participant. (Q)
14.08 Trust ~2sole source of benefits. The benefits provided
C! f. '\. hereunder will be p.aio solely from the trust fund created pursuant to the
trust, or from amo~htl(glaid by the trustee to the administrator, or from
the insurers. No p~fiei~ant or other person shall have any claim against,
right to, or security( I?S ~ther interest in, any fund, account or asset of the
Employer or the admirrLl?tfator from which any payment under the plan may
be made. CQc
14.09 Gende!~ pronoun or adjective in the masculine gender
includes the femini~et gender, and the singular includes the plural, unless
the context clearly rinEiieates otherwise. L-----.J
14.10 GOverni~w. This plan shall be construed, administered and
enforced according \to'-Ulei laws of the state in which the principal place of
business of the EmPlo%r1 is located, except to the extent the law of such
state is superced1eacby-federal statute. ~
rQl~.
~. Y ENDOFPLAN
J (02)
-43-
PLAN TRUST
OF
t ... J -L{frr;5f _e~eit caJ.f.L ______ _
~
01 1
~-l
10 / . 00 1
(~) ~A/. ~ Ii ~# ~OL
[II f~~. L. ___ -1
\~=:/ U! \..J l/
CAFETERIA PLAN TRUST
r!iJ Ol ~ TABLE Of CONTENTS ~~) Subiect Artjcle/Sectioo
r1 l '\ I '--) INCORPORATION Of PLAN ............... . \,~J ARTICLE I
ARTICLE" p. ::JTRUST ~~ND
Section 2.01 ~--IComposltlon of Trust fund ............. .
Section 2.02 '---) "pub-funds ............................ .
[ ... j
r;="PUTIES AND POWERS Of TRUSTEE
Section 3.01 '\ (-'j Receipt of Moneys in Trust. ............. .
ARTICLE JII
'--'"' J Section 3.02 '-.-/Disbursement on Direction of Administrator
Section 3.03 (J(~'Fower to Inve~t. ....................... .
Section 3.04 c/[}eCOrds ReqUired ....................... .
Section 3.05 /I f\ Reporting Requirements ................. .
Section 3.06 ((] I) ~uthorization Must be in Writing ......... .
Section 3.07 ~~Investigation .......................... .
Section 3.08~r--rraxes ................................. .
Section 3.0$ 0 C:::Compensation of the Trustee ............. .
Section 3.1 ~ Fayments by the Trustee ................ .
Section 3.11 No Responsibility for Payments .......... .
~[ ARTICLE IV ,-RECORDS Of TRUSTEE
Section 4.01 rQ'{\-ccounting ............................ .
Section 4.02 ~./Annual Report of Trustee ................ .
ARTICLE V 0 &= ~ENERAL PROVISIONS APPLICABLE TO THE
[ TRUSTEE
Section 5.01 /"l i'Trustee Acts Conclusive ................ .
Section 5.02 r (j D Duties, Responsibilities, Liabilities and
n' ./{2 ~ -) D~Sa?!lities of Trustee ............... .
8E!ctlon 5.03 ~ --"'\'lo Liability ............................ .
See'tibn 5.04 (0 Limitations on Trustee Responsibilities ... .
'S-:r -5 0 r' ':--!I d 'f" h T ectlon-. 5, n ' emm Icatlon oft e rustee ........... . "'~" -
jSection 5'.06 §rustee.s Rights Where Controversy ....... . "11'\ '" Sectio~ 5.07 Request for Instructions ................. . U II()/~ ~ l ~cJ i.
1
1
1
2
2
2
3
3
3
3
3
4
4
4
4
5
5
6
6
6
7
7
7
(¥~ ?l~s,Subiect
( Ci I I . \~.!RESIGNATION, REMOVAL AND SUBSTITUTION
Article/Section
ARTICLE VI
Section 6.01 (] (\rtesignation by the Trustee .............. .
Section 6.02 I L' Removal ofTrustee ..................... .
Section 6.03 ~ JProcedure upon Resigoation or Removal. .. . r-~AMENDMENT AND TERMINATION
Section 7.01 ~) ";Amendment by Mutual Agreement. ........ .
Section 7.02 r-' .JTermination ............................ .
ARTICLE VII
Section 7.03 ~Pisposition of Funds Upon Termination .... .
Section 7.04 I 0 No Violation of Rules Against Perpetuities ..
C/
ARTICLE VIII rJ/n'GENERAL PROVISIONS
Section 8.01 V~GOVerned by This Trust Agreement. ....... .
