AGNES SCOTT COLLEGE FLEXIBLE SPENDING PLAN SUMMARY PLAN DESCRIPTION An Employee Benefit Using the Salary Redirection Option

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1 SPD- Page one AGNES SCOTT COLLEGE FLEXIBLE SPENDING PLAN SUMMARY PLAN DESCRIPTION An Employee Benefit Using the Salary Redirection Option The Flexible Spending Plan (the Plan or Flexible Spending Plan ), commonly referred to as a either a Flexible Compensation Plan or a Cafeteria Plan, allows you the opportunity to save money and reduce your taxes by using your compensation before it is taxed (1) to pay for the cost of your payroll deducted insurance coverages, and (2) to pay certain approved health and dependent care expenses. This Plan is another part of your benefit package from AGNES SCOTT COLLEGE. You should read the enclosed information and other related materials carefully. These materials will help you take full advantage of the Plan, as well as guide you through the enrollment process. After reading the materials, we think you ll find this benefit to be one you will want to take advantage of - it may decrease your taxes and increase your spendable income. WHAT IS THE FLEXIBLE SPENDING PLAN? Our Flexible Spending Plan, permitted by Section 125 of the Internal Revenue Code, gives you the flexibility to redirect a portion of your taxable compensation in order to receive non-taxable benefits. As a result, you select the benefits that best fit your personal needs while saving tax dollars. WHAT ARE THE BENEFITS TO ME? You save FICA (Social Security) and federal income taxes on the amount of compensation you redirect through salary reductions to pay for available benefits. Depending upon the applicable law, you may also save state and local income taxes. At the lower tax brackets, you could realize a savings of approximately 28% (15% federal taxes, plus 7.65% FICA, plus 6% state taxes, if applicable). A $1,000 election could save you $280 of tax. This would equate to a pre-tax raise of almost $400 a year. HOW DOES IT WORK? The plan allows participating employees to redirect a portion of their taxable compensation on a pre-tax basis for the payment or reimbursement of certain non-taxable benefits. Three options are being offered: o Payment of the cost of payroll deduction insurance premiums.

2 SPD Page 2 o Reimbursement of approved Health Care Expenses listed in the Schedule of Reimbursable Health Care Expenses in your plan materials ( Health Care Reimbursement Account ); and, o Reimbursement of approved Dependent Care Expenses ( Dependent Care Reimbursement Account ). Your current coverage election for insurance will continue unless you make a change in your election using the enclosed Enrollment Form during the annual open enrollment period designated by the Benefits Administrator. After the annual enrollment period, you can only change your coverage election if you experience an event which qualifies as a change in status as explained in more detail below. Separate elections must be made to participate in the Health Care and Dependent Care Reimbursement Accounts. Each participating employee must decide and elect, before the start of each Plan Year (the Plan Year is the period that begins on January 1, 2015 and ends on December 31, 2015) the amount of his or her taxable compensation that will be redirected to the reimbursement accounts. WHO IS ELIGIBLE? All regular employees who work at least 0 hours per week are eligible for participation. New employees may join the Plan at the first of the month following completion of date of hire days. You may participate in the Health Care Reimbursement Account portion of the Plan even if you or your family are not covered by insurance offered by AGNES SCOTT COLLEGE HOW DO I ENROLL? Insurance Premiums: The cost for your payroll deducted insurance premiums will automatically be redirected through the Plan unless you request otherwise. You may not change your Premium election again until the next annual open enrollment period unless you have a qualified change in status. Any mid-year change in your election must be on account of and consistent with such a status a change in status and must be made within thirty (30) days of the status change. Health Care Reimbursement Account: You may enroll in the Health Care Reimbursement Account portion of the Plan even if you or your family are not covered by Insurance. To set up your Health Care Reimbursement Account, you must complete the Enrollment Form indicating your desired per pay period contribution level and authorizing the pre-tax payroll deductions within thirty (30) days of your eligibility or during the open enrollment period prior to the

