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HomeMy WebLinkAbout08-11-08 Trustees Meeting Packet WESTLAKE ACADEMY BOARD OF TRUSTEES REGULAR MEETING A G E N D A AUGUST 11, 2008 WESTLAKE TOWN HALL 3 VILLAGE CIRCLE MUNICIPAL COURT ROOM, SUITE 207 6:00 P.M. 1. CALL TO ORDER. 2. PLEDGE OF ALLEGIANCE. 3. CITIZENS' PRESENTATIONS. This is an opportunity for citizens to address the Board on any matter whether or not it is posted on the agenda. The Board cannot by law take action nor have any discussion or deliberations on any presentation made to the Board at this time concerning an item not listed on the agenda. Any item presented may be noticed on a future agenda for deliberation or action. 4. CONSENT AGENDA: All items listed below are considered routine by the Board of Aldermen and will be enacted with one motion. There will be no separate discussion of items unless a Board member or citizen so requests, in which event the item will be removed from the general order of business and considered in its normal sequence. a. Review and approve minutes of the School Board of Trustees special meeting held on May 19, 2008. b. Review and approve minutes of the School Board of Trustees regular meeting held on June 9, 2008. c. Review and approve minutes of the School Board of Trustees special meeting held on July 14, 2008. Westlake Academy Board of Trustees Page 2 of 3 Regular Meeting Agenda August 11, 2008 d. Review and approve minutes of the School Board of Trustees special meeting held on July 28, 2008. e. Consider a Resolution authorizing Westlake Academy to join the Region XI Benefits Cooperative. f. Consider a Resolution amending the current signers on the Westlake Academy bank account. 5. HEAR REPORT REGARDING WESTLAKE ACADEMY SCHOOL UNIFORM PROVIDERS. 6. CONSIDER A RESOLUTION APPROVING THE FY 2008-2009 PROFESSIONAL SALARY SCALE. 7. CONSIDER A RESOLUTION APPROVING THE ESTIMATED YEAR-END BUDGET FOR WESTLAKE ACADEMY FOR THE FISCAL YEAR ENDING AUGUST 31, 2008, AND ADOPTING THE PROPOSED BUDGET FOR THE FISCAL YEAR ENDING AUGUST 31, 2009. 8. BOARD CALENDAR. - Special Board of Trustees Meeting o 8/21/08, 9:30 a.m., Town Hall offices, Municipal Court Room - Back to School Night o 8/21/08, time TBD - Teacher Welcome Back Breakfast o 8/22/08, 8 a.m. – 9 a.m., Academy Dining Hall - Corporate Neighbors Reception o 5:30 – 7:30 p.m. @ the home of Doug and Laura Wheat - Joint Board of Aldermen/Planning & Zoning Commission land use/zoning training o 9/29/08, 6-8 p.m., Town Hall offices, Municipal Court Room - Texas Municipal League Annual Conference and Exhibition o 10/28 – 10/31/08, San Antonio, Texas 9. FUTURE AGENDA ITEMS: Any Board member may request at a workshop and / or Board meeting, under “Future Agenda Item Requests”, an agenda item for a future Board meeting. The Board member making the request will contact the Town Manager with the requested item and the Town Manager will list it on the agenda. At the meeting, the requesting Board member will explain the item, the need for Board discussion of the item, the item’s relationship to the Board’s strategic priorities, and the amount of estimated staff time necessary to prepare for Board discussion. If the requesting Board member receives a second, the Town Manager will place the item on the Board agenda calendar allowing for adequate time for staff preparation on the agenda item. - None Westlake Academy Board of Trustees Page 3 of 3 Regular Meeting Agenda August 11, 2008 10. EXECUTIVE SESSION. A. The Board will conduct a closed session under Texas Government Code section 551.071 to seek advice of counsel on legal matters involving pending or contemplated litigation, settlement offers, or other legal matters not related directly to litigation or settlement, specifically related to the Texas Education Agency ruling. 11. RECONVENE MEETING. 12. ADJOURNMENT. ANY ITEM ON THIS POSTED AGENDA COULD BE DISCUSSED IN EXECUTIVE SESSION AS LONG AS IT IS WITHIN ONE OF THE PERMITTED CATEGORIES UNDER SECTIONS 551.071 THROUGH 551.076 AND SECTION 551.087 OF THE TEXAS GOVERNMENT CODE. CERTIFICATION I certify that the above notice was posted at the Town Hall of the Town of Westlake, 3 Village Circle, on Friday, August 8, 2008, by 6 p.m. under the Open Meetings Act, Chapter 551 of the Texas Government Code. _____________________________________ Kim Sutter, TRMC, Town Secretary If you plan to attend this public meeting and have a disability that requires special needs, please advise the Town Secretary 48 hours in advance at 817-490-5710 and reasonable accommodations will be made to assist you.      Westlake  Academy  Item # 2 – Pledge of  Allegiance  Texas Pledge: "Honor the Texas flag; I pledge allegiance to thee, Texas, one state under God, one and indivisible."      Westlake  Academy  Item # 3 – Citizen  Presentations  This is an opportunity for citizens to address the Board on any matter whether or not it is posted on the agenda. The Board cannot by law take action nor have any discussion or deliberations on any presentation made to the Board at this time concerning an item not listed on the agenda. The Board will receive the information, ask staff to review the matter, or an item may be noticed on a future agenda for deliberation or action. MINUTES OF THE WESTLAKE ACADEMY BOARD OF TRUSTEES SPECIAL MEETING MAY 19, 2008 PRESENT: President Scott Bradley and Trustees Kevin Maynard, Don Redding, and Bob Timmerman. ABSENT: Trustees Larry Corson and Pete Steger. OTHERS PRESENT: Head of School Barbara Brizuela, Town Manager Thomas Brymer, Board Attorney Stan Lowry, Secretary Kim Sutter, Facilities and Recreation Director Troy Meyer, DPS Director Don Wilson, Finance Director Debbie Piper, Assistant to the Town Manager Ginger Awtry, and Finance Clerk Jaymi Ford. 1. CALL TO ORDER. President Bradley called the meeting to order at 6:35 p.m. 2. CITIZENS' PRESENTATIONS. Mr. Kent Bordelon (G10), 10 Cimarron Drive, Trophy Club, presented Mayor Bradley a signed thank you poster for his efforts associated with the establishment of the School. The following students joined Kent at the podium for the presentation: - Bain Howard (G9) - Jackson Howard (G4) - Ally Mijol (G8) - Dani Mijol (G6) - Annie Rennhack (G5) - Grace Rennhack (G2) - Riley Nicholson (G2) - Reece Nicholson (G1) President Bradley expressed his appreciation to the students, and recoginzed the founding members of the Board of Trustees: Mr. Fred Held, Mr. Bill Frey, Mr. Larry Sparrow, Mr. Don Redding, Mr. Buddy Brown, Mr. Trent Petty, and Founding Head of School Barbara Brizuela. Town of Westlake Board of Trustees Page 2 of 3 Regular Meeting May 19, 2008 The following individuals expressed their appreciation to Mayor Bradley for his years of service to the School: - Mrs. Darcy McFarlane, 1804 Talon Court, Keller - Ms. Jean Shivers, Westlake Academy - Ms. Claudia Ourthe-Cabale, Westlake Academy 3. HEAR REPORT FROM MYP STUDENTS WHO ATTENDED THE MUN (MODEL UNITED NATIONS) CONFERENCE. Ms. Bridgette Ledak (G7), 1220 Mt. Gilead Road, Keller, addressed the Board regarding the item and shared her experiences as a participant at the conference. 4. HEAR REPORT FROM G5 STUDENTS AND TEACHERS WHO TRAVELED TO MEXICO FOR THE FIRST PART OF THE MEXICO SCHOOL EXCHANGE PROGRAM. Head of School Brizuela introduced Grade 5 teachers Livia Miller and Tiffany DeVivo. Ms. Miller and Ms. DeVivo addressed the Board regarding the item. Grade 5 students Tristan Maynard, Blake Duncan, and Annie Rennhack addressed the Board regarding their experiences as participants in the exchange program. 5. CONSENT AGENDA. President Bradley introduced the item and asked for a motion. A. Review and approve minutes of the School Board of Trustees special meeting held on April 28, 2008. B. Review and approve minutes of the School Board of Trustees regular meeting held on May 5, 2008. Head of School Brizuela requested corrections to the May 5, 2008, minutes. MOTION: Trustee Redding made a motion to approve the consent agenda with corrections to the minutes. Trustee Maynard seconded the motion. The motion carried by a vote of 3-0. 6. ADJOURNMENT. There being no further business to come before the Board, President Bradley asked for a motion to adjourn the meeting. MOTION: Trustee Maynard made a motion to adjourn the meeting. Trustee Timmerman seconded the motion. The motion carried by a vote of 3-0. Town of Westlake Board of Trustees Page 3 of 3 Regular Meeting May 19, 2008 President Bradley adjourned the meeting at 6:59 p.m. APPROVED BY THE BOARD OF TRUSTEES ON AUGUST 11, 2008. _________________________________________ Laura Wheat, President ATTEST: ___________________________________ Kim Sutter, TRMC, Town Secretary MINUTES OF THE WESTLAKE ACADEMY BOARD OF TRUSTEES REGULAR MEETING June 9, 2008 PRESENT: President Laura Wheat and Trustees Tim Brittan, Larry Corson (arrived at 6:05 p.m.), Carol Langdon, Don Redding, and Rebecca Rollins. ABSENT: None. OTHERS PRESENT: Town Manager Thomas Brymer, Secretary Kim Sutter, Facilities and Recreation Director Troy Meyer, DPS Director Don Wilson Assistant to the Town Manager Ginger Awtry, Director of Administrative Services Todd Wood, and Public Works Superintendent Jarrod Greenwood. 1. CALL TO ORDER. President Wheat called the meeting to order at 6:03 p.m. 2. CONSENT AGENDA. Mayor Wheat introduced the consent agenda and asked for a motion. A. Resolution No. 08-10 - Consider a Resolution authorizing the CEO of the Academy to enter into a contract with French Toast as the new uniform supplier for the 2008- 09 school year. B. Resolution No. 08-11 - Consider a Resolution approving a three-year agreement with Apple Computers. C. Review and approve any outstanding bills. MOTION: Trustee Redding made a motion to approve the consent agenda as presented. Trustee Rollins seconded the motion. The motion carried by a vote of 4-0 (Alderman Corson was not present at the time of the vote.) Westlake Academy Board of Trustees Page 2 of 3 Regular Meeting Minutes June 9, 2008 3. HEAR A REPORT FROM MEMBERS OF THE MATH REVIEW TEAM. Ms. Claudia Ourthe-Cabale, PYP Coordinator, and Mr. Simon Aisthorpe, MYP Math teacher, addressed the Board regarding the item. Ms. Ourthe-Cabale stated that the purpose of the math review team was to coordinate a review to analyze the strengths and weaknesses of current K-10 mathematics teaching and learning. Ms. Ourthe-Cabale advised that the team consisted of 10 members, and included the observation of 35 classrooms. Following the evaluation, Ms. Ourthe- Cabale stated that an action plan was prepared based on the commendations and recommendations and other matters to be addressed. Mr. Aisthorpe reviewed the commendations and recommendations with the Board, and advised the Board that one recommendation includes an emphasis on the use of technology in the future. Discussion ensued with regard to the recommendations, TAKS scores, possibility of including parents in the review process as well as an accounting for the number of students receiving private tutoring, and posting student curriculum on the website. 4. HEAR REPORT FROM HEAD OF SCHOOL ANNOUNCING THE APPOINTMENT OF NEW MYP AND DP COORDINATORS. In the absence of the Head of School, a report was not given. 5. DISCUSS AND CONSIDER A RECOMMENDED STRATEGIC PLANNING PROCESS AND BOARD INITIATION OF IDENTIFICATION OF WESTLAKE ACADEMY POLICY ISSUES FOR DISCUSSION AT THE SECOND PHASE OF THEIR STRATEGIC PLANNING PROCESS. Town Manager Brymer introduced the item, and reviewed a Strategic Plan / Governance Cycle with the Board. Mr. Brymer recommended the Board of Trustees consider holding a strategic planning session. Alderman Corson suggested the Board consider establishing a scope and approach for oversight of the school. Town Manager Brymer suggested the Board consider designating a sub-committee of the Board to work with him and Head of School Mark Rosevear to identify policy issues for discussion. It was the consensus of the Board to designate Alderwomen Rollins and Langdon to work with the Town Manager and Head of School to identify policies for discussion by the Board as part of the strategic planning process. Westlake Academy Board of Trustees Page 3 of 3 Regular Meeting Minutes June 9, 2008 6. CITIZENS' PRESENTATIONS. There was no one present wishing to address the Board. 7. EXECUTIVE SESSION. President Wheat recessed the regular session of the Town of Westlake Board of Trustees meeting at 6:51 p.m., as she read the following item to be discussed in executive session: A. The Board will conduct a closed session under Texas Government Code section 551.071 to seek advice of counsel on legal matters involving pending or contemplated litigation, settlement offers, or other legal matters not related directly to litigation or settlement, specifically related to the Texas Education Agency ruling. President Wheat convened the executive session at 6:53 p.m. The executive session adjourned at 7:29 p.m. 8. RECONVENE MEETING. President Wheat reconvened the meeting at 7:31 p.m. 9. ADJOURNMENT. There being no further business to come before the Board, President Wheat asked for a motion to adjourn the meeting. MOTION: Trustee Langdon made a motion to adjourn the meeting. Trustee Brittan seconded the motion. The motion carried by a vote of 5-0. President Wheat adjourned the meeting at 7:32 p.m. APPROVED BY THE BOARD OF ALDERMEN ON AUGUST 11, 2008. __________________________________________ Laura Wheat, President ATTEST: ____________________________________ Kim Sutter, TRMC, Town Secretary MINUTES OF THE WESTLAKE ACADEMY BOARD OF TRUSTEES SPECIAL MEETING July 14, 2008 PRESENT: President Laura Wheat and Board Trustees Larry Corson, Carol Langdon, Don Redding, and Rebecca Rollins. ABSENT: Trustee Tim Brittan. OTHERS PRESENT: Town Manager Thomas Brymer, School Attorney Stan Lowry, and Secretary Kim Sutter. 1. CALL TO ORDER. President Wheat called the meeting to order at 6:34 p.m. 2. EXECUTIVE SESSION. President Wheat recessed the special meeting of the Westlake Academy Board of Trustees at 6:35 p.m., as she read the following item to be discussed in executive session: A. The Board will conduct a closed session under Texas Government Code section 551.071 to seek advice of counsel on legal matters involving pending or contemplated litigation, settlement offers, or other legal matters not related directly to litigation or settlement, specifically related to the Texas Education Agency ruling. President Wheat convened the executive session at 6:36 p.m. The executive session adjourned at 7:07 p.m. 3. RECONVENE MEETING. President Wheat reconvened the meeting at 7:10 p.m. Board of Trustees Page 2 of 2 Special Meeting Minutes July 14, 2008 4. ADJOURNMENT. There being no further business to come before the Board, President Wheat asked for a motion to adjourn. MOTION: Trustee Redding made a motion to adjourn the meeting. Trustee Corson seconded the motion. The motion carried by a vote of 4-0. There being no further business, President Wheat adjourn the meeting at 7:10 p.m. APPROVED BY THE BOARD OF ALDERMEN ON AUGUST 11, 2008. _________________________________________ Laura Wheat, Mayor ATTEST: ___________________________________ Kim Sutter, TRMC, Town Secretary MINUTES OF THE WESTLAKE ACADEMY BOARD OF TRUSTEES SPECIAL MEETING July 28, 2008 PRESENT: President Laura Wheat and Board Trustees Carol Langdon, Don Redding, and Rebecca Rollins. ABSENT: Trustee Tim Brittan and Larry Corson. OTHERS PRESENT: Town Manager Thomas Brymer, School Attorney Stan Lowry, and Secretary Kim Sutter. 1. CALL TO ORDER. President Wheat called the meeting to order at 6:56 p.m. 2. EXECUTIVE SESSION. President Wheat recessed the special meeting of the Westlake Academy Board of Trustees at 6:56 p.m., as she read the following item to be discussed in executive session: A. The Board will conduct a closed session under Texas Government Code section 551.071 to seek advice of counsel on legal matters involving pending or contemplated litigation, settlement offers, or other legal matters not related directly to litigation or settlement, specifically related to the Texas Education Agency ruling. President Wheat convened the executive session at 6:58 p.m. The executive session adjourned at 8:09 p.m. 3. RECONVENE MEETING. President Wheat reconvened the meeting at 8:15 p.m. Board of Trustees Minutes Page 2 of 2 July 28, 2008 4. ADJOURNMENT. There being no further business to come before the Board, President Wheat asked for a motion to adjourn. MOTION: Trustee Rollins made a motion to adjourn the meeting. Trustee Langdon seconded the motion. The motion carried by a vote of 3-0. There being no further business, President Wheat adjourn the meeting at 8:15 p.m. APPROVED BY THE BOARD OF ALDERMEN ON AUGUST 11, 2008. _________________________________________ Laura Wheat, Mayor ATTEST: ___________________________________ Kim Sutter, TRMC, Town Secretary Westlake Academy Memo To: Honorable Mayor and Members of the Board of Aldermen From: Mark Rosevear, Head of School Todd Wood, Director of Administrative Services Subject Regular Meeting of August 11, 2008 Date: August 11, 2008 ITEM Consider a Resolution authorizing Westlake Academy to join the Region XI Benefits Cooperative. BACKGROUND Westlake Academy has the opportunity to expand and enhance its employee benefit package by joining the Region XI Benefits Cooperative. The Cooperative, currently serving many school districts consisting of thousands of members, would offer Westlake Academy a more comprehensive and competitive benefits package at lower costs. By leveraging the numbers of its members, this program is capable of obtaining products and services more efficiently than the Academy can obtain on its own. Benefits of joining the cooperative include: 1. Enrollments are facilitated by a third-party administrator for all programs, reducing staff administration. 2. Life Insurance costs will be reduced by 15%, and provides the option for employees to purchase additional coverage. 3. Dental Insurance costs will reduced by as much as 45%, depending on the coverage tier selected. These policies are comparable to the Academy’s current policy. 4. Additional employee-paid benefits would be available to employees that are currently not offered. These programs include vision insurance, accident insurance, supplemental Life/AD&D insurance, and cancer insurance. 