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<br />Mlilim <br /> <br />Run Out Extension (COMPLETE ONL Y IF #2 IS CHECKED ABOVE). <br />Select one option: <br /> <br />1. We will be adopting the grace period and will maintain our current run-out <br />period, which expires at least 30 days after the expiration of the grace period. * <br /> <br />2. We will be adopting the grace period and request that the Plan be amended to <br />provide that the run-out period expires 30 days after the expiration of the <br />grace period. * <br /> <br />*We are recommending that the run-out period be at least 30 days after the grace period. <br /> <br />Employer Authorization <br /> <br />Employer Name <br /> <br />Authorized Signatory, Title <br /> <br />FAX Request to: Acclaim Benefits <br />Attn: Michelle L. Conger <br />(Fax # 763-278-4279) <br /> <br />Flexible Spending Account Department. 3405 Annapolis Lane North. Plymouth, MN 55447 . www.acclaimbenefits.com . fax 763-278-4004 <br /> <br />2/ <br />