MEMBER SERVICE AGREEMENT

By checking the box below you and your organization acknowledge and agree to the following:

Use of Intellectual Property

You agree to use supplied legal updates, SPD Wrap, 125 Premium Only Plans, HR materials, templates, forms, and other provided information or intellectual property only for your organization and will not allow access to such materials by any outside party. HR Service shall be the sole owner of the copyright concerning all materials which it shall provide.

HR Service Acknowledgement

You acknowledge that the services rendered by HR Service, Inc. are not legal service or legal advice. HR Service, Inc., along with our legal advisors, uses our best efforts to assist your organization in complying with ERISA, employment laws and regulations. However, your organization is and remains ultimately responsible for complying with all applicable laws and regulations. Your insurance broker and HR Service, Inc. are not responsible for your interpretation, use and implementation of provided documents and legal alerts.

PLAN DOCUMENT & TESTING AGREEMENT

The following Terms and Conditions apply to and are incorporated as a material portion of the Agreement between ("Client"), and HR Service B3PA, LLC ("B3PA")

Employer Plan Document and Plan Testing

a.     B3PA agrees to create and complete the below requested Plan Document or Testing.
b.     B3PA agrees to provide all federally required Amendment(s) and 1 employer directed Amendment at no cost for 1 year from the date of document creation. Additional Plan Document Amendment(s) will be $150.00 each.
c.     B3PA agrees to complete 1 additional test should the employer fail their original testing and request re-testing.
d.     Client agrees to provide timely, all requested documentation to facilitate the Plan Document creation or Testing. Should the client not provide this information timely or accurately, B3PA may charge an hourly fee up to $185/hr for follow up.
e.     Client agrees to review the final Plan Document or Testing within 15 business days of notification of completion by B3PA. B3PA will complete one additional editing of the initial draft document if requested within this 15 business days.

Payment Terms - Client agrees to pay a one-time fee of $299 for B3PA to create an Health Reimbursement Arraignment Plan Document and/or $299 for B3PA to complete the following Testing: FSA Non-Discrimination Testing

ACA REPORTING - FULL SERVICE AGREEMENT

HR Service, Inc. agrees to: 1) complete the below client’s 1095-C-or B and 1094-C or B reports for 2017 ACA Reporting, 2) provide 1095 forms to client for distribution and 3) to mail form 1094 with copies of forms 1095 to the IRS.

If Optional IRS E-Filing or mailing to employees is elected, HR Service will facilitate the completion of the E- filing and mailing through our partner firm, Nelco.  Applicable charges will apply as indicated on page two.

Client Agreements

The below listed client agrees to the following:

1) To provide HR Service with requested employee, and if applicable, dependent spreadsheet information in a timely fashion, and to follow all distribution instructions before deadlines.

2) Pay 50% of the initial fee:

B Forms (self-funded or level-funded plans)

1-25 employees - $350.00 initial fee 26-49 employees - $499.00 initial fee

C Forms

50-99 employees - $1600.00 initial fee, includes one EIN 100+ employees - $2000.00 initial fee, includes one EIN

$3.00 per form after the initial 249 forms

3) Pay the following additional cost(s), if applicable: (Additional costs will be invoiced upon completion and must be paid within 20 days of invoicing.)

• • $3.00 per form after the initial 249 forms
  • If more than one class of employees for insurance rates – Plus $100 per additional class
  • If banded rates based on Age, Territory, Tenure or Gender – $350.00 for first band, then $50 per Band
  • If multiple EINs – starting at $75.00
  • If submitted spreadsheet is not done as requested and must be reconfigured – Plus $600
  • If 250+ forms, client must use the E-file per IRS regulations – Plus Chart Rates on next page.

DUE DATES:

December 15th – All initial reporting (data from January to October/November) and company information must be submitted to HR Service to guarantee that forms will be completed within IRS required timelines (postmarked/distributed to employees by 1/31/17)

January 12th 2018 – All remaining information (data from Nov/Dec) due to HR Service to guarantee that forms will be completed within IRS required timelines.

HR Service will guarantee that forms will be completed by the first IRS deadline of January 31, 2017 if information is submitted before the above noted due dates.)

The below client acknowledges that the services rendered by HR Service, Inc. are not legal service or legal advice. HR Service, Inc., along with our legal advisors, uses our best efforts to assist in complying with the Affordable Care Act and IRS regulations. However, the below client is and remains ultimately responsible for complying with all applicable laws and regulations.

Optional E-Filing and/or Mailing to Participants (Pricing is per form) 

Service	1-50 ees	51-100	101-250	251-500	501-1000	1001+
A La Carte Federal E-file	1.82	1.49	1.27	1.11	1.05	1.00
MAIL ONLY TO Recipient Print/ Mail/ Online Retrieval	5.01	3.97	3.20	2.70	2.10	1.77
MAIL ONLY Recipient Print/ Mail/ Online Retrieval ($1 Peak=on due date)	6.01	4.97	4.20	3.70	3.10	2.77
BUNDLED Federal E-file & Print/ Mail/ Online Retrieval	5.73	4.85	3.97	3.25	2.48	2.04
BUNDLED: Federal E-file & Print/ Mail/ Online  Retrieval ($1 Peak)	6.73	5.85	4.97	4.25	3.48	3.04

*Appropriate charges will apply for any necessary corrections in E-file forms that error and require validation and resubmission due to data errors*