5. Employees will have the ability to see their benefits online and make changes if necessary. 6. The Academy will be insulated from volatile future cost increases normally associated with small groups. The Cooperative would allow Westlake Academy the same buying leverage enjoyed by large companies for its benefit products. 7. In the summer of 2008, the Academy’s supplemental disability insurance program was cancelled due to “non-payment”. The non-payment was due to billing errors made by the carrier’s billing service. The Cooperative will provide reinstatement of this policy and prevent similiar billing errors in the future. The Region XI Service Center currently processes Westlake Academy’s accounting and payroll transactions. The same office would facilitate employee deductions and payments to the insurance carriers, making participation in the Cooperative a seamless and efficient mechanism for benefit administration. FUNDING There is no budgetary impact in joining the Cooperative. The Academy will see reduced costs in its life insurance programs, and employee-paid insurance products will be expanded and more affordable. RECOMMENDATION Staff recommends approval. ATTACHMENTS: Resolution No. 08-11 ESC Region XI Benefits Cooperative Operational Procedures Agreement, 2008-2009 Benefit Guide 1 WESTLAKE ACADEMY RESOLUTION NO. 08-11 EDUCATION SERVICE CENTER REGION XI BENEFITS COOPERATIVE INTERLOCAL AGREEMENT RESOLUTION AND AGREEMENT. WHEREAS, Westlake Academy, an open-enrollment charter school operated by the Town of Westlake, Texas, (“Participant”) pursuant to the authority granted under Chapter 791 Government Code, as amended, desires to join together with other school districts, charter schools, or governmental entities to participate in employee benefits offered by the Education Service Center Region XI Employee Benefits Cooperative (the “ESC Region XI BC”), holding the opinion that participation in these programs will be beneficial to the school district, charter school, or governmental entities and its employees; and, WHEREAS, the ESC Region XI BC is managed by a committee called the Board of Record that consists of the superintendents or chief executive officers or their designees from each of the Participants in the Coop; NOW, THEREFORE, BE IT RESOLVED that Board of Trustees of Westlake Academy requests the ESC Region XI BC to include Westlake Academy as a participant. Westlake Academy acknowledges and agrees to the following: 1. The purposes of the ESC Region XI BC are governmental functions or services that each party to this agreement is authorized to perform individually; 2. Any obligation to pay any fees will come from current revenues available to the Participant; 3. Such fees fairly compensate the parties performing the functions and services under the agreement; 4. This agreement incorporates the Operational Procedures developed by the Board of Record as it currently exists or may be hereafter amended by action of the Board of Record; 5. Participant delegates to the Board of Record authority to modify the Operational Procedures as the Board of Record deems in the best interests of the ESC Region XI BC; 6. Participant delegates to the Board of Record all purchasing functions related to the purposes of this interlocal agreement to the maximum extent permitted by law; 7. Participant shall comply with the Operational Procedures as established, modified, and/or approved by the Board of Record; 8. The ESC Region XI BC shall comply with the purchasing requirements for the purchase of personal property and services as required by Chapter 44 of the Education Code and Chapter 791 of the Local Government Code; 9. The term of this agreement shall be one year, from September 1, 2008, to August 31, 2009, and shall automatically renew annually without the need for Participant’s Board action; and 10. Participant or the ESC Region XI BC may terminate Participant’s participation in the ESC Region XI BC for any reason by giving written notice to the ESC Region XI BC Board of Record sixty (60) calendar days before the anniversary date of this agreement. 2 BE IT FURTHER RESOLVED that the Board of Trustees of Participant authorizes its Superintendent/CEO to execute any and all documents and take whatever action necessary to carry out the desires of the Board of Trustees as stated herein. I certify that the foregoing is a true and correct copy of the resolution and agreement adopted by the Board of Trustees of Westlake Academy and that the same is reflected in the minutes of the Board meeting held on August 11, 2008. In witness thereof, we hereunto affix our signatures this 11th day of August, 2008. BY: __________________________________ Laura Wheat Signature of School Board or Charter Typed Name of School Board or Charter School Board President School Board President __________________________________ Kim Sutter Signature of School Board or Charter Typed Name of School Board or Charter School Board Secretary School Board Secretary __________________________________ Thomas Brymer Signature of School Board or Charter Typed Name of School Board or Charter School Superintendent/CEO School Board Superintendent/CEO Name of Agency: ________________________________________ Address: ________________________________________ ________________________________________ Name of Contact Person: ________________________________________ Phone Number: ________________________________________ __________________________________ Dr. Darrell Floyd Signature of ESC Region XI BC Board Typed Name of ESC Region XI BC Board President President __________________________________ Cheryl Floyd Signature of ESC Region XI BC Board Typed Name of ESC Region XI BC Board Secretary Secretary __________________________________ Richard Ownby Signature of ESC Region XI Executive Typed Name of ESC Region XI Director Executive Director __________________________________ Date Approved by ESC Region XI BC ProviderȱName:ȱȱFinancialȱBenefitȱServicesȱ ContactȱName:ȱȱAmberȱMungerȱ ProviderȱPhoneȱNumber:ȱȱ972.690.8500ȱ/ȱ800.583.6908ȱ ProviderȱWebȱAddress:ȱȱwww.fbsinc.comȱ Table of Contents S 2008-2009 Summary of Benefits ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱPG 7-9 Online Enrollment Instructions PG 10-12 OnlineȱEnrollmentȱ&ȱBenefitȱPlanȱInformationȱ ProviderȱName:ȱESCȱRegionȱXIȱȱ ContactȱName:ȱȱTeriȱPickettȱ ProviderȱPhoneȱNumber:ȱȱ817.740.7663ȱ ProviderȱWebȱAddress:ȱwww.esc11.net/bc/benefitscoopȱ EducationalȱServiceȱCenterȱInformationȱ ȱ Referȱtoȱthisȱlistȱwhenȱyouȱneedȱtoȱcontactȱoneȱofȱyourȱbenefitȱvendors.ȱȱForȱgeneralȱȱ informationȱpleaseȱcontactȱyourȱBenefitȱOffice,ȱFinancialȱBenefitȱServicesȱorȱlogȱȱ ontoȱwww.regionxibc.comȱ ProviderȱName:ȱȱBlueȱCrossȱBlueȱShieldȱ ProviderȱPhoneȱNumber:ȱȱ866.355.5999ȱ ProviderȱWebȱaddress:ȱȱwww.trs.state.tx.us/trsȬactivecareȱ ȱ TRSȬActiveCareȱMedicalȱPlanȱInformationȱ ESC Region XI Benefits Cooperative Benefit Web Address: www.regionxibc.com Page1 ProviderȱName:ȱȱGuardianȱ(ManagedȱDentalGuard—TX)ȱ GroupȱNumber:ȱ49340ȱ VerificationȱofȱBenefitsȱNumber:ȱȱ888.618Ȭ2016ȱ ProviderȱSearch:ȱwww.geoaccess.com/guardian/po56ȱ ProviderȱWebȱAddress:ȱȱwww.glic.comȱ ProviderȱName:ȱȱBlockȱVisionȱȱ GroupȱNumber:ȱȱ320580ȱ ProviderȱPhoneȱNumber:ȱȱ866.265.0517ȱ VerificationȱofȱBenefitsȱNumber:ȱȱ800.883.5747ȱ ProviderȱWebȱAddress:ȱȱwww.blockvision.comȱ BlockȱVisionȱPlanȱInformationȱ pȱ17-18 pȱ12-16 ȱ MG ProviderȱName:ȱȱOraQuestȱ VerificationȱofȱBenefitsȱNumber:ȱȱ877.493.6282ȱ ProviderȱSearch:ȱȱwww2.dentemax.com/members/FindaDentist.aspxȱ ProviderȱWebȱAddress:ȱwww.firstcontdental.comȱ(Siteȱcomingȱsoon)ȱ OraQuestȱPPOȱDentalȱPlanȱInformationȱ pȱ10– 11 GuardianȱDHMOȱDentalȱPlanȱInformationȱ ȱ FlexibleȱSpendingȱAccountsȱ(FSA)ȱ p ProviderȱName:ȱȱTown of Westlake ProviderȱPhoneȱNumber:ȱȱ817.490.5711ȱ ȱ See information above on TRS-Active Care MedicalȱPlanȱInformationȱ ȱ Referȱtoȱthisȱlistȱwhenȱyouȱneedȱtoȱcontactȱoneȱofȱyourȱbenefitȱvendors.ȱȱForȱgeneralȱȱ informationȱpleaseȱcontactȱyourȱȱBenefitȱOffice,ȱFinancialȱBenefitȱServicesȱorȱlogȱȱ ontoȱwww.regionxibc.comȱ Page2 ProviderȱName:ȱȱFtȱDearbornȱ ProviderȱContact:ȱȱFinancialȱBenefitȱServicesȱ ProviderȱPhoneȱNumber:ȱȱ972.690.8500ȱ/ȱ800.583.6908ȱ ProviderȱWebȱAddress:ȱȱwww.fbsinc.comȱ FtȱDearbornȱBasicȱLifeȱ/ȱAD&DȱPlanȱInformationȱ LoyalȱAmericanȱAccidentȱPlanȱInformationȱ pȱ32-36 pȱ30-31 ProviderȱName:ȱȱLoyalȱAmericanȱ ProviderȱPhoneȱNumber:ȱȱ800.633.6752ȱ ProviderȱWebȱAddress:ȱȱwww.gasbinsurance.comȱ ȱ Referȱtoȱthisȱlistȱwhenȱyouȱneedȱtoȱcontactȱoneȱofȱyourȱbenefitȱvendors.ȱȱForȱgeneralȱȱ informationȱpleaseȱcontactȱyourȱȱBenefitȱOffice,ȱFinancialȱBenefitȱServicesȱorȱlogȱȱ ontoȱwww.regionxibc.comȱ ProviderȱName:ȱȱUnumȱȱ ProviderȱPhoneȱNumber:ȱȱ800.858.6843ȱ ProviderȱWebȱAddress:ȱȱwww.unum.comȱ UnumȱDisabilityȱPlanȱInformationȱ ProviderȱName:ȱȱAmericanȱPublicȱLifeȱ ProviderȱPhoneȱNumber:ȱȱ800.256.6736ȱ ProviderȱWebȱAddress:ȱȱwww.ampublic.comȱ APLȱCancerȱPlanȱInformationȱ pȱ28-29 pȱ19-27 ESC Region XI Benefits Cooperative Benefit Web Address: www.regionxibc.com Page3 PassiveȱPPOȱDentalȱInsurance—ȱ FirstȱContinentalȱLifeȱȬOraQuestȱȱȱpȱ10-11 ȱ Oraquest is the dental PPO provider. This is a passive PPO dental plan that gives the participant the freedom to choose ANY DENTIST. There is a $1,000 annual maximum. A $50 annual deducti- ble for Type II and Type III Services. No deductible for preventive services. Cleanings are covered once every 6 months. There are no waiting periods for Type I and Type II services. Orthodontics covered only for children under 19, with a $1,000 lifetime maximum. *The 12 month waiting period for major services (Type III) is waived for the 1st year ONLY of the plan’s implementation. Employee Only: $24.84 per month Employee + Spouse: $51.75 per month Employee + Child(ren): $57.76 per month Employee + Family: $88.51 per month DHMOȱDentalȱInsurance—Guardianȱȱpȱ12Ȭ16ȱ Guardian is the DHMO dental provider. In-network providers must be used for all services. A provider search is available on-line. Office visit co-pay is $5.00. All services are paid per the plan schedule co-pay amount so plan members always know the out of pocket costs.NO WAITING PERIODS & NO LIFETIME MAXIMUMS. No exclusions for pre-existing conditions. Orthodontic services are covered for both children and adults. A referral is required from the member’s primary care dentist to see a specialty dentist. Employee Only: $11.36 per month Employee + Spouse: $17.97 per month Employee + Child(ren): $24.64 per month Employee + Family: $29.26 per month Medicalȱ&ȱDependentȱCareȱReimbursement ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ A summary of how the reimbursement plan works and how to file claims is available in the benefit guide. Tax-sheltered flexible spending accounts allow an individual to set aside dollars to pay for future health care and dependent care expenses. Eligible expenses must be incurred within the current plan year (01/01/2008-12/31/2008). The medical reimbursement maximum is $5,000.00/year The dependent care reimbursement maximum is $5,000.00/year* *The $5,000 maximum amount for the dependent care reimbursement is for a married couple filing jointly. Only one spouse can take out that maximum. Or it can be divided $2,500 per each spouse’s paycheck. ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱMedicalȱInsuranceȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ If the terms of this benefit summary differ from your policy, the policy will govern. For information on your group medical plan, please contact the HR department. Page 4 ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱVisionȱInsurance—BlockȱVisionȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱpȱ17-18 Members pay a co-pay for in-network benefits. Both private and retail providers are available in the on-line provider search. Exam co-pay is $10.00 and materials co-pay is $10.00. Out-of-network vision services are reimbursed up to a certain dollar amount for covered expenses. Exam, lenses and frames (within plan allowances) are covered in-network with a co-pay once every 12 months. Plan covers contacts in lieu of glasses. See plan summary for further information. Employee Only: $8.60 per month Employee + Spouse: $14.65 per month Employee + Child(ren): $15.50 per month Employee + Family: $23.25 per month ȱȱȱȱȱȱȱȱȱDisabilityȱIncome—UnumȱProvidentȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱpȱ19-27ȱ This insurance is designed to provide a monthly income to an individual that is disabled due to an accident or illness. There are different plans available with benefits becoming available from the 1st day of disability to as late as the 180th day. Benefits are payable to age 65 for injury and sickness if disability occurs prior to age 65. See plan brochure for further information. Eligible employees can enroll or increase coverage for up to a $7500 monthly benefit, based on salary, without providing evidence of insurability**. *Disability premiums are deducted on an after-tax basis. **All new coverage or increases in coverage will be subject to a 12 Month Pre-Existing Exclusion. ***ALL LINDSAY ISD EMPLOYEES WILL BE ON AN EXTENDED PLAN YEAR FROM MAY 1, 2008 TO AUGUST 31, 2009. THIS ENROLLMENT WILL BE THE ONLY TIME TO MAKE CHANGES TO YOUR DISABILITY PLAN.THE NEXT TIME AVAILABLE WILL BE THE ENROLLMENT FOR THE 9/1/2009 EFFECTIVE DATE. ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱCancerȱInsurance—AmericanȱPublicȱLifeȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱpȱ28-29ȱ Everyone can apply on a Guaranteed Issue Basis (NO HEALTH QUESTIONS ASKED.) However, no benefits are payable during the first year of coverage for a pre-existing condition.Cancer insurance is designed to be a supplement and pays for many of the costs not covered by your major medical insurance. This plan pays in addition to other coverage you may have. This plan reimburses up to $50 per calendar year for cancer screening tests on each insured person. Optional rider is available for ICU benefits. If the terms of this benefit summary differ from your policy, the policy will govern. Page 5 BasicȱLifeȱInsurance—FtȱDearbornȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱpȱ30ȱ Eligible employees with each school district receive Base Life and AD&D as an employer paid benefit . Amounts are specific to district and a reduction schedule does apply. TermȱLife/AD&DȱInsurance—FtȱDearbornȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱpȱ30-31ȱ Voluntary Term Life – The voluntary group term life plan with Fort Dearborn is an age banded rate plan that allows benefits of up to $500,000 in increments of $10,000, based on salary, for employee and spouse and increments of $5,000 or $10,000 for dependent children. Reduction schedules will apply to employee and spouse coverage beginning at age 65.New 2008 co-op school districts and new employees who enroll within 30 days of their hire date can apply on a Guaranteed Issue Basis (NO HEALTH QUESTIONS ASKED!) up to $230,000 for employee (not to exceed 5 times salary), up to $50,000 for spouse and up to $10,000 for children *Must meet actively at work requirement **Employees must elect coverage on self to insure dependents ***Evidence of insurability will be required for anyone who takes an amount over the guarantee issue level. Voluntary AD&D – Fort Dearborn voluntary accidental death and dismemberment benefits can be taken in $10,000 increments up to $500,000. Individual or Family coverage is available. Spouse will be insured for 50% and eligible children will be insured for 10% of the Principal Sum on the insured employee. This coverage does exclude certain hazardous activities; see policy for specific information. ****Group Term life and AD&D premiums are deducted on an after-tax basis. AccidentȱȱInsurance—LoyalȱAmericanȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱpȱ32-36 This policy pays benefit amounts for covered medical expenses as a result of an accident. This policy pays in addition to what your medical carrier pays and the money comes to you, not to your medical provider. It also pays for costs that traditional medical insurance doesn’t pay for like family transportation and lodging costs. Employee Only: $12.70 per month Employee + Spouse: $19.50 per month Employee + Child(ren): $20.40 per month Employee + Family: $27.20 per month If the terms of this benefit summary differ from your policy, the policy will govern. Page 6 EMPLOYEE GUIDE TO ENROLLING IN BENEFITS WITH THEbenefitsHUBSM Through THEbenefitsHUBSM, you have access to your benefits information 24 hours a day, 7 days a week, at the click of a computer key. You can access this information from anywhere that you have access to the Internet… your home, office, Internet cafe or any mobile Internet device. Step 1: log on! Go to www.regionxibc.com and click on the ONLINE ENROLLMENT LOGIN link. This will take you to your login screen. Username: Your username is the first 6 characters of your last name, followed by the first letter of your first name, followed by the last 4 digits of your Social Security Number. Password: Your password is your Social Security Number as shown below with no dashes. Examples: Renee Wills, 555111111 John Doe 987-65-4321 User name: willsr1111 Password: 555111111 User name: doej4321 Password: 987654321 Web Address: www.regionxibc.com Username: willsr1111 Password: 555111111 Step 2: now you can provide your own personal and benefits information! THEbenefitsHUBSM will guide you through the simple enrollment process page by page. employee usage agreement: You will see this screen when you log in to the system as an employee. Be sure to take the time to read this section to ensure that you understand the terms of your “electronic signature” within THEbenefitsHUBSM. When you have reviewed and understand this information, click on CONTINUE. employee data entry sections: Personal Information: Please review current information for accuracy and enter in any new or missing information. All fields listed in BOLD are required. Please enter an email address if you have one – if you ever forget your password, we can email it to you. Dependent