25A - AGMT FOR FLEX SPENDING - Laserfiche WebLink

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CocuSign Envelope ID: CFCE3443-EF37-4FD48DCD-D85D559F77AE 4. The Contract Administrative Firm will provide a check register or similar written report to the Client for all transactions posted during each reimbursement processing. 5. The Contract Administrative Firm will provide an electronic notification if the Client contracts Card services and a Participant uses his/her Card for a transaction that falls outside of the Card parameters set forth by the Internal Revenue Service (IRS). If no response is received within 14 days, a second request for substantiation will be sent. If no response is received within 7 days of this second request, the Card may be deactivated and the expense will be deemed ineligible. Once a transaction is deemed ineligible, resolution is required and can be made through one of the following methods: a. Submission of adequate receipts as substantiation to the Contract Administrative Firm within the corresponding plan year. Upon receipt, the transaction will be approved therefore reactivating the Card (if applicable); b. Refunding the applicable reimbursement account on an after- tax basis equal to the amount of the transaction. This refund must be made in accordance with the Client's internal policies. The Contract Administrative Firm will reverse the ineligible transaction and release the associated funds for future use upon written notification from the Client. c. A written report outlining unresolved and therefore ineligible transactions will be provided to the Client on a monthly basis. At the end of the plan year, all remaining ineligible transactions must be added to the Participant's W-2 as taxable income. 6. The Contract Administrative Firm will conduct at least one set of non- discrimination testing per component reimbursement account per year, if applicable, based on information provided in writing by the Client and will provide the Client with written interpretation of such testing following each enrollment period. Additional non-discrimination testing can be provided upon written direction. Additional fees may apply if additional testing is required based on the Client's failure to provide adequate and accurate information as requested in writing by the Contract Administrative Firm. 7. The Contract Administrative Firm will provide a written year-to-date report of reimbursement account balances, reimbursements paid, and scheduled payroll contributions (if applicable) for all Participants on a monthly basis. 8. The Contract Administrative Firm will attend any audit of hearing by a government agency or bureau regarding compliance issues directly J /GDE Cityof Santa Ana Spending Account Administrative Services Agreement Client Initials: PEPM17 Page 5 25A-7