SLETTO & ASSOCIATES, P - CHG Healthcare Services

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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 5 FLEXIBLE BENFITS PLAN
Page 1 and 2: BENEFITS AND BUSINESS LAW ADVISORS,
Page 3: Plan Administrator: [Plan Secs. 1.1
Page 7 and 8: G.5. Participants will be automatic
Page 9 and 10: a. Not applicable [no individual po
Page 11 and 12: L. COBRA Elections COBRA Elections:

SLETTO & ASSOCIATES, P - CHG Healthcare Services

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