Information: Please review current information for accuracy and enter in any new or missing information for each dependent (spouse, child/children). All fields listed in BOLD are required. To edit a dependent’s information, click on the pencil or click on the to delete a dependent.Please make sure to indicate if your child is a full-time student and/or is claimed on your tax return as this could affect their eligibility to be covered on some of the benefit plans. Enrollment in Benefits:Once all of your personal and dependent data is entered, you will have access to enroll online in the benefits for which you are eligible. Each benefit plan type (e.g. medical, dental, life) will appear individually for you to select the particular plan and coverage you want. VIEW BENEFIT DESCRIPTIONS… To view a benefit description, click on the benefit plan name or on the next to the name of the plan you would like to review. There you will find a plan summary and any available links to additional documentation or websites relevant to this plan. VIEW PLAN COST…To quickly view a particular benefit Plan’s cost to you, you may click on the circle to the left of the benefit name. Then click on the box next to each eligible family member or choose the coverage level that you are considering. Your cost will automatically show up in the box to the right of the members’ names and will be updated with each member you add or remove from coverage. VIEW TOTAL BENEFIT COST…As you select Plans, their cost will be continually added to the “Election Summary” box to the right of the Plan lists. Page 7 SELECT YOUR BENEFIT COVERAGE… After you have reviewed the Plan information and the costs of each Plan on each benefit type page: Click on the circle next to the appropriate plan (or next to “I waive enrollment…” at bottom of page if you do not want that type of coverage at all.) Click on the box next to each family member to be covered, if election made. If required under the Plan, enter primary provider information by clicking on the sentence at the bottom of the page. (If you don’t know if one is required, click “Save & Continue” and the system will let you know if it’s required.) There may be a link to the directory if available online for that Plan. If so, you will be guided to this link when you go to make your selection. FORMS… One or more of your Benefit Plans may require a paper form to be submitted with the Insurance Carrier. If this is the case, benefitsCONNECTSM will prompt you to print the necessary forms at the end of your online enrollment session. Step 3: beneficiary information Beneficiary Information Choose your beneficiary(ies) for each applicable plan. Step 4: consolidated enrollment form Consolidated Enrollment Form: This form will display all of the data from each of the sections listed above, including both your personal and enrollment information. Please review for accuracy. You may make changes to anything that is incorrect by clicking on click here to edit next to that item or, when you are finished with the enrollment process, you will be sent to the Employee Menu where you may make changes. (See Employee Menu section) ** Required Carrier Forms ** If your Plans’ carriers require paper forms, you will be prompted to print the appropriate forms at this point. Please complete the information on the form and sign and submit to your benefits/HR department! When you have completed your benefit selections, click the button, and then you will be automatically routed to the employee menu screen. EMPLOYEE MENU Once either you or your employer has entered your benefits enrollment information in the system, you will be shown the Employee Menu upon login. The sections are as follows: personal information: You may access and edit information from Sections 1-5 by selecting menu items under “Personal Information.” You may also see information that the Employer has provided such as certain payroll details. You may also update the directory information, change your password and track the forms you’ve printed. dependent information: You may access and edit information regarding your Dependents in this section. Make sure that you let your HR Department know of any major changes here, as they may change your eligibility status or give you the opportunity to change your enrollment in certain benefits! benefits plan information: You may view your enrollment in benefits in this section. You should not be able to change benefit elections unless it is an open enrollment period for your company. See a quick review of all your information on the “Consolidated Enrollment Form” company communications: Items such as forms that are commonly used by your company, News & Bulletins, and other Human Resources/ Benefits information reside here for the employees to access at any time from anywhere. Page 8 navigation and data entry tips… HELP!...If you need assistance while working in THEbenefitsHUBSM don’t hesitate to click on help at the upper right hand corner of the screen. BACK AND FORTH… It is very important to try to avoid using your web browser’s “back” and “forward” arrows while in the system. Use the navigation buttons in THEbenefitsHUBSM : REQUIRED DATA… As noted on each screen, the Bold items are required for you to continue to the next page. Of course, the more information entered, the better the system will work for you; but you may skip non-bolded items if they are irrelevant or you do not wish to complete those items. RESET… To clear all of the fields and “start over” on that particular page, click on MOVING ON… When each page is completed, go to the bottom of the page and click on UNABLE TO FINISH?… If you are unable to complete this process due to unavailability of data, time constraints, etc. you may simply logout and log in at another time. When you login again, you will be walked through the same process, but the data you entered will still be there. “post-enrollment” tips CHANGING YOUR PASSWORD…Go to “personal information,” then select “Change Password.” You may do this at any time after you have completed the enrollment process. WHAT ARE THOSE SYMBOLS? If you just “hover” your cursor/arrow on the icons, the definition of the icons will be revealed. Here are some common ones: = Delete = Edit = Preview LINKS…words, names or phrases in bold red that become underlined when you put your curser/arrow on them, those are links that will bring you to that section or, if e-mail addresses, will create an e-mail to that person. SCREEN NAVIGATOR…This line is at the top of your screen. You may click on the red items to quickly jump back to those previous screens. Page 9 Texas FIRST CONTINENTAL LIFE-ORAQUEST Region XI Benefits Cooperative Traditional (Passive) Dental Plan (100/80/50) ODP 185 TX (MKTG) VOLFCL (01/05) Annual Benefit - Per Person . . . . . . . . . . . . . . . . . $1,000 Percentage of Covered Benefits Per Policy Year TYPE I TYPE II TYPE III* DURING THE 1ST YEAR 100% 80% 0% * 2ND YEAR AND THEREAFTER 100% 80% 50% * 12-month waiting period (unless replacing prior coverage as described under “Takeover Benefit”) Calendar Year Deductible, Per Person $50 This deductible applies to Type II and III services Payment is based upon allowable charges in the area in which service is rendered. Services provided at a non-contracting provider are paid at the 90th percentile. (PPO LIST AT DENTEMAX.COM) TYPE I (PREVENTIVE SERVICES) Including: x No waiting period x Routine Exams x Prophylaxis (cleanings-one per 6 months) x Emergency exams for dental pain (minor procedures) x Fluoride treatments for dependent children under age 19 (one per 12 months) x Bitewing X-rays (once per 6 months) TYPE III (MAJOR SERVICES) Including: x 12 months waiting period x *(waiting period waived yr 1 for new Region XI x COOP Districts) x Major restorative services (crowns and inlays) x Prosthetics (bridges, dentures) x Replacement of prosthodontics, dentures, crowns and inlays x Denture relines x Space maintainers x General anesthesia (for services dentally necessary) (Region XI) With Ortho (2 yr rate) Employee $24.84 Employee + Spouse $51.75 Employee +Child(ren) $57.76 Family $88.51 Marketed and Administered by: —————————————————————————————— ORAQUEST DENTAL PLANS 12946 Dairy Ashford, Suite 360 Sugar Land, TX 77478 (281) 313-7150 - (800) 660-6064 FAX: (281) 313-7155 Underwritten By: —————————————————————————————— FIRST CONTINENTAL LIFE & ACCIDENT INSURANCE CO. 12946 Dairy Ashford, Suite 360 Sugar Land, TX 77478 (281) 313-7150 - (877) 493-6282 Fax (281) 313-7155 ORTHODONTIC SERVICES x 50% coverage x $1,000 lifetime maximum benefit x Children under 19 only TYPE II (BASIC SERVICES) Including: x No waiting period x Periapical X-rays x Full mouth or panorex X-rays (one per 36 months) x Simple restorative services (fillings) x Simple extractions x Endodontics/root canal therapy x Periodontics x Oral Surgery Page10 Limitations and Exclusions Covered Expenses Will Not Include and No Benefits Will be Payable: 1.For major services in the first 12 months that the Insured is covered, except as may be provided in the Takeover Benefits provision. 2.For any treatment which is for cosmetic purposes or to correct congenital malformations, except for medically necessary care and treatment of congenital cleft lip and palate. 3.To replace any prosthetic appliance, crown, inlay or onlay restoration, or fixed bridge within five years of the date of the last placement of these items, unless required because of an accidental bodily injury sustained while the Insured is covered. Replacement is not covered if the item can be repaired. 4.For initial placement of any prosthetic appliance or fixed bridge unless such placement is needed because of the extraction of natural teeth during the same period of continuous coverage. But the extraction of a third molar (wisdom tooth) will not qualify the item for payment. Any such appliance or fixed bridge must include the replacement of the extracted tooth or teeth. Coverage does not include the part of the cost that applies specifically to replacement of teeth extracted prior to the period of coverage. 5.For addition of teeth to an existing prosthetic appliance or fixed bridge unless for replacement of natural teeth extracted during the same period of continuous coverage. 6.For any expense incurred or procedure begun before the Insured’s current period of continuous coverage. 7.For any expense incurred or procedure begun after the Insured’s insurance under this section terminates, except for a prosthetic appliance, fixed bridge, crown, or inlay or onlay restoration for which both (a) the procedure begins before insurance ends and (b) the item’s final placement is within 90 days after insurance ends. 8.To duplicate appliances or replace lost or stolen appliances. 9.For appliances, restorations or procedures to: a. alter vertical dimension; b. restore or maintain occlusion; c. splint or replace tooth structure lost as a result of abrasion or attrition; or d. treat jaw fractures or disturbances of the temporomandibular joint. 10.For education or training in, and supplies used for, dietary or nutritional counseling, personal oral hygiene or dental plaque control. 11.For broken appointments or the completion of claim forms. 12.For orthodontia service or for any services associated with orthodontic therapy when this optional coverage is not elected and the premium is not paid. 13.For sealants which are: a. not applied to a permanent molar; b. applied before age 6 or after attaining age 16; or c. reapplied to a molar within three years from the date of a previous sealant application. 14.For subgingival curettage or root planing (procedure numbers 4220 and 4341) unless the presence of periodontal disease is confirmed by both x-rays and pocket depth summaries of each tooth involved. 15.Because of an Insured’s injury arising out of, or in the course of, work for wage or profit. 16. For an Insured’s sickness, injury or condition for which he or she is eligible for benefits under any Workers Compensation Act or similar laws. 17.For charges for which the Insured is not liable or which would not have been made had no insurance been in force. 18.For services which are not recommended by a dentist, not required for necessary care and treatment, or do not have a reasonably favorable prognosis. 19.Because of war or any act of war, declared or not, or while on full- time active duty in the armed forces of any country. 20.To an Insured if payment is not legal where the Insured is living when expenses are incurred. 21.For any services related to: equilibration, bite registration or bite analysis. 22.For crowns for the purpose of periodontal splinting. 23.For charges for: any implants; overdentures; precision or semi- precision attachments and associated endodontic treatment; other customized attachments; or specialized prosthodontic techniques or characterizations. 24.For charges for myofunctional therapy, orthognathic surgery or athletic mouthguards. 25.For procedures for which benefits are payable under the employer’s medical expense benefits plan for employees and their dependents. 26.Services or supplies provided by a family member or a member of the Insured’s household. Note: This is a general outline of covered benefits and does not include all the benefits, limitations and exclusions of the policy. See your certificate for details. Predetermination of Benefits: As a service to protect the Insured, First Continental Life & Accident Insurance Co. will provide predetermination of benefits for recommended treatment plans that exceed $300. This predetermination of benefits explains which of the recommended procedures will be covered and at what amount. This benefit helps Insured's better understand their coverage. The Insured should submit the treatment plan to First Continental Life & Accident Insurance Co. for review and predetermination of benefits before the servicebegins. TAKEOVER BENEFITS Takeover means that you are given credit for waiting periods for like coverage's accumulated under your existing plan. No credit is given for deductibles satisfied under your existing plan. 1.In order to provide Takeover Benefits your employer’s current dental plan must have been in effect continuously for at least 12 months prior to the effective date of this plan. 2.All employees insured on the effective date with continuous coverage from the prior group dental contract are eligible for Takeover Benefits. Waiting periods will be reduced by the amount of time insured under the prior plan. 3.A minimum of five (5) enrolled members are needed for an employer to be eligible for Takeover Benefits. 4.Takeover Benefits must be requested and are subject to the approval of First Continental Life & Accident Insurance Co. Submission of Claims: First Continental Life- Claims Dept. 12946 Dairy Ashford Rd. Suite 30 Sugar Land Tx 77478 Claims verification: 1-877-493-6282 Page 11 The Guardian Life Insurance Company of America, New York, NY 2004-4746 Managed DentalGuard (DHMO – Prepaid) Plan ESC REGION XI COOP Employee Only $11.36 Employee & Spouse $17.97 Employee & Child(ren) $24.64 Employee & Family $29.26 This handout is for illustrative purposes only. The payroll deductions are an approximation. Please see your paycheck for actual payroll deductions. If there is a discrepancy between this handout and your paycheck, your paycheck stub prevails. Page12 The Guardian Life Insurance Company of America, New York, NY Questions and Answers Guardian’s Managed DentalGuard Pre-Paid Dental Plan Can I visit any general dentist I want under the Managed DentalGuard plan? To have your dental services covered, you must go to the dental office that you choose when you enroll. You can find a conveniently located dentist in the Managed DentalGuard Directory of Participating General dentists. All of your dental care will be provided by, or arranged by, your selected dental office. What if I want to change my dental office after I've picked one? Is there a limit to how many times I can change? You can change dental offices just by calling Guardian at (888) 618-2016. The change will be effective on the first day of the next month, as long as you call before the 20th day of the month. There's no limit on the number of times you can change dental offices, but selections are always effective from the first day of a month to the last day of a month. Any services started at one dental office must be completed by that office, and your account with the first office must be paid in full before a transfer can be processed. Does the whole family have to use the same dental office, or can my dependents choose a different one? Each family member can enroll with a different dental office. What if I need to see a specialist? The Managed DentalGuard network includes oral surgeons, periodontists, endodontists, orthodontists and pediatric dental specialists. If you need dental services that only a specialist can provide, your dental office will request authorization from Guardian for you to see a participating specialist. (Usually your dental office will have the referral authorized within ten days; if it's an emergency, it is faster.) You will be responsible for the patient charge shown in your booklet for any covered services performed by a specialist dentist. I've taken my five-year-old to a pediatric dentist. Can I do that with Managed DentalGuard? Your child must first be seen by a general dentist at your selected dental office. If a child under age six is unmanageable, a referral to a pediatric dental specialist may be made. After the child's sixth birthday, pediatric specialty services will not be covered. What is meant by the term "patient charge"? With the Managed DentalGuard PPD plan, most diagnostic and preventive services are covered at no cost to you. However, for basic, major and some preventive services, you will pay a certain amount -- which is referred to as a patient charge -- for each covered service you receive. The patient charges for your PPD plan are listed in your certificate of coverage booklet, so you'll always know what you'll have to pay for services you need. Better yet, with the Managed DentalGuard plan there are no deductibles, annual maximums