| 
 https://benefits.paychex.com/fsa_emp/do/enroll
 
 
 
      | 2013 Enrollment |  | Confirmation |  | 
 |  |  |  
         |  |  | Thank you for participating in the FSA plan.  Your elections have been saved and will become effective on January 01, 2013.  Print this page for your records. |  |  |  |  |  |  |  |  | Submitted Date: | 11/18/2012 |  |  | Confirmation Number: | 7941774 |  
         
            |  |  
         
            | Plan Type | Employee Deduction Amount
 | Employee Annual Amount
 |  |  |  |  |  |  | Unreimbursed Medical Expense | $36.92 | $886.00 |  |  |  |  |  |  |  |  |