3 SPD Page 3 beginning of each Plan Year. Your election will remain effective until the beginning of the next Plan Year. Any mid-year change in your election must be on account of and consistent with a change in status and must be made within thirty (30) days of the status change. Dependent Care Reimbursement Account: To set up your Dependent Care Reimbursement Account, you must complete the Enrollment Form indicating your contribution level and authorizing the pre-tax payroll deductions within (30) days of your eligibility or during the open enrollment period prior to the beginning of each Plan Year. Your election will remain effective until the beginning of the next Plan Year, or, if earlier, when you change your election because of a qualified change in status. Any mid-year change in your election must be on account of and consistent with a change in status and must be made within thirty (30) days of the status change. CAN AN ELECTION BE CHANGED DURING THE PLAN YEAR? Once you make elections under the Premium Conversion Plan, the Health Care Reimbursement Plan and /or the Dependent Care Reimbursement Plan, you may not change your elections during the Plan Year unless you experience a change in status as described below. Generally, you cannot change your election to participate in the Plan or vary the salary reduction amounts you have selected during the Plan Year. Your election will terminate if you are no longer working for the Employer. There are several important exceptions to this general rule. You may change or revoke your previous election under the Cafeteria Plan if you have a change in status as follows: 1. Change in Status. If one or more of the events as outlined below occurs, then you will be considered to have a change in status and you may revoke your old election and make a new election under the Plan. Both you revocation of the old election and your change to new election must be caused by and must be consistent with the Change in Status. The occurrences that qualify as a Change in Status include the events described as follows: a. a change in your legal marital status such as marriage, divorce, annulment, legal separation, or the death or your spouse; b. a change in the number of your dependents, such as the birth or adoption of a child or such as the death of a dependent; c. termination or commencement of employment by either you, your spouse, or your dependent; d. a change in the working hours for either you, your spouse or your dependent, including a switch between full-time and part-time status; e. your dependent satisfying or ceasing to satisfy an eligibility requirement for a particular benefit; and f. a change in the place of residence or work of either you, your spouse, or your dependent where such change affects eligibility for benefit coverage.

4 SPD Page 4 In addition to events listed above, a Change in Status may include any other events that the Plan Administrator, in its sole discretion, determines to be within prevailing guidance with the IRS. If a Change in Status occurs, you must inform the Plan Administrator and complete a new election form within 30 days of the occurrence giving rise to the Change in Status. If you wish to change your election based on a Change in Status, you must establish that your requested change is consistent with and on account of that Change in Status. The Plan Administrator, in its sole discretion and in accordance with prevailing IRS guidance, will determine whether a requested change is consistent with and on account of the Change in Status. Some Examples of Permissible Changes are as follows: a. For health insurance benefits, you may change your election only if the Change in Status results in you, your spouse, or your dependent becoming eligible or becoming ineligible for the benefit (or a particular benefit option) under this plan (or under the plan of your spouse or of your dependent) and the election change corresponds with the gain or loss of coverage. However, if you, your spouse, or a dependent elect COBRA continuation coverage, under a plan sponsored by your employer, then you may be able to increase your contribution to pay for such coverage. b. For reimbursement benefits, you may change your election only if the Plan Administrator, in its sole discretion, determines that the change is on account of, and consistent with the Change in Status. 2. Special Enrollment Rights. If you, your spouse, and/or a dependent are entitled to special enrollment rights under a group health plan, you may change your election to correspond with the special enrollment right so long as the underlying benefit plan documentation permits such a change. For example, if declined enrollment in medical coverage for yourself or for your eligible dependents because of outside medical coverage, and if eligibility for such coverage is subsequently lost due to certain reasons (for example, due to a divorce, legal separation, death, termination of employment, reduction in hours, or exhaustion of a period of COBRA continuation coverage), then you may be able to elect medical coverage under the plan for yourself, and your eligible dependents who lost such coverage. Furthermore, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may also be able to enroll yourself, your spouse, and your newly acquired dependent provided that you request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. 3. Certain Court Orders. If a judgment, decree, or order from a divorce, separation, annulment or custody change requires your child to be covered either under this plan or under the plan if your spouse (or your former spouse, as the case may be), you may

