Richworth Benefits Management : simplebooklet.com

R ichworth Management is pleased to provide a variety of insurance benefits. You may select the insurance that best fits your needs. You are eligible for benefits if you are a regular, full-time employee working an average of 30 hours per week. Your coverage is effective the first of the month after you have completed 60 days of full-time employment. Enrollment must be completed within 31 days of the date of eligibility. Once your enrollment is completed, no changes will be allowed until the next annual open enrollment period unless you have a Qualifying Life Event or your hours worked per week drop below the minimum. The policy year runs from January 1, 2024 to December 31, 2024; however, the company reserves the right to make changes to the policies at anytime as well as the right to require appropriate documentation to prove your dependent relationship status including marriage, birth, tax returns and other legal documents. You may also enroll eligible dependents for benefits coverage. The cost to you for dependent coverage will vary depending on the number of dependents you enroll in the plan and the particular plans you choose. When covering dependents, you must select the same plans for your dependents as you select for yourself. Eligible Dependents include:  Your legal spouse Children under the age of 26, regardless of studentstatus, dependency or marital status* Natural Child* Legally Adopted Child* Step child* Child for who you or your spouse are the legal guardian as long as you have the sole legal right and obligation to provide support and medical care  Children who are fully dependent on you for supportdue to a mental or physical disability and who areindicated as such on your federal tax return; maycontinue coverage past age 26.Qualifying Life Events Once you elect your benefit options, they will remain in effect for the entire plan year until the following Open Enrollment. You may only change coverage during the plan year if you have a Qualifying Life Event, and you must do so within 30 days of the event. Qualifying Life Events include:  Marriage, divorce, legal separation or annulment Birth, adoption or placement for adoption of aneligible child Death of a spouse or child Change in your spouse’s employment that affectsbenefits eligibility  Change in your child’s eligibility for benefits(reaching the age limit) Change in residence that affects your eligibilityfor coverage Significant change in coverage or cost in your,your spouse’s or child’s benefit plans FMLA Leave, COBRA event, Court Judgment orDecree Becoming eligible for Medicare or Medicaid Receiving a Qualified Medical Child SupportOrderIf you have a Qualifying Life Event and want to request a mid-year change, you must notify Human Resources and complete your election changes within 30 days following the event. Be prepared to provide documentation to support the Qualifying Life Event. Eligibility 1

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Enrollment Instructions ENROLL IN YOUR BENEFITS: One step at a timeStep 1: Log InGo to ǁǁǁ͘ďĞŶĞĨŝƚƐŝŶŚĂŶĚ͘ĐŽŵand click Login• Returning users: Log in with the username and password you selected. ,I\RXKDYHIRUJRWWHQ\RXUSDVVZRUG&OLFN5HVHWDIRUJRWWHQSDVVZRUG• First time users: Click on your Registration Link in the email sent to youby your admin or Register as a new user. Create an account, andcreate your own username and password.ŽŵƉĂŶǇ/ĚĞŶƚŝĨŝĞƌ͗RWORTHStep 2: Welcome! After you login click Let’s Begin to complete your required tasks.Step 3: Onboarding (For ﬁrst time users, if applicable)Complete any assigned onboarding tasks before enrolling in your beneﬁts. Once you’ve completed your tasks click Start Enrollment to begin your enrollments. Step 4: Start EnrollmentsAfter clicking Start Enrollment, you’ll need to complete some personal & dependent information before moving to your beneﬁt elections.Have dependent details handy. To enroll a dependent in coverage you will need their date of birth and Social Security number.T I Pif you hit “Dismiss, complete later” you’ll be taken to your Home Page. You’ll still be able to start enrollments again by clicking “Start Enrollments”T I P2

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Enrollment Instructions Step 6: FormsIf you have elected beneﬁts that require a beneﬁciary designation, Primary Care Physician, or completion of an Evidence of Insurability form, you will be prompted to add in those details.Step 7: Review & Conﬁrm ElectionsReview the beneﬁts you selected on the enrollment summary page to make sure they are correct then click Sign & Agree to complete your enrollment. You can either print a summary of your elections for your records or login at any point during the year to view your summary online.Step 8: HR Tasks (if applicable)To complete any required HR tasks, click Start Tasks. If your HR department has not assigned any tasks, you’re ﬁnished! You can login to review your beneﬁts 24/7If you miss a step you’ll see Enrollment Not Complete in the progress bar with the incomplete steps highlighted. Click on any incomplete steps to complete them.T I PClick Save & Continue at the bottom of each screen to save your elections.If you do not want a beneﬁt, click Don’t want this beneﬁt? at the bottom of the screen and select a reason from the drop-down menu.Step 5: Beneﬁt ElectionsTo enroll dependents in a beneﬁt, click the checkbox next to the dependent’s name under Who am I enrolling? Below your dependents you can view your available plans and the cost per pay. To elect a beneﬁt, click Select Plan underneath the plan cost.3

