403(b) Program Highlights

403(b) Program Highlights As part of Henry Ford Health System s (HFHS) commitment to helping employees plan for their future financial wellness, HFHS offers a 403(b) program whereby employees can save additional money for their future. What is the Henry Ford Health System 403(b) Program? Because HFHS is a tax-exempt organization, HFHS can provide an opportunity for employees to participate in a 403(b) Program. The program consists of employee contributions where employees may elect to defer a portion of their annual income on a before-tax basis Traditional 403(b) or on an aftertax basis Roth 403(b). Who can participate in the 403(b) program? All employees can participate in the 403(b) program. Investing in the program is another means of saving for retirement outside of the HFHS Retirement Savings Plan. What amount can employees contribute to their 403(b) account each year? Employees determine the amount to contribute from each paycheck to their 403(b) account. The maximum contribution amount for 2013 is $17,500 or $23,000 if the employee will be age 50 or older by December 31, 2013. The IRS mandates that the maximum contribution amounts shown above be reduced by contributions that were made to certain former employer retirement plans. Thus, if contributions were made to another employer s retirement plan(s) during the same year the employee elects to contribute to the HFHS 403(b) account, the employee may need to make sure that those contributions plus their HFHS 403(b) contributions do not exceed the maximum amounts shown above. (see the 403(b) Rules & Provisions section of the HFHS 403(b) Election & Change Form located at www.henryfordconnect.com under HR Connect>Benefits>Retirement>HFHS 403(b) Enrollment) What is the 403(b) account enrollment process? 1. Select MetLife Resources and/or Fidelity Investments as your 403(b) provider. 2. Establish a 403(b) account with MetLife and/or Fidelity: a. If enrolling with MetLife, meet with a MetLife 403(b) on-site representative to complete the required enrollment paperwork. To schedule an appointment, contact MetLife at 800-945-0840. b. If enrolling with Fidelity, i. Print out a Fidelity 403(b) account application and HFHS 403(b) Enrollment & Change form at www.henryfordconnect.com, select: HRCONNECT>Benefits>Retirement>HFHS 403(b) Enrollment. ii. Complete and send the Fidelity application to the address listed on the application. iii. Contact Fidelity at 800-343-0860 to confirm that your 403(b) account has been set up. iv. Once your 403(b) account has been set up with Fidelity, complete the HFHS 403(b) Election & Change Form and submit it to the HFHS Employee Services by fax at 313-874- 6380 or employeeservices@hfhs.org. NOTE: Your contributions cannot commence until you have established a 403(b) account with Fidelity Investments and/or MetLife Resources. Can employees change the per pay amount that they contribute? Employees can change their per pay deferral amount on line through HFHS self-service at www.henryfordconnect.com. Select HR Connect to access Sign in to Self-Service. Once you are signed in, select the My Benefits tab and then savings summary. IRS regulations allow an individual to start, stop, increase or reduce the contribution amount any time during the calendar year, as often as necessary. Questions? Go to www.henryfordconnect.com Select: HRCONNECT>Benefits>Retirement>HFHS 403(b) Enrollment. 2012Dec10

HFHS 403(b) PROGRAM - 2013 Election & Change Form and Rules & Provisions What is the Henry Ford Health System 403(b) Program? Because Henry Ford Health System (HFHS) is a tax-exempt organization, HFHS can provide an opportunity for employees to participate in a 403(b) Program. The program consists of employee contributions where employees may elect to defer a fixed dollar amount or a percentage of their annual income on a before-tax basis Traditional 403(b) or on an after-tax basis Roth 403(b). Who is eligible to participate in the 403(b) Program? With the exception of HAP employees and students, all employees are eligible to participate in the 403(b) program, regardless of their employment status (i.e., full-time, part-time, house officer, temporary, union, etc.). When can employees enroll in the 403(b) Program? Employees can enroll at any time during their employment with HFHS. What 403(b) companies can HFHS employees invest with and who do employees contact? Fidelity Investments and/or MetLife Resources. Fidelity Investments: 800-343-0860 (Call this number for assistance with: a) completing the Fidelity 403(b) Account Application for Plan #53014, b) fund selections, c) fund reallocations, d) fund performance, e) beneficiary changes, and f) distributions). Fidelity Investments: 800-642-7131 (Call this number to meet with a Fidelity representative to review your Fidelity accounts and develop an investment strategy). MetLife Resources: 800-543-2520 (Call this number for assistance with: a) fund reallocations, b) fund performance, c) beneficiary changes, and d) distributions). MetLife Resources: 800-945-0840 (Call this number to meet with a MetLife representative to: a) enroll in the 403(b) program, b) review your MetLife accounts, and c) develop an investment strategy). What is the 403(b) enrollment process? 