5 SPD Page 5 change your election to correspond with the judgment, decree, or order. If the judgment, decree, or order requires you to cover the child, you may change your election to provide coverage for the child. If the judgment, decree, or order requires that your spouse or former spouse cover the child, you may change your election to revoke coverage for the child. 4. Entitlement to Medicare or Medicaid. If you, your spouse, or a dependent become entitled to Medicare or Medicaid, you may cancel that person s accident or health coverage and any corresponding elections under the Plan. 5. Significant Changes in Cost or Coverage. If the premiums for medical benefits significantly increases or the coverage is significantly curtailed, you may revoke your prior election and elect coverage under another health option with similar coverage provided you notify the Plan Administrator within thirty (30) days of receiving written notice of the significant premium increase or coverage curtailment. Note that no midyear election changes are permitted under the Health Care Reimbursement Plan for changes in insurance cost or coverage. 6. Changes in Coverage Attributable to Your Spouse s Employment. If there is a significant change in health coverage for either you or your spouse that is attributable to your spouse s employment, then you may change your election under the Plan provided that the change is consistent with the change in coverage. To make an election change, you must file a written request for change with the Plan Administrator within thirty (30) days of the event permitting the change. Additionally, the Plan Administrator may modify your election(s) downward during the Plan Year if you are a Key Employee or a Highly Compensated Employee, as either of those terms is defined by the Internal Revenue Code, if such downward modification is necessary to prevent the Plan from becoming discriminatory within the meaning of the federal income tax law. Adjustments to your election(s) may also be made by the Plan Administrator to reflect insignificant mid-year premium increases. CAN FUNDS BE TRANSFERRED FROM ONE REIMBURSEMENT ACCOUNT TO ANOTHER? No. The Premium portion of the Plan and the Reimbursement Accounts are totally separate. Once you decide on the amount for a specific benefit option, it cannot be transferred to another account. Also, reimbursement for one type of expense, such as dependent care, can be made only from the appropriate account. HOW ARE REIMBURSEMENTS OF HEALTH CARE AND DEPENDENT CARE EXPENSES MADE? Reimbursements of eligible Health Care and/or Dependent Care expenses will be made directly to you once you have filed the appropriate reimbursement request form with Benefit

6 SPD Page 6 Alternatives. The expenses that are eligible for reimbursement are explained in more detail in the Reimbursable Health Care Expenses worksheets in your plan enrollment materials. HOW OFTEN WILL REIMBURSEMENTS BE MADE? Payments will be made to coincide with your pay schedule. If you are paid weekly, reimbursements will be made on a per bi-weekly basis. All claims will be reviewed as soon as possible, but in no event later than 30 days after receipt. WHAT IS THE LATEST DATE FOR SUBMISSION OF CLAIMS? Claims must be received by Benefit Alternatives no later than the end of the business day on the ninetieth day after the end of the Plan Year. WHAT AMOUNT OF MY EXPENSES WILL BE REIMBURSED: You will receive a reimbursement check for Health Care Expenses from your Health Care Reimbursement Account each check run in the amount of the eligible expenses you submit, or in the amount of your current account total, whichever is less. Your current account total is your annual elected amount less prior reimbursements. For Dependent Care Expenses, you will receive a reimbursement check from your Dependent Care Reimbursement Account each check run in the amount of the eligible expenses you submit, or in the amount available in your account, whichever is less. For example, if you have $150 in reimbursable expenses, but your Dependent Care Reimbursement Account balance only equals $125, you will receive a nontaxable reimbursement check for $125. The additional $25 of expenses will be carried forward to the next month and you will be reimbursed then if you have enough in your account. WHAT IF MY CLAIM FOR REIMBURSEMENT IS DENIED? You will be notified in writing by Benefit Alternatives as to why the claim is being denied and what steps, if any, you can take to make the claim valid. You have up to 180 days to appeal the denial. You will be notified of the determination of the appeal within 60 days after receiving the request for appeal. WHAT HAPPENS TO BENEFITS NOT USED? As explained above, you have until 90 days after the end of the Plan Year to make certain that a claim is received by Benefit Alternatives for expenses for the previous Plan Year. After that date, any unused Health Care amounts above $ that you contributed during the Plan Year will be forfeited. These