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Medical Blue Cross Blue Shield Base Pan Middle Plan Buy Up Plan Plan Name B661CHC (HSA) S660CHC P621CHC In Network Blue Choice Blue Choice Blue Choice Individual Deducble $7,100 $6,250 $1,250 Family Deducble $14,200 $12,500 $3,750 Max Out of Pocket‐Individual (Including Deducble) $7,100 $9,000 $1,250 Max Out of Pocket‐Family $14,200 $18,000 $3,750 Coinsurance 100/0 90/10 100/0 Physician Services Primary Care Deducble $45 $25 Specialist Deducble $90 $45 Virtual Visits ‐ MDLIVE Deducble $45 $25 Simple Lab & X‐ray Deducble Deducble + 10% Deducble then 100% Other Services Hospital Admission Deducble 350 + Deducble + 10% $150 + Deducble then 100% Outpaent Surgery Deducble $300 + Deducble + 10% $100 + Deducble then 100% Emergency Room $650 + Deducble $500 + Deducble + 10% $400 + Deducble then 100% Urgent Care Deducble $80 $25 Complex Imaging Deducble $300 $250 Prescripon Drugs Preferred Non‐Preferred Preferred Non‐Preferred Rx Deducble Intrgated with Medical None None None None Tier I Deducble $0 $10 $0 $10 Tier II Deducble $10 $20 $10 $20 Tier III Deducble $50 $70 $35 $55 Tier IV Deducble $100 $120 $75 $95 Tier V Tier V & VI ‐ Deducble Tier V ‐ $150; Tier VI ‐ $250 Tier V ‐ $150; Tier VI ‐ $250 Mail Order ‐ 90 day sup‐3X Copay 3X Preferred Copay 3X Preferred Copay Out of Network Deducble $14,200 / $28,400 $12,500 / $25,000 $2,500 / $7,500 MaximumOutofPocket$14,200 / $28,400 Unlimited Unlimited Coinsurance100/0 70/30 80/20 Employee Only $0.00 $51.12 $230.61 Employee+Spouse $241.26 $343.47 $702.45 Employee+Child(ren) $283.76 $343.47 $702.45 Employee+Family $525.00 $635.82 $1,174.29 Employee Semi Monthly Payroll 4

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5101 SOUTH COMMERCE DRIVEMURRAY, UT 84107Corporate (801)262-7475Customer Service (800)662-5851EMIHealth.comRichworth Hospitality (Plan #7719)Summit Plus IndemnityEducators Health Plans Life, Accident and Health, Inc.Voluntary / Fully Insured1/1/2024CalendarIn-NetworkGroup:Plan:Underwritten & Administered by:Plan Type:Effective Date:Benefit Year:Type 3 - Major50% 50% up to R&CCrowns, Bridges, ProsthodonticsType 4 - OrthodonticsNo Coverage No CoverageDependent children ages 7 through 18Out-of-NetworkType 1 - Preventive100% 100% up to R&COral Exams, Cleanings, X-rays, FluorideType 2 - Basic80% 80% up to R&CFillings, Oral SurgeryEndodontics Type 3 - Major Type 3 - MajorPeriodontics Type 3 - Major Type 3 - MajorAdultsNo Coverage No CoverageWaiting periodsSealants Type 2 - Basic Type 2 - BasicSpace Maintainers Type 2 - Basic Type 2 - BasicDeductible In and Out of Network Deductibles are CombinedPer Person $50.00 $50.00Family Max $150.00 $150.00Type 2 - Basic NoneType 3 - Major 12 Month Waiting PeriodType 4 - Orthodontics N / ANetwork (Utah) Premier (EMI Health) N/ASemi Monthly Payroll RatesEmployee$12.65Deductible Applies To Type 2 & Type 3 Type 2 & Type 3Annual Maximum Per Person $1,000.00Orthodontic Lifetime Maximum N / ANetwork (Texas & Outside Utah) Summit Plus (Cigna) N/AFee Schedule Summit Plus R & C (80th)Provisions / Limitations / ExclusionsExams (including Periodontal), Cleanings and Fluoride 2 per yearFluoride Up to age 16Sealants Up to age 16Employee + Spouse$26.35Employee + Child(ren) $26.85Employee + Spouse + Child(ren) $41.20Panoramic X-Ray 1 every 3 yearsImpacted Teeth Covered in Type 2 - BasicAnesthesia - (Age 8 and over for the extraction of impacted teeth only) Covered in Type 3 - Major*Space Maintainers Up to age 16Bitewing X-Rays Up to 4, twice per yearPeriapical X-Rays 6 per yearFillings on the same surface 1 every 18 monthsBenefits illustrated are in summary only. Refer to your certificate for a complete description of benefits, limitations and exclusions.Anesthesia - (For children age 7 and under, once per year) Covered in Type 3 - Major*Implants / Implant Abutments Not CoveredCrowns, Pontics, Abutments, Onlays and Dentures 1 every 5 years per tooth* Anesthesia is not subject to waiting periods.When using a Non-participating Provider, the insured is responsible for all fees in excess of the Reasonable and Customary Charges (R&C).DENTAL6