1. Select MetLife Resources and/or Fidelity Investments as your 403(b) provider. 2. Establish a 403(b) account with MetLife and/or Fidelity: a. If enrolling with MetLife, meet with a MetLife 403(b) on-site representative to complete their investment company account application and the HFHS 403(b) Election & Change form. Contact MetLife at 800-945-0840 to schedule an appointment. b. If enrolling with Fidelity, i. Complete the attached Fidelity 403(b) account application and send it to Fidelity at the address listed on the application, and ii. Contact Fidelity at 800-343-0860 to confirm that a 403(b) account has been established for you. iii. Once your 403(b) account has been established at Fidelity, complete the attached HFHS 403(b) Election & Change Form and submit it to the HFHS Employee Services department by fax at 313-874-6380 or email at employeeservices@hfhs.org. NOTE: Employee 403(b) contributions cannot commence until you have established a 403(b) account with Fidelity Investments and/or MetLife Resources. What amount can employees contribute to their 403(b) annually? Employees determine the amount from each paycheck to be contributed to their 403(b) account not to exceed the maximum contribution amount of $17,500 or $23,000 if the employee will be age 50 or older by December 31, 2013. There are no employer matching 403(b) contributions to either the Traditional or Roth 403(b). Contributions consist of employee deferrals only. Reductions to maximum contribution limits: The IRS mandates that the employee must earn a certain gross annual pay in order to contribute the maximum to the program. For further details, see the HFHS Traditional & Roth 403(b) Election Form and Rules & Provisions (Section 403(b) Contribution Limits of page 1 of the election form). The IRS mandates that maximum contribution amounts be reduced by contributions that were made to certain former employer plans during the same year as your HFHS 403(b) contributions. For further details, see the HFHS Traditional & Roth 403(b) Election Form and Rules & Provisions document (Section 6.f. of the Rules & Provisions document) Can employees change the per pay amount that they contribute? Yes. Employees can change their per pay deferral amount on line through HFHS self-service at www.henryfordconnect.com. Once you access your self-service record, click on benefits home then savings summary. IRS regulations allow an individual to start, stop, increase or reduce the contribution amount any time during the calendar year, as often as necessary. Page 1 of 8

Do employees that contribute the maximum during the year need to complete a new election form to elect the maximum contribution amount for the following year? For employees who contribute the maximum amount during a payroll year and are actively participating in the Plan as of the first payroll period of the following year, HFHS will automatically change the contribution amount to the new annual limit. HFHS will prorate the annual limit amount, as a dollar amount per pay, based upon the new limit and the number of pay periods in the new payroll year. When can employees stop contributing to the 403(b) Program? Employees can stop and restart their contributions at any time by completing a HFHS 403(b) Election & Change Form (form attached). When can the funds be withdrawn from the 403(b) account? The IRS rules state that the 403(b) money saved is for retirement. If any funds are withdrawn under the hardship provision, the amount withdrawn is subject to normal income tax (Traditional 403(b) only) and if the participant has not attained age 59 1/2 at the time of withdrawal, an additional 10 penalty tax (Traditional and Roth 403(b)) is applied. For further details, contact the customer service center for Fidelity Investments or MetLife Resources. Can employees change providers and their choice of investment funds during the year? Providers can be changed any time during the year by completing the HFHS 403(b) Election & Change Form and the new investment company s 403(b) account application. Only the HFHS approved providers may be utilized. Contact Fidelity or MetLife directly. Employees can change their fund selection within a "family of funds" based on the provider s rules. Fund changes are processed directly by MetLife and/or Fidelity. Can employees change deferrals between Traditional and Roth 403(b)? Changes between Traditional and Roth 403(b) deferral elections can be made at any time during the year by completing a HFHS 403(b) Election Form. This form should be mailed or faxed to Employee Services at fax