7 SPD Page 7 unused amounts cannot be used to pay expenses for the next Plan Year and cannot be returned to you on an after-tax basis. For example, if you participate in the Health Care Reimbursement Plan you elect to set aside $2,000 on a tax-free basis for reimbursement of certain health expenses. You only incur $1,400 of health care expenses during the Plan Year. $ is carried forward to the new plan year, and the remaining $100 is forfeited. However, even though there is a small forfeiture, you should still be better off. In this example, the tax savings on your $2,000 election, using a 15% federal, 7.65% FICA and 6% state tax rate, is $573. The $573 of tax savings less the $100 forfeiture leaves you with a net savings of $473. WHAT CAN BE DONE TO MINIMIZE FORFEITURES? To avoid or minimize forfeitures, you should only elect compensation redirection amounts that will cover the reimbursements for expenses you realistically expect to incur. However, the tax savings percentage range on the elected amount will act as a cushion against any forfeiture you might realize. Worksheets are enclosed to help you calculate your yearly election. Also, each reimbursement check shows the current balance for each account. You may carry forward any amounts up to $ that you did not use. WILL MY ELECTIONS IMPACT ANY OTHER BENEFITS? Your Social Security wage base will be reduced by the amount of your compensation redirection election. As a result, although FICA taxes are saved, future Social Security benefits may be affected. However, in most cases, the future reduction in Social Security benefits is negligible and current tax savings should more than offset the reduction. WHAT HAPPENS TO MY PREMIUM AND REIMBURSEMENT ACCOUNTS IF I TERMINATE EMPLOYMENT? PREMIUMS: Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you and your dependents have the option to continue your insurance coverages for certain plans on an after-tax basis in certain instances when coverage would otherwise end. For more specific information regarding your COBRA rights, refer to the Summary Plan Description of the specific health insurance plans. COBRA does not apply to all employers. HEALTH CARE REIMBURSEMENT: If you terminate employment you will not be allowed to withdraw any balances remaining in your Health Care Reimbursement Account at termination. You will be allowed to continue submitting claims for health care expenses incurred during the Plan Year and prior to your termination. Claims may be submitted through the third month after the end of the Plan Year in which you terminated employment. You may elect to continue your coverage as explained below.

8 SPD Page 8 Under federal tax law, health care expenses incurred after you terminate only qualify for reimbursement if you continue contributing to your Health Care Reimbursement Account under COBRA. COBRA does not apply to all employers. You should ask your employer if you have questions about whether COBRA applies. If you are provided COBRA rights, you do not have to elect to continue your medical coverage in order to be eligible to elect to continue your Health Care Reimbursement Account under COBRA. You may elect to have the remaining portion of the year's election taken from your last paycheck. The required contributions for extended coverage under the Health Care Reimbursement Account may also be made on an after-tax basis. If COBRA is elected and properly paid for, it may last up through the end of the Plan Year in which the qualifying event occurs but cannot be continued for the next Plan Year. DEPENDENT CARE REIMBURSEMENT: If you have an unused balance in your Dependent Care Account at termination, you will be allowed to continue submitting claims for dependent care expenses until ninety (90) days after the end of the Plan Year incurred while you were a participant in the Plan until your balance is exhausted or otherwise forfeited. WHAT HAPPENS TO PREVIOUS YEAR S ELECTIONS, IF I FAIL TO MAKE AN ELECTION FOR THE UPCOMING YEAR? If you do not make a current decision for a future year: With Regard to Family Health Premiums, your previous election from last year will remain in effect, and pre-tax pay deferrals will continue at the same rate. With Regard to Health Care Reimbursement and Dependent Care Reimbursement, your previous elections are void and will not apply to the upcoming year. Thus, in order to participate for the upcoming year, you must complete a new Enrollment Form. WHAT EFFECT DOES TAKING A LEAVE OF ABSENCE UNDER THE FAMILY AND MEDICAL LEAVE ACT HAVE ON PARTICIPATION IN THE PLAN? If you take a leave of absence authorized under the Family and Medical Leave Act, you will be permitted to continue your participation (and your dependents) in the Plan and in all underlying coverages for the period of your authorized leave. However, AGNES SCOTT COLLEGE may require you to pay the costs for such coverages on an after-tax basis (rather than on a pre-tax basis as provided under the Plan) during such leave. This means you may be required to submit a monthly payment in order to continue such coverages during your authorized leave of absence. The decision to participate in the Flexible Spending Plan is yours! The Plan has the flexibility to meet a wide range of needs. However, it is up to you to decide if it is beneficial to you. You should: Read through this information and the enclosed materials carefully;