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Corporate (801)262-7475Customer Service (800)662-5851EMIHealth.comGroup:Richworth Hospitality (Plan #7719)Plan: VSP Plus 10-1601/1/2024Plan Type: VoluntaryIn-NetworkOut-of-Network$10 Co-pay Up to $65$10 Co-payUp to $30$10 Co-payUp to $50$10 Co-payUp to $65$10 Co-payUp to $100$0 Co-pay$95-$105 Co-pay$150-$175 Co-pay$17 Co-pay$15 Co-pay$75 Co-pay$31 Co-pay SV/$35 Co-Pay Multifocal$0 Copay$17 Co-pay$41 Co-pay$16 Co-payUp to 25% Discount$160 Allowance at any VSP doctor or $90 at Costco, Sam's Club or WalmartUp to $80 Up to 20% Off RetailN/A$160 Allowance Up to $145 Up to $500 in Savings Not CoveredUnderwritten by: Educators Health Plans Life, Accident & HealthEHPL.TX.V.VSP.SCH.DEffective Date:Lenses (Glass or Plastic)Single VisionVSP Choice PlusLenticularWellVision ExamNetworkProgressive (Standard no-line)Lined Bifocal Lined Trifocal Lens OptionsAdditional lens enhancements Scratch Resistant CoatingPlastic Gradient DyeSolid Plastic DyePhotochromic LensesPolycarbonate for AdultsThe reimbursement outlined under the Lenses section is a total reimbursement for lenses and any lens enhancements elected.Anti-Reflective CoatingUV ProtectionPolycarbonate for Children (under 18)CoatingsThe reimbursement outlined under the Lenses section is a total reimbursement for lenses and any lens enhancements elected.Custom Progressive OptionsPremium Progressive OptionsAllowance Based on Retail PricingAdditional Pairs of Glasses**Elective Contact Lenses In Lieu of Frame & LensesFrames*** Discounts average 15-20% off or 5% off a promotional offer for laser surgery, including PRK, LASIK, Custom LASIK, and IntraLase3 ** 20% discount off unlimited additional pairs of glasses offered through any VSP Choice Providers within 12 months of last covered eye exam.This is a summary of plan benefits. The actual Policy will detail all plan limitations and exclusions.NotesLASIK***Semi Monthly Payroll RatesEmployeeEmployee + SpouseEmployee + Child(ren)Employee + Spouse + Child(ren)Voluntary$5.00$10.70 $11.40 $16.40 Exam, Lenses, Frame or ContactsRefractive SurgeryElective contact lens fitting, evaluation services and prescription contact lenses are covered up to plan allowance. 15% discount given off contact lens fitting and evaluation services, excluding materials.FrequencyEvery 12 MonthsVision7

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45103Voluntary Term Life InsuranceWe’ve Got You CoveredAs an active employee of Richworth Hospitality, you haveaccess to a life insurance policy from United of Omaha LifeInsurance Company.It replaces the income you would have provided, and helps payfuneral costs, manage debt and cover ongoing expenses.How much insurance is enough?When determining how much life insurance you need, thinkabout the expenses you may encounter now and through everystage of your life.Coverage guidelines and benefits are outlined in the chart below.ELIGIBILITY - ALL ELIGIBLE EMPLOYEESEligibility Requirement You must be actively working a minimum of 30 hours per week to be eligible forcoverage.Dependent EligibilityRequirementTo be eligible for coverage, your dependents must be able to perform normalactivities, and not be confined (at home, in a hospital, or in any other care facility),and any child(ren) must be under age 26. In order for your spouse and/orchild(ren) to be eligible for coverage, you must elect coverage for yourself.Premium Payment The premiums for this insurance are paid in full by you.COVERAGE GUIDELINESMinimum Guarantee Issue MaximumFor You $10,000 5 times annual salary, up to$100,000$300,000, in increments of$10,000, but no more than 5times annual salarySpouse $5,000 100% of employee’s benefit,up to $30,000100% of employee’s benefit, inincrements of $5,000, up to$150,000Child(ren) $2,000 100% of employee’s benefit 100% of employee’s benefit, inincrements of $1,000, up to$10,0008

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Subject to any reductions shown below. Guarantee Issue is available to new hires. Amounts over the Guarantee Issue will require ahealth application/evidence of insurability. For late entrants, all amounts will require a health application/evidence of insurability.BENEFITSLife InsuranceBenefit AmountWithin the coverage guidelines defined above, you select the amount of life insurance coverageyou want.This plan includes the option to select coverage for your spouse and dependent child(ren).Child(ren) include those up to age 26.In the event of death, the benefit paid will be equal to the benefit amount after any age reductionsless any living care/accelerated death benefits previously paid under this plan.AccidentalDeath &Dismemberment(AD&D) BenefitAmountFor you, your spouse and your dependent child(ren): The Principal Sum amount is equal to theamount of the life insurance benefit.AD&D coverage is available if you or your dependents are injured or die as a result of an accident,and the injury or death is independent of sickness and all other causes. The benefit amountdepends on the type of loss incurred, and is either all or a portion of the Principal Sum.FEATURESLiving Care/AcceleratedDeath Benefit80% of the amount of the life insurance benefit is available to you if terminally ill, not to exceed$240,000.Waiver ofPremiumIf it is determined that you are totally disabled, your life insurance benefit will continue withoutpayment of premium, subject to certain conditions.Annual BenefitAmountIncreaseIf you enroll for even the minimum amount of coverage during your initial enrollment, you have theability to increase your coverage at your next enrollment by up to $10,000, provided the totalamount of insurance does not exceed your maximum benefit amount. This feature allows you tosecure additional life insurance protection in the event your needs change (ex. you get married orhave a child). Amounts over the Guarantee Issue will require evidence of insurability (proof of goodhealth).AdditionalAD&D BenefitsIn addition to basic AD&D benefits, you are protected by the following benefits:- Seat Belt - Airbag - Spouse Education- Coma- Repatriation- Common Carrier - ParalysisPortability Allows you to continue this insurance program for yourself and your dependents should you leaveyour employer for any reason, without having to provide evidence of insurability (information aboutyour health). You will be responsible for the premium for the coverage.Conversion If your employment or class membership ends, you may apply for an individual life insurance policyfrom Mutual of Omaha without having to provide evidence of insurability (information about yourhealth). You will be responsible for the premium for the coverage.SERVICESHearingDiscountProgramThe Hearing Discount Program provides you and your family discounted hearing products,including hearing aids and batteries. Call 1-888-534-1747 or visitwww.amplifonusa.com/mutualofomaha to learn more.Will PrepServicesWe work with Epoq, Inc. to offer employees online will prep tools. In just a few clicks you cancomplete a basic will or other documents to protect your family and property. To get started visitwww.willprepservices.com.9

