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NEGOTIATED AGREEMENT - Faith School District

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APPENDIX F CAFETERIA PLAN ARRANGEMENT<br />

(SUPPORTING PLAN DOCUMENT SECTION 125 CAFETERIA PLAN ARRANGEMENT<br />

EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN)<br />

This Supporting Plan Document sets out the provisions of the Cafeteria Plan Arrangement for the <strong>Faith</strong> <strong>School</strong><br />

<strong>District</strong> #46-2 Employee Health and Welfare Benefit Plan as effective 9/1/89.<br />

The purpose of the Cafeteria Plan Arrangement is to provide the Plan holder and eligible employee a method of<br />

choice between compensation or additional premium payments by Plan holder for benefits under the Welfare<br />

Plan.<br />

The purpose of this Cafeteria Plan Arrangement is intended to qualify as a Cafeteria Plan under Internal<br />

Revenue Code Section 125, as amended, and is to be interpreted in accordance with the requirements of the<br />

provision.<br />

Neither the Administrator nor the Planholder make any guarantee that amounts paid for the benefit of any<br />

Participating Employee are excluded from the Participating Employee’s income for federal or state income tax<br />

purposes, or from wages for FICA purposes.<br />

Upon adoption of this supporting Plan Document for the Cafeteria Plan Arrangement, Planholder will promptly<br />

notify all employees of its existence and eligibility requirements, and of the terms of the Cafeteria Plan<br />

Arrangement.<br />

The Planholder specifically reserves the right and authority to amend the provisions of this Supporting<br />

Document for the Cafeteria Plan Arrangement to the extent and in the manner that the Planholder deems<br />

advisable, by written amendment signed by <strong>Faith</strong> <strong>School</strong> <strong>District</strong> # 46-2. In addition, the Planholder specifically<br />

reserves the right and authority to terminate this Cafeteria Plan Arrangement. Participating Employees must be<br />

given 30 days advance notice in the event of such termination.<br />

I. DEFINITION OF TERMS<br />

A. WELFARE PLAN: The <strong>Faith</strong> <strong>District</strong> #46-2 Employee Health and Welfare Benefit Plan.<br />

B. CAFETERIA PLAN ARRANGEMENT: The Section 125 Cafeteria Plan Arrangement established by<br />

this Supporting Plan Document.<br />

C. PLANHOLDER: <strong>Faith</strong> <strong>School</strong> <strong>District</strong> #46-2, the employer establishing this Section125 Cafeteria Plan<br />

Arrangement.<br />

D. PLANHOLDER’S BUSINESS ADDRESS: Box 619<br />

<strong>Faith</strong>, S.D.57626<br />

E. PLAN YEAR: The date that the Cafeteria plan arrangement begins up to the date of the next following<br />

year.<br />

F. PLAN ANNIVERSARY: The date that the Cafeteria plan Arrangement begins in any calendar year.<br />

G. DESCRIPTION OF WELFARE PLAN BENEFITS AND COVERAGE PERIODS: See attached policy<br />

(ies) Welfare Plan Document (s).<br />

H. INSURED BENEFITS UNDERWRITTEN BY: SDSDBF<br />

PO BOX 1059<br />

PIERRE, SD 57501<br />

I. ADMINISTRATOR: The Planholder or any other person or committee, which may be appointed by the<br />

Planholder to supervise the administration of the Cafeteria Plan Arrangement.<br />

J. PARTICIPATING EMPLOYEE ELIGIBILITY: All permanent employees regularly scheduled to work<br />

20 hours or more per week.<br />

<strong>NEGOTIATED</strong> <strong>AGREEMENT</strong> PAGE 30

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