9 SPD Page 9 Determine whether Health and Dental Insurance coverage is needed for your dependents; Review the benefits of the Health Care and Dependent Care Reimbursement Accounts; Estimate your amount of eligible Health Care and Dependent Care Expenses over the next year; Decide which expenses to pay for with before-tax dollars; and Make the appropriate elections during the annual enrollment period. WHAT ARE MY ERISA RIGHTS UNDER THE PLAN? The Cafeteria Plan is not an ERISA welfare Benefit Plan under the Employee Retirement Income Security Act (ERISA). However, certain component benefits may be governed by ERISA. THE INFORMATION BELOW APPLIES ONLY TO ERISA COVERED PLANS As a participant in an ERISA- covered Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all plan participants shall be entitled to: Receive Information About Your Plan and Benefits Examine, without charge, at the plan administrator s office and at other specified locations, such as worksites and union halls, all documents, including insurance contracts, and collective bargaining agreements, and a copy of the latest annual report (Form 5500 Series) filed by the plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration. Not all plans are required to file an annual report. Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the plan, including insurance contracts and collective bargaining agreements, and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The Plan Administrator may make a reasonable charge for the copies. Receiving a summary of the plan s annual financial report. Not all plans are required to have a summary annual report. If the plan is required to have a summary annual report, the plan administrator is required by law to furnish each participant with a copy of this summary annual report.

10 SPD Page 10 Continue Group Health Plan Coverage Continue group health coverage for yourself, spouse, or dependents if there is a loss of coverage under a health plan as a result of a qualifying event. You or your dependents may have to pay for such coverage. Review this summary plan description and the documents governing the plan on rules governing your COBRA continuation coverage rights. COBRA does not apply to all employers. Prudent Actions by Plan Fiduciaries In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your plan, called fiduciaries of the plan have a duty to do so prudently and in the interest of you and the other plan participants and beneficiaries. No one, including your employer, your union, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a benefit or exercising your rights under ERISA. Enforcing Your Rights If your claim for a benefit is denied or ignored in whole or in part, you have the right to know why this was done, obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules. A plan s administrative review process must first be exhausted before you enforce your rights under ERISA in court. Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of plan documents or the latest annual report from the plan and do not receive them within 30 days, you may file suit in Federal court. In such a case, the court may require the plan administrator to provide the materials and pay you up to $110 per day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the administrator. If you have a claim for benefits that is denied or ignored, in whole or in part, you may file suit in State or Federal court. If it should happen that plan fiduciaries misuse the plan s money, (if the plan is considered as having money) or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a Federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose the court may order you to pay these costs and fees, for example, if the court finds that your claim is frivolous. Assistance with Your Questions If you have any questions about your plan, you should contact the plan administrator. If you have any questions about this statement, about your rights under ERISA, or if you need assistance in obtaining documents from the plan administrator, you should contact the nearest office of Employee Benefits Security Administration listed in your telephone directory, or the Division of Technical Assistance and Inquiries Employee Benefits Security Administration, U.S. Department of Labor listed in your telephone

11 SPD Page 11 directory. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefit Security Administration. WHAT OTHER GENERAL INFORMATION SHOULD I KNOW? This section contains certain general information that you may need to know about the plan. General plan Information: AGNES SCOTT COLLEGE Flexible Spending Plan is the name of the Plan. Your employer has assigned the Plan number 501 to your Plan. The provisions of the Plan described herein became effective as of January 1, Your Plan s records are maintained on a 12-month (except in the case of a short Plan Year) period of time. This is known as the Plan Year. The Plan Year begins on January 1 and ends on December 31 each year. Employer Information: Your employer s name, address, telephone number, and federal tax identification number are as follows: AGNES SCOTT COLLEGE 141 E. College Avenue, Decatur, GA (404) Plan Administrator: The Employer is the Plan Administrator. Benefit Alternatives, Inc. has been contracted to act as Plan Supervisor. Their address and telephone number are: Benefit Alternatives, Inc. 902 Macy Drive Roswell, GA (770) Service of legal process: Any service of legal process should be sent to AGNES SCOTT COLLEGE.

