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SUMMARY OF ADMINISTRATIVE INFORMATION <br />Name of the Plan: <br />The name of the Plan is the City of Roseville Cafeteria Benefits Plan. <br />Employer, Plan Sponsor and Plan Administrator: <br />City of Roseville <br />2660 Civic Center Drive <br />Roseville, MN 55113 <br />Telephone: (651) 792-7025 <br />Employer ldentification Number: 41-6007849 <br />Claims Administrator: <br />City of Roseville <br />Plan Numbers: <br />Cafeteria Benefits Plan: 501 <br />Type of Plan: <br />This Plan is commonly known as a"Cafeteria Plan," and it includes a Premium <br />Conversion Plan, a Medical Expense Reimbursement Plan, a Dependent Care Expense <br />Reimbursement Plan and contributions to Health Savings Accounts. <br />Type of Funding: <br />This Plan is funded by employee contributions made through salary reduction ("Pay <br />Conversion") elections, in the form of benefits or benefit credits under the Plan. <br />Type of Administration: <br />Records are maintained by Employer. <br />Agent for Service of Legal Process: <br />Service may be made upon the City Administrator or the Employer <br />25 <br />