SLETTO & ASSOCIATES, P - CHG Healthcare Services

BENEFITS AND BUSINESS LAW ADVISORS, PLLC
FLEXIBLE BENEFITS PLAN
ADOPTION AGREEMENT #01
Z:\Shared\Docs\Welfare\125-PLAN\2007\Adopt Agree 2008 Redline.docx
A. Preamble
Effective Date: A.1. BY THIS AGREEMENT, the Sponsoring Employer, in a good faith attempt to comply with the Proposed and
Final Regulations under §1.125, hereby … [check one]:
a. Adopts a new IRC Section 125 cafeteria plan. effective as of [month, day, year]
b. Amends/restates its existing IRC Section 125 cafeteria plan effective as of January 1, 2008
[month, day, year]
B. Document Sponsor Information
Document
Sponsor:
[Plan Sec. 14.3]
B.1.
The Document Sponsor shall be as follows…:
a. Entity Name: Benefits and Business Law Advisors, PLLC
b. Address: 2600 Eagan Woods Drive
Suite 450
Eagan, Minnesota, 55121
c. Telephone #: 651-789-1107
d. Facsimile # 651-452-2818
C. Sponsoring Employer Information
Plan Sponsor:
[Plan Secs. 1.35]
C.1.
The Sponsoring Employer shall be as follows… [complete]:
a. Entity or individual Name: CHG Companies, Inc.
b. Address: 6440 South Millrock Drive
Salt Lake City, Utah 84121 [city, state, zip]
c. Telephone #: 801-930-3622
d. Facsimile #: 801-930-4506
C.2. The Employer is a … [check one]:
a. Sole Proprietorship.
b. Partnership … [check one]:
i. General
ii. Limited
iii. Limited Liability (LLP)
c. Limited Liability Company (LLC)
d. Corporation …[check one]:
i. Type…[check one]:
A. Regular for profit
B. Professional service
C. Not for profit
ii. “S” Tax Status Elected…[check one]:
A. N/A – not for profit
B. No
C. Yes, effective: [month, day, year]
C.3. Date Business Commenced…[month, day, year]: 02/20/1985
C.4. Fed. Tax EIN: 58-1615085
ADOPTION AGREEMENT
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FLEXIBLE BENFITS PLAN

C.5.
Fiscal Year-End of Employer: December
C.6. Employer’s Principal Trade or Business…[enter same as on IRS Form 5500]:
C.7.
C.8.
Business Code # … [enter same as on Employer’s IRS Tax Return]:
Predecessor Employers … [check one and enter information if applicable]:
a. N/A - no Predecessor Employer(s) existed
b. See attached Predecessor Employer Addendum
c. Enter entity name(s) and information:
Entity Name: Entity Type: Fed. Tax EIN:
Entity Name: Entity Type: Fed. Tax EIN:
C.9. Affiliated Employers … [check one and enter information if applicable]:
a. N/A - no Affiliated Employer(s) existed
b. See attached Affiliated Employer Addendum
c. Enter entity name(s) and information:
Entity Name: CompHealth Associates, Inc. Entity Type: Corp Fed. Tax EIN: 06-0878058
Entity Name: CHG Medical Staffing, Inc. Entity Type: Corp Fed. Tax EIN: 87-0502658
Entity Name: CHG Management, Inc. Entity Type: Corp Fed. Tax EIN: 51-0343802
Entity Name: Weatherby Locums, Inc. Entity Type: Corp Fed. Tax EIN: 65-0592339
Entity Name: Entity Type: Fed. Tax EIN:
Entity Name: Entity Type: Fed. Tax EIN:
Note:
Affiliated Employers may participate in this Plan by executing the Plan’s Adoption Agreement Participating
Employer Addendum. "Affiliated Employer" means the Sponsoring Employer and those Employers
required to be aggregated with the Sponsoring Employer under sections 414(b), (c), (m) or (o) of the Code.
Such Employers will immediately cease to be a Participating Employer as of the date it ceases to be an
Affiliated Employer.
D. Plan Information
Plan Name and
Number:
[Plan Secs. 1.30]
D.1.
The Plan’s name and number are as follows…[complete]:
a. Current Name of Plan: CHG Companies, Inc. Staff Flexible Benefits Plan
b. Previous Name of Plan:
c. Plan Number: 506
Note:
This is the three-digit identifying number [e.g., 501] that the Sponsoring Employer assigns for
Government filing purposes [e.g., Form 5500].
Plan Year:
[Plan Secs. 1.31]
D.2.
Plan Year is as follows…[check each that applies and complete]:
a. The Plan Year is the twelve-consecutive-month period ending each December 31 [month, day]
b. A short Plan Year occurs as follows … [check each that applies]:
i.. The first Plan Year is a short year that began on the Effective Date and ended [month, day,
year]
ii. The Plan Year has been amended. The last Plan Year before the amendment ended
[month, day, year] and the short Plan Year resulting from the amendment began the next day and
ended [month, day, year]
c. The Plan’s Initial Effective Date is as follows: January 1, 2004 [month, day, year]
Note:
Note:
If two or more plans have been merged, or consolidated, insert the original effective date
of the plan shown as the surviving plan for Federal filing purposes (e.g, Form 5500)]
The Plan Anniversary Date is the last day of the applicable Plan Year.
ADOPTION AGREEMENT
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FLEXIBLE BENFITS PLAN