or co-insurance -- plus no pre-treatment reviews are required for services provided by your participating general dentist. When I visit a dentist, are there any claim forms to fill out? No. Under the Pre-paid plan, any necessary paperwork for services from participating dentists is handled by your selected dental office. You just show your Managed DentalGuard ID card. Page 13 The Guardian Life Insurance Company of America, New York, NY Questions and Answers What if I have a problem with my dentist, or with my coverage? Call Managed DentalGuard Member Services and discuss your problem with the representative. He or she will work with you to help you resolve your problem. If you are still unsatisfied, you can submit a grievance form explaining the matter. Member Services, your dental office or your employer can provide a form for you to use. Guardian keeps track of all grievances, and regularly reviews grievance reports to identify potential problem areas. When will my coverage go into effect? Your benefits coordinator will notify you when your coverage takes effect. What happens if a member wants a more expensive service than the one the plan covers, or that the dentist recommends? Most indemnity and PPO plans cover the least expensive treatment appropriate for your condition. Even if your dentist feels a more expensive treatment would be better for you, these plans pay for the less expensive treatment, and you have to pay the difference between what the plan pays for the less expensive treatment and what the dentist charges for the more expensive treatment. Under the Managed DentalGuard plan, the covered service that the participating dentists recommends is provided at the defined patient charge, regardless of the relative cost. So you are never caught between what your dentist recommends and what the plan covers. If you want a more expensive, but still covered, treatment than the one that your participating dentist recommends, then you are responsible for the patient charge for the recommended service, plus the difference between the dentist's fees for the two procedures. How are patient charges for specialty care determined? Covered specialist services are listed in your certificate of Coverage, along with the specific patient charge for each service. You generally pay a higher patient charge when a service is performed by a specialist than if the same service were performed by a general dentist. However, unlike most plans, the Managed DentalGuard plan always tells you exactly what the patient charge for covered specialty care will be. There are some services that are not covered if performed by a specialist. Managed DentalGuard plans have defined, a specific patient charges for covered specialty care services. Most other optional plans offer specialty care at a percentage discount off of the specialist's usually fee, which is not defined. Important Information About Managed DentalGuard: This plan provides pre-paid dental benefits through a network of participating general dentists and specialists. All covered services must be provided by the member's Primary Care Dentist. Specialists' services are covered only when referred by the member's Primary Care Dentist and approved in advance by Guardian. Only those services listed in the plan are covered. Certain services are subject to annual or other periodic limitations. The services, exclusions and limitations listed here do not constitute a contract and are a summary only. The Managed DentalGuard plan documents are the final arbiter of coverage. GP-1-MDG1, et al. Log 99-438 Pub 3135 (5/99) Page14 Page 1 of 2 Covered ServicesCovered Services Appointments & Diagnostic Services Crown, Bridge & Other Cast Restorations Periodic oral evaluation, participating general dentist No ChargeInlay - metallic - one surface ^ ** $180.00 Periodic oral evaluation, participating specialty care dentist $10.00Inlay - metallic - two surfaces ^ **$235.00 Limited oral evaluation - problem focused, participating general dentist No ChargeInlay - metallic - three or more surfaces ^ **$235.00 Limited oral evaluation - problem focused, participating specialty care Onlay - metallic - three surfaces ^ **$250.00 dentist $25.00Onlay - metallic - four or more surfaces ^ ** $260.00 Comprehensive oral evaluation, participating general dentist No ChargeCrown - porcelain/ceramic substrate ^ $250.00 Comprehensive oral evaluation, participating specialty care dentist $25.00Crown - porcelain fused to high noble metal ^ **$230.00 Pulp vitality tests No ChargeCrown - porcelain fused to predominantly base metal ^ $230.00 Diagnostic casts No ChargeCrown - porcelain fused to noble metal ^ $250.00 Office visit - during regular hours - participating general dentist only $5.00Crown - full cast high noble metal ^ **$230.00 Consultation (by dentist other than practitioner providing treatment), $30.00Crown - full cast predominantly base metal ^ $230.00 participating general dentist Crown - full cast noble metal ^ $250.00 Consultation (by dentist other than practitioner providing treatment), $45.00Crown - 3/4 cast metallic ^ ** $240.00 participating specialty care dentist Crown supporting existing partial denture, in addition to crown$125.00 Office visit for observation - regular hours - no other service performed No ChargeDental lab service - per inlay, onlay, crown or bridge unit$75.00 Emergency office visit - after regularly scheduled office hours $50.00Pontic - cast high noble metal ^ **$230.00 Radiographs Pontic - cast metal predominantly base metal ^ $230.00 Intraoral - complete series (including bitewings)$5.00Pontic - cast noble metal ^$250.00 Intraoral - periapical - single film No ChargePontic - porcelain fused to high noble metal ^ ** $230.00 Intraoral - periapical - each additional film No ChargePontic - porcelain fused to predominantly base metal ^$230.00 Intraoral - occlusal - each film No ChargePontic - porcelain fused to noble metal ^$250.00 Bitewing - single film No ChargeInlay - abutment - metallic - two surfaces ^ ** $260.00 Bitewings - two films No ChargeInlay - abutment - metallic - three or more surfaces ^ ** $265.00 Bitewings - four films No ChargeOnlay - abutment - metallic - three surfaces ^ ** $275.00 Panoramic film $5.00Onlay - abutment - metallic - four or more surfaces ^ ** $290.00 Preventive & Space Maintenance Crown - abutment - porcelain fused to high noble metal ^ ** $230.00 Prophylaxis - adult (first 2 services in any 12 month period) +No ChargeCrown - abutment - porcelain fused to predominantly base metal ^ $230.00 Prophylaxis - child (first 2 services in any 12 month period) +No ChargeCrown - abutment - porcelain fused to noble metal ^ $250.00 Prophylaxis - adult or child (with or without fluoride)(each additional Crown - abutment - 3/4 cast metallic ^ ** $230.00 service in same 12 month period) +$60.00Crown - abutment - full cast high noble metal ^ ** $230.00 Topical application of fluoride (including prophylaxis) - child Crown - abutment - full cast predominantly base metal ^$230.00 (first 2 services in any 12 month period) +No ChargeCrown - abutment - full cast noble metal ^$250.00 Topical application of fluoride (prophylaxis not included) – child Multiple crown and bridge unit treatment plan - per unit$125.00 (first 2 services in any 12 month period) +No Charge Other Restorative Services Topical application of fluoride (prophylaxis not included) – child Recement inlay$20.00 (each additional service in same 12 month period) +$20.00Recement crown$20.00 Nutritional counseling for control of dental diseaseNo ChargePrefabricated stainless steel crown$60.00 Oral hygiene instruction No ChargePrefabricated stainless steel crown - permanent tooth$60.00 Sealant - per tooth - molars only $10.00Prefabricated resin crown$90.00 Sealant - per tooth - non-molars only $35.00Sedative filling$15.00 Space maintainer - fixed - unilateral $65.00Core buildup, including any pins$50.00 Space maintainer - fixed - bilateral $110.00Pin retention - per tooth, in addition to restoration$15.00 Recementation of space maintainer $15.00Cast post & core$95.00 Restorative Prefabricated post & core$85.00 Amalgam - one surface - primary $10.00Labial veneer (laminate) - chairside$235.00 Amalgam - two surfaces - primary $10.00Recement bridge$15.00 Amalgam - three surfaces - primary $15.00Cast post & core, in addition to abutment$95.00 Amalgam - four or more surfaces - primary $15.00Prefabricated post & core, in addition to abutment$85.00 Amalgam - one surface - permanent $8.00Core buildup for abutment, including any pins$55.00 Amalgam - two surfaces - permanent $12.00 Endodontics Amalgam - three surfaces - permanent $14.00Pulp cap$10.00 Amalgam - four or more surfaces - permanent$17.00Therapeutic pulpotomy$30.00 Silicate cement - per restoration $15.00Root canal - anterior$95.00 Resin/composite - one surface, anterior $20.00Root canal - bicuspid$160.00 Resin/composite - two surfaces, anterior $25.00Root canal - molar$170.00 Resin/composite - three surfaces, anterior $30.00Root canal - retreatment - anterior$310.00 Resin/composite - four or more surfaces or incisal angle, anterior $45.00Root canal - retreatment - bicuspid$370.00 Composite resin crown, anterior - primary $45.00Root canal - retreatment - molar$445.00 Resin/composite - one surface, posterior - primary $30.00Apicoectomy/periradicular surgery – anterior $135.00 Resin/composite - two surfaces, posterior - primary$35.00Apicoectomy/periradicular surgery - bicuspid - first root$145.00 Resin/composite - three or more surfaces, posterior - primary$40.00Apicoectomy/periradicular surgery - molar - first root$155.00 Resin/composite - one surface, posterior - permanent$35.00Apicoectomy/periradicular surgery - each additional root$80.00 Resin/composite - two surfaces, posterior - permanent$50.00Retrograde filling - per root$35.00 Resin/composite - three or more surfaces, posterior - permanent$70.00 continued on Page 2 3110/3120 6930 6970 6780 6790 3346 3347 3348 3410 2510 2751 2752 2520 2530 2543 2544 2740 2750 2331 2110 1515 1550 2140 1203 1204 1310 2790 2791 0999 2332 2150 2160 2161 2210 2120 2130 2131 2330 1510 0330 0210 0220 0230 1120 1999 1201 2792 1110 0240 0270 0272 0274 9440 2381 2382 2385 2386 2387 3421 3425 3426 3430 Patient Charge 0120 0120 0140 MDG Codes++ 0140 0150 0150 0460 0470 2335 2336 2380 9310 9310 9430 1330 1351 9999 2810 2999 6199 6210 6211 6212 6240 6241 6242 6520 6530 6543 6544 6750 6751 6752 6791 6792 6999 2910 2920 2930 2931 2932 2940 2950 2951 2952 2954 2960 3330 3220 3310 3320 6972 6973 Managed DentalGuard Plan Schedule 35-M Orthodontic Plan Schedule 1 MDG Codes++ Patient Charge V.01265 Page15 Page 2 of 2 Covered ServicesCovered Services Periodontics Oral Surgery (cont.) Gingivectomy or gingivoplasty - per quadrant$80.00Root removal - exposed roots$25.00 Gingivectomy or gingivoplasty - per tooth$25.00Surgical removal of erupted tooth$30.00 Gingival curettage, surgical - per quadrant - by report$45.00Removal of impacted tooth - soft tissue$50.00 Gingival flap procedure-including root planing - per quadrant$190.00Removal of impacted tooth - partially bony$70.00 Clinical crown lengthening - hard tissue$170.00Removal of impacted tooth - completely bony$80.00 Osseous surgery - including flap entry, closure - per quadrant - Removal of impacted tooth - completely bony, with unusual surgical $90.00 five to eight teeth $255.00 complications Pedicle soft tissue graft procedure$185.00Surgical removal of residual tooth roots (cutting procedure)$40.00 Free soft tissue graft procedure (including donor site surgery)$205.00Tooth reimplantation and/or stabilization of accidentally evulsed Periodontal scaling & root planing - per quadrant$30.00 tooth$90.00 Full mouth debridement to enable evaluation & diagnosis$35.00Surgical exposure of impacted or unerupted tooth for orthodontic Periodontal maintenance procedures (following active therapy)$30.00 reasons$130.00 Unscheduled dressing change (by other than treating dentist)$25.00Surgical exposure of impacted or unerupted tooth to aid eruption$90.00 Osseous surgery - including flap entry, closure - per quadrant - Biopsy of oral tissue - hard$70.00 one to four teeth $155.00Biopsy of oral tissue - soft$65.00 Occlusal adjustment - limited - per visit$20.00Alveoplasty in conjunction with extractions - per quadrant$50.00 Prosthodontics (Removable)Alveoplasty not in conjunction with extractions - per quadrant$70.00 Complete denture (including routine post delivery care) ^ ^$345.00Removal of odontogenic cyst/tumor - up to 1.25cm$85.00 Immediate denture (including routine post delivery care) ^ ^$345.00Removal of odontogenic cyst/tumor - over 1.25cm$160.00 Partial dentures (including routine post delivery care):Removal of exostosis - maxilla or mandible$125.00 Resin base - including clasps, rests, teeth ^ ^$310.00Incision & drainage of intraoral abscess$40.00 Cast metal framework with resin base - including clasps, rests, Frenulectomy (separate procedure)$95.00 teeth ^ ^$355.00 Orthodontic Treatment (covers 24 months active treatment) Repairs & adjustments:Comprehensive orthodontic treatment, including fabrication and Denture adjustments$20.00 insertion of fixed banding appliance and periodic visits, up to 24 Repair denture base ^ ^ ^$45.00 months; dependent child to age 18 (as determined by the Replace missing or broken teeth - per tooth ^ ^ ^$35.00 Member’s age on the date of banding)$2,285.00 Repair or replace clasp ^ ^ ^$60.00 Comprehensive orthodontic treatment, including fabrication and Add tooth to existing partial ^ ^ ^$45.00 insertion of fixed banding appliance and periodic visits, up to 24 Add clasp to existing partial ^ ^ ^$45.00 months; employee, spouse, or dependent child over age 18 Rebase denture ^ ^ ^$125.00 (as determined by the Member’s age on the date of banding)$2,285.00 Reline denture (chairside)$65.00Orthodontic evaluation and consultation $100.00 Reline denture (laboratory) ^ ^ ^$120.00Periodic comprehensive orthodontic treatment visit No Charge Interim partial denture (stayplate)$95.00Orthodontic retention $415.00 Tissue conditioning$30.00 Orthodontic treatment plan and records, including x-rays, study model $150.00 Dental lab service - each new complete, immediate, or partial denture $165.00 Miscellaneous Services Dental lab service - denture repair, rebase or reline - per denture$35.00Palliative (emergency) treatment - per visit$15.00 Oral Surgery Local anesthesiaNo Charge Extraction - single tooth$8.00External bleaching - per arch - take home bleaching only$165.00 Extraction - each additional tooth$9.00 ++ + ^ ^ ^ ^ ^ ^ ** Plan Schedule 35-M is only valid for Covered Services rendered by Participating Dentists in the State of Texas. Orthodontic Plan Schedule 1 is only valid for Authorized Services rendered by Participating Orthodontic Specialty Care Dentists in the State of Texas. see codes 1204 and 1999 for the applicable patient charge There is an additional dental lab service patient charge for these procedures. See code 5899 for the applicable patient charge. There is an additional dental lab service patient charge for these procedures. See code 5999 for the applicable patient charge. If high noble metal is used, there may be an additional patient charge for the actual cost of the high noble metal. The total patient charge for high noble metal plus the applicable dental lab service Covered Services are subject to exclusions, limitations and Plan provisions. Other codes may be used to describe Covered Services. The patient charges for codes 1110, 1120, 1201 and 1203 are limited to the first two services in any 12 month period. For each additional service in the same 12 month period, There is an additional dental lab service patient charge for these procedures. See code 6199 for the applicable patient charge. 