12 SPD Page 12 AGNES SCOTT COLLEGE FLEXIBLE SPENDING PLAN HEALTH CARE REIMBURSEMENT ACCOUNT ENROLLMENT If you are an eligible employee, i.e., work at least 0 hours per week, you may elect to participate in the Health Care Reimbursement Account by completing the Enrollment Form. This form must be completed annually during the Open Enrollment Period, which will be announced each year in advance. Based upon your completed Enrollment Form, a portion of your compensation will be redirected on a pre-tax basis to your Health Care Reimbursement Account. This amount will be deducted from your gross pay on a pro-rata basis in equal installments each pay period for the period during which you are an eligible participant during the Plan Year January 1, 2015 December 31, ENROLLMENT AMOUNT ELIGIBLE HEALTH CARE EXPENSES Before completing the Enrollment Form, you should carefully estimate your health care costs. Using the Employee Enrollment Worksheet tools included in your kit, you should then estimate the pre-tax dollars to be redirected to your Health Care Reimbursement Account. Generally, your election may not be changed during a Plan Year except in very specific circumstances described above. There is a maximum election amount of $2,550 per Plan Year. Be conservative. You may carry forward any unused amounts up to $ to the next Plan Year. The Health Care Reimbursement Account may be used for qualified health and dental expenses, (i.e., those health and dental expenses that would qualify for coverage under the Medical Plan, but that will not be paid because of the applicable deductibles and co-payments). In addition, you may be reimbursed for qualified expenses. See the Reimbursable Health Care Expenses worksheet enclosed in your plan enrollment materials. Expenses for cosmetic services or items used for general well being are not eligible. As of 1/1/11 OTC drugs are no longer eligible for reimbursement. P articipants must have a letter from a hea lthcare practitioner prescribing the OTC drug to qualify for reimbursement after that date. LIMITATIONS There are a few limitations on eligible expenses. Some of the points to remember are listed below:

13 SPD Page 13 They must be expenses that are not reimbursed through another benefit plan. Expenses must be incurred by you, your spouse, or your eligible dependents. Expenses must be incurred while you are a participant in the Plan. You cannot deduct reimbursed expenses from your income taxes. REIMBURSEMENT REQUESTS Requests for reimbursement will be sent directly to Benefit Alternatives on the Claim Form provided. All receipts must be received by Benefit Alternatives seven (7) business days prior to your payday. Any receipts received after that date will be applied to the next check run. Also see SPD Pages 4 & 5 for important claims procedure information.

14 SPD Page 14 AGNES SCOTT COLLEGE FLEXIBLE SPENDING PLAN DEPENDENT CARE REIMBURSEMENT ACCOUNT ENROLLMENT If you are an eligible employee, i.e. work at least 0 hours per week, you may elect to participate in the Dependent Care Reimbursement Account by completing the Enrollment Form. This form must be completed annually during the Open Enrollment Period, which will be announced each year in advance. Based upon your completed Enrollment Form, a portion of your compensation will be redirected on a pre-tax basis to your Dependent Care Reimbursement Account. This amount will be deducted from your gross pay on a pro-rata basis in equal installments each pay period for the period during which you are an eligible participant during the Plan Year January 1, 2015 December 31, ENROLLMENT AMOUNT Before completing the Enrollment Form, you should carefully estimate your dependent care costs. Be sure to consider summer vacations and time off. Using the Employee Enrollment Worksheet, you should then estimate the pre-tax dollars to be redirected to your Dependent Care Reimbursement Account. You may change your election during the Plan Year only if you do so as a result of a qualified change in status Your election may be changed during the Plan Year only if you do so as a result of a change as defined in the Plan (for example, if you get married or divorced, have or adopt a child, or your spouse terminates his or her employment, or there is a change in cost charged by a non-family member provider). Any election change due to a qualified change in status must be on account of and consistent with the change status. Be conservative. The Plan provides that your election, on an annual basis, may not exceed the lesser of any one of the following: $5,000 ($2,500 if married filing separate returns), your earned income if married, your spouse s taxable earnings for the year.