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Voluntary Term Life and AD&D Coverage Selection and Premium CalculationPlease note that the premium amounts presented below mayvary slightly from the amounts provided on your enrollmentform, due to rounding.To select your benefit amount and calculate your premium,do the following:1) Locate the benefit amount you want from the top row of theemployee premium table. Your benefit amount must be inan increment of $10,000. Refer to the Coverage Guidelinessection for minimums and maximums, if needed.2) Find your age bracket in the far left column.3) Your premium amount is found in the box where the row(your age) and the column (benefit amount) intersect.4) Enter the benefit and premium amounts into their respectiveareas in the Voluntary Life and AD&D section of yourenrollment form.If the benefit amount you want to select is greater than anyamount in the table below, select the benefit amount from the toprow that when multiplied by another number results in the benefitamount you want. For example, if you want $150,000 incoverage, you obtain your premium amount by multiplying therate for $50,000 times 3.EMPLOYEE PREMIUM TABLE (24 PAYROLL DEDUCTIONS PER YEAR)Age $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000 $100,0000 - 29$0.45 $0.90 $1.35 $1.80 $2.25 $2.70 $3.15 $3.60 $4.05 $4.5030 - 34$0.50 $1.00 $1.50 $2.00 $2.50 $3.00 $3.50 $4.00 $4.50 $5.0035 - 39$0.60 $1.20 $1.80 $2.40 $3.00 $3.60 $4.20 $4.80 $5.40 $6.0040 - 44$0.80 $1.60 $2.40 $3.20 $4.00 $4.80 $5.60 $6.40 $7.20 $8.0045 - 49$1.30 $2.60 $3.90 $5.20 $6.50 $7.80 $9.10 $10.40 $11.70 $13.0050 - 54$2.05 $4.10 $6.15 $8.20 $10.25 $12.30 $14.35 $16.40 $18.45 $20.5055 - 59$3.10 $6.20 $9.30 $12.40 $15.50 $18.60 $21.70 $24.80 $27.90 $31.0060 - 64$4.75 $9.50 $14.25 $19.00 $23.75 $28.50 $33.25 $38.00 $42.75 $47.5065 - 69$8.40 $16.80 $25.20 $33.60 $42.00 $50.40 $58.80 $67.20 $75.60 $84.0070 - 74$14.95 $29.90 $44.85 $59.80 $74.75 $89.70 $104.65 $119.60 $134.55 $149.5075 - 79$24.55 $49.10 $73.65 $98.20 $122.75 $147.30 $171.85 $196.40 $220.95 $245.5080+$49.55 $99.10 $148.65 $198.20 $247.75 $297.30 $346.85 $396.40 $445.95 $495.50Follow the method described above to select a benefit amount and calculate premiums for optional dependent spouse and/orchild(ren) coverage. Your spouse’s rate is based on your age, so find your age bracket in the far left column of the SpousePremium Table. Your spouse’s premium amount is found in the box where the row (the age) and the column (benefit amount)intersect. Your spouse’s benefit amount must be in an increment of $5,000. Refer to the Coverage Guidelines section forminimums and maximums, if needed.SPOUSE PREMIUM TABLE (24 PAYROLL DEDUCTIONS PER YEAR)Age $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,0000 - 29$0.23 $0.45 $0.68 $0.90 $1.13 $1.35 $1.58 $1.80 $2.03 $2.2530 - 34$0.25 $0.50 $0.75 $1.00 $1.25 $1.50 $1.75 $2.00 $2.25 $2.5035 - 39$0.30 $0.60 $0.90 $1.20 $1.50 $1.80 $2.10 $2.40 $2.70 $3.0040 - 44$0.40 $0.80 $1.20 $1.60 $2.00 $2.40 $2.80 $3.20 $3.60 $4.0045 - 49$0.65 $1.30 $1.95 $2.60 $3.25 $3.90 $4.55 $5.20 $5.85 $6.5050 - 54$1.03 $2.05 $3.08 $4.10 $5.13 $6.15 $7.18 $8.20 $9.23 $10.2555 - 59$1.55 $3.10 $4.65 $6.20 $7.75 $9.30 $10.85 $12.40 $13.95 $15.5060 - 64$2.38 $4.75 $7.13 $9.50 $11.88 $14.25 $16.63 $19.00 $21.38 $23.7565 - 69$4.20 $8.40 $12.60 $16.80 $21.00 $25.20 $29.40 $33.60 $37.80 $42.00ALL CHILDREN PREMIUM TABLE (24 PAYROLL DEDUCTIONS PER YEAR)*$2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000 $10,000$0.20 $0.30 $0.40 $0.50 $0.60 $0.70 $0.80 $0.90 $1.00*Regardless of how many children you have, they are included in the "All Children" premium amounts listed in the table above.10

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Group Critical Illness Plan 1 – Critical Illness Benefits Critical illness insurance helps supplement major medical coverage by providing a lump- sum benefit the policyholder can use to pay for expenses associated with a heart attack, stroke or other covered critical illness. These benefits can help pay for recovery expenses, additional medical procedures or any other way they choose. Guarantee Issue during Initial Enrollment.Benefit amounts available: $10,000Spouse coverage is available at 50% of the employee coverage PLAN 1: Full Critical Illness Benefits with Subsequent Diagnosis, $50 Health Screening Benefit Rates shown semi-monthly (24)12