5510/5610 5520/5640 5630 5211/5212 4920 Managed DentalGuard Plan Schedule 35-M Orthodontic Plan Schedule 1 Patient Charge charge may not exceed the general dentist’s actual lab MDG Codes++ Patient ChargeMDG Codes++ 5999 5750/51/60/61 5820/5821 5850/5851 5899 5410/11/21/22 5650 5660 5710/11/20/21 5730/31/40/41 4999 5213/5214 9951 5110/5120 5130/5140 4271 4341 4355 4910 4240 4249 4260 4270 4210 4211 4220 7110 7120 7130 7210 7220 7230 7240 7241 7250 7270 7280 7281 7285 7286 7310 7320 7450 7451 8680 7510 7960 8070/8080/8090 8070/8080/8090 8660 8670 7470 9972 8999 9110 9215 V.01265 Page16 BLOCK VISION OF TEXAS BENEFIT ILLUSTRATION ESC REGION XI BENEFITS COOPERATIVE Platinum $125 VISION PLAN $10 Exam/$10 Eyewear Copayments, Full Service – Illustration Service / Material Participating Provider Non-Participating Provider Vision Examination: Paid in full* Up to: $35.00 Retail Value* Frame: Up to: $125.00 Retail Value* Up to: $70.00 Retail Value* Lenses:(Clear, Standard, Glass or Plastic) Single Vision (per pair) Paid in full* Up to: $25.00Retail Value* Bifocal (per pair) Paid in full* Up to: $40.00Retail Value* Trifocal (per pair)** Paid in full* Up to: $45.00Retail Value* Lenticular (per pair) Paid in full* Up to: $80.00Retail Value* Contact Lenses:*** Elective Up to $150.00* Up to: $80.00 Retail Value* Medically Required Paid in full* Up to: $150.00 Retail Value* * After applicable copayments listed above are fulfilled. ** Member pays difference in retail price between standard trifocal lenses and progressive lenses. *** Contact lenses and related professional services (fitting, evaluation and follow-up) are covered in lieu of eyeglasses. Coverage to include all contact lens types (i.e. standard daily wear, extended wear, disposable, toric, gas permeable, and bifocal). Frequency: Vision Examination Once Each 12 Months Frame Once Each 12 Months Lenses Once Each 12 Months Contact Lenses Once Each 12 Months Rates: Voluntary Participation Monthly Employee $8.60 Employee+ Spouse $14.65 Employee+ Child(ren) $15.50 Family $23.25 Non-Covered Eyewear Discount: Members may also receive a discount of 20% from a participating provider’s usual and customary fees for eyewear purchases which exceed the benefit coverage (except disposable contact lenses, for which no discount applies). This includes eyeglass frames which exceed the selected benefit coverage, specialty lenses (i.e. progressives) and lens “extras” such as tints and coatings. Eyewear purchased from a Wal-Mart Vision Center does not qualify for this additional discount because of Wal-Mart’s “Always Low Prices” policy. WE FOCUS ON YOU SO YOU CAN FOCUS ON LIFE FOR MORE INFORMATION PLEASE CONTACT US TOLL-FREE AT (866) 265-0517 Page17 Vi s i o n P l a n Q u e s t i o n s & A n s w e r s Wh a t p l a n o p t i o n s a r e a v a i l a b l e ? ES C R e g i o n X I B e n e f i t s C o o p e r a t i v e e m p l o y e e s a r e b e i n g o f f e r e d o u r P l a t i n u m $1 2 5 p l a n . T h e P l a t i n u m $ 1 2 5 p l a n i n c l u d e s a r o u t i n e / b a s i c v i s i o n e x a m i n a t i o n ye a r l y . T h e e y e w e a r b e n e f i t p r o v i d e s c o v e r a g e f o r l e n s e s o r c o n t a c t s e v e r y y e a r a n d pr o v i d e s u p t o $ 1 2 5 c o v e r a g e f o r f r a m e s e v e r y o t h e r y e a r . Ho w d o I e n r o l l i n t h i s p l a n ? Yo u m u s t c o m p l e t e t h e e n r o l l m e n t f o r m f u r n i s h e d t o y o u . A t e n r o l l m e n t , y o u s h o u l d ma r k y o u r c o v e r a g e s e l e c t i o n ( i . e . e m p l o y e e , e m p l o y e e + s p o u s e , e m p l o y e e + c h i l d (r e n ) , o r f a m i l y ) . I f y o u s e l e c t e m p l o y e e + s p o u s e , e m p l o y e e + c h i l d ( r e n ) , o r f a m i l y be s u r e t o i n c l u d e a l l t h e i n f o r m a t i o n r e q u e s t e d f o r c o v e r e d d e p e n d e n t s , i n c l u d i n g so c i a l s e c u r i t y n u m b e r s a n d b i r t h d a t e s . Ho w d o I u s e t h i s p l a n ? Wi t h y o u r v i s i o n b e n e f i t , c h o o s e a p r o v i d e r f r o m t h e p a r t i c i p a t i n g p r o v i d e r l i s t . Pr e s e n t y o u r I D c a r d f o r s e r v i c e s a t t h e t i m e o f s e r v i c e . E X C E P T F O R A N Y AP P L I C A B L E C O P A Y M E N T , D O N O T P A Y Y O U R P A R T I C I P A T I N G PR O V I D E R F O R S E R V I C E S O R E Y E W E A R C O V E R E D B Y Y O U R B L O C K VI S I O N O F T E X A S B E N E F I T . If y o u c h o o s e a n o n - p a r t i c i p a t i n g p r o v i d e r , y o u w i l l b e e x p e c t e d t o p a y t h e d o c t o r f o r se r v i c e s r e c e i v e d . Y o u w i l l t h e n n e e d t o s e n d t h e o r i g i n a l r e c e i p t f r o m y o u r n o n - pa r t i c i p a t i n g d o c t o r t o B l o c k V i s i o n f o r r e i m b u r s e m e n t . B l o c k V i s i o n w i l l r e v i e w yo u r e l i g i b i l i t y a n d s e n d t h e a p p r o p r i a t e r e i m b u r s e m e n t t o y o u . Co n t a c t l e n s e s a n d r e l a t e d p r o f e s s i o n a l s e r v i c e s w i t h a r e t a i l v a l u e o f u p t o $ 1 5 0 a r e co v e r e d i n l i e u o f e y e g l a s s e s . C o v e r a g e i n c l u d e s t h e c o m p l e t e c o n t a c t l e n s p a c k a g e (c o n t a c t l e n s e s a n d r e l a t e d p r o f e s s i o n a l s e r v i c e s s p e c i f i c t o c o n t a c t l e n s f i t t i n g , ev a l u a t i o n a n d f o l l o w - u p ) . M e m b e r s r e c e i v e a $ 1 5 0 r e t a i l a l l o w a n c e t o w a r d t h e pu r c h a s e o f c o n t a c t l e n s e s t h a t r e t a i l f o r m o r e t h a n $ 1 5 0 . Am I a b l e t o o b t a i n e y e g l a s s e s a n d c o n t a c t l e n s e s i n t h e s a m e y e a r ? No . B l o c k V i s i o n ’ s p l a n p r o v i d e s c o v e r a g e f o r e y e g l a s s e s o r c o n t a c t l e n s e s , b u t n o t bo t h , w i t h i n t h e s t a t e d b e n e f i t p e r i o d . Wh a t i s t h e d i f f e r e n c e b e t w e e n a n O p t o m e t r i s t a n d O p h t h a l m o l o g i s t ? Bo t h a r e k n o w n a s e y e d o c t o r s a n d b o t h p e r f o r m e y e e x a m i n a t i o n s . A n O p t o m e t r i s t is a n e y e s p e c i a l i s t . A n O p h t h a l m o l o g i s t i s a n " e y e s u r g e o n . " S o m e o f o u r n e t w o r k Op t o m e t r i s t s a r e n o w l i c e n s e d t o t r e a t e y e i n f e c t i o n s , p r e s c r i b e m e d i c a t i o n a n d re m o v e f o r e i g n b o d i e s . Ho w w i l l t h e B l o c k V i s i o n p r o v i d e r d e t e r m i n e w h a t I a m e l i g i b l e t o r e c e i v e ? Em p l o y e e s e l e c t i n g s i n g l e c o v e r a g e w i l l r e c e i v e 1 I D c a r d . E m p l o y e e s e l e c t i n g em p l o y e e + s p o u s e , e m p l o y e e + c h i l d ( r e n ) , o r f a m i l y c o v e r a g e w i l l b e i s s u e d 2 I D ca r d s . T h e B l o c k V i s i o n I D c a r d e n a b l e s t h e B l o c k V i s i o n p r o v i d e r t o a c c e s s B l o c k Vi s i o n ’ s c o m p u t e r s y s t e m t o d e t e r m i n e w h a t y o u a r e e l i g i b l e t o r e c e i v e . P l e a s e b e aw a r e t h a t y o u r e l i g i b i l i t y w i t h B l o c k V i s i o n i s c a l c u l a t e d o n a d a t e o f s e r v i c e - t o da t e o f s e r v i c e m e t h o d , n o t c a l e n d a r y e a r . F o r e x a m p l e , i f y o u a r e e n t i t l e d t o a n ex a m o n c e e a c h 1 2 m o n t h s a n d r e c e i v e y o u r f i r s t e x a m o n 3 - 1 1 - 0 6 , y o u w i l l b e c o m e el i g i b l e a g a i n f o r a n e w e x a m o n 3 - 1 1 - 0 7 . If I w e a r d i s p o s a b l e c o n t a c t l e n s e s , m u s t I u s e m y e n t i r e b e n e f i t a t o n e t i m e ? No . Y o u m a y c o n t i n u e t o m a k e u s e o f t h e r e m a i n i n g a m o u n t o f y o u r c o n t a c t l e n s be n e f i t d u r i n g t h e b e n e f i t f r e q u e n c y s t a t e d i n y o u r p l a n . F o r e x a m p l e , i f y o u n e e d di s p o s a b l e l e n s e s o n c e e v e r y t h r e e m o n t h s , t h e n t h a t i s t h e w a y y o u o b t a i n y o u r le n s e s i n t h e B l o c k V i s i o n p l a n u n t i l s u c h t i m e a s y o u r b e n e f i t m a x i m u m h a s b e e n re a c h e d . A n y r e m a i n i n g b e n e f i t v a l u e s a t t h e e n d o f t h e b e n e f i t p e r i o d a r e n o t ca r r i e d o v e r t o t h e n e x t b e n e f i t p e r i o d . Wh a t t y p e o f e y e g l a s s l e n s e s a m I e l i g i b l e f o r ? W h a t a b o u t P r o g r e s s i v e L e n s e s ? Ti n t s ? Al l B l o c k V i s i o n ’ s p l a n s c o v e r c l e a r , s t a n d a r d g l a s s o r p l a s t i c l e n s e s , w i t h s i n g l e vi s i o n , b i f o c a l o r t r i f o c a l p r e s c r i p t i o n s . Y o u m a y c h o o s e t o u p g r a d e y o u r l e n s e s b y pa y i n g t h e d i f f e r e n c e o v e r a n d a b o v e t h e s t a n d a r d l e n s p r i c e . F o r e x a m p l e , i f y o u wa n t a n a n t i - r e f l e c t i v e c o a t i n g o n y o u r l e n s e s , t h e p l a n w i l l p a y f o r t h e s t a n d a r d l e n s an d y o u a r e r e s p o n s i b l e f o r t h e c o s t o f t h e a n t i - r e f l e c t i v e c o a t i n g . I f y o u w o u l d l i k e pr o g r e s s i v e l e n s e s , y o u r b e n e f i t w i l l p a y f o r s t a n d a r d t r i f o c a l l e n s e s a n d y o u w i l l p a y an y a m o u n t o v e r a n d a b o v e t h e s t a n d a r d t r i f o c a l p r i c e . T i n t i n g , c o a t i n g a n d a n y ot h e r " a d d i t i o n s " t o y o u r l e n s e s a r e a d d e d a t y o u r o w n e x p e n s e . B l o c k V i s i o n w i l l pa y f o r t h e c l e a r , s t a n d a r d g l a s s o r p l a s t i c l e n s e s w i t h s i n g l e v i s i o n , b i f o c a l o r t r i f o c a l pr e s c r i p t i o n s . Wh a t i f I h a v e o t h e r q u e s t i o n s ? Yo u m a y c a l l B l o c k V i s i o n ’ s o f f i c e t o l l - f r e e a t ( 8 6 6 ) 2 6 5 - 0 5 1 7 , M o n d a y t h r o u g h Fr i d a y 8 : 0 0 A M t o 5 : 3 0 P M ( C e n t r a l T i m e ) w i t h a n y q u e s t i o n s y o u m a y h a v e . I f yo u c a l l d u r i n g e v e n i n g o r w e e k e n d h o u r s , y o u w i l l b e a b l e t o l e a v e a m e s s a g e o n t h e Bl o c k V i s i o n v o i c e m a i l s y s t e m . Y o u r c a l l w i l l b e r e t u r n e d a s s o o n a s p o s s i b l e . Page18  Educator Select Income Protection Plan Insurance Highlights EB-975-TX 1, MO 1,OK 1 ESC Region XI Benefits Cooperative Please read carefully the following description of your UnumProvident Educator Select Income Protection Plan insurance. Your Plan Eligibility You are eligible for disability coverage if you are an active employee in the United States working a minimum of 20 hours per week. The date you are eligible for coverage is the later of: the plan effective date; or the day after you complete the waiting period. Guarantee Issue Employees in an eligible group on or before your School’s policy effective date*: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may enroll on or before your School’s policy effective date. After the initial enrollment period, you can apply only during an annual enrollment period. Benefits are subject to the pre-existing condition exclusion referenced later in this document. Please see your Plan Administrator for your eligibility date. Employees in an eligible group after your School’s policy effective date*: Coverage is available to you without answering any medical questions or providing evidence of insurability. You may apply for coverage within 60 days after your eligibility date. If you do not apply within 60 days after your eligibility date, you can apply only during an annual enrollment period. Benefits are subject to the pre-existing condition exclusion referenced later in this document. Please see your Plan Administrator for your eligibility date. *Your Plan Administrator will provide you with this date. Benefit Amount You may purchase a monthly benefit in $100 units, starting at a minimum of $200, up to 66 2/3% of your monthly earnings rounded to the nearest $100, but not to exceed a monthly maximum benefit of $7,500. Please see your Plan Administrator for the definition of monthly earnings. The total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 100% of your monthly earnings unless the excess amount is payable as a Cost of Living Adjustment. However, if you are participating in UnumProvident’s Rehabilitation and Return to Work Assistance program, the total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 110% of your monthly earnings (unless the excess amount is payable as a Cost of Living Adjustment). Page 19 EB-975-TX 1, MO 1, OK 1 Elimination Period The Elimination Period is the length of time of continuous disability, due to sickness or injury, which must be satisfied before you are eligible to receive benefits. You may choose an Elimination Period (injury/sickness) of 0/7, 14/14, 30/30, 60/60,90/90, or 180/180 days. If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Inpatient means that you are confined to a hospital room due to your sickness or injury for 23 or more consecutive hours. (Applies to Elimination Periods of 30 days or less.) Benefit Duration Federal Income Taxation Your duration of benefits is based on your age when the disability occurs. Your duration of benefits is based on the following table: Age at Disability Maximum Duration of Benefits Less than age 60 To age 65, but not less than 5 years Age 60 through 64 5 years Age 65 through 69 To age 70, but not less than 1 year Age 70 and over 1 year The taxability of benefits depends on how premium was taxed during the plan year in which you become disabled. If you paid 100% of the premium for the plan year with post-tax dollars, your benefits will not be taxed. If premium for the plan year is paid with pre-tax dollars, your benefits will be taxed. If premium for the plan year is paid partially with post-tax dollars and partially with pre-tax dollars, or if you and your Employer share in the cost, then a portion of your benefits will be taxed. Additional Benefits Survivor Benefit UnumProvident will pay your eligible survivor a lump sum benefit equal to 3 months of your gross disability payment. This benefit will be paid if, on the date of your death, your disability had continued for 180 or more consecutive days, and you were receiving or were entitled to receive payments under the plan. If you have no eligible survivors, payment will be made to your estate, unless there is none. In that case, no payment will be made. However, we will first apply the survivor benefit to any overpayment which may exist on your claim. You may receive your survivor benefit prior to your death if you are receiving monthly payments and your physician certifies in writing that you have been diagnosed as terminally ill and your life expectancy has been reduced to less than 12 months. This benefit is only payable once and if you elect to receive this benefit, no survivor benefit will be payable to your eligible survivor upon your death. Return to Work/ Work Incentive Benefit UnumProvident supports efforts that enable a disabled employee to remain on the job or return to work as soon as possible. If you are disabled but working part time with monthly disability earnings of 20% or more of your indexed monthly earnings, during the first 12 months, the monthly benefit will not be reduced by any earnings until the gross disability payment plus Page 20 EB-975-TX 1, MO 1, OK 1 your disability earnings, exceeds 100% of your indexed monthly earnings. The monthly benefit will then be reduced by that amount. Worksite Modification Rehabilitation and Return to Work Assistance Waiver of Premium If a worksite modification will enable youto remain at work or return to work, a designated UnumProvident professional will assist in identifying what’s needed. A written agreement must be signed byyou, your employer and UnumProvident, and we will reimburse your employer for the greater of $1,000 or the equivalent of two months of your disability benefit. UnumProvident has a vocational Rehabilitation and Return to Work Assistance program available to assistyou in returning to work. We will make the final determination of your eligibility for participation in the program, and will provide you with a written Rehabilitation and Return to Work Assistance plan developed specifically for you. This program may include, but is not limited to the following benefits: x coordination with your Employer to assist your return to work; x adaptive equipment or job accommodations to allow you to work; x vocational evaluation to determine how your disability may impact your employment options; x job placement services; x resume preparation; x job seeking skills training; or x education and retraining expenses for a new occupation. If you are participating in a Rehabilitation and Return to Work Assistance program, we will also pay an additional disability benefit of 10% of your gross disability payment to a maximum of $1,000 per month. In addition, we will make monthly payments to you for 3 months following the date your disability ends, if we determine you are no longer disabled while: x you are participating in a Rehabilitation and Return to Work Assistance program; and x you are not able to find employment. After you have received disability payments under the plan for 90 consecutive days, from that point forward you will not be required to pay premiums as long as you are receiving disability benefits. Work/Life Balance Employee Assistance Program1 Work-life balance is a comprehensive resource providing access to professional advice for a wide range of personal and work-related issues. The service is available to you and your family members twenty-four hours a day, 365 days a year, and provides resources to help employees find solutions to everyday issues such as financing a car or selecting child care, as well as more serious problems such as alcohol or drug addiction, divorce, or relationship problems. Services include: toll-free phone access to master’s-level consultants, up to three face-to-face counseling sessions to help with more serious issues; and online resources. There is no charge for utilizing the program. Participation is confidential and strictly voluntary, and employees do not have to have filed a disability claim or be receiving benefits to use the program. However, if you become disabled and are receiving benefits, UnumProvident's On Claim Support can provide additional resources including: coaching on how to communicate effectively with medical personnel, conducting consumer research for medical equipment and Page 21 EB-975-TX 1, MO 1, OK 1 x x Dependent Care Expense Benefit supplies, assessing emotional needs and locating counseling resources. If you are disabled and participating in UnumProvident’s Rehabilitation and Return to Work Assistance program, UnumProvident will pay a Dependent Care Expense Benefit when you are disabled and you provide satisfactory proof that you: are incurring expenses to provide care for a child under age 15; and/or start incurring expenses to provide care for a child age 15 or older or a family member who needs personal care assistance. The payment will be $350 per month per dependent, to a maximum of $1,000 per month for all dependent care expenses combined. Education Benefit Other Important Provisions Pre-existing Condition Exclusion Continuity of Coverage If you are disabled and receiving monthly disability benefits, you may receive an additional monthly Education Benefit of $200 for each child who is an eligible student. Benefits will be payable in between terms provided the eligible student is enrolled for the next scheduled term. Eligible student means your unmarried dependent child(ren) who are: x x less than 25 years of age; and attending an accredited post-secondary school beyond the 12th grade level on a full-time basis. Benefits will not be paid for disabilities caused by, contributed to by, or resulting from a pre-existing condition. You have a pre-existing condition if: x you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and x the disability begins in the first 12 months after your effective date of coverage. If you are actively at work at the time you convert to UnumProvident’s plan and become disabled due to a pre-existing condition, benefits may be payable if you were: x in active employment and insured under the plan on its effective date; and x insured by