7
8
8
8
9
9
9
9
~:~!:~~ ::~; t(jll'~:::~~~ ~~ :.~~i~i:~~~ ~I~i.~~ ....................... .
Section 8.04 \~~Choice of Law. . . . . . . . . . . . . . . . . . . . . . . . . . 10
Section 8.09 ,,·--.V··· ..... Vse of Courts. . . . . . . . . . . . . . . . . . . . . . . . . . 10
9
9
Section 8.09 0 CSeverability........................... 10
Section 8.0? -ponfidential Nature of Records. . . . . . . . . . . 10
Section 8.08 Arbitration. . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
P-J SIGNATURES ...... -.~.-.-.-...................................... . 11
@
IJ=----,
ii.
rJ!RJ @ CAFETERIA PLAN TRUST
(J (\
THIS CAFETERIA 1 PLAN TRUST (hereinafter referred to as the "Trust
Agreement" or "Ag~eme'nt") is entered into by the Employer and the Trustee
for the purpose Of[~rOViding benefits to employees under the cafeteria plan
established by the r~mp1~yer.
~=») L........J ARTICLE I
@ INCORPORATION OF PLAN
This trust ag~erne,nt is established pursuant to and is a part of the
plan. and the plant iJ jiridorporated herein by reference. Any term defined in
the plan shall hav~tt{' same meaning when used in this trust agreement,
unless the contexl (ql~~l:Iy indicates a different meaning. ~ rrJ '0 r I ) '~ ARTICLE II
TRUST FUND
Section 2.01 ~sjtjon of Trust Fund. The trust fund shall consist of
all contributions m(c:le,tlnder the plan, investments made on property of any
kind acquired wit~ lari~ such contributions, and all income, profits and
proceeds derive<Q~Tm.
, Section 2.02 1$1b-Eunds. The trust fund may be held, administered, and
invested as a singih'1::;;fllntJ, or it may be divided into such sub-funds as the I
administrator may direb~~ The assets of each sub-fund shall be held in trust
aSt:'a-::portior:V'Of thk "t6tal trust fund. In the event the administrator divides th~(frH~J1~~ int0;Su6<unds, the administrator may designate a separate trure~t6serve r3~?ie of that portion of the trust fund constituting a
JU. UI (J!ij -1-
r' ,..~ Uf R) .
single sub-fund. I~;thfl~vent that sub-funds are set up and the administrator
designates a sepa'r?-t~ i) trustee for each such sub-fund, then the trustee of
each such sub-fun\;! 'oJsfi'ali furnish such information concerning the investment '-~../ of the assets of its'-sub,fund as the administrator may require for the proper
J i t \
administration of th~..Jru'st fund. The plan administrator may also require
that all expenses r~lfitee' to the operation of any sub-fund be charged against
the assets of such~ sub-~und. The trust fund may be held by the trustee in
such custodial account; or accounts with such banks or other financial
institutions the aC6ounts1 of which are insured by an instrumentality of the
United States as th'e~a:d,tninistrator may from time to time select. ~.""."
/"~~~
I ' ( C) )
'---",J ARTICLE III
rlr\ ( (j lQl.JTIES AND pOWERS OF TRUSTEE
'\.Jl..!
Section 3.01 ~~iDt of Moneys in Trust. The trustee shall receive all
contributions and r:n'cjrl~ys paid by the Employer to it under the terms and
~ conditions of the'15'lan;-'in trust, for the purpose and uses set forth in said
plan, and with t6erporefs and duties hereinafter set forth, ! U ---l
Section 3.0"2-DisDursement on Direction of Administrator. The trustee
shall hold and adtThiste{ the trust fund subject to the following provisions:
(a) The trusfe.9:·'shall hold and administer the trust fund subject to
the proper written ~iredt[bn of the administrator or its deSignated agent, and
the trustee shall pe::b:6,und by and may act in reliance upon the written
instructions of t~e-admlinistrator. or its designated agent, insofar as the
trust fund is concfrhedd. I i
(b) When s~J~\ected in writing by the administrator, the trustee sha!l~egregaie p6rtiQI&. of the trust fund, create special accounts, and/or di~bfJ?sJv'tr(e1(rust f;;md--..in such amounts and to such persons as directed by thllel.ia&lmin.l~trator, 6r(-its.lde. signated agent. I ~ t'_..J~ I i' ~3.03 GEoweJ to Inyest. The trustee shall conserve and protect th!3l!p~i:+pall of the Jr.L!sh funds. The trustee shall have the power to invest
anY, fi!~rt of I ~II of [the._tjust funds in savings accounts at banks, savings and lYJ ~I @!2) ·2·
r1f~' l(~)c) 1-:-' :\
loan associations., Cl ~\o'ney market accounts, Treasury bills, banker's
acceptances, insur'al]j::~/ contracts or other property of a like kind, that a
prudent man would-Ju'S"e, under like circumstances with due regard for the
purpose of the pI~rka~~ trust fund and its need for liquidity. The trustee
shall have the pOlI'{er-to transfer any part of all of the money or property of
the trust fund to any--common or collective trust fund or pooled investment , ,
fund maintained b¥-:::ttle-] trustee. The trustee may, directly or through the
administrator, emp'loY"',s'6ch investment adviser or advisers, with power to
f-'-···-I direct the investme,.nl.2.call or any part of the trust funds, as the trustee may
select, and such investment adviser or advisers shall direct the investment
of such trust fund~. (@n)~istent with the terms hereof.
