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❑ Restrictions, if any(Describe): <br /> ❑ Fixed formula (Describe): <br /> ❑ Per month <br /> ❑ Per quarter <br /> ❑ Per year <br /> ❑ Other(Describe): <br /> ❑ Restrictions, if any(Describe): <br /> ❑ Annual Contribution of Accumulated Paid Time Off, Vacation, or Sick Leave (Describe): <br /> ❑ Contribution of Accumulated Paid Time Off,Vacation, or Sick Leave Upon Termination of <br /> Employment(Describe): <br /> 5.1 Transfers from another HRA: <br /> ❑ N/A <br /> Shall be made from the HRA described in Section 3.1 as described in the Basic <br /> Document. <br /> ❑ Other(Describe): <br /> 5.3 Direction of Investments: <br /> ❑ Plan Administrator <br /> ❑ Participant <br /> ❑ Other(Describe): <br /> ARTICLE X: GENERAL PROVISIONS <br /> 10.6 Administrative expenses shall be paid as follows: <br /> ❑ Fixed fees shall be charged to the Plan and paid from the general assets of the <br /> Adopting Employer; asset-based fees shall be charged to the Participant and paid <br /> from the Participant's HC Account. <br /> ❑ All fees shall be charged to the Plan and paid from the general assets of the <br /> Adopting Employer. <br /> ❑ All fees shall be charged to the Participant and paid from the Participant's HC <br /> Account. <br /> ® Other(Describe): As outlined on the fee schedule for the Plan. <br /> ©Copyright 2017 Hitesman&Wold,P.A. Page 5 <br /> PRA Basic Plan Document Adoption Agreement(Single Employer Non-ERISA) <br />