number 313-874-6380 (phone: 855-874-7100). Do Fidelity Investments and MetLife Resources offer loans and hardship withdrawals? Fidelity Investments: Fidelity Loans: Does not offer loans. However, you should contact Fidelity to see if they did offer loans if you would have qualified for a loan. If Fidelity indicates that if they offered loans you would qualify for a loan, you can transfer the amount needed for the loan or your entire 403(b) account balance from Fidelity Investments to MetLife Resources. Once this transfer is complete, you can file for a 403(b) loan with MetLife. Your loan application will be filed directly with MetLife Resources. Call MetLife Resources at 800-945-0840 to find out the contact information for the MetLife on-site representative who services your work location. This representative can assist you with the loan process. Fidelity Hardship Withdrawal: You should contact the Fidelity Investments at 800-343-0860 to determine if you qualify for a hardship withdrawal. You must first exhaust your loan options in order to qualify for a hardship withdrawal. You can do this by transferring 403(b) assets from Fidelity Investments to MetLife Resources (see directly above under Fidelity Loans). If Fidelity indicates that you qualify for a hardship withdrawal: 1) complete a Fidelity 403(b) hardship withdrawal form (obtain form from Fidelity) and 2) obtain the IRS required support documentation (obtain a list from the HFHS 403(b) Hardship Processing Center). Fidelity Investments (800-343-0860) or the HFHS 403(b) Hardship Processing Center (888-649-4636) can provide you with information regarding the support documentation that is required by the IRS. Once both sets of documentation are complete, you can fax them to the HFHS 403(b) Hardship Processing Center at 770-956-8780 or will submit them to the following address: HFHS 403(b) Hardship Processing Center, 3003 Summit Blvd., Suite 100, Atlanta, GA 30319-1468. MetLife Resources: MetLife Loans: Offers loans. You should contact the MetLife Resources customer service center at 800-543-2520 to determine if you qualify for a loan. If MetLife indicates that you qualify for a loan, complete a MetLife 403(b) Loan form and submit it to MetLife for processing. MetLife Hardship Withdrawal: You should contact the MetLife Resources customer service center at 800-543-2520 to determine if you qualify for a hardship withdrawal. If MetLife indicates that you qualify for a hardship withdrawal: 1) complete the MetLife 403(b) hardship withdrawal form, and 2) obtain the IRS required support documentation. MetLife Resources or the HFHS 403(b) Hardship Processing Center can provide you with information regarding the support documentation that is required by the IRS. Once both sets of documentation are complete, you will submit them to the following address: HFHS 403(b) Hardship Processing Center, 3003 Summit Blvd., Suite 100, Atlanta, GA 30319-1468. The HFHS 403(b) Hardship Withdrawal Processing Center s telephone number is (888-649-4636, at the prompt say MetLife 403(b) hardship. For additional information regarding 403(b) rules and regulations, review the 403(b) Rules & Provisions portion of the Henry Ford Health System Tax Sheltered Annuity 403(b) Election Form. Page 2 of 8

HFHS 2013-403(b) Election & Change Form and Rules & Procedures 403(b) Contribution Limits Employees who are enrolled in the HFHS Retirement Savings Plan, the maximum deduction for the year 2013 is: 1) $17,500 for employees who earn a gross (all earnings) annual pay of $19,800 or greater, or 2) 87 of gross pay for employees who earn a gross annual pay of less than $19,300 if under age 50 or $26,100 if age 50 or older by Dec 31 st (net pay after 403(b) deduction must exceed minimum gross annual pay or the 88 will be automatically reduced) Employees who are NOT enrolled in the HFHS Retirement Savings Plan, the maximum deduction for the year 2013 is: 1) $17,500 for employees who earn a gross annual pay of $18,900 or greater, or 2) 92 of gross pay for employees who earn a gross annual pay of less than $18,408 if under age 50 or $24,900 if age 50 or older by Dec 31 st (net pay after 403(b) deduction must exceed minimum gross annual pay or the 92 will be automatically reduced) Employees who are or will be age 50 by December 31 st are eligible to contribute an additional amount (Age 50 Extension). The maximum age 50 Extension amount for 2013 is $5,500. See attached Rules & Provisions page for additional 403(b) rules and regulations. 