Laserfiche WebLink
❑ Pay administrative costs which would otherwise be paid from the Trust (i.e., <br /> Participants' HC Account balances) <br /> ▪ Contributed to the HC Accounts of other Participants on a per capita basis. <br /> ❑ Other (Describe): <br /> 4.11 Which plan pays first: <br /> ❑ This Plan <br /> ® Flex plan sponsored by the Adopting Employer. <br /> 4.12(d) Other Limitations, if any: <br /> ARTICLE V: CONTRIBUTIONS AND TRUST <br /> 5.1 Employer Contribution amount, timing, restrictions (check all that apply): <br /> One Time Contribution: <br /> ® Fixed dollar amount As determined by each CBA <br /> MOU, Labor Contract or any other agreement for a Union or Non-Represented <br /> Participant. <br /> ❑ Fixed formula (Describe): <br /> ® Restrictions, if any (Describe): Mid-Year participation is Pro-rated. <br /> Contributed on (Identify Date): <br /> Recurring Contributions: <br /> ® Fixed dollar amount <br /> ❑ Per month <br /> ❑ Per quarter <br /> ❑ Per year <br /> ® Other (Describe): As determined by each CBA, MOU, Labor Contract or <br /> any other agreement for a Union or Non-Represented Participant. <br /> *Note: Second year applies to First year lump sum payment group. <br /> ❑ Restrictions, if any (Describe): <br /> ❑ Fixed formula (Describe): <br /> ❑ Per month <br /> ❑ Per quarter <br /> ❑ Per year <br /> ❑ Other (Describe): <br /> ©Copyright 2017 Hitesman&Wold, P.A. Page 5 <br /> HRA Basic Plan Document Adoption Agreement(Single Employer Non-ERISA) <br />