Plan
Administrator:
[Plan Secs. 1.1
and 13.1]
D.3.
The Plan Administrator is the … [check one]:
Note: To delegate administrative authority to an individual or committee, check item b. or c.
and enter information.
a. Sponsoring Employer, using its address as shown on Item C.1. and the following contact person:
b. The following individual or entity … [complete]:
i. Name:
ii. Address:
[city, state, zip]
iii. Telephone #:
iv. Facsimile #:
v. Fed. I.D. #
c. The following committee or individuals … [check one]:
i. Name of committee:
ii. Committee member(s) … [complete]:
Note:
Either enter the name of the committee or list the individual committee members.
Trust Agreement:
[Plan Secs.16.6]
D.4.
The Plan Trustee(s), if applicable, shall be as follows… [check one]:
a. N/A - Plan assets are not maintained in a Trust [skip to E.1.]
b. Plan assets are maintained in a Trust … [attach Trust Agreement and indicate type of Trustee
and enter information]:
i. Corporate Trustee:
A. Name:
B. Address:
C. Telephone #:
D. Facsimile #:
E. Fed. I.D. #
[city, state, zip]
ii.
Individual Trustee(s) [complete]:
A. Name(s):
B. Address:
1. Use address/telephone/facsimile of Sponsoring Employer
2. Use address/telephone/facsimile of Plan Administrator
3. Use the following address/telephone/facsimile:
a. Address:
b. Telephone #:
c. Facsimile #:
[city, state, zip]
iii.
Unless the Trust Agreement specifically states otherwise, the State law that governs the
Trust is [enter name of state] to the extent that such laws are not preempted by
ERISA
ADOPTION AGREEMENT
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FLEXIBLE BENFITS PLAN

E. Participation
Eligibility:
[Plan Sec. 2.1]
E.1 In order to be eligible to participate in the following Plan components, an Employee must meet the following
eligibility requirements… [check each that applies]:
Employee
Salary
Reductions
Employer
Contributions
Eligibility
Requirements
N/A – Plan does not provide for this
component
a. AGE: i. N/A – no AGE requirement
ii.
Age
b. SERVICE: i. N/A – no SERVICE requirement
ii.
Days(s) of Service
iii. 1 1 Month(s) of Service
iv.
Year(s) of Service
c. CLASSES:
N/A – no CLASSES included/excluded
included included
The following CLASSES are to be:
excluded excluded
i. Highly Compensated Employee
ii.
iii.
iv.
vi.
vii.
viii.
ix.
Employees whose employment is governed by
the terms of a collective bargaining agreement
[Code § 7701(a)(46)] under which retirement
benefits were the subject of good faith
bargaining
Key Employees
Leased Employees
Salaried Employees
Hourly-wage Employees
Employees paid primarily on a commission
basis
Employees eligible to participate in the
Following Employee benefits plan or program
[enter plan or program name]
x. Employees classified as temporary
xi.
xii.
xiii.
xiv.
Employees classified as seasonal
All except Employees whose employment is
governed by the terms of a collective
bargaining agreement [Code § 7701(a)(46)]
Employees expected to work less than
Hours of Service per [week; pay period;
calendar month; Plan Year quarter; Plan Year;
other]
Other…[enter CLASS included/excluded]
ADOPTION AGREEMENT
d. EXCEPTION: i.
4
N/A - no EXCEPTION
FLEXIBLE BENFITS PLAN