"'--
Section 3.04 {FreCO?ds Required. The trustee shall maintain suitable and
adequate records OeaQd} for the administration of the trust. '-/~/
S ' 3 osr:JR 11\. R' Th h II k II ectlon . . r' ep0rtlngegUirements. e trustee s a rna e a
reports required by\E;mSA and any other applicable law or laws,
f'?I
Section 3.rOUN~orization Must be in Writing. All checks, drafts,
vouchers or otht?r withdr,.awals of money from the trust shall be authorized in
writing by the ad,mjnistrator. > 1,'---1
Section 3.07/.JnV,6sti g atio n, The trustee shall not be required to
determine or to m,akeja:ny investigation to determine the identity or mailing
address of any ~e'rsonj entitled to benefits hereunder and shall have
discharged its 01;>Ii.g~ti0n:lin that respect when it shall have sent or caused to
be sent checks 'aMj~ther papers by first class mail to such persons at their
respective address~asJmay be certified to it by the administrator.
. Section 3.08r;Jk~s. If the whole or any part of the trust fund or the p~Oc~qs th'e\-eof \shMII become liable for the payment of any estate, in,h~i~~c(fi'~cOme(6r"iqy other tax, charge or assessment which the trustee s~~ll ~qUired t,o@yL the trustee shall have the full power and authority to: RaYi~ax, cliarge_orJassessment out of any moneys or other property in I! II" . \~ '--'] itll I hahas ge ongif,lg-!.o. the trust fund for the account of the person whose
II!' II! j c~~J
i II I () (7:-\ -3-~J Li ~)r)
G(0
interests hereunder(are"'liable for the payment thereof, but at least ten (10)
days prior to the ~a:gi~~ )Of any such payment the trustee shall give notice in
writing to the administrator of its intention to make such payment. Prior to
making any transfe'fl 6J\distributions of any portion of the trust fund, the I tt( 'It I
trustee may require-s'u.ch releases or documents from any legal taxing
authority as it shaJ~dee'rn necessary. t~ Section 3.?9 L6~m.~ensati?n of the Trustee. The trustee shall ~eceive
such compensation, for)lt;:; services rendered hereunder as may from time to
time be agreed upon ~yI separate agreement between the administrator and
the trustee. So 10r:lQ,aS\the trustee is Dwight H. Mensinger, the trustee shall
. I"--"t' f . h d not receive any co~a Ion or services ereun er.
Section 3.10'lJ1ijYments by the Trustee. As directed by the
administrator, the i;Sst'e'ei shall make payments from the trust to an account
established to pay /¥-af<IPaintain plan benefits. In addition, the trustee shall
make payments fr~~l ~El trust to a separate account established to pay all
expenses of the r>lal1..:-arid trust, including plan and trust administration fees.
The trustee sha!l7eim~rse to the Employer any amounts remaining in the
fund or in suc~· ~ccfunts after all liabilities for the' plan year have peen
satisfied, but not includirlg any earnings thereon.