1. Employee Information Circle ONE: Mr. Ms. Dr. House Officer Date of Birth Employee Name (first, middle initial, last) Social Security Number Employee I.D. ( ) ( ) Work Location (department name and location) Daytime Phone Fax Number 2. Non-HFHS Employer Plan Contributions If during this year, you made contributions to any other employer s (non-hfhs Plans) Retirement Plan(s) (i.e., defined in IRC Section 403(b) (TSA), 401(k) (Cash or Deferred Arrangement), 401(k) (Roth Contributions), 408(k)(6) (SARSEP), or 408(p) (SIMPLE)), enter the amount that you contributed to these plans below. See Item 6(g) on the attached Rules or call HFHS Employee Services if you have any questions. The IRS requires that the amount you contributed to a non-hfhs employer during this year will reduce the amount you can contribute to the HFHS 403(b) program this year. The annual limit is an individual limit and applies to everyone equally (with the exception of the age 50 extension) regardless of the number of employers you have during any year. COMPLETE: $ dollar amount contributed (contributions to a non-hfhs employer) (if zero, indicate NONE) 3. Contribution Election - Payroll Effective Date(s) Select ONE Option (a or b): a) ( ) Next available pay period, OR b) ( ) Pay period beginning (pay period begin date) Page 3 of 8

4. 403(b) Salary Reduction Amount COMPLETE 4A OR 4B (this election supersedes all prior elections) 4A. Complete this section only if you are enrolling in the TRADITIONAL 403(b) - (BEFORE-TAX CONTRIBUTIONS) TRADITIONAL 403(b) (BEFORE-TAX) Normal Elective Deferral Amount (complete a. b. OR c.) ($17,500 withheld in the current payroll year) Enter per pay dollar amount. If electing to stop contributions, enter $0.00 on line b. a. ( ) Check this box if you are electing the Annual maximum allowable deduction ($17,500). (your per pay deduction amount will be calculated by the HFHS Employee Services Department) b. $ Dollar amount deducted each pay period. Enter percent of pay to be deducted each pay period. TRADITIONAL 403(b) (BEFORE-TAX) Age 50 Extension Amount - Complete a & b Must be age 50 or older by the end of the calendar year in order to contribute an extra Age 50 deferral amount. c. Percent of gross pay deducted each pay period. a. ( ) Check this option if you elect to tax shelter an additional amount in the year 2013 representing the Age 50 Extension. (You may make this election only if you are age 50 or older by the end of the 2013 calendar year.) b. $ Enter your total year 2013 Age 50 Extension annual contribution amount. (Enter a dollar amount up to $5,500). Note: The per pay deduction amount will be calculated by Employee Services. 4B. Complete this section only if you are enrolling in the ROTH 403(b) (AFTER-TAX CONTRIBUTIONS) ROTH 403(b) (AFTER-TAX) Normal Elective Deferral Amount - (Complete a, b OR c) ($17,500 withheld in the current payroll year) Enter per pay dollar amount. If electing to stop contributions, enter $0.00 on line b. Enter percent of pay to be deducted each pay period. ROTH 403(b) (AFTER-TAX) Age 50 Extension Amount (Complete a & b) Must be age 50 or older by the end of the calendar year in order to contribute an extra Age 50 deferral amount. a. ( ) Check this box if you are electing the Annual maximum allowable deduction ($17,500). (your per pay deduction amount will be calculated by the HFHS Employee Services Department) b. $ Dollar amount deducted each pay period, c. Percent of gross pay deducted each pay period. a. ( ) Check this option if you elect to tax shelter an additional amount in the year 2013 representing the Age 50 Extension. (You may make this election only if you are age 50 or older by the end of the 2013 calendar year.) b. $ Enter your total year 2013 Age 50 Extension annual contribution amount. (Enter a dollar amount up to $5,500). Note: The per pay deduction amount will be calculated by Employee Services. Page 4 of 8

5. 403(b) Investment Company Election In this section, indicate the percent of your Salary Reduction Amount (amount indicated in Number 3, Section I of this form) to be invested with each investment company (must total 100). I elect to have my Salary Reduction Amount invested with the following company(ies): Investment Percent of Salary Reduction Amount Companies Per Investment Company Fidelity MetLife TOTAL 100 I UNDERSTAND I MUST ALSO COMPLETE A SEPARATE 403(B) INVESTMENT COMPANY APPLICATION(s) FOR ALL NEW COMPANIES THAT I HAVE ELECTED TO TAX SHELTER WITH Submit your 403(b) investment company application directly to the investment company. Once you receive confirmation that your 403(b) account has been established, mail the confirmation along with this HFHS Election form to: Employee Services, One Ford Place - 4E Phone: (855) 874-7100, Fax: (313) 874-6380 6. Signatures Employee Section: I have read the attached Rules and Provisions of the HFHS 403(b) Program and understand them and agree to be bound by them. I understand that HFHS shall have no liability for any loss attributable to my selection of an annuity product or custodial mutual fund or any specific investment fund offered. X Employee Signature Date Human Resources Service Center Section: Date Entered Pay Period Effective Date Date Received In H.R. Service Center Employee Services Representative Signature For additional information regarding 403(b) rules and