Common use of CHECK APPROPRIATE BOX Clause in Contracts

CHECK APPROPRIATE BOX. |_| For employers who are required to make a determination letter submission to the IRS: Detailed instruction regarding the requirements for notification of interested parties may be found in sections 6,7 and 8 of Revenue Procedure 80-30. Additional information concerning this adoption or amendment (including, where applicable, an updated copy of the plan and related trust; the application for determination; and any additional documents dealing with the application for determination; and copies of section 6 of Revenue Procedure 80-30) is available at _________________ during the hours of __________________ for inspection and copying. (There is a nominal charge for copying and/or mailing.) |_| For employers who are not required to make a determination letter submission to the IRS: Detailed instruction regarding the requirements for notification of interested parties may be found in sections 6,7 and 8 of Revenue Procedure 80-30. Additional information concerning this adoption or amendment (including, where applicable, a description of the provisions providing for nonforfeitable benefits; a description of the circumstances which may result in ineligibility or loss of benefits; a description of the source of financing of the plan; and copies of section 6 of Revenue Procedure 80-30) is available at _________________ during the hours of __________________ for inspection and copying. (There is a nominal charge for copying and/or mailing.) Appendix A Key District Addresses Key District IRS Districts Covered Mid Atlantic Region Baltimore Baltimore, Pittsburgh, Richmond ▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇ Baltimore, MD 21201 Newark Newark, Philadelphia, Wilmington ▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ North Atlantic Region Brooklyn Albany, Augusta, Boston, Brooklyn, ▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇ Buffalo, Burlington, Hartford, ▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ Manhattan, Portsmouth, Providence Central Region Cincinnati Cincinnati, Cleveland, Detroit, ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ Parkersburg Midwest Region Chicago Aberdeen, Chicago, Des Moines, ▇▇▇ ▇. ▇▇▇▇▇▇▇▇ Street Fargo, Helena, Milwaukee, Omaha, ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ St. Louis, St. ▇▇▇▇, Springfield Southeast Region Atlanta Atlanta, Birmingham, Columbia, ▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇ Greensboro, ▇▇▇▇▇▇▇, Jacksonville, ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ Little Rock, Nashville, New Orleans Southwest Region Dallas Albuquerque, Austin, Cheyenne, ▇▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇▇, ▇▇▇▇▇▇▇, Oklahoma ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ City, Phoenix, Salt Lake City, Wichita Western Region Los Angeles Anchorage, Boise, Honolulu, Laguna 300 N. Los Angeles Street Niguel, Los Angeles, Portland, Reno, ▇▇▇ ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ Sacramento, San Francisco, San ▇▇▇▇, Seattle ------------- TELEPHONE NUMBERS AND ADDRESSES ============= ----------------------------------------- For questions about ▇▇▇▇▇▇▇ Flexi-Plan Call: (Toll-free) ▇-▇▇▇-▇▇▇-▇▇▇▇ or Write to: ▇▇▇▇▇▇▇ Funds Group Retirement Plans Dept. ▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇ ----------------------------------------- For questions about the ▇▇▇▇▇▇▇ Funds Call: (Toll-free) ▇-▇▇▇-▇▇▇-▇▇▇▇ or Write to: ▇▇▇▇▇▇▇ Funds ▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ ----------------------------------------- To arrange transactions and for questions about existing accounts Call: (Toll-free) ▇-▇▇▇-▇▇▇-▇▇▇▇ or Write to: ▇▇▇▇▇▇▇ Funds ▇.▇. ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇ ================================================================================ ▇▇▇▇▇▇▇ Offices Boston ▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇-▇▇▇-▇▇▇▇ Chicago ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇, 22nd Fl. Chicago, Illinois 60601 ▇▇▇-▇▇▇-▇▇▇▇ Cincinnati ▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇ Cincinnati, Ohio 45202 ▇▇▇-▇▇▇-▇▇▇▇ Cleveland ▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇, ▇▇▇▇ ▇▇▇▇▇ ▇▇▇-▇▇▇-▇▇▇▇ Houston ▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇, ▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇-▇▇▇-▇▇▇▇ ▇▇▇-▇▇▇-▇▇▇▇ (in Texas) Los Angeles ▇▇▇ ▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇ ▇▇. ▇▇▇ ▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇-▇▇▇-▇▇▇▇ New York ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇ ▇▇. ▇▇▇ ▇▇▇▇, ▇▇▇ ▇▇▇▇ ▇▇▇▇▇ ▇▇▇-▇▇▇-▇▇▇▇ Philadelphia Three Mellon Bank Center ▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇-▇▇▇-▇▇▇▇ Portland, Oregon ▇▇▇ ▇.▇. ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇-▇▇▇-▇▇▇▇ San Francisco ▇▇▇ ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇ ▇▇. ▇▇▇ ▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇-▇▇▇-▇▇▇▇ ▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇, Suite 1100 ▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇▇, ▇▇▇▇▇ ▇▇▇-▇▇▇-▇▇▇▇ Return a copy to: ▇▇▇▇▇▇▇ Fund Distributors, Inc. Retirement Plan Services ▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇▇ FLEX I-PLAN Profit Sharing Plan Plan number 005 Adoption Agreement The undersigned (the "Employer") establishes, or amends, the (▇▇▇▇▇▇▇ automatically inserts employer's name) Profit Sharing Plan, by completing this Adoption Agreement adopting or amending the Profit Sharing Plan in the form of the Prototype Plan attached.