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Filing online means never waiting for mail or dealing with fax machines and complex paper forms . Our guided question wizard walks you through the process and checks for missing information that could cause delays. Opting for direct deposit can also get approved payments to you up to a week faster than paper check. NEED TO FILE A CLAIM?Here’s what you can do on Colonial Life for Policyholders:Update yourpersonal info& preferencesFile claimswith a simple,guided form Opt for instant alerts by email or textView claim statusor policy details anytimeCheck your claim status by logging into your account at ColonialLife.com/access. You can also sign up for text or email alerts so you know instantly if status changes or more information is needed. For your convenience, you can login anytime with a mobile device to photograph and upload documents with your camera.AFTER YOU FILE:Find out how simple your claims and beneﬁts experience can be by learning more about the Colonial Life for Policyholders portal. Just visit ColonialLife.com to see what this online account administration platform can do for you.LEARN MOREBECOME A MEMBER TODAY:Go to ColonialLife.com/access to register.Click “create an account”, ﬁll out the required information and click Submit.Enjoy faster service and improved beneﬁts awareness.123THE PORTALOFFERS YOU:Faster service than calling/emailingConﬁrmation when a claim has been submittedSimpliﬁed bill payment and managementAnswers to frequently asked questions and live chat assistance if you don’t see what you are looking for.Colonial Life for Policyholders PortalA faster, simpler way to manage your beneﬁtsColonial Life for Policyholders is an online portal created with you in mind. It’s the most convenient and ecient way to ﬁle a claim and manage your beneﬁts. Colonial Life products are underwritten by Colonial Life & Accident Insurance Company, Columbia, SC. ©2022 Colonial Life & Accident Insurance Company. All rights reserved. Colonial Life is a registered trademark and marketing brand of Colonial Life & Accident Insurance Company.43233-41Set up directdeposit forapproved payments16

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Let's take a tour of your dashboardMy EMI Health AccountNote: not all of these blocks may appear on your dashboard. This guide covers all that may possibly show up, but they may not apply to the EMI Health plans you are enrolled in. Welcome to the your member dashboard! In less than 30 seconds, you can see everything you need to know.12431View your member ID cardView, download, or print your EMI Health ID card by clicking on ?View Your Member ID Card? button.2See your plan documentsHere are the plans you are currently enrolled in through EMI Health. From here, you can view your plan documents (your coverage grids and/ or fee schedules if applicable) and access your pharmacy tools. 3View and sort your recent claimsUse the toggles to filter and sort your claims by type, covered member, network, and date range. View your Explanation of Benefits (EOBs) documents by clicking on ?View EOB? to the right of each claim. Note: These documents are not mailed, so it's important to check your dashboard regularly for any new EOBs that come into your account.4At- a- glance accumulatorsIn this block, you are able to see your progress towards applicable plan accumulators for medical and dental plans. Use the drop down options at the top to switch between covered members on your plan, time period, and accumulator type.21

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Bonus tools included with your accountBelow your account tools, you can scroll through some additional tools included with your plan to help you save money and get the most out of your EMI Health benefits. (What you will see in your dashboard depends on the plans you are currently enrolled in with EMI Health.)$0 Copay TeleMedYou can speak to a board- certified physician for FREE anytime, anywhere. You can save money and time by avoiding the doctor?s office, urgent care, and emergency room visits for acute, non- emergency illnesses or injuries. Be Well - Wellness Platform powered by WebMDBe Well puts you in the driver?s seat when it comes to your health and wellness goals. Your platform is customized to your health profile and your interests, so the resources, challenges, and recommendations you can access in this platform are tailored to you. Setup your My EMI Health AccountIf you haven?t set up your My EMI Health account yet, here are the instructions:- Go to emihealth.com.- Click Login and select My EMI Health.- Select Register and choose Member as the type of account.- Enter the data to identify yourself and click Continue.* You will need your Member ID found on your EMI Health ID card. Also, for your security, your password must be at least six characters and include a special character, e.g., !, @, #, $, etc.**Please note that you will only make an EMI Health account for your family through the plan subscriber. Dependents and spouses will not have their own account.22

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Card FrontYour ID Card (front)It is important that you present your ID card each time you receive services. Your EMI Health ID card contains a lot of useful information for you and your provider. DECBAGHFDThese are your participating provider dental networks outside of Utah. To verify a provider's status, visit em ihealth.com or call 800-662-5851.If this section is not on your card, you do not have dental coverage through EMI Health. CIf you have dental coverage with EMI Health, the nam e of your dental plan will appear here. This also indicates your dental participating provider network. To verify a provider's status, visit em ihealth.com or call 800-662-5851. BThe em ployee's nam e is listed on the ID card. Covered dependents are not listed.AEMI Health is your dental and vision insurance carrier.HThis is the telephone num ber to call for custom er service inquiries. GIf you have vision coverage with EMI Health, the nam e of your vision plan will appear here. This also indicates your vision participating provider network. To verify a provider's status, visit em ihealth.com or call 800-662-5851. If this section is not on your card, you do not have vision coverage through EMI Health.FYour unique m em ber num ber is required in order to verify coverage, determ ine benefits, and pay claim s for you and your dependents. EThis is the claim s subm ission address for all dental claim s. In m ost cases, your provider will subm it claim s directly to EMI Health. 24

