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CITY OF MOUNDSVIEW <br />DCA SCHEDULE OF PEES AND SERVICES <br />I. Plan Installation <br />Draft Plan Documents and Summary <br />Plan Description for review by legal <br />counsel <br />Initial set up of Plan records, <br />establish individual accounts, <br />reimbursement schedule and <br />procedures <br />$40.00 <br />II. Employee Communication <br />Communication package including <br />$367.50 <br />folder, customized question and <br />answer booklet, enrollment <br />information and instructions for <br />each employee (45 packets) <br />DCA consultant conduct employee <br />$300.00 per <br />meetings including slide/sound <br />half day <br />presentation and question and <br />answer session <br />III. Annual Administration <br />Monthly fee <br />Semi-monthly or bi-weekly check <br />processing, participant reports, <br />enrollment and claim forms, return <br />envelopes, employer accounting: <br />Base Account Fee for Medical <br />Reimbursement account <br />$30.00 <br />Base Account Fee for Dependent <br />$30.G0 <br />Care Reimbursement account <br />A <br />Per Participant charge for each <br />employee participating in only <br />one reimbursement account 2.90 <br />Per Participant charge for each 4.50 <br />employee participating in both <br />reimbursement account: <br />Minimum Monthly Administration <br />Fee $100.00 <br />IV. Annual Reporting Form 5500 <br />Overall Plan $250.00 <br />n <br />