regulations, review the 403(b) Rules & Provisions portion of this form. HFHS shall have no liability for any loss attributable to the Employee s selection of an annuity product or custodial mutual fund or any specific investment fund offered. None of the investment options offered by 403(b) Program companies Fidelity Investments or MetLife Resources should in any way be deemed as recommended by HFHS for investment. Neither HFHS nor the investment manager will guarantee any investment results. This document summarizes 403(b) program provisions as clearly as possible. However, this form is not intended to summarize all 403(b) provisions. The official 403(b) Program Document remains the final authority. If this document is in conflict with the 403(b) Program Document, the respective official program document remains the final authority. The HFHS 403(b) Program is governed by the terms and conditions of the official agreements that participants complete with Fidelity Investments and/or MetLife Resources and the HFHS 403(b) enrollment form. If this document is in conflict with the official agreements, then the official agreements remain the final authority. In addition, similar to all HFHS benefit plans/programs, HFHS maintains the right to amend, modify or terminate the HFHS 403(b) program at anytime. Page 5 of 8

RULES AND PROVISIONS OF THE HENRY FORD HEALTH SYSTEM (HFHS) 403(b) PROGRAM 1. In no event shall a salary reduction authorized by this Election exceed the legally permissible tax exclusion as may be permitted under Internal Revenue Code Sections 402(g), 403(b) and 415(c). To the extent there needs to be a reduction of the contribution amount of this election, the reduction shall be made upon notice to the affected Employee. Salary reduction amounts Normal Elective Deferral shall in no event exceed $17,500 for the year 2013. Furthermore, by signing this Election the Employee understands the $17,500 (normal elective deferral limit) will be adjusted if regulations so require, unless the Employee is eligible for the Age 50 Extension (up to an additional $5,500 deferral) deferral allowed for those individuals who will attain age 50 by the end of the year as described in Number 2 of this document. This Normal Elective Deferral election will continue to be in effect during the remainder of this payroll year unless and until a new Election Form is signed by the Employee. This Election will automatically be continued into the next payroll year, unless the Employee notifies HFHS in writing within thirty days prior to the date that the Employee wishes to have this Election either terminated or modified. For employees who contributed the maximum amount during a payroll year and are actively participating as of the first payroll period of the following year, HFHS will automatically change the contribution amount to the annual limit by prorating the new limit amount over the number of pay periods in the new payroll year. The 2013 limits for 403(b) Elective Deferrals is $17,500. Any future increases will be based upon the cost of living. 2. Employees who reach age 50 by the end of the year 2013, may be eligible to make an additional deferral of up to $5,500 in excess of the $17,500 limit. Thus, individuals electing the Age 50 Extension may tax shelter up to $23,000 ($17,500 Normal Elective Deferral plus up to $5,500 Age 50 Extension) in the year 2013. This year 2013 Age 50 Extension election of up to $5,500 will continue to be in effect during the remainder of this payroll year unless and until a new Election Form is signed by the Employee. This Election will automatically be continued into the next payroll year, unless the Employee notifies HFHS in writing within thirty days prior to the date that the Employee wishes to have this Election either terminated or modified. Page 6 of 8

3. Employees are allowed to make changes to their 403(b) Program salary reduction amount (including the allocation of contributions between pre-tax and after-tax amounts) by completing a revised Election & Change Form or by making changes online using the HFHS employee selfservice feature at www.henryfordconnect.com. Employees acknowledge that they are fully responsible for any changes they process through a revised Election & Change Form or changes they process through employee self-service. Further, any changes they make by a subsequent Election Form or by using the online feature are subject to the Rules and Provisions of the HFHS 403(b) Program. 4. HFHS will apply the amount of the salary reduction described in Numbers 1 & 2 of this document to the purchase of a custodial mutual fund described in Section 403(b)(7) of the Internal Revenue Code of 1986, as amended, from one or more underwriters authorized by the HFHS and selected by the Employee. The selection of an underwriter shall be made on the HENRY FORD HEALTH SYSTEM 403(b) ELECTION form (attached) hereto and any subsequent change in said underwriter selection shall also be made on the HENRY FORD HEALTH SYSTEM 403(b) ELECTION form. 5. By hereby authorizing the HFHS to purchase, on the Employee s behalf, a mutual fund held by a custodial bank, the Employee hereby accepts the provisions of the HFHS 403(b) Program. 