ii.
iii.
iv.
Employees employed as of the effective date
of the most recent Plan amendment
Employees employed as of the Anniversary
Date of the most recent Plan amendment
Other…[enter EXCEPTION]
Date of Entry:
[Plan Sec. 2.2]
E.2 An Employee who meets the above eligibility requirements and who is not an excluded Employee,
shall become a Participant effective as of… [check one and complete]:
a. The date on which the Employee meets the requirements
b. The first day of the pay period [week; pay period; calendar month; Plan Year quarter; other] that
coincides with or next follows the date on which the Employee meets the requirements
c. Same date that the Employee becomes eligible to participate in the Employer’s group
medical plan
d. Same date that the Employee becomes eligible to participate in the following employee
benefits plan or program maintained by the Employer: Group health plan
e. Other:
Service
Determinations:
[Plan Sec. 2.1]
Service with
Other
Employers:
[Plan Sec. 2.3]
E.3 Service will be determined as follows for eligibility purposes, using the … [check one]:
a. N/A – no service requirement for participation in either the Salary Reduction or
Employer Contribution component(s) of the Plan [skip to item F.1.]
b. Elapsed time method
c. Actual hours method
i. An Employee must complete at least Hours of Service during the
ii.
applicable Computation Period for it to count as a of Service.
An Employee for whom a record of actual hours is not maintained or available [e.g., salaried
employees] will be credited with … [check one]:
A. 10 Hours of Service for each day
B. 45 Hours of Service for each week
C. 95 Hours of Service for each semi-monthly payroll period
D. 190 Hours of Service for each month
… in which he/she has one or more Hour(s) of Service.
iii. An Employee for whom a record of actual hours is maintained and available [e.g. hourly employees]
will be credited using … [check one]:
A. Actual hours method
B. The same equivalency as specified in Item E.3.c.ii. above.
iv. The Plan shall use the following computation periods for eligibility purposes… [check one]:
A. N/A – no eligibility service period is specified
B. Employment anniversary shifting to Plan Year
C. Employment anniversary for all years
E.4 An Employee’s service with the following employer(s) will be recognized for eligibility purposes… [check one]:
a. N/A – no other service recognized
b. All entities listed on the Affiliated Employers Addendum
c. Service with the following employer(s) will be recognized…[enter employer’s name(s):
F. Plan Compensation
Plan
Compensation:
[Plan Sec. 1.8]
F.1.
Plan Compensation means earnings … [check one]:
a. Wages, Tips, other Compensation [as reported on the Participant's IRS Form W-2 as required under
sections 6041 and 6051 of the Code]
b. Wages [as that term is defined in section 3401 of the Code for purposes of federal income tax
withholding at the source]
c. 415 (c)(3) Safe-Harbor Compensation
ADOPTION AGREEMENT
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FLEXIBLE BENFITS PLAN

F.2.
Applicable Period means…[check one]:
a. Plan Year
b. Fiscal Year coinciding with or ending within the Plan Year
c. Calendar Year coinciding with or ending within the Plan Year
F.3.
Plan Compensation exclusions … [check each that applies]:
Employee
Salary
Reduction
Employer
Contribution
Exclusions:
N/A – Plan does not provide for this component
a. N/A – No exclusions
b. N/A Remunerations prior to Date of Entry
c.
Participant Code § 402(a)(8), 402(h)(1)(B) and/or 403(b) Elective
N/A
Deferrals
d. N/A Participant Code § 125 salary reductions (cafeteria plan)
e.
N/A
Reimbursements or other expense allowances, fringe benefits (cash and
non-cash), moving expenses, deferred compensation and welfare benefits
f. Severance pay due to Termination of Service
g. Non-discretionary bonuses
h. Discretionary bonuses
i. Overtime
j. Commissions.
k. Other… [specify]:
G. Benefit Election Period
Benefit
Election
Period:
[Plan Secs. 3.2
and 3.3]
G.1.
The Benefit Election Period prior to the first payroll period that coincides with or next follows the Participant’s
effective date of participation will be…[check one and complete]:
a. A period of [enter number] [day(s), week(s), month(s), other] prior to the Participant’s entry date
b. A period of 30 [enter number] days [day(s), week(s), month(s), other] prior to the first payroll period that
coincides with or next follows the Participant’s effective date of participation
c. A period determined annually at the Administrator's discretion and applied in a
non-discriminatory manner
d. Other… [specify]:
G.2.
The Benefit Election Period prior to each Plan Year for subsequent Plan Year’s of participation will be…[check
one and complete]:
a. A period of 30 [enter number] days [day(s), week(s), month(s), other]
b. From the [enter number] to the [enter number] [day, week, month, other] period
c. A period determined annually at the Administrator's discretion and applied in a
non-discriminatory manner
d. Other… [specify]:
G.3.
The extended Benefit Election Period for Participants who fail to elect during their initial Benefit Election Period
will be…[check one and complete]:
a. N/A – no extended Benefit Election Period
b. A day period prior to [each; the next; other] payroll period(s)
c. From the day of the day period prior to [each; the next; other] payroll period(s)
d. A period prior to [each; the next; other] payroll period(s) determined annually at the
Administrator's discretion and applied in a nondiscriminatory manner
e. Other… [specify]: Thirty (30) days after the end of the Benefit Election Period, or such nondiscriminatory
period determined by the Administrator.
G.4.
Participants who fail to make new Benefit elections during the subsequent Benefit Election Period(s) will [check
one]:
ADOPTION AGREEMENT
a. Continue their prior year elections
b. Continue their prior year elections, but only for insured Benefits
c. Be deemed to have elected not to participate for the upcoming Plan Year
d. Other… [specify]:
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FLEXIBLE BENFITS PLAN