Section 3.11VNo~.,responsibility for Payments. No trustee shall be
responsible for the l~deq~acy of the trust fund to meet and discharge any and
all payments and l)abiHties hereunder. All persons dealing with any trustee
are released from ,iny) rksponsibility to inquire into the decision or authority
of such trusteerto1retl and from responsibility for the application of any
monies, securitie~trve. Sjtments or other property paid or delivered to such
trustee. .
frilt\
nv '~~o;:;.·~· ~ RECORDS OF TRUSTEE
~ ,--.-:-
SectiOI[l'lr.01 IAcco'cloting. The trustee shall keep or cause to be kept by
or)l 4~ mor~ Icust!ildi.aris.~, appointed pursuant to Section 2.02, complete and I j fl, ~_/ . II f)Q 4-~. U ts:PJ
ARTICLE IV
(10 \~)L)
accurate records andaccounts of its receipts and disbursements. The books
and records of the( fr1kt7b shall be available for inspection at all reasonable
times and places b',,-tt;Je duly authorized representatives of the Employer of ,..-,"-
the administrator. ( J " \,
\ Lj I
Section 4.02 ~ApDdal Report of Trustee. Within thirty (30) days after
the close of each Iplal! Jyear of the receipt of a written request from the
administrator, or upono-termination of the duties of the trustee, the trustee I shall file with tt1e-aBministrator a written account setting forth all
investments, recei~ts,-=di~bursements and other transactions effected by the
trustee during suCh(eJiil\year. Such account may consist of written accounts
of custodians ana \..in.vestment advisers appointed hereunder which are
provided to the tru~tee~r the administrator. Such account shall also contain
an exact descriPticfnJ/Of, all securities and other investments purchased and
sold, the cost or In~t/!p~oceeds of sale and shall show the securities and
investments held as>"dfr,he date of such account and the cost of each item
thereof as carried (o~ IJhe books of the trustee. The trustee shall also file
with the administ~ato!) a monthly report on the receipts, investments,
disbursements ar:lddt~ transactions related to the investment funds in that
same month. lA!l]apcounts so filed shall be open to inspection during I -.--, business hours 12)' the I!,Clministrator.
C\_ L_~ ARTICLE V (~
GENERAt!rmOVISIONS APPICABLE TO THE TRUSTEE
'-/
Section 5.0~ ~T;rustke Acts Conclusive:' No third party dealing with the
trustee shall be obJig'ated to see to the application of any monies or property t I of the trust, or to /see,. that the terms of this trust agreement have been
complied with, or t0099~ire as to the necessity or expediency of any act of th~~5teE3.;;EverkJn}tfument executed by the trustee or by his direction
snail bk!'COf'lCIUSiVe(iil favor of every person who Itll~ r.O) . Ca»;:::::'at~ the tlme_crllhe delivery of the instrument, this plan and trust
areeM'ent i~re in: full) )rce and effect;
~ I @72) -5-
GrJiJ
(b) the ins~_Ht was executed in accordance with the terms and
conditions of this plan_and trust agreement; and
(J l')
(c) the trustee) was duly authorized to execute the instrument or
direct its executiO&~
Section 5.02~~utils. ResQonsibilities, Liabilities and Disabilities of
Trustee. The dune!>;) responsibilities, liabilities and disabilities of the
trustee under this ~ and trust agreement shall be determined solely by the
express provisions/t1ei'eof. No further duties, responsibilities, liabilities or t !.--, disabilities shall be, if]pJi~d or imposed. The trustee may delegate any of his
ministerial powers ~~~es to any of its agents or employees.
Section 5.03~0/;LiabjlitY. The trustee shall incur no liability fdr acting
upon the papers, docGM'ents, data or information believed by the trustee to be
genuine and acc6r,a;t¥) 'and to have been made, executed, delivered or
assembled by the \p&~ef parties. The trustee shall incur no liability for any
act taken by the(frustee "in reliance upon the advice of legal counsel. 1..--'
Section 5.<;l4Ltikrration on Trust Responsibilities. The trustee shall be
responsible only for the property actually received by it as trustee '--1 hereunder. It shall t:Jave no duty or authority to compute any amount to be
paid to it by. the EIf'!Jploy~r or to bring any action or proceeding to enforce the
collection from the (Em'P,loyer of any contribution to the trust fund. The
trustee shall have \no.J~~thority or responsibility with respect to any part of
the trust fund as-to.=wlik:h it does not serve as trustee. U~J
The trustee ~y-conCIUSiveIY rely upon any directive which purports to
have been authorihiap)¥, and executed on behalf of, the administrator, and I
shall not be under(anY)duty to question any such direction. The trustee shall ha~no dutVto rev\i~.:v .. br make recommendations with regard to the making, rJtentibh~r~isposifio"h\ of any investment subject to the direction of the I In. U'. ,y I 0 ) . admlrn,!lstrator. \ ,/
"
~ L--=:J it~~~fitee ~~ Q'ot be liable nor responsible for losses or unfavorable
results arising from-J the trustee's compliance with directions of the
lU ~ ctJ2) -6-
(!!})
administrator Which(@~~ade in accordance with the terms of the plan and
trust. If applicable.;./helther the Employer nor the trustee shall be
responsible or liable)o7\the failure of any insurance company, HMO, health
services provider, depe~dent care assistance service provider, or other third
party contractor to "pal or provide any benefits due the participant as a
result of premiums [p~icr~on behalf of that participant.