6. Employee releases all rights present and future to receive from HFHS the amounts specified above. 7. Employee understands and agrees that: a. HFHS shall have no liability whatsoever for any loss attributable to the Employee s selection of an annuity product or custodial mutual fund or any specific investment fund offered thereunder. b. HFHS executes this voluntary Salary Reduction Agreement solely to provide the Employee with the opportunity to benefit from the provisions of IRC Section 403(b) and nothing in this Agreement, expressed or implied, is intended to constitute an employer sponsored plan. c. An Employee s participation hereunder shall be voluntary, including the ability to decide what if any portion of the contribution is made on an after tax basis to the Roth 403(b). d. Any tax issues that may arise due to an Employee s participation in this voluntary 403(b) program shall solely be the responsibility of the Employee. e. All computations made in connection with the determination of the maximum amount the Employee can contribute to the IRC Section 403(b) program shall be the sole responsibility of the Employee. Page 7 of 8

f. The Employee agrees to promptly notify HFHS of any elective contributions he/she makes to any other plan defined in [IRC Section 403(b) (TSA), 401(k) (Cash or Deferred Arrangement, 408(k)(6) (SARSEP, or 408(p) SIMPLE, including Roth contributions to any of these programs)] which will reduce the maximum allowable elective deferrals that the employee can make during the calendar year. Employee confirms that he/she is aware that any elective contributions made to the HFHS 403(b) program will be aggregated with any contributions made to a 401(a) qualified plan sponsored by a non-hfhs employer of which the Employee has a 50 or more ownership in for purposes of the maximum annual addition limitations of IRC Section 415 (the lesser of 100 of pay or $50,000) that apply to the non-hfhs employer Plan. g. The annual Normal Elective Deferral amount of $17,500 and the annual Age 50 Extension amount up to $5,500 referred to in Numbers 1 & 2 of this document will also be reduced by any previous elective deferrals during the year made by the Employee to any other 403(b), 401(k), 408(k)(6) or 408(p) plans. Employee states that the sum of these elective contributions for the current payroll year (including contributions at a previous employer) are disclosed in Number 4 of the Enrollment Form. h. If the amount chosen in Number 3, Sections I & II of the Enrollment Form is a dollar amount, the amount will be prorated over the remaining pay periods of the current year. If any subsequent change is made in the dollar amount, the increase or decrease shall be similarly prorated. 8. This Agreement is legally binding and irrevocable with respect to amounts earned while it is in effect. Each party to the Agreement expressly reserves the right to terminate said Agreement upon giving thirty (30) days notice to the other party. 9. No provision of this Agreement shall affect HFHS s right to discharge the Employee, with or without cause. 10. HFHS shall have no liability for any loss attributable to the Employee s selection of an annuity product or custodial mutual fund or any specific investment fund offered. 11. None of the investment options offered by 403(b) Program companies Fidelity Investments or MetLife Resources should in any way be deemed as recommended by HFHS for investment. Neither HFHS nor the investment manager will guarantee any investment results. 12. This document summarizes 403(b) program provisions as clearly as possible. However, this document is not intended to summarize all 403(b) provisions. The official 403(b) Program Document remains the final authority. If this document is in conflict with the 403(b) Program Document, the respective official program document remains the final authority. 11. The HFHS 403(b) Program is governed by the terms and conditions of the official agreements that participants complete with Fidelity Investments and/or MetLife Resources and the HFHS 403(b) enrollment form. If this document is in conflict with the official agreements, then the official agreements remain the final authority. 12. In addition, similar to all HFHS benefit plans/programs, HFHS maintains the right to amend, modify or terminate the HFHS 403(b) program at anytime. Page 8 of 8