15 SPD Page 15 If your spouse is a full-time student or is incapable of self-care, then he or she is deemed to be working and to have earned income of not less than $200 per month if you have dependent care expenses for one dependent, or $400 per month if you have expenses for two or more. The amount you contribute annually to your Dependent Care Reimbursement Account must be reduced by any amounts contributed to, or received as benefits from, another employer s dependent care spending account. For example, if your spouse is contributing to his or her employer s dependent care reimbursement account, the total that each of you can contribute to your individual account is $2,500 ($5,000 combined). ELIGIBLE Generally, if you pay for day care or other dependent care expenses, so DEPENDENT CARE that you (and your spouse if your are married) can work, then you EXPENSES can pay for those expenses through your Dependent Care Reimbursement Account. Eligible expenses must be for the care of dependents under the age of 13 o r for the care of your disabled spouse (or other disabled dependent) and include expenses for: In-home day care Day care at someone s home Cost of Nursery/Pre-School (if state funded is not available) School tuition for education is not an eligible expense. After School Care Adult Day Care Dependent Care Centers. If the center cares for more than six (6) individuals, it must also comply with applicable state and local laws and licensing requirements. Household services needed to care for the dependent. They include the services of a maid, baby-sitter, housekeeper, cook or cleaning person if the services are incidental to the primary dependent care duties.

16 SPD Page 16 Summer day camp (if the cost compares reasonably with other alternatives). Overnight camp is not eligible. IMPORTANT RESTRICTIONS There are a few restrictions on the reimbursement of eligible expenses: The total payments made in a taxable year, under this and any other dependent care plan, cannot exceed the lesser of your earned income, or your spouse s earned income (if married), during that taxable year. The expenses m ust be necessary to enable you and your spouse (if married) to work or actively search for employment. Your spouse m ust work outside the home, be a f ull-time student or be incapacitated. Your dependent must be under age 13 and eligible to be claimed as a dependent on your federal income tax return, or your dependent is physically or mentally incapable of caring for himself or herself (a disabled spouse or elderly parent, for example). If services were provided outside the home for a dependent who is physically or mentally incapable of self care, the dependent must spend at least eight (8) hours a day in your household. The person providing the service is not a dependent of yours under the age of 19 or will not be claimed as a dependent on your income tax return for the Plan Year in which the service was provided. Eligible expenses must be incurred after you become a participant in the Plan and must be incurred during the Plan Year. COORDINATION OF THE FEDERAL DEPENDENT CARE TAX CREDIT AND DEPENDENT CARE REIMBURSEMENT ACCOUNT The amount that a participant may take into account in calculating the federal dependent care tax credit will be reduced, dollar for dollar, by any amounts run through the Dependent Care Reimbursement Account. For example, consider a participant with one child and $6,000 in dependent care expenses who contributes $5,000 into the Dependent Care Reimbursement Account for that child. Since the $5,000 contributed exceeds the $3,000 credit limit, the tax return credit limit is reduced to zero (-0-). In addition, the participant may not take a tax credit on the

17 SPD Page 17 remaining $1,000 ($6,000 less $5,000). If the participant was reimbursed for only $1,000 from the Dependent Reimbursement Account, the tax credit limit would be reduced to $2,000 ($3,000 less $1,000). WHICH TO USE... THE PLAN OR THE TAX CREDIT? Deciding whether to use the Dependent Care Expense Reimbursement Account or the federal dependent care tax credit, or both, is a little complicated. The decision is based on your adjusted gross income (from your Federal Income Tax Form 1040). USE YOUR EMPLOYEE ENROLLMENT WORKSHEET TOOLS TO HELP MAKE YOUR DECISIONS. A few points about the tax credit: 1. It can be used for the same types of expenses as the Dependent Care Reimbursement Account. 2. The eligible credit percentage is applied to: - $3,000 for one dependent, - $6,000 for two or more dependents, and is limited to your earned income or that of your spouse (if married), whichever is less. 3. Dependent Care costs reimbursed through the Dependent Care Reimbursement Account cannot be used in calculating the federal income tax credit for dependent care. Every dollar put into a Dependent Care Reimbursement Account reduces the $3,000 or $6,000 creditable amount accordingly. REIMBURSEMENT Requests for reimbursement may be made directly to Benefit Alternatives, REQUEST Inc. All receipts must be received by Benefit Alternatives seven (7) business days prior to your payday. Any receipts received after that date will be applied to the next check run. Also see SPD Pages 4 & 5 for important claims procedure information. YOU MUST FILE A FORM 2441 WITH YOUR TAXES EACH YEAR.