the prior plan at the time of change. To receive a payment, you must satisfy the pre-existing condition under the UnumProvident policy or the prior carrier’s policy. If you satisfy UnumProvident’s pre-existing condition provision, payments will be determined by the UnumProvident policy. Page22 EB-975-TX 1, MO 1, OK 1 x x x Definition of Disability Gainful Occupation Benefit Integration If you only satisfy the pre-existing condition provision for the prior carrier’s policy, the claim will be administered according to the UnumProvident policy. However, the payments will be the lesser of the benefit payable under the terms of the prior plan or the benefit under the UnumProvidentplan; the elimination period will be the shorter of the elimination period under the prior plan or the elimination period under the UnumProvident plan; and benefits will end on the earlier of the end of the maximum period of payment under the UnumProvident plan or the date benefits would have ended under the prior plan. You are disabled when UnumProvident determines that: x you are limited from performing the material and substantial duties of your regular occupation due to your sickness or injury; x you have a 20% or more loss in indexed monthly earnings due to the same sickness or injury; and x during the elimination period you are unable to perform any of the material and substantial dutiesof your regular occupation. After benefits have been paid for 24 months, you are disabled when UnumProvident determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience. You must be under the regular care of a physician in order to be considered disabled. Gainful occupation means an occupationthat is or can be expected to provide you with an income within 12 months of your return to work, that exceeds 80% of your indexed monthly earnings if you are working or 60% of your indexed monthly earnings if you are not working. Your disability benefit will be reduced by deductible sources of income and any earnings you have while disabled. Your gross disability payment will be reduced immediately by such items as disability income or other amounts you receive or are entitled to receive from workers compensation or similar occupational benefit laws, sabbatical or assault leave plans and the amount of earnings you receive from an extended sick leave plan as described in Louisiana Revised Statutes or any other act or law with similar intent. After you have received monthly disability payments for 12 months, your gross disabilitypayment will be reduced by additional deductible sources of income you receive or are entitled to receive under: state compulsory benefit laws; automobile liability insurance; legal judgments and settlements; certain retirement plans; salary continuation or sick leave plans; other group or association disability programs or insurance;andamounts you or your family receive or are entitled to receive from Social Security or similar governmental programs. Page23 EB-975-TX 1, MO 1, OK 1 Mental Illness/Self-Reported Symptoms Instances When Benefits Would Not Be Paid Termination of Coverage Regardless of deductible sources of income, an employee who qualifies for disability benefits is guaranteed to receive a minimum benefit amount of 25% of the gross disability payment. The lifetime cumulative maximum benefit period for all disabilities due to mental illness and disabilities based primarily on self-reported symptoms is 24 months. Only 24 months of benefits will be paid for any combination of such disabilities even if the disabilities are not continuous and/or are not related. Payments would continue beyond 24 months only if you are confined to a hospital or institution as a result of the disability. Benefits will not be paid for disabilities caused by, contributed to by, or resulting from: x intentionally self-inflicted injuries; x active participation in a riot; x commission of a crime for which you have been convicted; x loss of professional license, occupational license or certification; x pre-existing conditions (see definition). UnumProvident will not cover a disability due to war, declared or undeclared, or any act of war. UnumProvident will not pay a benefit for any period of disability during which you are incarcerated. Your coverage under the policy ends on the earliest of the following: x The date the policy or plan is cancelled; x The date you no longer are in an eligible group; x The date your eligible group is no longer covered; x The last day of the period for which you made any required contributions; x The later of the last day you are in active employment except as provided under the covered layoff or leave of absence provision; or if applicable, the last day of your contract with your Employer but not beyond the end of your Employer’s current school contract year. UnumProvident will provide coverage for a payable claim which occurs while you are covered under the policy or plan. Page24 EB-975-TX 1, MO 1, OK 1 Next Steps How to Apply/ Effective Date of Coverage Employees in an eligible group on or before your School’s policy effective date*:To applyfor coverage, complete your enrollment form prior to your School’s policy effective date. Your effective date of coverage is the policy effective date of your school or the day after you complete your waiting period, whichever is later. UnumProvident will confirm your effective date of coverage and the plan you select in a confirmation letter. The confirmation letter will be sent to your Employer to distribute following the close of the enrollment period. If you do not enroll during the initial enrollment period, you may apply only during an annual enrollment period. Employees in an eligible group after your School’s policy effective date*:To apply for coverage, complete your enrollment form within 60 days of your eligibility date.Your effective date of coverage is your eligibility date if you applied for coverage on or before that date or the date you applied for insurance, if you applied within 60 days after your eligibility date. UnumProvident will confirm your effective date of coverage and the plan you select in a confirmation letter. The confirmation letter will be sent to your Employer to distribute following the close of the enrollment period. If you do not enroll during the initial enrollment period, you may apply onlyduring an annual enrollment period. *Your Plan Administrator will provide you with this date. Delayed Effective Date of Coverage If you are absent from work due to injury, sickness, temporary layoff or leave of absence, your coverage will not take effect until you return to active employment. Please contact your Plan Administrator after you return to active employment for when your coverage will begin. Questions If you should have any questions about your coverage or how to enroll, please contact your Plan Administrator. This plan highlight is a summary provided to help you understand your insurance coverage from UnumProvident. Some provisions may vary or not be available in all states. Please refer to your certificate booklet for your complete plan description. If the terms of this plan highlight summary or your certificate differ from your policy, the policy will govern. For complete details of coverage, please refer to policy form number C.FP-1, et al. 1 Work-life balance employee assistance program and On-Claim Support services are provided by Ceridian Corporation. Services are available with selected UnumProvident insurance offerings. Exclusions, limitations and prior notice requirements may apply, and service features, terms and eligibility criteria are subject to change. The services are not valid after termination of coverage and may be withdrawn at any time. Please contact your UnumProvident representative for full details. Underwritten by: Unum Life Insurance Company of America 2211 Congress Street, Portland, Maine 04122, www.unumprovident.com ©2006 UnumProvident Corporation. All rights reserved. UnumProvident is the marketing brand of UnumProvident Corporation’s insuring subsidiaries. Page 25 ESC REGION XI BENEFITS COOPERAT IVE Costs below are based on a Monthly payroll deduction (Employer billing mode is based on 12 Payments per year) Product:Plan A Educator Select Income Protection Plan ADEA II Duration of Benefits Elimination Period (Days) Injur y (Days)0* 14*30* 60 90 180 Sickness (Days)7* 14*30* 60 90 180 Annual Earnings Monthly Earnings Maximum Monthly Be nefit 3600300 200 8.006.785.88 4.802.761.96 5400 450 300 12.00 10.17 8.82 7.20 4.14 2.94 7200600 400 16.0013 .5611.769.60 5.523.92 9000 750 500 20.00 16.95 14.70 12.00 6.90 4.90 10800900 600 24.0020 .341 7.6414 .40 8.285.88 12600 1050 700 28.00 23.73 20.58 16.80 9.66 6.86 144001200 800 32.002 7.1223 .5219.2011.04 7.84 16200 1350 900 36.00 30.51 26.46 21.60 12.42 8.82 180001500 1000 40.0033 .9029 .4024 .0013.809.80 19800 1650 1100 44.00 37.29 32.34 26.40 15.18 10.78 216001800 1200 48.0040 .68 35.28 28.8016.5611.76 23400 1950 1300 52.00 44.07 38.22 31.20 17.94 12.74 252002100 1400 56.004 7.4641 .1633 .6019.3213.72 27000 2250 1500 60.00 50.85 44.10 36.00 20.70 14.70 288002400 1600 64.00 54.244 7.043 8.4022.08 15.68 30600 2550 1700 68.00 57.63 49.98 40.80 23.46 16.66 324002700 1800 72.0061 .02 52.9243 .2024.8417.64 34200 2850 1900 76.00 64.41 55.86 45.60 26.22 18.62 360003000 2000 80.006 7.80 58.8048.0027.6019.60 37800 3150 2100 84.00 71.19 61.74 50.40 28.98 20.58 396003300 2200 88.00 74.58 64.6852.8030.3621.56 41400 3450 2300 92.00 77.97 67.62 55.20 31.74 22.54 432003600 2400 96.00 81.36 70.56 57.6033.1223.52 45000 3750 2500 100.00 84.75 73.50 60.00 34.50 24.50 468003900 2600 104.00 88.14 76.4462 .4035.88 25.48 48600 4050 2700 108.00 91.53 79.38 64.80 37.26 26.46 504004200 2800 112.0094.92 82.326 7.2038.6427.44 52200 4350 2900 116.00 98.31 85.26 69.60 40.02 28.42 540004500 3000 120.00101.7 0 88.20 72.0041.4029.40 55800 4650 3100 124.00 105.09 91.14 74.40 42.78 30.38 576004800 3200 128.00108.48 94.0876.8044.1631.36 59400 4950 3300 132.00 111.87 97.02 79.20 45.54 32.34 61200 5100 3400 136.00115.2699.96 81.6046.9233.32 63000 5250 3500 140.00 118.65 102.90 84.00 48.30 34.30 64800 5400 3600 144.00122.04105.84 86.4049.68 35.28 66600 5550 3700 148.00 125.43 108.78 88.80 51.06 36.26 68400 5700 3800 152.00128.82111.7291.20 52.4437.24 70200 5850 3900 156.00 132.21 114.66 93.60 53.82 38.22 720006000 4000 160.00135.60117.6096.00 55.2039.20 73800 6150 4100 164.00 138.99 120.54 98.40 56.58 40.18 756006300 4200 168.00142.38 123.48 100.8 0 57.9641.16 77400 6450 4300 172.00 145.77 126.42 103.20 59.34 42.14 792006600 4400 176.00149.16129.36105.6060.7243.12 81000 6750 4500 180.00 152.55 132.30 108.00 62.10 44.10 828006900 4600 184.00155.94135.24110.4063.48 45.08 84600 7050 4700 188.00 159.33 138.18 112.8 0 64.86 46.06 86400 7200 4800 192.00162.7 2141.12115.2066.2447.04 88200 7350 4900 196.00 166.11 144.06 117.60 67.62 48.02 90000 7500 5000 200.00169.5 0147.00120.0069.0049.00 91800 7650 5100 204.00 172.8 9 149.94 122.40 70.38 49.98 93600 7800 5200 208.00176.28 152.88 124.8 0 71.76 50.96 REF #: 1653137 * If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Findyour Annual/Monthly Earnings above to determine your Maximum Monthly Benefit. If your Annual/Monthly Earnings are not shown, use the next lower Annual/Monthly Earnings and corresponding Maximum Monthly Benefit. Or, you may refer to the Plan Highlights to calculate your Maximum Monthly Benefit based on your earnings. Page 26 ESC REGION XI BENEFITS COOPERATIVE Costs below are based on a Monthly payroll deduction (Employer billing mode is based on 12 Payments per year) Product:Plan A Educator Select Income Protection Plan ADEA II Duration of Benefits Elimination Period (Days) Injur y (Days)0* 14*30* 60 90 180 Sickness (Days)7* 14*30* 60 90 180 Annual Earnings Monthly Earnings Maximum Monthly Be nefit 95400 7950 5300 212.00179.67 155.82127.20 73.14 51.94 97200 8100 5400 216.00 183.06 158.76 129.60 74.52 52.92 99000 8250 5500 220.00186.45 161.70132.00 75.90 53.90 100800 8400 5600 224.00 189.8 4 164.64 134.40 77.28 54.88 102600 8550 5700 228.00193.23167.58 136.8 0 78.66 55.86 104400 8700 5800 232.00 196.62 170.52 139.20 80.04 56.84 106200 8850 5900 236.00200.01173.46141.60 81.42 57.82 108000 9000 6000 240.00 203.40 176.40 144.00 82.80 58.80 1098009150 6100 244.00206.7 9179.34146.40 84.1859.78 111600 9300 6200 248.00 210.18 182.28 148.80 85.56 60.76 1134009450 6300 252.00213.57 185.22151.20 86.9461.74 115200 9600 6400 256.00 216.96 188.16 153.60 88.32 62.72 1170009750 6500 260.00220.35 191.10156.00 89.7063.70 118800 9900 6600 264.00 223.7 4 194.04 158.40 91.08 64.68 12060010050 6700 268.00227.13196.98 160.8 092.4665.66 122400 10200 6800 272.00 230.5 2 199.92 163.20 93.84 66.64 12420010350 6900 276.00233.91202.86165.6095.2267.62 126000 10500 7000 280.00 237.30 205.80 168.00 96.60 68.60 12780010650 7100 284.00240.69208.74170.4097.98 69.58 129600 10800 7200 288.00 244.08 211.68 172.8 0 99.36 70.56 13140010950 7300 292.00247.47 214.62175.20100.74 71.54 133200 11100 7400 296.00 250.8 6 217.56 177.60 102.12 72.52 13500011250 7500 300.00254.25 220.50180.00103.50 73.50 REF #: 1653137 * If, because of your disability, you are hospital confined as an inpatient, benefits begin on the first day of inpatient confinement. Find your Annual/Monthly Earnings above to determine your Maximum Monthly Benefit. If your Annual/Monthly Earnings are not shown, use the next lower Annual/Monthly Earnings and corresponding Maximum Monthly Benefit. Or, you may refer to the Plan Highlights to calculate your Maximum Monthly Benefit based on your earnings. Page27 American Public Life Group Cancer Plan (APL GC AP GC-3 5/1/06)- Region XI Employee Benefit Cooperative This coverage is offered on a guarantee issue basis. However, no benefits are payable for any loss during the first year of a Covered Person’s coverage as the result of a Pre-Existing Specified Disease. A Pre-Existing Specified Disease is defined as one for which, within twelve (12) months prior to the Covered Person’s effective date of coverage, medical advice, consultation, or treatment, including prescribed medications, was recommended or received from a member of the medical profession, or for which symptoms manifested ins such a manner as would cause an ordinarily prudent person to seek diagnosis, medical advice or treatment. Benefit Low Option Base PlanHigh Option Base Plan Radiation/Chemotherapy/Immunotherapy Hormone Therapy $500/month of treatment $50/treatment; 12/year $1500/month of treatment $50/treatment; 12/year Surgical Schedule Anesthesia Reconstructive Surgery Skin Cancer $1,600 Schedule; $15/unit 25% of schedule Included in schedule Included in schedule $4,800 Schedule; $45/unit 25% of schedule Included in schedule Included in schedule Hospital Confinement Government/Charity Hospital/HMO Ambulatory Surgical Fac ility $100/day 1-90; $100/day 91+ in lieu of other benefits $100/day in lieu of other benefits $200/day $300/day 1-90; $300/day 91+ in lieu of other benefits $300/day in lieu of other benefits $600/day Drugs and Medicine - Inpatient Drugs and Medicine - Outpatient $150/confinement $50/script; $50/month $150/confinement $50/script; $150/month Transportation and Lodging Patient Transportation Family Transportation Patient Lodging Family Lodging $.40/mile up to 1,000 miles $.40/mile up to 1,000 miles $50/day up to 50 days/cal year (out) $50/day up to 50 days/cal year (in) $.40/mile up to 1,000 miles $.40/mile up to 1,000 miles $50/day up to 50 days/cal year (out) $50/day up to 50 days/cal year (in) Blood and Plasma$150/day; $7,500/cal year (50 days)$250/day; $12,500/cal year (50 days) Bone Marrow/Stem Cell Transplant autologous non-autologous for other type cancer Experimental Treatment Attending Physician Prosthesis - Surgical Prosthesis - hairpiece Dread Disease Hospice Care Private Nursing Ambulance - Ground Ambulance - Air Extended Care Home Health Care Second & Third Surgical Opinion Waiver of Premium Physical Therapy $500/cal year $1,500/cal year Same as non-experimental $30/day of confinement $1,000/device; lifetime max 2 $50/hairpiece; lifetime max 2 $100/day up to 90 days $50/day; $9,000 lifetime max $150/day of confinement $200/trip; 2/confinement $2,000/air; 2/confinement $100/day up to confinement days $100/day up to confinement days $300/diagnosis 90 day elimination period $25/visit; 4/month; $1,000 life $1500/cal year $4,500/cal year Same as non-experimental $50/day of confinement $3,000/device; lifetime max 2 $50/hairpiece; lifetime max 2 $300/day up to 90 days $100/day; $18,000 lifetime max $150/day of confinement $200/trip; 2/confinement $2,000/air; 2/confinement $300/day up to confinement days $300/day up to confinement days $300/diagnosis 90 day elimination period $25/visit; 4/month; $1,000 life Diagnostic Testing Benefit$50; 1per person, per year (30 day waiting period)$50; 1per person, per year (30 day waiting period) Critical Illness Rider: Heart Attack/Stroke $2500 Lump Sum Benefit; 30 day WP, no survival period Payable once for cancer and once for heart attack or stroke $2500 Lump Sum Benefit; 30 day WP, no survival period - Payable once for cancer and once for heart attack or stroke Optional Benefit ICU Rider$600 - up to a maximum of 20 days per confinement$600 - up to a maximum of 20 days per confinement Monthly Premiums Individual Single Parent Family Family Individual Single Parent Family Family Plan Opt 1 - Low Option Base Only $14.80 $20.60 $26.40 Plan Opt 2 - Low Option Base Plan + Intensive Care Rider $17.80 $24.80 $32.70 Plan Opt 3 - High Option Base Plan Only $29.40 $40.40 $51.50 Plan Opt 4 - High Option Base Plan + Intensive Care Rider $32.40 $44.60 $57.80 Page 28 LIMITATIONS AND EXCLUSIONS Only Loss For Cancer: This Policy pays only for loss resulting from definitive Cancer treatment including direct extension, metastatic spread, or recurrence. Proof must be submitted to support each claim. This Policy also covers other conditions or diseases directly caused by Cancer or the treatment of Cancer. Pre-Existing Condition Limitation: No benefits are payable for any loss incurred during the first year of the Covered Person’s coverage under this Policy as the result of a Pre-Existing Specified Disease, as defined