2016-665-E HR - Selerix Systems, Inc. for ACA filing terms and conditions

Browse Search

i DocuSign Envelope ID:9786A36A-88C6-45C6-8299-B927DCBC8AFC Exhibit A ACA Filing Terms and Conditions Amendment iE for Renewing 2015 Clients A. Selerix Systems, Inc. is a Delaware Corporation with its principal place of business located at 2851 Craig Drive,Suite 300, McKinney,TX 75070(hereinafter referred to as"SELERIX"). The undersigned (hereinafter referred to as"SUBSCRIBER")is both a subscriber to SELERIX's ACA Reporting Module under a subscription agreement with SELERIX(the"Subscription Agreement"), and through a third party's license agreement with SELERIX, is an authorized user of SELERIX's Benefits-Selection software system (the "Licensed Product"). SUBSCRIBER utilizes the ACA Reporting Module to track the employee's medical eligibility, the medical plan benefits offered to each employee, and medical plan enrollment status of each employee, as defined by the federal Affordable Care Act law and the regulations promulgated to implement such act("ACA"). B. SUBSCRIBER agrees to the following terms and conditions, each of which shall constitute an amendment to the Subscription Agreement and to the extent these terms and conditions conflict with the Subscription Agreement, these terms and conditions shall control. SUBSCRIBER desires SELERIX to provide additional services for calendar year 2016 as indicated below: 1. Electronic Submission of IRS Forms SELERIX will electronically submit the SUBSCRIBER's IRS Forms 1094-C and 1095-C(collectively, the "IRS Forms") via the IRS AIR system on SUBSCRIBER's behalf after SUBSCRIBER has reviewed and affirmatively approved in writing SUBSCRIBER'S IRS Forms. a. SUBSCRIBER is solely responsible for the accuracy and integrity of data stored in the Licensed Product on which the IRS Forms are based. SUBSCRIBER is solely responsible for all data input and maintenance of SUBSCRIBER'S employee and benefit plan information. Once SUBSCRIBER receives the draft IRS Forms from SELERIX, SUBSCRIBER shall thoroughly review the IRS Forms to ensure there are no inaccuracies or omissions therein. If SUBSCRIBER discovers any inaccuracies or omissions, SUBSCRIBER shall correct SUBSCRIBER's data upon which the IRS Forms are based and shall request that SELERIX produce revised IRS Forms based on the corrected data. b. Once SUBSCRIBER determines the IRS Forms are accurate and complete, SUBSCRIBER shall notify SELERIX of the same and shall instruct SELERIX to electronically file the same with the IRS. Upon receipt of SUBSCRIBER's approval to file the SUBSCRIBER's IRS Forms, SELERIX will transmit the information using the IRS AIR system in the XML format required by the IRS. c. SELERIX warrants that if SUBSCRIBER's data uploaded in the Licensed Product is accurate, then the IRS Forms will be sufficiently accurate for SUBSCRIBER to use the same to comply with the ACA requirements. SELERIX does not undertake any obligation to determine whether or not SUBSCRIBER'S data is accurate or complete; nor does SELERIX undertake any obligation to notify SUBSCRIBER of any portion of SUBSCRIBER'S data known or suspected to be inaccurate or incomplete by SELERIX. d. SUBSCRIBER shall bear the risk of, loss during any transmission of SUBSCRIBER's records and data over all communications links and devices. e. If the IRS rejects the SUBSCRIBER's information Selerix will advise the SUBSCRIBER of such fact so that SUBSCRIBER may resolve the issue. Following SUBSCRIBER's written notification to SELERIX that SUBSCRIBER's issue has been corrected and SUBSCRIBER wishes SELERIX to refile, SELERIX will submit to the IRS, with the required IRS tracking credentials the IRS Forms based on the corrected data. Upon IRS acceptance of the SUBSCRIBER's IRS filing SELERIX will advise the SUBSCRIBER of such. ACA FILING TERMS AND CONDITIONS AMENDMENT PAGE 1