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DocuSign Envelope ID:97D49820-FEB8-4DCA-BA8C-7909CD9FA2F9 <br /> B. ACA Reporting Module Services. The ACA Reporting Module will provide the following tracking <br /> and reporting capabilities to SUBSCRIBER: <br /> 1) Basic Services: <br /> a. IIRS Forms Generation <br /> SELERIIX Responsibilities: <br /> (1) Configure ACA Reporting Mlodulle and Licensed Product to generate 1094-C and <br /> 1095-C forms based on group and benefits information supplied by the <br /> SUBSCRIBER. <br /> (2) Facilitate SUBSCRIBER's ongoing upload by SUBSCRIBER of census files <br /> containing employee-specific data. <br /> (3) Train SUBSCRIIBER's designated personnel in using the ACA Reporting Module to <br /> generate ACA reports and track eligibility. Such training provided to SUBSCRIBER <br /> will not constitute legal, financial or consulting advice or direction surrounding ACA <br /> rules and regulations. Likewise, communication to SUBSCRIBER's employees or <br /> among SUBSCRIIBER's employees lis not a responsibility SELERIIX is obligated to <br /> fulfill as part of this Agreement. <br /> (4) Utilize SUBSCRIBER-provided employer and employee data to complete the IRS <br /> Form 1095-C and 1094-C forms. The forms will be in a format suitable for the <br /> SUBSCRIBER to review, amend, print or distribute electronically (ii.e. PDIF format). <br /> SUBSCRIBER Responsibilities: <br /> (1) Provide SELERIX with the necessary organizational, medical plan and job class <br /> structure and data,and benefit rules and policies to support ACA compliance. <br /> (2) Regularly upload employee census data includ ing eligibility events prompting plan <br /> and/or coverage changes; this process includes regular Qualified Life Events. This <br /> information provides the basis for employee tracking and compliance reporting. <br /> (3) Communicate to its employees the terms and timing required for employee <br /> enroillment into elligiiblle medical l plan. This effort must be synchronized by <br /> SUBSCRIBER with the census upload information. <br /> (4) Review SEILERIIX's system-generated reports throughout the calendar year to ensure <br /> completeness,accuracy and compliance. SUBSCRIBER is responsible for validating <br /> the 1095-C and 1094-C form output to ensure data alignment. <br /> (5) SUBSCRIBER represents that its employees using the Licensed Product have <br /> !sufficient training to use the Licensed Product to its functionality. Further, <br /> SUBSCRIBER represents 'its employees will continue their training by attending <br /> weblinars offered by SEILERIIX to assist such employees in becoming proficient in <br /> utilizing the ACA functionality in the ACA Reporting Module. <br /> b. IRS Electronic Forms Transmittal Services <br /> SELERIIX.responsibilities:. <br /> (I) SELIERIX will electronically submit the SUBSCRIBER's IRS Forms via the IRS AIR <br /> system on SUBSCRIIBER's behalf after SUBSCRIBER has reviewed and approved <br /> SUBSCRIIBER's IRS Forms. Upon IRS acceptance of the SUBSCRIBER's IRS filing <br /> SELIERIX will advise the SUBSCRIBER of acceptance and provide transmission' <br /> receipt records. If the IRS rejects the SUBSCRIIBER's IRS filling, SELERIX will advise. <br /> the SUBSCRIBER of such so that SUBSCRIBER may resolve the issue. When <br /> SELIERIX s notified by SUBSCRIBER that the issue Is resolved, SELERIIX.will <br /> resubmit the revised IRS Forms based an the corrected data. <br /> 2017 ACA SUBSCRIPTION AGREEMENT FOR NON-LICENSEES PAGE 2 <br />