Benefit Plan AdministrativeS ervices BPAS 4/28/2020

continue to access the HC Account for purposes of obtaining reimbursement of Eligible Expenses. Such access shall continue until the earliest to occur of the events identified in Section 3.7(b), (c), or(d). Such access shall also be provided to those individuals, if any, who were the Participant's Spouse or Dependents at the time of the termination of the Participant's employment. Such access to the Participant's HC Account by a Spouse and Dependents shall cease upon the earlier of the date of termination of the Participant's access or the date the Spouse ceases to be a Spouse or the Dependent ceases to be a Dependent, as the case may be. ® In lieu of COBRA continuation coverage (if applicable),the balance of the former Participant's HC Account shall be transferred to a post-employment HRA sponsored by the Adopting Employer for the purpose of allowing the Participant to spend down the HC Account under that plan. El The balance of the Participant's HC Account will be forfeited after a Claims Run-out Period of: ❑ Other(Describe): 4.7(b) Post-death Access by Spouse &Dependents: El In lieu of COBRA continuation coverage (if applicable), the deceased Participant's surviving Spouse and Dependents, if any, may continue to access the Participant's HC Account for purposes of obtaining reimbursement of Eligible Expenses until the earlier of: (1)the date on which the HC Account balance reaches zero; or (2)the date on which the last surviving Spouse or Dependent dies. Z In lieu of COBRA continuation coverage (if applicable),the balance of the former Participant's HC Account shall be transferred to a post-employment HRA sponsored by the Adopting Employer for the purpose of allowing the surviving Spouse and Dependents to spend down the HC Account under that plan. El No access allowed. The balance of the Participant's HC Account will be forfeited after the Claims Run-out Period. ❑ Other(Describe): Post-death Access by Designated Beneficiary: El The deceased Participant's Designated Beneficiary, if any, may continue to access the Participant's HC Account for purposes of obtaining reimbursement of Eligible Expenses until the earlier of: (1)the date on which the HC Account balance reaches zero; or(2)the date on which the Designated Beneficiary dies. El The balance of the former Participant's HC Account shall be transferred to a post- employment HRA sponsored by the Adopting Employer for the purpose of allowing the Designated Beneficiary to spend down the HC Account under that plan. ® No access allowed. The balance of the Participant's HC Account will be forfeited after the Claims Run-out Period. 4.9 Forfeitures occur: ® As provided in the Basic Document ❑ Other(Describe): 4.9 Use of forfeitures: El Pay administrative costs which would otherwise be paid from the Trust(i.e., Participants'HC Account balances) ©Copyright 2017 Hitesman&Wold,P.A. Page 4 HRA Basic Plan Document Adoption Agreement(Single Employer Non-ERISA)