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B. No Surviving Spouse or Surviving Dependents <br /> If chere are no living spouse or dependents at the time of death of�he P��rricipa�t�, the accoun�will reverr ro the Plan to <br /> bc applied as specified in Section VIII. <br /> XII.The Plan will operate according to the following provisions: <br /> A. Employer Responsibilities <br /> I. ��'he Ernployer will submit all VantageCare Retiretnent Health S�tvings Plan concribueion data via elearonic submission. <br /> 2. The Ernployer will subrnic all VanrageCare Ret�irei7ient Hea(ch Savings Plan Parricipanr sta�us updares or persorial <br /> information iipd;ates via elecu-onic submission. `I'his includes bu�is��ot liinited to termination notification and <br /> beneEir cligihility norificarion. � <br /> B. Participant account administration and asset-based Fees will be paid through the redemption oF Participant account � <br /> shares, unless agreecl upon otherwise in the Aciministrative Services Agreement. � <br /> C. Assignmcnt of bene6rs is noc per�nitred. Benefits will be paid only ro thr.Parricipant,his/her Survivors, the <br /> Employer,or an i�surance provider (as allowed by the claims administraror). Payments to an third-E�arry payee <br /> (e.g., medical service provider)are noc permitred wi�h the exception of reimburseinent to rhe Employer or insurance <br /> provider(as allowed by t�he claims administrat�or), <br /> D. An eligible dependent is the Participant's lawful spouse and anv other individual who is a person described in IRC <br /> Section 1S2(a), as clarifird hy Inrernaf Revenue Service Notice 200�?9. <br /> F. "i��hr I?mployer will 6e re�sE�onsible For wirhholcling, reporting and remi�ting any applicable taxes for payrnents which <br /> are deemed to be discriminacory under IhC Section ]05(h),as outlined in the VantageCare Recirement Health <br /> Savings Plan Gmp(oyer Manual. <br /> XIII.Employer Acknowledgements <br /> A. 'I hc Lmploycn c�rcby acknowlcdges it iu�dcrstands that failure to properly fill out this Employ�r VantageCarc <br /> Reiirement�He�zlrh Savings Plan Adoprion�greemenc may resul�in the loss of tax exemp�ion of the Trusr and/or loss <br /> of tax-deFerred status for Employer contributions. <br /> B. ❑ Check chis box if you are including supporting docuinents that include p1�n�rovisions. <br /> X NAT jRE ;� <br /> EMPLO SI � / �„ _ <br /> / / r_ <br /> � ,. <br /> $y; � ,,l � U "� _ Date: ��� / � /, � _ <br /> ��, n,�Ll,ti l;ti' <br /> Title: �_ , <br /> — — � c'. <br /> � l � . �-- �`� -��- �=--------� — '�,<'' �� � ��� � <br /> Attest� ��'i`" � i �"t" } Date: <br /> Title: — ------�---'��''l � �� ��,-��– - -- - <br /> Accepted: VAN"I'I�GLPOINT"I'RANSFEIZ AGENTS,LLC <br /> , <br /> � �� ' , <br /> �'�,��i,� � % � I �?-v`�-z�/ <br /> -�., <br /> Assistant Secretarv,ICMf1-RC <br /> �� �aa� � <br /> �., <br /> " � � <br /> F.__��� � � � <br />