IGOE ADMINISTRATIVE SERVICES (3)

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DocuSign Envelope ID: tODC72A2-A9C6-40FS-A2DC-2AB28AF423E9 EXHIBIT A-1 to Third Amendment Igoe Recommendations: Fee: $100: Services include Plan Amendments, Summary Plan Descriptions, System Updates, customized participant communication options. This fee is billed one time. To qualify for this discounted package, you must select an option listed in each of the below 6 sections. If you are not able to select options for each of the 6 sections below, please proceed to the Additional Relief Section of this Statement of Work. Add and/or Increase Carryover for All Eligible Plans Carryover amounts can now be unlimited for plan years that end in 2020 and 2021. Additionally, carryover is now available for both Health FSAs and/or Dependent Care Assistance Plans (DCA). The carryover option is highly recommended for the following reasons: ➢ Preserves the employee's ability to use contributed plan funds which can in turn increase adoption of this benefit and promote good will toward your benefit package as a whole ➢ Allows employers and employees to have flexibility with future plan designs as carryover funds, when designed correctly, do not prohibit HSA contributions (unlike the grace period feature) ➢ Simplifies the accountholder's user experience by keeping all spendable funds in a single plan year view ➢ Allows finance to close out administration for old plan years after a standard run out period has ended ➢ Contains costs for per participant/per account -based fee structures 1. ® Change/Add Carryover to my Health FSA/s for the full value allowed in the plan year ending in 2021. Include the plan year that ended in 2020: ® Yes ❑ No Client agrees to automatically recalibrate the carryover amount to the maximum allowed each applicable plan year, if the maximum value is adjusted ($50 annual charge applies if future adjustments are made as a result of newly indexed amounts). Additionally, please set up the Carryover with the following provisions (chose one): ❑ Add minimum carryover value of $20 OR © Add minimum carryover value of $0.00 for 2020 & $0.00 for 2021 (Input $0 if you do not want to have a minimum carryover value.) 2. 0 Allow carryover funds to be waived or moved into a Limited Purpose FSA (LPFSA) if an employee wishes to accept and/or begin making HSA contributions in the future. I understand that I will need to inform Igoe as part of open enrollment if any accountholder choses to waive carryover or move funds into an LPFSA. If you do not have an LPFSA and wish to add one, check here: ❑ ® Add Carryover to my DCA forthe full value allowed for the plan years that end in the calendar year indicated below. If you do not have the grace period and do not wish to add it, indicate that below.. By checking this box, Igoe is authorized to amend out any Grace Period (if applicable). NOTE: minimum carryover values will match selections made in the Health FSA Carryover section above. Plan Design Change CAA 2021 COVID-19 — SOW: Page 2 �IGVL' © Igoe Administrative Services