2023/11/29 Council Agenda Packet

© Peak One Administration 2016 21 BENEFIT PLAN COMPLIANCE SERVICES APPENDIX The Client has established one or more employee benefit plans which are subject to various compliance requirements under the Internal Revenue Code, ERISA or other applicable law. Client has engaged PSP to assist it with the ministerial functions related to performing compliance requirements for the following employee benefit plans: A Code Section 125 Plan to allow eligible employees who make a proper election to pay for their share of certain benefit plan coverage with pre-tax salary reductions (“Cafeteria Plan”). A Flexible Spending Account to allow participants to be reimbursed for eligible medical expenses (“FSA”). A Code Section 105 health expense reimbursement plans (“HRA”) to allow participants to be reimbursed for eligible medical expenses. A Code Section 129 dependent care assistance plan to allow participants to be reimbursed for eligible dependent care assistance expenses (“DCAP”.) A Premium Only Section 125 Plan (“POP”). A Health Savings Account (“HSA”). A Parking/Mass Transit Fee Plan (“Transportation Plan”). A Section 115 Plan (“Section 115 Plan”) A Section 501(9)(c) Plan (Collectively the selected plans are referred to in this Appendix as “Benefit Plans”). PSP will provide assistance, designated below by Client, only with respect to the Benefits Plans selected above for which PSP has provided the sample plan documentation or, if PSP’s sample plan documentation is not utilized, then only such plans identified by Client and agreed to by PSP pursuant to separate written notice. This Service Appendix is incorporated into and made a part of the Administrative Services Agreement (the “Agreement”). The effective date of this Service Appendix is the effective date of the Agreement or if later, the date that both parties have signed this Service Appendix as set forth below. The responsibilities of the parties set forth in this Service Appendix are in addition to any responsibilities set forth in the Agreement. If there is a conflict between this Service Appendix and the Agreement, the Agreement controls. PSP and Client Responsibilities The services PSP will perform pursuant to this Appendix are limited to those identified below as PSP responsibilities. 1. Forms 5500. (a) PSP will assist Client in preparing the applicable Form 5500 for the: i. FSA ii. HRA PSP will assist Client in preparing the applicable Form 5500 by providing, upon written request from the Client, any information maintained in PSP’s database that is required