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This information describes some of the features of the benefits plan. Benefits may not be available in all states. Please refer to the certificatebooklet for a full explanation of the plan's benefits, exclusions, limitations and reductions. Should there be any discrepancy between thecertificate booklet and this outline, the certificate booklet will prevail. Availability of benefits is subject to final acceptance and approval ofthe group application by the underwriting company. Life insurance and accidental death & dismemberment insurance are underwritten byUnited of Omaha Life Insurance Company, 3300 Mutual of Omaha Plaza, Omaha, NE 68175. Policy form number G2018MP or stateequivalent (in NC: G2018MP NC). United of Omaha Life Insurance Company is licensed nationwide, except New York.VOLUNTARY LIFE INSURANCEWho is eligible for this insurance?You must be actively working (performing all normal duties of your job) at least 30 hours per week.Your dependent(s) must be performing normal activities and not be confined (at home or in a hospital/care facility) and anychild(ren) must be under age 26.What is Guarantee Issue?The amount of insurance applied for without answering any health questions (or which does not require evidence of insurability).Coverage amounts over the Guarantee Issue Amount will require evidence of insurability.What is Evidence of Insurability?Evidence of Insurability or proof of good health – may be required if you are a late entrant and/or you request any additionalcoverage above your guarantee issue amount.Can I take this insurance with me if I change jobs/am no longer a member of thisgroup?In the event this insurance ends due to a change in your employment/membership status with the group, or for certain otherreasons, you or your insured spouse may have the right to continue this insurance under the Portability or Conversion provision,subject to certain conditions.Are there any limitations, reductions or exclusions?The benefits payable are based on the following:· Insurance benefits and guarantee issue amounts are subject to age reductions:- At age 65, amounts reduce to 65%- At age 70, amounts reduce to 50%· Spouse coverage terminates when you reach age 70.· Life insurance benefits will not be paid if the insured’s death is the result of suicide within two years from the date coveragebegins. If this occurs, the sum of the premiums paid will be returned to the beneficiary. The same applies for any futureincreases in coverage under this plan.· Information about the AD&D exclusions for this plan will be included in the summary of coverage, which you will receiveafter enrolling.All exclusions may not be applicable, or may be adjusted, as required by state regulations.26

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Required Notices Women’s Health and Cancer Rights Act of 1998 In October 1998, Congress enacted the Women’s Health and Cancer Rights Act of 1998. This notice explains some important provisions of the Act. Please review this information carefully. As specified in the Women’s Health and Cancer Rights Act, a plan participant or beneficiary who elects breast reconstruction in connection with a mastectomy is also entitled to the following benefits:  All stages of reconstruction of the breast on which the mastectomy was performed;  Surgery and reconstruction of the other breast to produce a symmetrical appearance; and  Prostheses and treatment of physical complications of the mastectomy, including lymphedema. Health plans must determine the manner of coverage in consul-tation with the attending physician and the patient. Coverage for breast reconstruction and related services may be subject to de-ductibles and coinsurance amounts that are consistent with those that apply to other benefits under the plan. Special Enrollment Rights This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time. Loss of Other Coverage or Becoming Eligible for Medicaid or a state Children’s Health Insurance Program (CHIP) If you are declining coverage for yourself or your dependents because of other health insurance or group health plan coverage, you may be able to later enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage). However, you must enroll within 31 days after your or your dependents’ other coverage ends (or after the employer that sponsors that coverage stops contributing toward the other coverage). If you or your dependents lose eligibility under a Medicaid plan or CHIP, or if you or your dependents become eligible for a subsidy under Medicaid or CHIP, you may be able to enroll yourself and your dependents in this plan. You must provide notification within 60 days after you or your dependent is termi-nated from, or determined to be eligible for such assistance. Marriage, Birth or Adoption If you have a new dependent as a result of a marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must enroll within 31 days after the marriage, birth, or placement for adoption. For More Information or Assistance To request special enrollment or obtain more information contact: Richworth Management 1610 Shadywood Ln Mt. Pleasant, TX 75455 Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Richworth Management and about your op-tions under Medicare’s prescription drug coverage. This infor-mation can help you decide whether or not you want to enroll in a Medicare drug plan. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice. If neither you nor any of your covered dependents are eligible for or have Medicare, this notice does not apply to you or the dependents, as the case may be. However, you should still keep a copy of this notice in the event you or a dependent should qualify for coverage under Medicare in the future. Please note, however, that later notices might supersede this notice. 1. Medicare prescription drug coverage became available in 2006 to everyone with Medicare. You can get this coverage through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that offers prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium. 2. Richworth Management has determined that the pre-scription drug coverage offered by the BlueCross BlueShield medical plan is, on average for all plan partici-pants, expected to pay out as much as the standard Medicare prescription drug coverage pays and is considered Credita-ble Coverage. The HSA plan is not considered Creditable Coverage. Because your existing coverage is, on average, at least as good as standard Medicare prescription drug coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to enroll in a Medicare prescription drug plan, as long as you later enroll within specific time periods. You can enroll in a Medicare prescription drug plan when you first become eligible for Medicare. If you decide to wait to en-roll in a Medicare prescription drug plan, you may enroll later, during Medicare Part D’s annual enrollment period, which runs each year from October 15 through December 7 but as a general rule, if you delay your enrollment in Medicare Part D, after first becoming eligible to enroll, you may have to pay a higher pre-mium (a penalty). 28

