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- No set-up ree I OgICING -"` - • Annual AdMIn F e- fiat rate (due now) (] TASC"HIPAA compliance Services �INR0: ee (billed autamedca Nm�: plan ud oa9� an the frsrc/rhe month in which oprccurron isreceried. " —___..— • Annual Renewal P ADMIN ONLY: TASCHIPAA- Special Instructions: - - - - ------ a Set -Up Fee(du tRomp, PRICING •Admin"" pe participant, per month ,INFO: Monthtyivion' none, Fee ❑ TASC Giveeack (Workplace Giving Administration) , Annual Renew l Fee 1 Wu ber of EIIgIble,Emplogees:; . ❑ �lonthl❑ other. ❑ Veekly p gl_ NeektI Semi-MonY i Payroll/Funding Cycle (select one): if Contributions In 12-md plan Year:rill dotes: Participant Eontri(iutiop Schedule: ccntdhution datesmoyarmoynot be_thzsamedata paYI 2`'Contributlon: Jam_ st Cnhtr)bution: _jJ_ "(663ed an Plan wndfn4sdl dole belpw/or 1"ConMbutloni Jam— � _-------- _ First Ycar Administration to begin: .Pint day oP __J— (01011) the month prior to tMssti . BENEFITOFPERIN�S ...-.. •— ^---^^^ Company Match: �— ❑ No ❑ Yes ! if yes, enter Maximum Match for each b Per Employee, Per Year; S Per Payroll: $ . ❑ No 17 Yes fjyes, enter Company Enrollment Bonus Enrollment Bonus: ❑Yes (company fvndraiserarfeatured employ This Seatondcures the method that your Plan will utilim to me a Payroll and payroll matchat is through AMW - sect,,, are In addition to the fess due under PART3 (Fes), The preferred method of payment Is through an Auto AM where TP Payment -via ACL. To start this process: (11 choose which ACH process you want beldw, (2) verily your Expected Da �rovid_eyour bank (1) O TASC ACH(default): TASC Initiates fundi ng payfnentvla Aai on the EOR. ❑ Client MYTASCFunding'. cientrnitiatesfundlngpaymentviaMyTASConorbeforethe-e0ft.Note.Underthis and Routing Numbers to post any unpaid funding amounts that are one (1) business additional annual fee w11I apply it ACH is not elected ($10.00 per paymll). (1) Expected Date of Receipt EDR is the date that TASC will pull in Auto ACH front your designated account ands parelclpanes account(s)- This may or may not be the same date as the participant's (EDR): payroll contribution schedule indicated above for each Payroll elde- (al Bank Information: ❑ Use same ACH Info from Part 4 of this Application Q Use differen Financial Institution Name: Bank Reuling Number (9 digits): Cheeping Accc ADIYIIN ONLY: TASC GiveBack - Special Instructions: page 11 Employer T:391a.0101V 25E-67 Of encs described in :his submission Of your fee lay pait the due date.Also, ply the payroll mriClbutlons to your syroll date. The EDR data Is the ACH. information as per belovr. State: int ti: ! I vII�TASC