Henry Ford Health System 403(b) Program Fidelity Investments Account Application/Enrollment Form and Beneficiary Designation 1. GENERAL INSTRUCTIONS Opening a new account: Please complete this form and sign it on the back. Once your account is established, you can submit a Contribution Form to your employer, who can then forward contributions to your account. Please contact Fidelity, your employer, or your tax advisor to determine your maximum allowable contribution. Moving assets from an existing plan: To consolidate/move money to your employer-sponsored retirement savings account, please complete the enclosed Transfer/Rollover/Exchange form. If a form was not included within your enrollment kit, please call to request a form. Fees: Your account may be subject to an annual maintenance and/or recordkeeping fee. Mailing instructions: Return this form in the enclosed postage-paid envelope or to Fidelity Investments, P.O. Box 770002, Cincinnati, OH 45277-0090 If you wish to send your form via overnight service, please send it to Fidelity Investments, Mailzone KC1E, 100 Crosby Parkway, Covington, KY 41015 Questions? Call Fidelity Investments at 1-800-343-0860, Monday through Friday, from 8:00 a.m. to midnight Eastern time, excluding holidays that the New York Stock Exchange is closed, or visit us at www.fidelity.com/atwork. 2. SELECTING YOUR INVESTMENT OPTIONS In whole percentages, please indicate how you wish to have your contributions allocated to the investment options available for investment under your plan. Please ensure that your allocations total 100 (for example, 50 for your first, 30 for your second, and 20 for your third fund choice). If your percentages do not add up to 100 or you select an unavailable investment option, your contribution will be invested in an investment option according to your plan rules. If you would like to select more than four investment options, please write the fund code, fund name, and allocation percentage for each additional fund on a separate sheet of paper and attach it to your account application. The fund code can be found in your investment options brochure. Please note that if you would like to select a different investment mix for your Roth contributions, you must go to NetBenefits. 3. DESIGNATING YOUR BENEFICIARY(IES) You are not limited to two primary and two contingent beneficiaries. The beneficiaries designated on this form will apply to all the plans named in Section 1. To assign additional beneficiaries, or to designate a more complex beneficiary designation, please attach, sign, and date a separate piece of paper. You may revoke the beneficiary designation and designate a different beneficiary by submitting a new Beneficiary Designation Form to Fidelity or your Human Resources department. When designating primary and contingent beneficiaries, please use whole percentages and be sure that the percentages for each group of beneficiaries total 100. Your primary beneficiary cannot be your contingent beneficiary. If you designate a trust as a beneficiary, please include the date the trust was created, and the trustee s name. If more than one person is named and no percentages are indicated, payment will be made in equal shares to your primary beneficiaries who survive you. If a percentage is indicated and a primary beneficiary does not survive you, the percentage of that beneficiary s designated share shall be divided among the surviving primary beneficiaries in proportion to the percentage selected for them. 4. SPOUSAL CONSENT Spousal Consent: If you are married, your plan requires you to designate that your spouse receives 50 or more of your vested account balance in the form of a preretirement survivor annuity. If you are married and you do not designate your spouse as your primary beneficiary for a portion of your account balances as described above, your spouse must sign the Spousal Consent portion of this form in the presence of a notary public or a representative of the plan. Please provide your signature. 5. AUTHORIZATION AND SIGNATURE Fidelity Investments Institutional Operations Company, Inc. Page 1 024740001

Henry Ford Health System 403(b) Program Fidelity Investments Account Application/Enrollment Form and Beneficiary Designation 1. YOUR INFORMATION Please use a black pen and print clearly in CAPITAL LETTERS. Social Security Number: OR U.S. Tax ID Number: Date of Birth: Date of Hire: First Name: Last Name: Mailing Address: Address Line 2: City: State: ZIP: Daytime Phone: Evening Phone: Email Address: Name of Employer: Plan Numbers (if known): 5 3 0 1 4 Employer City/State: Employer ZIP (if known): I am: Single OR Married Name of Site/Division: 2. SELECTING YOUR INVESTMENT OPTIONS Please check here if you are selecting more than four investment options. Investment Options Please use whole percentages Fund Code: Fund Name: Percentage: Total = 100 Page 2

