PLAN AMENDMENTPLAN AMENDMENT
ARTICLE
PREAMBLE
1.1 Adoption and effective date of amendment. The Employer adopts this Amendment to the
City of Clearwater Cafeteria Plan (enter name of plan)
("Plan") to reflect changes to internal Revenue Code (IRC) Section 125(i), as amended by the Internal
Revenue Service (IRS) Notice 2013-17. The employer and Plan sponsor Intends this Amendment as
good faith compliance with the requirements of this Notice. This Amendment shall be effective on
or after the date the Employer elects in Section 2.1 below.
1.2 Election of Carryover. To the extent that the Plan contains "grace period" language, said language
for any "grace period" for the health flexible spending account (health FSA) will be voided for Plan
years following the Plan year that carryover is adopted and such language shall be replaced with the
"carryover" language outlined below.
1.3 Supersession of inconsistent provisions. This Amendment shall supersede the provisions of the Plan
to the extent those provisions are inconsistent with the provisions of this Amendment.
ARTICLE II
CARRYOVER ELECTION
2.1 Effective Date. This Amendment Is entered Into as of the date outlined below and shall be effective
for al the 2013 PlanyearorLjthe2Ol4Planyearand beyond.
2.2 Carryover Amount. The Plan shall provide for a carryover of $500 of any amount remaining unused
in a health FSA as of the end of the Plan year. Such carryover amount may be used to pdy or reimburse
medical expenses under the health FSA incurred during the entire Plan year to which it is carried over.
2.3 Participant Opt Out Notwithstanding the foregoing, any Plan participant shall have the right to opt
out of the carryover if such participant has already enrolled in a healthcare savings account for the
following Plan year.
This Amendment has been executed this (5 day of /j1,19 i-tr
Name of Employer: City of Clearwater
By: See attached
EMPLOYER
Countersigned:
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George N. Cretekos
Mayor
Approved as to form:
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Leslie K. DougaI des
Assistant City A • ney
CITY OF CLEARWATER, FLORIDA
By:
William B. Horne II
City Manager
Attest:
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Rosemarie Ca I
City Clerk