G.5.
Participants will be automatically enrolled in the Insurance Premium Conversion Program to the extent of the
premiums that they pay for insurance Benefits by payroll withholding… [check one]:
a. N/A – Insurance Premium Conversion program is not available
b. Yes - negative elections are allowed for Participants who do not wish to participate in the Insurance
Premium Conversion program
c. No - participation in the Insurance Premium Conversion program only by positive election
H. Participant Salary Reductions
Participant
salary
Reductions:
[Plan Secs. 4.1
and 4.2]
H.1.
Eligible Employees may elect to have their earnings reduced by… [check one and complete]:
a. Not applicable [Employee Salary Reductions are not allowed - Skip to Section H.3.]
b. By an amount sufficient to fund Benefits selected
c. Percentage [check one or more and enter percentage amount(s)]:
i. Minimum: % of Plan Compensation
ii. Maximum: % of Plan Compensation
d. Dollar [check one or more and enter dollar amount(s)] :
i. Minimum: $ of Compensation
ii. Maximum: $ of Compensation
e. Percentage/Dollar [check one or more and enter dollar amount(s)]:
i. Minimum: % of Plan Compensation or $ of Compensation
ii. Maximum: % of Plan Compensation or $ of Compensation
f. Other [specify]:
H.2.
The Salary Reduction period for the limitation(s) set forth in Item H.1. are as follows…[check one]:
a. Payroll period
b. Month
c. Plan Year quarter
d. Plan Year half
e. Other [specify]:
H.3.
Participants may convert Paid Time Off into Plan contributions:…[check one]:
a. N/A – Paid Time Off conversion not allowed
b. Up to total available Paid Time Off
c. Up to Days Paid Time Off
d. Up to Dollars worth of Paid Time Off
e. To the lesser of Days Paid Time Off or Dollars worth of Paid Time Off
f. Other [specify]:
I. Employer Credits
Employer
Contributions:
[Plan Sec. 5.1]
I.1.
Employer Credits will be calculated as follows… [check one]:
a. Not applicable [Skip to Item J.1.]
b. At the Employer’s discretion
c. dollars per Participant
d. % of Compensation per eligible Participant
e. Pursuant to the following formula…[enter contribution formula]:
f. Other [specify]:
ADOPTION AGREEMENT
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FLEXIBLE BENFITS PLAN