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You should compare your current coverage, including which drugs are covered at what cost, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. See the Plan’s summary plan description for a summary of the Plan’s prescription drug coverage. If you don’t have a copy, you can get one by contacting Richworth Management at the phone number or address listed at the end of this section. If you choose to enroll in a Medicare prescription drug plan and cancel your current prescription drug coverage, be aware that you and your dependents may not be able to get this coverage back. To regain coverage, you would have to re-enroll in the Plan, pursuant to the Plan’s eligibility and enrollment rules. You should review the Plan’s summary plan description to de-termine if and when you are allowed to add coverage. If you cancel or lose your current coverage and do not have prescription drug coverage for 63 days or longer prior to enrolling in the Medicare prescription drug coverage, your monthly premium will be at least 1% per month greater for every month that you did not have coverage for as long as you have Medicare prescription drug coverage. For example, if nineteen months lapse without coverage, your premium will always be at least 19% higher than it would have been without the lapse in coverage. For more information about this notice or your current prescription drug coverage: Contact the Higginbotham at 903-572-4366. NOTE: You will receive this notice annually and at other times in the future, such as before the next period you can enroll in Medicare prescription drug coverage and if this coverage changes. You may also request a copy. For more information about your options under Medicare prescription drug coverage: More detailed information about Medicare plans that offer pre-scription drug coverage is in the “Medicare & You” handbook. You will get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare pre-scription drug plans. For more information about Medicare pre-scription drug coverage:  Visit www.medicare.gov.  Call your State Health Insurance Assistance Program (see the inside back cover of your copy of the “Medicare & You” handbook for their telephone number) for personal-ized help.  Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 877-486-2048. If you have limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this help is available from the Social Security Administra-tion (SSA) online at www.socialsecurity.gov, or you can call them at 800-772-1213. TTY users should call 800-325-0778. Remember: Keep this Cr editable Cover age notice. If you enroll in one of the new plans approved by Medicare which offer prescription drug coverage, you may be required to pro-vide a copy of this notice when you join to show whether or not you have maintained creditable coverage and whether or not you are required to pay a higher premium (a penalty). Date: 1/1/2024 Richworth Management 1610 Shadywood Ln Mt. Pleasant, TX 75455 Notice of HIPAA Privacy Practices This notice describes how medical information about you may be used and disclosed and how you can access this infor-mation. Please review it carefully. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on employer health plans concerning the use and disclosure of individual health information. This information known as protected health information (PHI), includes virtually all individually identifiable health information held by a health plan - whether received in writing, in an electronic medium or as oral com-munication. This notice describes the privacy practices of the Employee Benefits Plan (referred to in this notice as the Plan), sponsored by Spring Creek Enterprises, hereinafter referred to as the plan sponsor. The Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan’s legal duties and privacy practices with respect to your health information. It is important to note that these rules ap-ply to the Plan, not the plan sponsor as an employer. You have the right to inspect and copy protected health infor-mation which is maintained by and for the Plan for enroll-ment, payment, claims and case management. If you feel that protected health information about you is incorrect or incom-plete, you may ask the Human Resources Department to amend the information. For a full copy of the Notice of Priva-cy Practices describing how protected health information about you may be used and disclosed and how you can get access to the information, contact the Human Resources De-partment. Complaints: If you believe your privacy rights have been vio-lated, you may complain to the Plan and to the Secretary of Health and Human Services. You will not be retaliated against for filing a complaint. To file a complaint, please contact the Privacy Officer. Richworth Management 1610 Shadywood Ln Mt. Pleasant, TX 75455 Required Notices 29

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Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP) If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from your employer, your State may have a premium assistance program that can help pay for coverage using funds from their Medicaid and CHIP pro-grams. If you or your children are not eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance pro-grams but you may be able to buy individual coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed, you can contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your em-ployer plan, your employer must allow you to enroll in your employer plan if you are not already enrolled. This is called a “special enrollment” opportunity, and you must request cover-age within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your em-ployer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272). If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of July 31, 2018. Contact your State for further information on eligibility. TEXAS – Medicaid Website: http://www.gethipptexas.com/ Phone: 1-800-440-0493 To see if any more States have added a premium assistance pro-gram since July 31, 2018 or for more information on special enrollment rights, you can contact either: U.S. Department of Labor Employee Benefits Security Administration www.dol.gov/ebsa 1-866-444-EBSA (3272) U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services www.cms.hhs.gov 1-877-267-2323, Menu option 4, Ext. 61565 Required Notices Continuation of Coverage Rights Under COBRA The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in cov-erage through the Marketplace, you may qualify for lower monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees. What is COBRA continuation coverage? COBRA continuation coverage is a continuation of Plan cov-erage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your depend-ent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:  Your hours of employment are reduced, or  Your employment ends for any reason other than your gross misconduct. If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:  Your spouse dies  Your spouse’s hours of employment are reduced;  Your spouse’s employment ends for any reason other than his or her gross misconduct;  Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or  You become divorced or legally separated from your spouse. 30

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Required Notices New Health Insurance Marketplace Cover-age Options and Your Health Coverage PART A: General Information With key parts of the health care law now in effect, there is a new way to buy health insurance: the Health Insurance Marketplace. To assist you in evaluating options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by the employer. What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance op-tions. You may also be eligible for a new kind of tax credit that low-ers your monthly premium right away. Open enrollment for health insurance coverage through the Market-place begins in November for coverage starting as early as January 1. Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers cover-age that doesn’t meet certain standards. The savings on your premi-um that you’re eligible for depends on your household income. Does Employer Health Coverage Affect Eligibility for Premi-um Savings through the Marketplace? Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan. However, you may be eligible for a tax credit that low-ers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the “minimum value” standard set by the Affordable Care Act, you may be eligible for a tax credit. Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution – as well as your employee contribution to employer-offered coverage-is often ex-cluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. How Can I Get More Information? For more information about your coverage offered by your employ-er, please check your summary plan description or your Human Resources Administrator. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area. PART B: Information About Health Coverage Offered by Your Employer This section contains information about any health coverage of-fered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application. PART B: Information About Health Coverage Offered by Your Employer Continued Here is some basic information about health coverage offered by this employer: As your employer, we offer a health plan to:  Full-time associate who work a minimum of 30 hours per week and are at least 18 years of age are eligible to participate in the benefits program. Enrollment must be completed with-in 31 days of the date of eligibility.  Once your enrollment is completed, no changes will be al-lowed until the next annual open enrollment period unless you have Qualifying Life Event or your hours worked per week drop below the minimum.  Additional information regarding Eligibility can be found on pg 3. With respect to dependents:  Your eligible dependents include: —Your legally-married spouse. —Your children from birth to age 26 —Your unmarried dependent children of any age who are mentally or physically disabled and who are dependent on you for support.  Children include: —Natural children —Legally-adopted children (or children place with you for adoption) —Stepchildren —Children for whom you or your spouse are the legal guardian, as long as you have the sole legal right and obligation to provide support and medical care.  Dependent coverage takes effect on the same date your cover-age begins. You may be asked to provide evidence that your dependents meet the eligibility requirements, such as birth certificate, adoption or guardianship papers, a marriage li-cense or a federal income tax return.  Additional info regarding Dependents found on pg 3.  This coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages. 31

