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<br />M9JJim <br /> <br />Amendment Request <br /> <br />The undersigned, being properly authorized to act on behalf of the employer in its <br />capacity as the Plan Administrator of the <br />Flexible Benefit Plan (the "Plan"), hereby requests that the following actions be <br />implemented with respect to the Plan: <br /> <br />Grace Period Extension <br />Select one option: <br /> <br />1. The Plan WILL NOT BE AMENDED to adopt a grace period consistent with <br />the terms and conditions of IRS Notice 2005-42. The Plan will maintain its <br />current "run-out period", allowing Participants to submit claims from the <br />previous plan year for reimbursement only if the expense was incurred in the <br />plan year and submitted before the end of the existing run out period. <br /> <br />or <br /> <br />2. 'f. <br /> <br />The Plan WILL BE AMENDED to adopt a grace period consistent with the <br />terms and conditions oflRS Notice 2005-42. Claims incurred during the <br />grace period will be applied to any remaining balance applicable to the prior <br />year before being applied to the current plan year balance. Please proceed <br />with the Plan amendment, incorporating the elections identified below: <br /> <br />Select one option: <br />X . Effective for the plan year ending December 31, 2005 <br />Effective for the plan year beginning January 1, 2006 <br />Other: <br /> <br />Select one option: <br />Grace Period: 2 months 15 days (maximum) <br />Grace Period: 2 months <br />X Grace Period: 1 month 15 days <br />Grace Period: 1 month <br />Other: <br /> <br />Select one option: <br />Grace period applies to both HCRA & DCRA <br />)( Grace period to HCRA only <br /> <br />Flexible Spending Account Department . 3405 Annapolis Lane North . Plymouth, MN 55447 . www.acclaimbenefits.com . fax 763-278-4004 <br /> <br />)YJ <br />