I "1
Section 5.05 'In'dealnifjcation of the Trustee. The administrator shall
indemnify and hol~f the! trustee harmless from all liabilities and claims,
including reasonable!fittorneys' fees ana costs in defending against such
liabilities and claim'e)a result of:
(a) Any ac~'action of the administrator; or
(b) Any a~t~pKinaCtiOn of the trustee resulting from acting in
accordance with a~YJ~Jections from the administrator, or resulting from the
absence of direCtio'AL!J;dm the administrator where the trustee is entitled to
'direction. 102
Section 5.06 Trustee's Rights Where Controversy. If a controversy
~-"'-arises concerning the person entitled to a distribution, the trustee may,
without liability. refaih~thle funds or property involved pending settlement of
the controversy d~pendirig ~n adjudication by a court of competent
jurisdiction. ( 0)
Section 5.p7 rBe(iUlest for Instructions. The trustee may request
instruction or cla~!tieatidn of instruction from the administrator and may
delay acting purs"u~n!J to instruction until th'e clarification request is
ARTICLE VI
I d ,.OL, 'I ~ RESIGNATION. REMOVAL AND SUBSTITUTION
! seQ 6.01 ~~ation by the Trustee. The trustee may resign at any
tim, eLl~~ 9iViQ~, thJ,rfY-:;;{B,O) days wirtten notice to the administrator. ~ ~I ®?J -7-
®?J
Cit\ Section 6.02~ Removal of Trustee. The trustee and any successor
trustee hereunder mlly.-:b'e removed by the administrator upon delivery by the
administrator of af(.Jvlitten notice of removal to the trustee, to become
effective in not lebs'-thll?h thirty (30) days after delivery thereof, unless an
earlier date or a ~ter/ date is agreed upon by the administrator and the
trustee. However;;" 'nolremoval shall become effective until a successor
trustee appointed ~y-t~'e: administrator has accepted in writing, in trust, the
trust fund. A succe ~or trustee shall have all of the powers, without
exception, conferrefLup~oA its predecessor trustee.
/~
Section 6.03 (p';ocedure upon Resignation or Remoyal. The trustee who
has resigned or b'eep/removed as trustee shall endorse, transfer, assign,
convey and delive~/fh~ trust fund to the successor trustee, together with
true copies of all ~tVrecords relating to the trust fund so transferred and
delivered. The resign,ing trustee shall also execute all documents necessary
to vest title as t{ugtt~ lof the trust fund in the successor trustee as may be
necessary or desiFaQleJ in order that the successor trustee may properly
administer the ~Q~~under.
In the evehtqf su¢h removal or resignation of any trustee hereunder, it
shall, within thirtyc_(30) days from the effective date of such removal or
reSignation, file wfth-the administrator a statement and report of its
accounts and proc~edinds covering the period from and containing the items
of its last statem6pt-r~port in this respect to the effective date of such
removal or reSignd~ In the absence of any objection ma(ie within ninety
(90) days of thEl,receip,t of such written acc?~nt by the administrator, the
account shall be a~emed approved by the administrator.
L=J
t(l ~) ARTICLE VII ~~ ~-~ J 1ft ul (~~MENPMENT AND TERMINATION I ~C))"
I fS~\ 7.01lAmend1ent by Agreement. Any provision of this plan. and
t it f t ," t r bid d d 'f' d t . . . . b rlus agreer;J1!'m maY,e amen e or mo I Ie a any time, In writing y
apfberhl:lnt C\lfl!the tmpl~'Yer, the administrator, and the trustee. III II J II "l.' . ~ ~lW -8-
(!!PJ
Section 7.02 6.el~nation. This agreement may be terminated by the
Employer or the admirllstrator and the trustee by an instrument in writing at
any time. (J __ Sl
Section 7.03~~rs6osition of Funds Upon Termination. Upon the
termination of the ~1:rst1 any and all monies remaining in the trust after
payment of all beoefit-0Iaims, administrative fees and charges shall revert
to the Employer to lthe)Jxtent permitted by law. In no event shall any funds
of this trust be usf<jioJany purpose other than as provided for in this plan
and trust agreementnar returned to a participant except in the form of
benefits previously e~e'd in accordance with the plan.
