(ii) Your spouse. (iii) All dependents you list on your federal income tax return. (iv) If you are divorced or separated, any child of yours that is listed as a dependent on his or her other parent's federal income tax return (and certain other individuals in the case of a multiple support agreement). IRS Publication 502, Medical and Dental Expenses, has a checklist of medical expenses that can be deducted and therefore reimbursed under this Plan, and those that cannot. Page 23

Summary Plan Description for Achieva Section 125 and FSA Plan - Page 23 Summary Plan Description for Achieva Section 125 and FSA Plan Page 22 Page 24