I.2.
The Employer Credit(s) shall be limited for each eligible Participant … [check one and complete]:
a. Not applicable [no limit]
b. By an amount sufficient to fund Benefits selected
c. Percentage [check one or more and enter percentage amount(s)]:
i. Minimum: % of Plan Compensation
ii. Maximum: % of Plan Compensation
d. Dollar [check one or more and enter dollar amount(s)] :
i. Minimum: $ of Compensation
ii. Maximum: $ of Compensation
e. Percentage/Dollar [check one or more and enter dollar amount(s)]:
i. Minimum: % of Plan Compensation or $ of Compensation
ii. Maximum: % of Plan Compensation or $ of Compensation
f. Other [specify]:
I.3.
The Employer Credit period applicable to Item I.1. and I.2. is as follows…[check one]:
a. Payroll period
b. Month
c. Plan Year quarter
d. Plan Year half
e. Other [specify]:
I.4.
The Employer Credit(s) shall be submitted pro-rata each… [check one]:
a. Pay period
b. Month
d. Plan Year quarter
d. Plan Year half
e. Other [specify]:
Allocation
Requirements:
[Plan Sec. 5.4]
I.5.
To be eligible to receive an Employer Credit allocation for a Plan Year, the Participant
must… [check one]:
a. Not applicable [all Participants are eligible]
b. Other [specify]:
J. Insurance Premium Conversion
Insurance
Premium
Conversion:
[Plan Sec. 6.1]
Dependent
Coverage:
[Plan Sec. 7.1]
J.1.
J.2.
The following Insurance Benefits are available for payment through the Plan on a pre-tax basis… [check one]:
a. N/A - Spending Accounts only [skip to Item J.2.]
b. Accident or Health Insurance [IRC Section 106]
i. Health Care
ii. Accidental Death or Dismemberment
iii. Dental Care
iv. Vision Care
v. Long-Term Disability
vi. Other [specify]:
c. Group-Term Life Insurance [IRC Section 79]
d. Other [specify] :
Dependent coverage may be elected by the Participant for… [check one]:
a. Not applicable [only Participant coverage allowed]
b. Health Care
c. Accidental Death or Dismemberment
d. Dental Care
e. Vision Care
f. Long-Term Disability
g. Group-Term Life Insurance
h. Other [specify] : ____________
J.3.
ADOPTION AGREEMENT
Participants may, at the discretion of the Administrator, obtain individual policies for the following
Insurance Benefits… [check one]:
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FLEXIBLE BENFITS PLAN

a. Not applicable [no individual policies will be allowed]
b. Health Care
c. Dental Care
d. Vision Care
e. Long-Term Disability
f. Other [specify] :
J.4.
In addition to legal limits, if any, Insurance Benefits will be limited as follows… [check one]:
a. N/A [no additional limits]
b. Other [Note: Group Term Life Insurance coverage over $50,000 of death benefit may result in taxation
to the Participant.]
K. Spending Accounts
Spending
Accounts:
[Plan Sec. 6.2]
K.1.
Spending Accounts will be established for… [check one]:
a. N/A [Insurance Premium Conversion only - skip to Item L.]
b. Medical Reimbursement Expense [IRC Section 106]
c. Dependent Care [IRC Section 129]
d. Adoption Assistance [IRC Section 137]
e. Health Savings Account [IRC Section 223]
d. 401(k) [IRC Section 401(k)]
e. Paid Time Off
f. Cash Payments
g. Other [specify; must not provide benefits which are prohibited under Prop. Reg. 1.125-1(q)]:
K.2.
In addition to legal limits, if any, Spending Accounts will be limited as follows… [check one]:
a. N/A [no additional limits]
b. Medical Reimbursement Expense [IRC Section 106]
i. N/A [no additional limits]
ii. Other [specify]: $5,000
c. Dependent Care [IRC Section 129]
i N/A [no additional limits]
ii. Other [specify]:
d. Adoption Assistance [IRC Section 137]
i. N/A [no additional limits]
ii. Other [specify]:
d. 401(k) [IRC Section 401(k)]
i N/A [no additional limits]
ii. Other [specify]:
e. Paid Time Off
i N/A [no additional limits]
ii. Other [specify]:
f. Cash Payments
i N/A [no additional limits]
ii. Other [specify]:
g. Other [specify]:
Note:
Even if no limit is specified by the Sponsoring Employer, the applicable legal
limits to maintain the tax-qualified status of the applicable Benefit shall apply.
K.3.
For Medical Reimbursement Expense Account reimbursements, new elections due to a Change In Status are:
[check one]:
a. Not applicable [Benefit not allowed]
b. Not permitted
c. Permitted without limitation
d. Permitted, but only to increase Benefit elections
e. Permitted, but not lower than the net amount of claims as of the election date
f. Other [specify]:
ADOPTION AGREEMENT
9
FLEXIBLE BENFITS PLAN

