Rose and Kiernan, Inc.

Flexible Benefits Plan

Election Form and Compensation Reduction Agreement

Employee Name: ____________________________________________________________________________

Employee Address: __________________________________________________________________________

City, State and Zip: __________________________________________________________________________

Employee Social Security Number: ________________________________ DOB: _______________________

Flexible Spending Plan Year: January 1 through December 31, 2008 Enrollment: Ends December 15th

My employer and I hereby agree that my cash compensation will be reduced by the amounts set forth below for each pay period during the plan year (or during such portion of the year as remains after the date of this agreement).

I. Unreimbursed Medical Expense Account

I elect to make contributions to a medical reimbursement account for this plan year as follows:

Amount of compensation reduction: $ _____________ per pay period, for 26 pay periods.

Yearly compensation reduction: $_______________

The annual plan limit is $7,500 per participant.

Qualifying Medical Care Expenses

Under the Plan, you will be reimbursed only for those types of medical expenses normally deductible on your federal income tax return with certain exceptions (i.e., health insurance provided by a spouse’s employer cannot be reimbursed).

II. Dependent Care Assistance Account

I elect to make contributions to a dependent care assistance account for this plan year as follows:

Amount of compensation reduction: $ _____________ per pay period, for 26 pay periods.

Yearly compensation reduction: $_______________

(Up to $5,000 or $2,500 if married filing separate tax returns)

THIS AGREEMENT IS SUBJECT TO THE TERMS OF THE EMPLOYER’S FLEXIBLE BENEFITS PLAN, MEDICAL REIMBURSEMENT PLAN, AND/OR DEPENDENT CARE ASSISTANCE PLAN AS AMENDED FROM TIME TO TIME; AND SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH APPLICABLE LAWS. I UNDERSTAND THAT I CANNOT CHANGE ANY OF MY ELECTIONS DURING THE PLAN YEAR UNLESS I HAVE A CHANGE IN FAMILY STATUS AND THAT ANY MONEY LEFT IN MY ACCOUNT(S) AT THE END OF THE PLAN YEAR WILL BE FORFEITED.

Employee’s Signature ______________________________________________ Date _________________

Accepted and agreed to by the employer’s Authorized Representative.

By _____________________________________________________________ Date __________________

Please mail completed form to: Rose and Kiernan, Inc. Attn: Human Resources Dept.