in this Certificate. Pre-Existing Conditions specifically named or described as excluded in any part of this contract are never covered. Waiting Period: This Policy/Certificate contains a 30-day Waiting Period during which no benefits will be paid under this Policy/Certificate. If any Covered Person has a Specified Disease diagnosed before the end of the 30-day period immediately following the Covered Person’s effective date, coverage for that person will apply only to loss that is incurred after one year from the effective date of such person’s coverage. If any Covered Person is diagnosed as having a Specified Disease during the 30-day period immediately following the effective date, the Insured may elect to void the Certificate from the beginning and receive a full refund of premium. If this Policy replaced Specified Disease Cancer coverage from another company that terminated within 30 days of the effective date of the Certificate, the 30-day Waiting Period will be waived for those Covered Persons that were covered under the prior coverage. However, the Pre-Existing Condition Limitation paragraph will still apply. Optional Hospital Intensive Care Unit Rider - No benefits will be provided during the first two years of this rider for Hospital Intensive Care Unit confinement caused by any heart condition when any heart condition was diagnosed or treated prior to the 30th day following the covered person’s effective date of this rider. (The heart condition causing the confinement need not be the same condition diagnosed or treated prior to the effective date.) Page29 ESC Region XI Cooperative #GFZ05049 - BENEFITS AT A GLANCE Your Basic and Voluntary Life Insurance benefits are provided by Fort Dearborn Life Insurance Company. Below is a summary of the benefits available to you: BASIC GROUP TERM LIFE/AD&D Any full-time, active employee working at least 20 hours per week is eligible for Basic Group Term Life and Accidental Death and Dismemberment (AD&D). Coverage is equal to the following: Basic Life/AD&D: Class I: $10,000 - All full-time, active employees of Alvord, Argyle, Bluff Dale, Boyd, Dublin, Era, Huckabay, Kennedale, Lake Dallas, Lindsay, Lingleville, Lipan, Metro Academy of Math and Science, Millsap, Morgan Mill, Sivells Bend , Three Way or Valley View ISD’s Class II:$30,000 – All full-time, active employees of Stephenville ISD Class III: $20,000 –All full-time, active employees electing medical insurance of Carroll ISD Your Employer pays the entire cost of this coverage. Coverage reduces to 65% upon attainment of age 65, further reduces to 50% of the original amount upon attainment of age 70, and terminates at retirement. VOLUNTARY GROUP TERM LIFE Any full-time, active employee and their spouse are eligible to elect Voluntary Life coverage for themselves and their eligible dependents within 31 days of their initial eligibility period. Employee and Spouse benefits are available in $10,000 increments to a maximum of $500,000. The employee benefit amount, combined with basic life insurance benefit, may not exceed seven times the employee’s annual salary. The amount of coverage elected for a dependent cannot exceed the employee’s benefit amount. Employee and Spouse Voluntary Term Life coverage reduces to 65% of the original amount upon attainment of age 65 and to 50% of the original amount upon attainment of age 70. Reductions due to attained age and premium rates for Spouse Term Life will be based on the Spouse’s age. Guaranteed Issue:Employee $230,000 Spouses $50,000 Employees and /or Spouses who do not enroll within their initial eligibility period no longer have a Guaranteed Issue and Must provide Evidence of Insurability for the full amount applied for. Dependent Child amounts: Age 15 days to 6 months $100 Age 6 months to age 25 $5,000 ($0.90 per family) or Full-time students $10,000 ($1.80 per family) Age < 30 30-34 35-39 40-4445-4950-5455-5960-6465-69 70-7475+ 10,000 $ 0.60 $ 0.80 $ 0.90 $ 1.10 $ 1.60 $ 2.70 $ 4.30 $ 6.80 $ 12.70 $ 20.60 $ 30.50 20,000 1.20 1.60 1.80 2.20 3.20 5.40 8.60 13.60 25.40 41.20 61.00 30,000 1.80 2.40 2.70 3.30 4.80 8.10 12.90 20.40 38.10 61.80 91.50 40,000 2.40 3.20 3.60 4.40 6.40 10.80 17.20 27.20 50.80 82.40 122.00 50,000 3.00 4.00 4.50 5.50 8.00 13.50 21.50 34.00 63.50 103.00 152.50 60,000 3.60 4.80 5.40 6.60 9.60 16.20 25.80 40.80 76.20 123.60 183.00 70,000 4.20 5.60 6.30 7.70 11.20 18.90 30.10 47.60 88.90 144.20 213.50 80,000 4.80 6.40 7.20 8.80 12.80 21.60 34.40 54.40 101.60 164.80 244.00 90,000 5.40 7.20 8.10 9.90 14.40 24.30 38.70 61.20 114.30 185.40 274.50 100,000 6.00 8.00 9.00 11.00 16.00 27.00 43.00 68.00 127.00 206.00 305.00 110,000 6.60 8.80 9.90 12.10 17.60 29.70 47.30 74.80 139.70 226.60 335.50 120,000 7.20 9.60 10.80 13.20 19.20 32.40 51.60 81.60 152.40 247.20 366.00 130,000 7.80 10.40 11.70 14.30 20.80 35.10 55.90 88.40 165.10 267.80 396.50 140,000 8.40 11.20 12.60 15.40 22.40 37.80 60.20 95.20 177.80 288.40 427.00 150,000 9.00 12.00 13.50 16.50 24.00 40.50 64.50 102.00 190.50 309.00 457.50 Page30 VOLUNTARY GROUP Accidental Death and Dismemberment (AD&D) Any full-time, active employee is eligible to elect Voluntary AD&D coverage. Evidence of Insurability is not required for Voluntary AD&D coverage. The Individual Plan covers you in the event of accidental death or dismemberment. Benefits are available in $10,000 increments to a maximum of $500,000. The cost for this coverage is $0.04 per $1,000 of benefit. The Family Plan covers you and your eligible dependents in the event of accident or dismemberment. Employee amounts are available in $10,000 increments to a maximum of $500,000. The spouse benefit is equal to 50% of the employee amount, and the child benefit is equal to 10% of the employee amount. The cost for this coverage is $0.07 per $1,000 of benefit. Coverage reduces to 65% of the original amount upon attainment of age 65, further reduces to 50% of the original amount upon attainment of age 70, and terminates at retirement. Your Basic and Voluntary Group Term Life coverage automatically includes: Waiver of Premium: Your term life coverage may continue to age 65 at no cost to you if you become totally disabled prior to age 60, subject to the requirements of this benefit. Accelerated Death Benefit: If you are diagnosed with a Terminal Condition which with reasonable medical certainty will result in your death within12 months, you may choose to accelerate up to 50% of your group term life insurance amount. This sum is limited to a maximum of $150,000 and a minimum of $7,500. The amount of the accelerated payment will reduce the death benefit payable under the term life coverage by the amount of the requested payment. Conversion Option (applies to Basic and Voluntary Term Life): Should you leave your employment with ESC Region XI Cooperative, you may convert your term life coverage to an individual whole life insurance policy. The request to convert must be made within 31 days following termination of coverage. Portability Option (applies to Voluntary Term Life only): Should you leave your employment with ESC Region XI Cooperative, you may port your term life coverage for as long as the group policy is in force. The request to port must be made within 31 days following termination of coverage. Upon termination of the group policy, you will have the option to convert your coverage so long as the request is received within 31 days of the group’s termination. This summary is for illustrative purposes only and does not constitute a contract. The full terms and conditions of the coverage you select will be contained in the policies provided to ESC Region XI Cooperative. If there is any discrepancy between this benefit description and the policy, the terms of the policy will control. Basic and Voluntary Life Insurance is Underwritten by: Fort Dearborn Life Insurance Company Page31 FINANCIAL RESOURCES SUPPLEMENTAL BENEFITS 'RQ¶WWDNHDFKDQFHZLWK\RXU¿QDQFLDOKHDOWK Transfer the financial risk to Loyal American Life Insurance Company®, a member of Great American® Financial Resources, Inc. Accidents Happen Fast, Without Warning, Anywhere, $Q\WLPH$FFLGHQWV&DQ+DSSHQWR$Q\RQH(YHQ<RX Every 10 minutes, accidents cost Americans PLOOLRQ.* In the United States, an accident occurs aEvery 4 seconds in the home.* aEvery 8 seconds on the job.* aEvery 14 seconds on the road.* * National Safety Council: 2001 Injury Facts. Use does not imply endorsement.L-6020-AD (04/03) Accident Insurance Policy Accident Insurance Policy Underwritten By: Loyal American Life Insurance Company® P.O. Box 559004, Austin, TX 78755-9004 Call Toll-Free 1-800-633-6752 Page 32 Loyal American’s Accident Policy Protects You Eight Ways 'HVFULSWLRQRI%HQH¿WV $LU$PEXODQFH%HQH¿W Plan A $600 Plan B $300 /R\DO$PHULFDQZLOOSD\WKLVEHQH¿WLI\RXUHTXLUH transportation by a licensed professional air ambulance company to or from a hospital or between medical facilities within 48 hours for injuries sustained after a covered accident. Payable once per accident. $PEXODQFH%HQH¿W Plan A $150 Plan B $75 /R\DO$PHULFDQZLOOSD\WKLVEHQH¿WLI\RX UHTXLUHWUDQVSRUWDWLRQE\DOLFHQVHGSURIHVVLRQDO ambulance company to or from a hospital or between medical facilities within 90 days for injuries sustained after a covered accident. Payable once per accident. Ambulance Emergency Room 7UHDWPHQW%HQH¿W Insured and SpousePlan A $150Plan B $75 Children Plan A $75Plan B $40 /R\DO$PHULFDQZLOOSD\WKLVEHQH¿WLI\RXUHFHLYH hospital emergency room treatment within 72 hours for injuries sustained in a covered accident and for which charges are submitted. ,QGHPQLW\%HQH¿WV $FFLGHQW)ROORZ8S 7UHDWPHQW%HQH¿W Plan A $50/visitPlan B $25/visit /R\DO$PHULFDQZLOOSD\WKLVEHQH¿WIRUWKUHH additional treatments of injuries sustained in a covered accident over and above emergency WUHDWPHQWDGPLQLVWHUHGGXULQJWKH¿UVWKRXUV following the accident. Treatment must begin within 30 days of the covered accident and must be within the 6 month period following the covered accident.6SHFL¿F6XP ,QMXULHV%HQH¿W 7KHVSHFL¿FLQGHPQLW\DPRXQWDVOLVWHG LQWKHSROLF\¶V%HQH¿W6FKHGXOHZLOOEH paid according to the type of injury re- ceived in a covered accident. Loyal American will pay for dislocations (separated joint), burns, tendon (torn, ruptured, severed, ligaments, or rotator cuff), torn knee cartilage, eye injuries, lacerations, and fractures (broken bones). %ORRG3ODVPD3ODWHOHWV%HQH¿W Plan A $100 Plan B $50 /R\DO$PHULFDQZLOOSD\WKLVEHQH¿WLI\RXUHTXLUH transfusion, administration, cross matching, typing and processing of blood, plasma or platelets when administered within 90 days for injuries sustained in a covered accident. Payable once per accident. a 3K\VLFDO7KHUDS\%HQH¿WV a $FFLGHQWDO'HDWK%HQH¿WV a $PEXODQFH%HQH¿WV a ,QGHPQLW\%HQH¿WV a+RVSLWDO%HQH¿WV a ,QWHQVLYH&DUH &RQ¿QHPHQW%HQH¿WV a 'LVPHPEHUPHQW%HQH¿WV a )DPLO\/RGJLQJ 7UDQVSRUWDWLRQ Page33 +RVSLWDO&RQ¿QHPHQW%HQH¿W Plan A $200/dayPlan B $100/day /R\DO$PHULFDQZLOOSD\WKLVEHQH¿WIRUD PD[LPXPRIGD\VSHUFRQ¿QHPHQW LI\RX UHTXLUHFRQ¿QHPHQWLQDKRVSLWDORULQDKRVSLWDO intensive care unit–sub acute within six months for injuries sustained in a covered accident. ,QLWLDO$FFLGHQW +RVSLWDOL]DWLRQ%HQH¿W Plan A $500 Plan B $250 /R\DO$PHULFDQZLOOSD\WKLVEHQH¿WLIKRVSLWDO FRQ¿QHPHQWLVUHTXLUHGZLWKLQVL[PRQWKVIRU injuries sustained in a covered accident. Payable once per accident. +RVSLWDO,QWHQVLYH&DUH8QLW &RQ¿QHPHQW%HQH¿W Plan A $400/dayPlan B $200/day /R\DO$PHULFDQZLOOSD\WKLVEHQH¿WIRUDPD[LPXP RIGD\VSHUFRQ¿QHPHQW LI\RXDUHFRQ¿QHGLQD hospital intensive care unit within 30 days because of injuries received in a covered accident. +RVSLWDO%HQH¿WV 7UDQVSRUWDWLRQ%HQH¿W Plan A $300 Plan B $150 /R\DO$PHULFDQZLOOSD\WKLVEHQH¿WIRUD maximum of three trips per calendar year if you UHTXLUHVSHFLDOWUHDWPHQWDQGFRQ¿QHPHQWLQD hospital located more than 100 miles from your residence or site of the accident for injuries sustained in a covered accident. Physical Therapy Family Lodging & Transportation )DPLO\/RGJLQJ%HQH¿W Plan A $100/day Plan B $50/day /R\DO$PHULFDQZLOOSD\WKLVEHQH¿WIRU a maximum of 30 days per accident, GXULQJWKHWLPH\RXDUHFRQ¿QHGLQ a hospital, for one motel/hotel room for a family member to accompany you if injuries VXVWDLQHGLQDFRYHUHGDFFLGHQWUHTXLUHKRVSLWDO FRQ¿QHPHQWDQGLIWKHKRVSLWDODQGPRWHOKRWHODUH more than 100 miles from your residence. 3K\VLFDO7KHUDS\%HQH¿W Plan A $50/treatment Plan B $25/treatment /R\DO$PHULFDQZLOOSD\WKLVEHQH¿WQRWWRH[FHHG ¿YHWUHDWPHQWVSHUDFFLGHQWIRUVHUYLFHVSUHVFULEHG by a doctor and rendered by a licensed physical therapist. Physical therapy must be for injuries sustained in a covered accident and must start within 60 days after the accident. Treatment must be completed within six months after the accident. $SSOLDQFH%HQH¿W Plan A $50 Plan B $25 /R\DO$PHULFDQZLOOSD\WKLVEHQH¿WLIDGRFWRU advises you to use a medical appliance as an aid in personal locomotion within 90 days as a result of injuries sustained in a covered accident. %HQH¿WVDUHSD\DEOHIRUFUXWFKHVZKHHOFKDLUV EUDFHVHWF%HQH¿WVDUHSD\DEOHIRUFUXWFKHVDQG wheelchairs once per accident. 3URVWKHVLV%HQH¿W Plan APlan B One prosthetic device or DUWL¿FLDOOLPE$100 $50 More than one prosthetic GHYLFHRUDUWL¿FLDOOLPE$500 $250 /R\DO$PHULFDQZLOOSD\WKLVEHQH¿WLIDGRFWRU prescribes the use of a prosthetic device due to the loss of a hand, foot or sight of an eye in a covered accident. The prosthetic device must be received within one year of the covered DFFLGHQW7KLVEHQH¿WLVSD\DEOH once per accident and is not payable for hearing aids, dental aids, false teeth, or for cosmetic prothesis (e.g. hair wigs). We will not pay for joint replacement (e.g. DUWL¿FLDOKLSRUNQHH  &RQ¿QHPHQWV separated by less than 90 days will be considered as the same period RIFRQ¿QHPHQW Intensive Care Page34 7KLVLVDOLPLWHGEHQH¿WSROLF\7KLVSROLF\GRHVQRWSD\IRUORVVHVUHVXOWLQJIURPVLFNQHVV RENEWABILITY CONDITIONS: The policy is guaranteed renewable. Premium rates may be changed on a class basis. A FODVVPD\EHGH¿QHGE\DJHVH[RFFXSDWLRQSUHPLXPSD\PHQWPHWKRGLVVXHVWDWHHOLPLQDWLRQSHULRGEHQH¿WSHULRGHWF :+$7,6127&29(5('%<7+,632/,&<:HZLOOQRWSD\EHQH¿WVIRUDQ\LQMXU\DVDUHVXOWRI\RX U  •Operating, learning to operate, serving as a crew member of or jumping or falling from any aircraft. Aircraft includes those which are not motor-driven. •Engaging in hang gliding, bungee jumping, parachuting, sailgliding, parakiting, or hot-air ballooning. •Participating or attempting to participate in an illegal activity. •Riding in or driving any motor-driven vehicle in a race, stunt show, or speed test. ‡,QWHQWLRQDOO\FDXVLQJDVHOILQÀLFWHGLQMXU\ ‡+DYLQJDQ\VLFNQHVVRUGHFOLQLQJSURFHVVFDXVHGE\DVLFNQHVVLQFOXGLQJSK\VLFDORUPHQWDOLQ¿UPLW\:HDOVRZLOOQRWSD\ EHQH¿WVWRGLDJQRVHRUWUHDWWKHVLFNQHVV6LFNQHVVPHDQVDQ\GLVHDVHRUGLVRUGHUWKDWLVQRWFDXVHGE\DQLQMXU\ •Practicing for or participating in any semi-professional or professional competitive athletic contest for which any type of compensation or remuneration is received. •Committing or trying to commit suicide, whether sane or insane. •Being in an accident which occurs more than 40 miles outside the territorial limits of the United States, Canada, Puerto Rico, and Virgin Islands. ‡,QYROYHPHQWLQDQ\SHULRGRIDUPHGFRQÀLFWHYHQLILWLV not declared. This brochure contains a summary of the Accident Insurance Policy form L-6020. Coverage as described in the brochure is provided only through the issuance of a policy. The policy should be consulted for full terms and conditions of coverage. $FFLGHQWDO'HDWK %HQH¿W 7KLVSROLF\ZLOOSD\WKHIROORZLQJEHQH¿WIRUGHDWK if it is the result of injuries sustained in a covered accident. Death must occur within 90 days of a covered accident. &RPPRQ&DUULHU Insured Plan A $100,000Plan B $50,000 Spouse Plan A $50,000 Plan B $25,000 Child Plan A $15,000 Plan B $7,500 (You must be a fare paying passenger on a common- FDUULHU&RPPRQFDUULHUYHKLFOHVDUHOLPLWHGWR Accidental Death commercial airplanes, trains, buses, trolleys, subways, ferries and boats that operate on a regularly scheduled EDVLVEHWZHHQSUHGHWHUPLQHGSRLQWVRUFLWLHV7D[LV DQGSULYDWHO\FKDUWHUHGYHKLFOHVDUHQRWLQFOXGHG Other Accidents Insured Plan A $25,000 Plan B $12,500 Spouse Plan A $10,000 Plan B $5,000 Child Plan A $ 5,000 Plan B $ 2,500 2WKHU$FFLGHQWVDUHWKRVHQRWFODVVL¿HGDV &RPPRQ&DUULHUDQGDUHQRWVSHFL¿FDOO\H[FOXGHGLQ WKHOLPLWDWLRQVDQGH[FOXVLRQVVHFWLRQRIWKHSROLF\ $FFLGHQWDO'LVPHPEHUPHQW %HQH¿W This policy will pay a percentage of the Accidental 'HDWK2WKHU$FFLGHQWV%HQH¿WIRUWKHVHOHFWHGSODQ Plan APlan B Both arms and both legs 100%100% Two arms or legs 50%50% Sight of two eyes, hands, or feet 50%50% Sight of one eye, hand, foot, arm, or leg 20%20% 2QHRUPRUH¿QJHUVDQGRU one or more toes 5%5% Dismemberment *Death or dismemberment must occur within 90 GD\VRIWKHDFFLGHQW2QO\WKHKLJKHVWVLQJOH EHQH¿WZLOOEHSDLGIRUDFFLGHQWDOGLVPHPEHUPHQW L-6020-AD (04/03) American Hospital Association Endorsement For more than 100 years, the American Hospital Association has EHHQDSRZHUIXOV\PERORITXDOLW\$+$6ROXWLRQVDVXEVLGLDU\ of the AHA, awards the AHA endorsement only to products and services that help hospitals achieve organizational excellence. Healthcare organizations that select AHA-endorsed products support the AHA’s efforts on behalf of the nation’s hospitals. AHA 6ROXWLRQVLVSURXGWRUHLQYHVWLWVSUR¿WVLQWKH$+$¶VPLVVLRQ creating healthier communities. $+$6ROXWLRQV,QFDVXEVLGLDU\RIWKH$PHULFDQ+RVSLWDO Association, is compensated for the use of the AHA marks and IRULWVDVVLVWDQFHLQPDUNHWLQJHQGRUVHGSURGXFWVDQGVHUYLFHV By agreement, pricing of endorsed products and services may QRWEHLQFUHDVHGE\WKHSURYLGHUVWRUHÀHFWIHHVSDLGWRWKH$+$ Page35 Westlake Academy Memo To: Honorable President and Members of the Board of Trustees From: Debbie Piper, Finance Director Todd Wood, Director of Administrative Services Subject: Regular Meeting of August 11, 2008 Date: August 6, 2008 ITEM Consider a Resolution amending the current signers on the Westlake Academy bank account. BACKGROUND Due to the recent personnel changes involving the Head of School and CEO positions, it is necessary to amend the authorized signers on the Academy’s bank account at First Financial Bank. The Finance Director will continue to be the primary signer on the account. The CEO of the Academy and the Mayor Pro-Tem will also be listed as authorized signers in order to sign checks over $10,000 as two signatures