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Required Notices Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following quali-fying events:  The parent-employee dies;  The parent-employee’s hours of employment are reduced;  The parent-employee’s employment ends for any reason oth-er than his or her gross misconduct;  The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);  The parents become divorced or legally separated; or the child stops being eligible for coverage under the Plans as a “dependent child.” When is COBRA continuation coverage available? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events:  The end of employment or reduction of hours;  Death of the employee;  The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both). For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Admin-istrator within 60 days after the qualifying event occurs. How is COBRA continuation coverage provided? Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be of-fered to each of the qualified beneficiaries. Each qualified benefi-ciary will have an independent right to elect COBRA continua-tion coverage. Covered employees may elect COBRA continua-tion coverage on behalf of their spouses, and parents may elect on behalf of their children. COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. There are also ways this 18-month period of COBRA continuation coverage can be extended: Disability extension of 18-month period of COBRA continua-tion coverage If you or anyone in your family covered under the Plan is deter-mined by Social Security to be disabled and you notify the Plan Administrator timely, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation cov-erage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA contin-uation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage. Second qualifying event extension of 18-month period of continuation coverage If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continua-tion coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose cov-erage under the Plan had the first qualifying event not oc-curred. Are there other coverage options besides COBRA Continu-ation Coverage? Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or oth-er group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continua-tion coverage. You can learn more about many of these op-tions at www.healthcare.gov. If you have questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights un-der the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.healthcare.gov. Keep your Plan informed of address changes To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator. Plan Contact Information: Richworth Management 1610 Shadywood Ln Mt. Pleasant, TX 75455 32

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 Even if your employer intends your coverage to be afforda-ble, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are hourly or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discounts. Newborns’ and Mothers’ Health Protection Act (NMHPA): Group health plans & health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s at-tending provider, after consulting the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans & issuers may not, under federal law, require that a provider obtain authorization from the Plan or the issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). Notice Regarding Wellness Program The employee wellness program is a voluntary program admin-istered according to federal rules permitting employer-sponsored wellness programs that seek to improve employee health or prevent disease, including the Americans with Disabil-ities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accounta-bility Act, as applicable, among others. If you choose to partici-pate in the wellness program you may be asked to complete a voluntary health risk assessment or "HRA" that asks a series of questions about your health-related activities and behaviors and whether you have or had certain medical conditions (e.g., can-cer, diabetes, or heart disease). You may also be asked to com-plete a biometric screening, which could include a blood test for certain medical conditions such as diabetes, heart disease, etc. You are not required to complete the HRA or to participate in the blood test or other medical examinations. However, employees who choose to participate in the wellness program may qualify for an incentive. Although you are not required to complete a HRA or biometric screening, the well-ness program may specify that only employees who do so will If you are unable to participate in any of the health-related activ-ities or achieve any of the health outcomes required to earn an incentive, you may be entitled to a reasonable accommodation or an alternative standard. You may request a reasonable accom-modation or an alternative standard by contacting your HR dept. If you choose to participate in a HRA and/or biometric screen-ing, information from your HRA and results from your bio-metric screening will be used to provide you with information to help you understand your current health & potential risks & may also be used to offer you services through the wellness program. You also are encouraged to share your results or concerns with your own doctor. Protections from Disclosure of Medical Information We are required by law to maintain the privacy and security of your personally identifiable health information. Although the wellness program may use aggregate information it collects to design a program based on identified health risks in the work-place, the wellness program will never disclose any of your per-sonal information publicly or to the employer, except as neces-sary to respond to a request from you for a reasonable accom-modation needed to participate in the wellness program, or as expressly permitted by law. Medical information that personally identifies you provided in connection with the wellness program will not be provided to your supervisors or managers & may never be used to make decisions regarding your employment. Your health information will not be sold, exchanged, trans-ferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness pro-gram, and you will not be asked or required to waive the confi-dentiality of your health information as a condition of participat-ing in the wellness program or receiving an incentive. Anyone who receives your information for purposes of providing you services as part of the wellness program will abide by the same confidentiality requirements. In addition, all medical information obtained through the well-ness program will be maintained separate from your personnel records, information stored electronically will be encrypted, & no information you provide as part of the wellness program will be used in making any employment decision. Appropriate pre-cautions will be taken to avoid any data breach, and in the event a data breach occurs involving information you provide in con-nection with the wellness program, we will notify you immedi-ately. You may not be discriminated against in employment because of the medical information you provide as part of par-ticipating in the wellness program, nor may you be subjected to retaliation if you choose not to participate. If you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact Human Resources. 3. Employer Name: Richworth Management 4. Employer Identification Number (EIN): 26-3860200 5. Employer Address: 1610 Shadywood Ln 6. Employer Phone Number: (903) 572-4366 7. City: Mt. Pleasant 8. State: TX 9. Zip Code: 75455 10. Who can we contact about employee health coverage at this job?: Tammy Bell Required Notices 33

Richworth Benefits Management

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