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Va Participant permanently opt.+ our and waives (otUVC relmbursnmenes, as allowed tinder IRS Notice 2013-54, all funds in <br />the Participant's accountat the time of waiver shall be forfchcd in accordance with the box checked under xhissection? <br />❑ Remain in rho Trust to be reallocated anwng tell Plan Participants with a balance as Direct Employer Contributions <br />for the next and succeeding contribution cycle(s)." <br />Z Remain in the Trust to be reallocated on an equal dollar basis among all Plan Participants with a balance.*" <br />❑ Remain in the Titut to be reallocated among all Plan Participants based upon Participant account balances," <br />❑ Reverr to the Employer via check. <br />IX. Eligibility Requirements to Receive IvIcilical Benefit Payments from the Vurnagi Care Retirement Health Savings <br />Program <br />A. A Participant is eligible to. receive benefits; <br />❑ Ax retheoem only (also complete Section B.) <br />Definition of retirement: <br />❑ Same as Section VIIA <br />❑ Other <br />© At sepuation lino service with the following resaictions <br />[] No restrictions <br />❑ Other <br />B, Termination prior to general benefit eligibility: In case where the general benefit eligibility as outlined in Section <br />IX.A includes a retirement component, a Participant who separates from service of the Employer prior to retirement <br />will be eligible to receive benefits: <br />M Immediately upon separation front service <br />❑ Other— <br />C. AParticipmrtthatbenomestotaUyandpermanentlydisabled <br />❑ as defined by tlhe Social Secrtriw Adntinistrariort <br />❑ as defined bytltcEmployer's primary redremeittplm <br />❑ other___ <br />will become immediately eligible to receive medical benefit payments from his/her account under the Employer's <br />welfare benefits plan. <br />D. Upon the death of the Participant, benefits shall become payableas outlined in Section X.I. <br />"lftbe 6'mplayers RATS Program does not lhnir eligibility to penticlpants who have separareel fivni service, the ernphyer twill be required <br />to provide funkier doertion to7CAM-RC reparding the treatment ofpos able contributions t/oat are )equiroel to be meth following the <br />participants rvarver. <br />Lf the forfeited balance is small whereby the reallocation ammrnt to each Plan Participant with a balance is ntininial, the assets will <br />revert to nruployerF forfeiture ,rccnwic forlvtrtfiar dirzzrioulrovt the eraplaycr. Ifthrre are partiripaats euithnnr a Prmlance elm shmrlrl <br />rerdlve foi fzittrru assets, please provide altrrurttix`c iiutructiomr to /CM:I-RC' oa tfie for fritura reallncatian notice <br />11:1G <br />