3. DESIGNATING YOUR BENEFICIARY(IES) Please check here if you have more than two primary or two contingent beneficiaries. The beneficiaries designated below shall apply to all the plan numbers named in Section 1. If you do not list plan numbers, this designation will apply to all retirement plans of the employer named in Section 1 when Fidelity recordkeeps beneficiary designations. Primary Beneficiary(ies) I hereby designate the person(s) named below as primary beneficiary(ies), to receive payment of the value of my account(s) under the plan upon my death. 1. Individual: OR Trust Name: Social Security Number: OR U.S. Tax ID Number: Percentage: Date of Birth or Trust Date: Relationship to Applicant: Spouse OR Trust OR Other 2. Individual: OR Trust Name: Social Security Number: OR U.S. Tax ID Number: Percentage: Date of Birth or Trust Date: Relationship to Applicant: Spouse OR Trust OR Other Total = 100 Contingent Beneficiary(ies) If there is no primary beneficiary living at the time of my death, I hereby specify that the value of my account is to be distributed to my contingent beneficiary(ies) listed below. Please note: Your primary beneficiary cannot be your contingent beneficiary. 1. Individual: OR Trust Name: Social Security Number: OR U.S. Tax ID Number: Percentage: Date of Birth or Trust Date: Relationship to Applicant: Spouse OR Trust OR Other 2. Individual: OR Trust Name: Social Security Number: OR U.S. Tax ID Number: Percentage: Date of Birth or Trust Date: Relationship to Applicant: Spouse OR Trust OR Other Total = 100 Payment to contingent beneficiary(ies) will be made according to the rules of succession described under Primary Beneficiary(ies). 4. SPOUSAL CONSENT I am the spouse of the participant named in Section 1. By signing below, I hereby acknowledge that I understand (1) that the effect of my consent may result in the forfeiture of benefits I would otherwise be entitled to receive upon my spouse s death; (2) that my spouse s waiver is not valid unless I consent to it; (3) that my consent is voluntary; (4) that my consent is irrevocable, unless my spouse completes a new Beneficiary Designation; and (5) that my consent (signature) must be witnessed by a notary public or, if allowed by the plan, a plan representative. Page 3 024740003

4. SPOUSAL CONSENT (CONTINUED) I understand that if this beneficiary designation is executed prior to the first day of the plan year in which the participant turns 35, the waiver of my spousal death benefit as determined by the retirement plan provisions will be restored to me on the earlier of (a) the first day of the plan year in which the participant attains age 35 or (b) the date the participant separates from service with the employer sponsoring the retirement plan. After that date, in order for another person to receive the death benefit that would be restored to me, I would need to consent to a new beneficiary designation. Signature of Participant s Spouse: X To be completed by a notary public or representative of the plan (if provided for under the terms of your employer s plan): Date: Sworn before me this day In the state of, County of Notary Public Signature: X My Commission Expires: Notary stamp must be in the above box As plan representative, I witnessed the spouse signing this form: Date: X 5. AUTHORIZATION AND SIGNATURE Individual Authorization: By executing this form I certify under penalties of perjury that my Social Security or U.S. taxpayer identification number in Section 1 on this form is correct. I acknowledge that I have read the prospectus of any mutual fund in which I invest and that it is my responsibility to read the prospectus of any fund into which I exchange and agree to the terms. If my account is established under a Fidelity Investments Section 403(b) Individual Custodial Account Agreement, I hereby adopt the Fidelity Investments Section 403(b)(7) Custodial Account (the Program ) and certify that I have received and read the Custodial Agreement. I acknowledge that the provisions of the Program shall be governed by the laws of the Commonwealth of Massachusetts. If my account is established under a Section 403(b) Group Custodial Agreement, I understand that my employer and Fidelity Management Trust Company (FMTC) have executed a Fidelity Investments Section 403(b)(7) Custodial Account Agreement (the Program ) and that an account under the Program has been established on my behalf. I recognize that although FMTC is a bank, neither Fidelity Distributors Corporation nor any mutual fund in which my accounts may be invested is a bank, and mutual fund shares are not backed or guaranteed by any bank or insured by the FDIC. I understand that I may designate a beneficiary for my assets accumulated under the plan, and that if I choose not to designate a beneficiary, my beneficiary will be my surviving spouse, or if I do not have a surviving spouse, distributions will be made based on the provisions of the plan. I understand that my account may be subject to an annual maintenance and/or recordkeeping fee. Your Signature: X Date: Check this box if you are signing this form as an attorney-in-fact under a power of attorney. 624244.1.0 Fidelity Investments Institutional Operations Company, Inc. 3.EPCP53014002.101 Page 4