Section 7.04 rN'rviolation of Rule Against Perpetuities. Unless sooner
terminated, this trusFshklr in any event terminate upon the death of the last
survivor of such p~s6\(s who are living at the time of the creation of this
I 'l' trust, who are entitled lO receive benefits hereunder. However, if, as, and
when the trust wittIPll)benefit of this provision shall not violate the rule
against perpetumes:-"tI:ii~ provision shall be of no further force or effect, and
this trust shall ~ohtinue in perpetuity unless otherwise terminated. lUI
ARTICLE VIII
~\ GENERAL PROVISIONS
Section 8.0~1-~~roed by This TruSt Agreement. The rights and duties
of all parties, i~el~e)ingJthe Employer, the participants, other beneficiaries,
the administrator amd~the trustee, shall be governed by the provisions of this
plan and trust agre~mentl. (~Sect~~8.02 \L9Ji~)tion of Participant Claims. All benefits provided by thi,(Pl~h::::;paii be lrnited to .t~e funds contributed by the Employer to the tn!1ste~Lpn behalf oJ(f!\E!) participants.
II ~ r--~ ! 11 S~8.03 ~. Any notice required to be given under the terms of
, II erctlO71 ---.. " this plan a~d trUl~t_agr~ement shall be deemed to have been duly served if
f 'II t~,
I ~ ~I @J2) -9-.
~.'"
'-.. [) .. ,
delivered personall~~~the person notified in writing, or if mailed in a
sealed envelope, po~tageJprepaid, to such person at his last known address as
shown on the recor& LOf) the trust, or if sent by wire to such person at his
last known addresst (~
Section 8.04~h~0-il<e of Law. All questions pertaining to the trust
agreement, the trust or the plan and their validity, administration and
construction, shall ~e-dfrt~rmined in accordance with the laws of the State of
California, except itoth_J extent California law is superseded by federal
statute. ~
I (J)
Section 8.05 \Js;/bf Courts. All reference in this instrument to courts
will mean courts o,(lioQipetent jurisdiction located in the State of California. rut j
Section 8.06>sl/erabili~Y, If any provision .of this plan and. trust
agreement, the rulesc,and) regulations made pursuant hereto, or any act In the
administration of thk,pr~n' is held to be illegal or invalid for any reason, such
illegality or invaliaTty,~all not ·affect the remaining portions of this plan
and trust agreerh@ and its rules and regulations unless such illegality or
invalidity will pr~veQt 'th~ accomplishment of the objectives and purposes of
this plan and trust ,..§greement, or the rules and regulations, as the case may
require shall be m9difiedJ to remedy such defect.
Section 8.07 (6;;;}idential Nature of Records. Except to the extent
necessary for the, prop~r administration of the plan, all books, records,
. papers, reports, rcjo'cunfu1nts, . or other information obtained with respect to
the plan shall beJ 60nfidentiai and shall not be made public or used for any
other purposes. ~6thing in this Section shall prohibit the preparation of
statistical data and I""s'q'~:inary reports with respect to the operations of the
plan if authorized by; the administrator. ~\ ~ \::lJ Ilr~eetjon;78.08d:rbit[ation. Any controversy or claim arising out of or rel~fin~tr~.iS pla1Q~alhbe settle? ~y arbitration in accordance with rules
of I 1 Ie r(~~aa !::J"jMa A'''o<at,on thea m effect. Judgmeot upon the
I II 11c?) ~ .. (J!RJ -10-
(d~ , ;r l "'--' L...-
award rendered b(G6~' arbitrator or arbitrators may be entered in any
state or federal < cbu~having jurisdiction. The fee of the arbitrator or
arbitrators shall b~--::bOr'1 by each of the parties in accordance with the
rules of the Amer{~an))rbitration Association. ,-, ;;, "--L __ ~
r----' i J ,-)j
L_.J
END OF TRUST
IN WITNESS/Wi"IEREOF, this trust agreement, and the plan and
adoption agreeme~tGD~drporated herein, are executed by the trustee and
employer on "'-_J ,19_.
TRUSTEE:
EMPLOYER:
IV "\ { (/ P I
\ /[ I ~ ,/ (~
~/~J":J LL,
I _..-..l
CZJ;;tj(£!1v_/~
DwrGHT H. MENSINGER
By:
ATI~
CitycIerk
-11-