K.4. For Medical Reimbursement Expense, Dependent Care and Adoption Assistance Spending Account
reimbursements, Participants must file Benefit claims… [check one]:
a. Not applicable [No Benefit is allowed]
b. Within days after Plan Year end for expenses incurred in the current Plan Year
c. By March 31 [enter Month and day] of the following Plan Year for expenses incurred in the current
Plan Year
d. Other [specify]:
K.5. The applicable Grace Period for Medical Reimbursement Expense, Dependent Care, and Adoption Assistance
Spending Account reimbursements will be… [check one](not to exceed the time period in K.5.b):
a. Not applicable [No Benefits is allowed]
b. The fifteenth day of the third month following the end of the Plan Year
c. Sixty days after the end of the Plan Year
d. Thirty days after the end of the Plan Year
e. Other [specify]:
K.6.
Spending Account Forfeitures shall be reallocated during the following Plan Year as follows… [check one]:
a. Not applicable
b. Pro-rata by Eligible Participant
c. Used to reduce Employer Contributions
d. Added to Employer Contributions
e. Other [specify]: Used to defray administrative expenses.
K.7. An Employee who becomes ineligible to participate in the plan with an unused salary reduction amount in their
Dependent Care Spending Account will… [check one]:
a. Forfeit the account balance to the Forfeiture Surplus Account.
b. be allowed to “spend down” those funds as long as they satisfy IRC §129.
ADOPTION AGREEMENT
10
FLEXIBLE BENFITS PLAN

L. COBRA Elections
COBRA
Elections:
[Plan Sec. 19.1]
L.1.
For Medical Reimbursements, if Employee is eligible for COBRA coverage, terminated Participants will do one
of the following[check one]:
a. COBRA will be offered as required by federal law and Participant could only elect COBRA if
usage is less than contributions at the time of the Qualifying Event.
b. At Participant’s election, contribution and reimbursements will continue for the remainder of the Plan Year
to the extent initially elected, regardless of the usage at the time of the Qualifying Event.
c. N/A; Medical Reimbursement is not offered under the Plan.
M. FMLA Elections
FMLA
Elections:
[Plan Sec. 20.1]
M.1.
Participants on unpaid FMLA Leave may elect from the following payment options to pay their Group Health
Care Plan premiums… [check as appropriate]:
a. Pay-as-you-go
b. Pre-pay
c. Catch-up
d. Payments waived and paid by Employer with no repayment by the Participant
Note:
Pursuant to IRS Proposed Regulation Section 1.125-3 Q&A-3(b), the following exceptions apply:
a. The pre-pay option cannot be the sole option offered to Eligible Employees on FMLA Leave. However,
the Plan may include pre-payment as an option for Eligible Employees on FMLA Leave, even if
such option is not offered to employees on non-FMLA Leave-without-pay.
b. The catch-up option can be the sole option offered to Eligible Employees on FMLA Leave if and only if the
catch-up option is the sole option offered to employees on non-FMLA Leave-without-pay.
c. The Plan cannot offer Eligible Employees on FMLA Leave a choice of either the pre-pay option or the
catch-up option without also offering the pay-as-you-go option, if the pay-as-you-go option is offered to
employees on non-FMLA Leave-without-pay.
M.2.
Participants on non-FMLA Leave are entitled to, but not required to, continue the following non-health benefits…
[check one]:
a. N/A – non-FMLA Leave benefit continuation not allowed
b. Life Insurance
c. Dependent Care Spending Account
d. Other…[specify] : As determined in Administrator’s discretion
N. Other Elections
N.1.
The following additional Employer elections shall apply to the extent not in conflict with the qualification
requirements of federal tax law or the provisions of the Plan… [check one]:
a. Not applicable [no additional provisions elected]
b. Other…[specify] :
ADOPTION AGREEMENT
11
FLEXIBLE BENFITS PLAN

O. Employer Signatures
IN WITNESS WHEREOF, the Sponsoring Employer has caused this Adoption Agreement to be adopted effective as of the date written on
page 1.
By executing this Adoption Agreement, the Sponsoring Employer certifies and warrants that it has relied on the advice of an attorney
or other independent qualified advisor as to the legal and tax effect of adopting the Plan.
Date signed: ________________________________
Sponsoring Employer: CHG Companies, Inc.[same as Item
C.1.A.]:
By
Name (Print)
Its
Trustee(s):
N/A – Plan assets are not maintained in a Trust [Item
D.4.a. elected]
Date signed: ________________________________
Corporate Trustee [Item D.4.b.i. elected - enter same as
Item D.4.b.i.A.]:
Note:
Corporate Trustee signature only when Item D.4.b.1.
of the Adoption Agreement has been completed and
a Trust Agreement attached.
By
Name (Print)
Its
Date signed: ________________________________
Individual Trustee(s) [Item D.4.b.ii. elected - enter same
as Item D.4.b.ii.A.]:
Note:
Individual Trustee(s) signature only when Item
D.4.b.2. of the Adoption Agreement has been
completed and a Trust Agreement attached.
ADOPTION AGREEMENT
12
FLEXIBLE BENFITS PLAN