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Dakota, Ltd. During 2001, Plastic Surgery Associates provided
health insurance to Ms. Albers that covered her but not Mr.
Albers or their children.
On December 21, 1995, Mr. Albers signed a preprinted form
that was an authorization to provide a medical reimbursement plan
under AgriPlan through AgriBiz. The preprinted form on which
that authorization appeared stated in pertinent part:
(1) EMPLOYER INFORMATION AgriPlan : BizPlan 9
Employer Last Name First Name
Albers Darwin
Filing Status: : Sole proprietor 9 K-1 Partnership
9 C Corporation 9 Sub S Corporation
(2) PARTICIPATION AND ELIGIBILITY REQUIREMENTS (Check
excluded employees and elect the respective
maximums; if a maximum is not elected, it will
automatically be defaulted to the maximum allowed.)
: Part-time employees not completing 20 hours of
work per week (maximum of 35 hours * * *
: Seasonal employees not completing 9 months of
work within a year (maximum of 9 months * * *
: Employees not completing 25 years of age
(maximum 25 years)
: Current employees not completing 36 months of
service with employer (maximum of 36 months)
: New employees not completing 36 months of
service with employer (maximum 36 months)
: Employees who are non-U.S. citizens
(3) ELIGIBLE EMPLOYEES -- Each additional employee is
$50.00. Attach a separate list, if necessary.
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Last modified: November 10, 2007