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The Flex Company of America , Inc. <br /> Flex SpendingAccount Plans - Fees <br /> Section 125 <br /> Optional Services and Fees <br /> • Flex Convenience Debit Card $1 .50/month/cardholder <br /> Employers can elect to either have the cards automatically issued to each <br /> flex participant or issued only to those employees requesting a card. Employees <br /> with the debit card can also obtain one additional spouse/dependent debit card <br /> free ofcharge. <br /> If a participant wishes to receive more than one spouse/dependent card, they are <br /> available for a one-time $ 5 fee for each additional card. Replacement cards are <br /> $ 5 for each re-issuance. These fees are the responsibility of the employee and are <br /> payable by personal check. <br /> • Preparation of signature-ready Section 125 Form 5500 and Summary Annual $150/each form <br /> Report, if required. $50/form <br /> ■ Rush fee $50/filing <br /> ■ Extension filing <br /> • Direct mail of fourth quarter employee account balance notification $.25/statement plus <br /> statements to employees ' homes (no charge if statements are sent to postage <br /> employer for distribution) $100/hour <br /> • Consulting fees falling outside the scope of normal services as outlined above <br /> $10/month <br /> • Non-Internet based monthly paper reports <br /> (Reports available any time on our website ivNiTi -. theflexcompanv. com at no $ 100/amendment <br /> charge) <br /> • Amendments to existing Plan Document and Summary Plan Description $25/copy <br /> • Replacement copy of lost documents (including Summary Plan Description) $ 10 each <br /> s Reimbursements reissued under the following circumstances : <br /> ■ Lost or stolen check <br /> ■ Check mailed to employee' s correct home address (as supplied by <br /> employer or via employee enrollment or claim form ), but not <br /> received by employee $25 each <br /> ■ Reprocessing of direct deposit due to employer or participant error <br /> • Returned claim as requested by participating employee. <br /> All prices provided are based on a two year Service Agreement and are valid for a period of 60 days from the <br /> proposal date. The Flex Company may bill for services rendered after written acceptance of this proposal <br /> should acceptance be cancelled prior to execution of a Service Agreement. Because of the unique nature of <br /> this information, we encourage you to share the contents with your legal counsel, finance office or business <br /> advisor . Consider this information proprietary. We request that your company not divulge any part of this <br /> information to representatives from other benefit-related firms. <br /> Flexible Spending Account Proposal <br />