MEDICAL REIMBURSEMENT PLAN

FOR EMPLOYEES OF
[CompanyName]
A [State] Corporation

SUMMARY PLAN DESCRIPTION

THIS PLAN SUMMARY IS INTENDED TO BE A SUMMARY OF MANY OF

THE PLAN PROVISIONS BUT IS NOT A COMPLETE RESTATEMENT OF THE
PLAN. THE COMPLETE PLAN IS AVAILABLE FOR YOUR REVIEW WHICH
THE EMPLOYER ENCOURAGES SINCE THE PROVISIONS OF THE PLAN ON
ALL MATTERS WILL BE CONTROLLING.

1. Name of Plan:

This Plan is known as the Medical Reimbursement Plan of [Company Name], a

[State] Corporation.

2. Name, Address and Telephone Number of Employer:

[Street Address]
[City], [State] [Zip]
[Phone number]

3. Employer Identification Number:

Your Employer is the Plan Sponsor and the Identification Number assigned to your
Employer by the Internal Revenue Service is ##-#######. Your plan number is 001.

4. Type of Plan:

This is a single employer Employee Welfare Plan through which your employer
provides eligible employees with partial or complete reimbursement for medical expenses
they incur.

5. Plan Administration:

The Board of Directors of your Employer is the Plan Administrator and the business
address and telephone number of your Employer is stated above.

6. Agent for Service of Legal Process:

The person designated as agent for the service of legal process is:

[Name of plan administrator]

[Street Address]
 [City], [State] [Zip]

In addition, service of legal process may be made upon the Plan Administrator.

7. Eligibility:

All active full-time employees who have attained twenty-five (25) years of age and
who have completed one (1) or more Years of Service are eligible for medical
reimbursement under this Plan. Certain employees who are covered by a collective
bargaining agreement may not be covered under this Plan.

8. Plan Benefits:

This Plan provides for the reimbursement for the medical expenses incurred by an
eligible for the medical care of such eligible employee, his or her spouse and dependents
(as defined in Section 152 of the Internal Revenue Code) for whom such eligible
employee furnishes over one-half (1/2) of their support. Expenses for medical care shall
include all amounts paid for hospital bills and co-payments, doctor bills and co-payments,
dental expenses, drugs and premiums on accident or health insurance, including
hospitalization, surgical, and medical insurance.

9. Funding:

The cost of this Plan is met through Employer contributions.

10. Plan Year:

The year for purposes of maintaining plan records ends on December 31.

11. Limitation on Benefits:

(a) The reimbursement provided under this Plan shall be made only in the event and
to the extent that such reimbursement is not provided for under any insurance
policy or policies, whether owned by you or your Employer, under any other
health or accident plan, or under any other recovery providing for
reimbursement or payment in whole or in part.

(b) A Plan Administrator may change or eliminate benefits under the Plan and may
terminate the entire plan or any portion of it. Your individual coverage
terminates when you leave active service, when you are no longer in an eligible
class or when the Plan Administrator terminates the Plan, whichever occurs
first.

12. Claim Procedure:

 (a) To obtain reimbursement for medical expenses, an eligible employee must
submit within 60 days after the end of each calendar quarter a request for
reimbursement for medical expenses incurred by him or her during the
preceding quarter, together with such evidence of payment of such expenses.

(b) Reimbursement shall be made to the eligible employee in the same taxable year
of the Employer as the year of employee payment.

13. Statement of ERISA Rights:

As a participant in this plan you are entitled to certain rights and protections under the
Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all
plan participants shall be entitled to:

(a) Examine, without charge, at the Plan Administrator’s office and at other
specified locations, such as work sites and union halls, all plan documents,
including insurance contracts, collective bargaining agreements and copies of all
documents filed by the plan with the U.S. Department of Labor, such as detailed
annual reports and plan descriptions.
(b) Obtain copies of all plan documents and other plan information upon written
request to the Plan Administrator. The administrator may make a reasonable
charge for the copies.
(c) Receive a summary of the plan’s annual financial report if the plan covers 100
or more participants. The Plan Administrator is required by law to furnish each
participant with a copy of this summary financial report.

In addition to creating rights for plan participants, ERISA imposes duties upon the
people who are responsible for the operation of the employee benefit plan. The people
who operate your plan, called “fiduciaries” of the plan, have a duty to do so prudently
and in the interest of you and other plan participants. No one, including your employer,
your union or any other person, may fire you or otherwise discriminate against you in any
way to prevent you from obtaining a welfare benefit or exercising your rights under
ERISA. If your claim for a welfare benefit is denied in whole or in part, you may receive
a written explanation of the reason for the denial. You have the right to have the plan
review and reconsider your claim.

Under ERISA, there are steps you can take to enforce the above rights. For instance,
if you request materials from the plan and do not receive them within thirty (30) days,
you may file suit in a federal court. In such case, the court may require the Plan
Administrator to provide the materials and pay you up to $100 a day until you receive the
materials, unless the materials were not sent because of reasons beyond the control of the
Administrator.

If you have a claim for benefits which is denied or ignored, in whole or in part, you
may file suit in a state or federal court. If it should happen that plan fiduciaries misuse
the plan’s money or if you are discriminated against for asserting your rights, you may
seek assistance from the U.S. Department of Labor, or you may file suit in a federal
court. The court will decide who should pay court costs and legal fees. If you are
successful the court may order the person you have sued to pay these costs and fees. If
you lose, the court may order you to pay these costs and fees, for example, if it finds your
claim is frivolous.

If you have any questions about your plan, you should contact the Plan Administrator.
If you have any questions about this statement or about your rights under ERISA, you
should contact the nearest Area Office of the U.S. Labor-Management Services
Administration Department of Labor.

____________________________________
Plan Administrator