18 Notice of Privacy Practices This Notice Describes How Medical Information About You May Be Used and Disclosed and How You Can Get Access To This Information. Please Review It Carefully. If you have any questions about this notice, please contact your Human Resources Department Who Will Follow This Notice: This notice describes the medical information practices of AGNES SCOTT COLLEGE health flexible spending arrangement plan (the Plan ) and that of any third party that assists in the administration of Plan claims. Our Pledge Regarding Medical Information: We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the health care claims reimbursed under the Plan for Plan administration purposes. This notice applies to all of the medical records we maintain. Your personal doctor or health care provider may have different policies or notices regarding the doctor s use and disclosure of your medical information created in the doctor s office or clinic. This notice will tell you about the ways in which we may use and disclose medical information about you. It also describes our obligations and your rights regarding the use and disclosure of medical information. We are required by law to: make sure that medical information that identifies you is kept private; give you this notice of our legal duties and privacy practices with respect to medical information about you; and follow the terms of the notice that is currently in effect. How We May Use and Disclose Medical Information About You: The following categories describe different ways that we may use and disclose medical information. For each category of uses or disclosures we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories. For Reimbursement (as described in applicable regulations). We may use and disclose medical information about you to determine eligibility for Plan benefits, to facilitate reimbursement for the treatment and services you receive from health care providers, to determine benefit responsibility under the Plan, or to coordinate Plan coverage. For Health Care Operations (as described in applicable regulations). We may use and disclose medical information about you for other Plan operations. These uses and disclosures are necessary to run the Plan. For example, we may use medical information in connection with: conducting quality assessment and improvement activities; activities relating to Plan coverage; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; business planning and development such as cost management; and business management and general Plan administrative activities.

19 As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law. For example, we may disclose medical information when required by a court order in a litigation proceeding such as a malpractice action. To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. For example, we may disclose medical information about you in a proceeding regarding the licensure of a physician. Special Situations: Disclosure to Health Plan Sponsor. Information may be disclosed to another health plan maintained by AGNES SCOTT COLLEGE for purposes of facilitating claims payments under that plan. In addition, medical information may be disclosed to AGNES SCOTT COLLEGE personnel solely for purposes of administering benefits under the Plan. Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation. Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority. Workers Compensation. We may release medical information about you for workers compensation or similar programs. These programs provide benefits for work-related injuries or illness. Public Health Risks. We may disclose medical information about you for public health activities. These activities generally include the following: to prevent or control disease, injury or disability; to report births and deaths; to report child abuse or neglect; to report reactions to medications or problems with products; to notify people of recalls of products they may be using; to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when

20 required or authorized by law. Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws. Lawsuits and D isputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. Law Enforcement. We may release medical information if asked to do so by a law enforcement official: in response to a court order, subpoena, warrant, summons or similar process; to identify or locate a suspect, fugitive, material witness, or missing person; about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person s agreement; about a death we believe may be the result of criminal conduct; about criminal conduct at the hospital; and in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime. Coroners, Medical Examiners and Funer al Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties. National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

21 Your Rights Regarding Medical Information About You: You have the following rights regarding medical information we maintain about you: Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your Plan benefits. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Human Resources Department. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Plan. To request an amendment, your request must be made in writing and submitted to the Human Resources Department. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: is not part of the medical information kept by or for the Plan; was not created by us, unless the person or entity that created the information is no longer available to make the amendment; is not part of the information which you would be permitted to inspect and copy; or is accurate and complete. Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures where such disclosure was made for any purpose other than treatment, reimbursement, or health care operations. To request this list or accounting of disclosures, you must submit your request in writing to the Human Resources Department. Your request must state a time period which may not be longer than six years and may not include dates before May, Your request should indicate in what form you want the list (for example, paper or electronic). The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, reimbursement or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the reimbursement for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had. We are not required to agree to your request. To request restrictions, you must make your request in writing to. In your request, you must tell us: (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

22 Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to the Human Resources Department. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. To obtain a paper copy of this notice, contact the Human Resources Department Changes to This Notice: We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice on the Plan website, if applicable. The notice will contain on the first page, in the top right-hand corner, the effective date. Complaints: If you believe your privacy rights have been violated, you may file a complaint with the plan or with the Secretary of the Department of Health and Human Services. To file a complaint with the Plan, contact your Human Resources Department. All complaints must be submitted in writing. You will not be penalized for filing a complaint. Other Uses of Medical Information: Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.