are required; or in the event that a check must be processed in an emergency situation. This account set-up is consistent with the municipality’s authorized signers. RECOMMENDATION Staff recommends approval. FUNDING N/A ATTACHMENTS Resolution No. 08-12 WESTLAKE ACADEMY RESOLUTION NO. 08-12 A RESOLUTION OF THE BOARD OF TRUSTEES OF WESTLAKE ACADEMY, AMENDING THE AUTHORIZED SIGNERS OF THE ACADEMY’S DEPOSITORY ACCOUNT WITH FIRST FINANCIAL BANK. WHEREAS, authorized signers of Westlake Academy’s depository account may require amendments at certain times due to changes in structure and/or personnel; WHEREAS, recent changes in Westlake Academy personnel have necessitated such amendments; NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF TRUSTEES OF WESTLAKE ACADEMY: SECTION 1: That the Westlake Academy Board of Trustees does hereby appoint Thomas E. Brymer, Debbie J. Piper, and Don Redding as authorized signers of Westlake Academy’s depository account with First Financial Bank. SECTION 2: That this Resolution shall become effective on the date of its passage. PASSED AND APPROVED ON THIS 11TH DAY OF AUGUST 2008. ___________________________________ Laura Wheat, President ATTEST: ______________________________ __________________________________ Kim Sutter, Town Secretary Mark A. Rosevear, Head of School APPROVED AS TO FORM: ___________________________ L. Stanton Lowry, Town Attorney Westlake Academy MEMO TO: Honorable President and Members of the Board of Trustees FROM: Tom Brymer, CEO Mark Rosevear, Head of School Darcy McFarlane, Administrative Coordinator SUBJECT: Regular meeting of August 11, 2008 DATE: August 7, 2008 ITEM Hear report regarding Westlake Academy school uniform providers. BACKGROUND For the past two school years, Westlake Academy was in contract with Mills to be the exclusive uniform provider for the school uniforms. In that contract, we agreed to advertise to our parents that Mills was the only approved place to purchase school uniforms. During the past two years the school has received feedback from our parents both positive and negative regarding the service and quality of the uniforms from Mills (and before, Parker Uniforms). The one concern that we have heard most often has been the price of the uniforms and how the large output at the beginning of the school year to outfit students has been a burden. In some cases, and as with any clothing, the replacement cost is an issue when the students either wear through or out grow the clothes. This school year in an effort to try to scale down the cost of the uniforms, several parents and staff members suggested French Toast as an alternative since their pricing is significantly lower than our previous local uniform providers. Parents who have used French Toast products in the past have given us positive feedback about the pricing and quality of the product. With the past experiences in mind, the subject was brought up in a staff meeting with a general consensus that we should ask the Board to approve French Toast as the uniform provider for the 2008-09 school year. The resolution was brought before the Board and approved at the June 9th meeting. With the approval of the Board, school staff worked with French Toast to build a specific program for Westlake Academy parents to order the uniforms through their website. Once the program was up and running, parents were notified of the change in companies. Since that time the office staff of Westlake Academy has received numerous complaints and concerns about the ordering process, availability of the web-site and the customer service provided by French Toast. To try to remedy the recent concerns and complaints, the decision was made to allow parents to purchase uniform items from both French Toast and Mills. This is possible because when we signed on with French Toast, we were not required to sign an exclusive agreement. Additionally, Mills has offered to continue selling uniform items to our parents. Since this new decision has been made this week to offer both options of purchase, we have already received several positive comments from parents and appreciation that this option was made. Westlake Academy Memo To: Honorable Mayor and Members of the Board of Aldermen From: Mark Rosevear, Head of School Todd Wood, Director of Administrative Services Subject Regular Meeting of August 11, 2008 Date: August 11, 2008 ITEM Consider a Resolution approving the FY 2008-2009 Professional Salary Scale. BACKGROUND One goal of Westlake Academy is to recruit and retain an excellent professional staff. Therefore, it is essential that annual salary and benefit studies are conducted on an annual basis to ensure that we remain competitive with surrounding school districts. The proposed salary scale for the 2008-2009 academic year establishes the standard base compensation for full-time teachers, nurses, librarians, and counselors. The proposed scale is based on data compiled from nine surrounding school districts; representing a broad and consistent sampling of salaries in the immediate area. Since 2004, Westlake Academy has maintained a salary scale that is within 3% of the median of surveyed districts. The proposed scale maintains this current level of comparability, and reflects a 3.1% increase over the 07-08 scale. Returning personnel also receive an average step increase of 1.1%, resulting in a 4.2% average salary increase from 2007-2008. FUNDING The overall budgetary impact of adopting the proposed FY 08-09 salary scale is $61,710 above the FY 07-08 scale. This figure includes all related taxes and benefit costs. Adoption of the proposed scale will ensure Westlake Academy remains competitive with surrounding districts, and enables us to attract and retain the most talented and qualified staff possible. RECOMMENDATION Staff recommends approval. ATTACHMENTS: 2008-2009 Proposed Professional Salary Scale 2007-2008 Professional Salary Scale WESTLAKE ACADEMY RESOLUTION NO. 08-13 A RESOLUTION OF THE BOARD OF TRUSTEES OF THE WESTLAKE ACADEMY, APPROVING THE TEACHER’S SALARY SCALE FOR THE 2008- 2009 ACADEMIC YEAR. WHEREAS, Westlake Academy desires to recruit and maintain the most qualified and professional employees available; and WHEREAS, Westlake Academy desires maintain a salary scale that is competitive with surrounding school districts; and WHEREAS, the goal of the Board of Trustees is to maintain a salary scale that is within 3% of the median of surveyed school districts. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF TRUSTEES OF THE WESTLAKE ACADEMY: SECTION 1: That the Westlake Academy Board of Trustees does hereby approve the FY 08-09 salary scale as proposed. SECTION 2: That this Resolution shall become effective upon the date of its passage. SECTION 3: That this Resolution shall be effective only for the 2008-2009 academic year. PASSED AND APPROVED ON THIS 11TH DAY OF AUGUST 2008. ___________________________________ ATTEST: Laura Wheat, Mayor ___________________________ __________________________________ Kim Sutter, TRMC, Town Secretary Tom Brymer, Town Manager APPROVED AS TO FORM: _____________________________ L. Stanton Lowry, Town Attorney Westlake Academy 2007-2008 Salary Scale Classroom Teachers, Counselors, Librarians, and Nurses Y e a r s E x r e r i e n c e A n n u a l S a l a r y ( 1 8 7 d a y s ) 0 43,252 1 43,391 2 43,785 3 43,682 4 44,073 5 44,655 6 44,965 7 45,230 8 45,386 9 45,594 10 45,971 11 46,250 12 46,614 13 47,057 14 47,399 15 47,593 16 48,321 17 49,402 18 49,798 19 50,718 20 52,055 21 52,904 22 53,310 23 53,737 24 54,424 25 56,317 26 57,299 27 58,100 28 58,100 29 58,744 30 58,744 Westlake Academy 2008-2009 Proposed Salary Scale Classroom Teachers, Counselors, Librarians, and Nurses Y e a r s E x p e r i e n c e 0 8 - 0 9 P r o p o s e d S a l a r y (1 8 7 d a y s ) 0 43,798 1 44,559 2 44,866 3 45,459 4 45,652 5 46,426 6 46,828 7 47,180 8 47,476 9 47,635 10 48,004 11 48,407 12 48,659 13 48,838 14 49,063 15 49,762 16 49,925 17 50,199 18 51,148 19 52,119 20 53,306 21 54,198 22 54,869 23 55,291 24 55,780 25 57,522 26 58,392 27 59,008 28 59,639 29 59,739 30 60,483 Westlake Academy MEMO TO: Honorable President and Members of the Board of Trustees FROM: Tom Brymer, CEO Mark Rosevear, Head of School Debbie Piper, Finance Director SUBJECT: Regular meeting of August 11, 2008 DATE: August 6, 2008 ITEM Consider a resolution approving the estimated year-end budget for Westlake Academy for the fiscal year ending August 31, 2008 and adopting the proposed budget for the fiscal year ending August 31, 2009. BACKGROUND In accordance with State law, the staff has prepared the FY 2008/2009 budget outlining the anticipated revenues and expenditures. The school will grow by adding eleventh grade and additional students in all other grade levels raising the projected number of students from 365 in 2007/08 to over 425. This will also be the first year that Westlake Academy will implement the Diploma Program. Staff will also increase from 41 full time and six part time employees in 2007/08 to 46 full time and two part-time employees for the 2008-09 year. RECOMMENDATIONS Staff recommends approval. FUNDING N/A ATTACHMENTS Resolution No. 08-14 Proposed Budget WESTLAKE ACADEMY RESOLUTION NO. 08-14 A RESOLUTION OF THE BOARD OF TRUSTEES OF THE WESTLAKE ACADEMY TO ADOPT THE REVISED BUDGET FOR FISCAL YEAR ENDING AUGUST 31, 2008 AND THE PROPOSED BUDGET FOR FISCAL YEAR ENDING AUGUST 31, 2009. WHEREAS, Section 44.002 of the Education Code of the Texas Education Agency Texas School Law Bulletin states the budget must be prepared according to generally accepted accounting principles; and WHEREAS, the budget must be approved by the Board of Trustees prior to August 31st according to Texas Education Agency’s Financial Accountability System Resource Guide, Section 2.6.2 – TEA Legal Requirements; NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF TRUSTEES OF THE WESTLAKE ACADEMY: SECTION 1: That the Board of Trustees hereby adopts the revised budget for the fiscal year ending August 31, 2008 and adopts the proposed Annual Operating Budget for the fiscal year ending August 31, 2009 and appropriates the funds contained therein. SECTION 2: That a copy of the official adopted 2008-2009 Budget shall be kept on file in the office of the Town Secretary. SECTION 3: That this Resolution shall become effective upon the date of its passage. PASSED AND APPROVED ON THIS 11th DAY OF AUGUST, 2008. ___________________________________ ATTEST: Laura Wheat, President _______________________________ __________________________________ Kim Sutter, Secretary Tom Brymer, CEO APPROVED AS TO FORM: _________________________________ L. Stanton Lowry, Attorney AA nn nn uu aa ll OO pp ee rr aa tt ii nn gg BB uu dd gg ee tt .. Fiscal Year 2008/2009 . is WWWWWWWW eeeeeeee ssssssss tttttttt llllllll aaaaaaaa kkkkkkkk eeeeeeee AAAAAAAA cccccccc aaaaaaaa dddddddd eeeeeeee mmmmmmmm yyyyyyyy a convergence of quality * a commitment to excellence WWWWWWWWeeeeeeeessssssssttttttttllllllllaaaaaaaakkkkkkkkeeeeeeee AAAAAAAAccccccccaaaaaaaaddddddddeeeeeeeemmmmmmmmyyyyyyyy Table of Contents Westlake Academy * 2600 JT Ottinger Road * Westlake, Texas 76262 i Administrative Officials 01 Fund Descriptions 02 Account Coding Matrix 03 General Fund General Fund Program Summary 04 General Fund Proposed Budget by Function and Object Code 05 General Fund Budget Comparison 06 General Fund Revenues and Expenditures Percentage Graphs 08 Operating Expenditures including Municipal Support 09 Revenue and Expenditure Comparison Fiscal Year 03/04 through 08/09 10 Special Revenue Fund Program Summaries Fund 244 IDEA-B Reimbursement Grant 11 Fund 397 Advanced Placement/IB 12 Fund 411 Technology Allotment 13 Fund 429 FSP/High School Allotment 14 WWeessttllaakkee AAccaaddeemmyy Page 1 ADMINISTRATIVE OFFICIALS FISCAL YEAR 2008/2009 Laura Wheat PPrreessiiddeenntt Tim Brittan, Larry Corson, Carol Langdon, Rebecca Rollins, Don Redding BBooaarrdd ooff TTrruusstteeeess Mark Rosevear HHeeaadd ooff SScchhooooll Thomas Brymer CChhiieeff EExxeeccuuttiivvee OOffffiicceerr WWeessttllaakkee AAccaaddeemmyy Page 2 FUND DESCRIPTIONS Governmental Fund Types are those through which most governmental functions of the Academy are financed. The acquisition, use and balances of the District’s expendable financial resources, and the related liabilities are accounted for through the Governmental Fund Types. Following are the Academy’s Governmental Fund Types: General Fund The General Fund is the fund that accounts for financial resources in use for general types operations. This is a budgeted fund, and any fund balances are considered resources available for current operations. Fund balances may be appropriated by the Board of Trustees to implement its responsibilities. Special Revenue Funds The Special Revenue Funds are the funds that account for local, state and federally financed programs or expenditures legally restricted for specified purposes or where unused balances are returned to the grantor at the close of a specified project period. Fund 224 IDEA-B Reimbursement Grant (Federally Funded) Fund is used, on a project basis, for funds granted to operate educational programs for children with disabilities. Fund 397 Advanced Placement/IB Awards (State Funded) Fund is used to account, on a project basis, for funds awarded under the Texas Advanced Placement Award Incentive Program, Chapter 28, Subchapter C, Texas Education Code. The purpose of this incentive program is to recognize and reward those students, teachers, and schools that demonstrate success in achieving the state’s educational goals. Fund 411 Technology Allotment (State Funded) Fund is to be used to account, on a project basis, for funds awarded to purchase technological software or equipment that contributes to student learning, or to pay for training for educational personnel involved in the use of these materials. Fund 428 FSP-High School Allotment (State Funded) Fund is to be used for the allotment providing $275 per student in average daily attendance in grades 9-12 by the state. Note: The audited financial statements of the Academy include all funds. However, the Texas Education Agency only requires the adoption of the General Fund, Food Service Special Revenue Fund and Debt Service Fund. In the Westlake Academy’s case, only the General Fund is required to be adopted. Function CodeFunction Code Description 11Instruction & Related 12Instructional Resources & Media Sources (Library) 13Curriculum Development & Inst. Staff Development 21Instructional Leadership 23School Leadership (Principal) 31Guidance, Counseling & Evaluation Services 32Social Work Services 33Health Services 34Student (Pupil) Transportation 35Food Services ACCOUNT CODING MATRIX 36Cocurricular/extracurricular activities 41General Administration (Superintendent/Board) 51Plant Maintenance and Operations 52Security and Monitoring Services 53Data Processing Services 61Community Services Object CodesObject Code Description 61XX Payroll and Payroll Related 62XXProfessional & Contracted Services 63XXSupplies and Materials 64XXOther Operating Costs Page 3 Adopted Estimated Proposed Actual Budget Budget Budget FY 06/07 FY 07/08 FY 07/08 FY 08/09 Beginning Fund Balance427,720$ 691,740$ 691,740$ 561,863$ Revenues 2,879,531 2,951,311 3,234,899 3,453,580 Expenditures2,615,511 3,271,416 3,364,775 3,438,560 Net Revenues over (under) Expenditures 264,020 (320,105) (129,876) 15,019 Ending Fund Balance691,740$ 371,635$ 561,863$ 576,883$ # Days Operating (Based on 365)97 41 61 61 Days operating expense 7,166$ 8,963$ 9,219$ 9,421$ WESTLAKE ACADEMY General Fund - 199 Program Summary Page 4 Westlake Academy Proposed FY 2008-2009 Budget GeneralFund The image cannot be displayed. 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General Fund Adopted Estimated Proposed Actual Budget Budget Budget FY 06-07 FY 07/08 FY 07/08 FY 08/09 REVENUESREVENUES Local Revenues512,335$ 593,498$ 534,102$ 540,212$ State Program Revenues2,367,196 2,357,813 2,700,797 2,913,368 Total Revenues2,879,531$ 2,951,311$ 3,234,899$ 3,453,580$ EXPENDITURES BY FUNCTION 11 - Instructional1,597,408$ 1,956,274$ 1,961,827$ 1,939,291$ 12 - Resources & Media59,039 70,317 71,470 71,106 13 - Staff Development29,886 26,000 26,275 29,870 p 21 - Instructional Leadership9,190 10,968 12,305 6,548 23 - School Leadership216,472 132,396 143,179 208,426 31 - Guidance & Counseling41,988 111,926 113,072 147,254 33 - Health Services25,412 25,248 26,426 27,457 35 - Food Services84,484 95,918 32,389 34,301 36 - CoCurricular Activities53,463 58,305 50,125 84,990 41 - Administrative218,670 401,373 524,672 462,604 51 - Maintenance & Operations195,264 233,381 240,281 267,180 53 - Data Processing68,177 82,401 95,796 90,967 61 - Community Services15,958 66,909 66,958 68,567 Total Expenditures 2,615,411 3,271,416 3,364,775 3,438,560 Revenues Over (Under) Expenditures264,120$ (320,105)$ (129,876)$ 15,019$ REVENUES Local Revenues512,335$ 593,498$ 534,102$ 540,212$ State Program Revenues2,367,196 2,357,813 2,700,797 2,913,368 Total Revenues2,879,531$ 2,951,311$ 3,234,899$ 3,453,580$ EXPENDITURES BY OBJECT CODE 61XXPayroll and Related Items1,981,908$ 2,484,284$ 2,579,406$ 2,627,144$ 62XXContracted Services350,544 412,559 531,209 543,228 63XXSupplies & Materials175,956 246,650 135,225 124,191 64XXOther Operating107,103 127,923 118,935 143,998 Total Expenditures2,615,511 3,271,416 3,364,775 3,438,560 Revenues Over (Under) Expenditures264,020$ (320,105)$ (129,876)$ 15,019$ Page 5 Westlake Academy Proposed FY 2008-2009 Budget BudgetComparison-GeneralFund The image cannot be displayed. 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Budget Comparison - General Fund Variance Adopted Estimated Proposed Proposed Actual Budget Budget Budget to FY 06-07 FY 07/08 FY 07/08 FY 08/09 Estimated REVENUESREVENUES Local Revenues512,335$ 593,498$ 534,102$ 540,212$ 6,110$ State Program Revenues2,367,196 2,357,813 2,700,797 2,913,368 212,571 Total Revenues2,879,531$ 2,951,311$ 3,234,899$ 3,453,580$ 218,681$ EXPENDITURES 6100Payroll1,485,079$ 1,785,774$ 1,787,802$ 1,776,486$ (11,316)$ 6200 ContractedServices 27883 30000 76525 77020 495 11 Instructional 6200 Contracted Services 27,883 30,000 76,525 77,020 495 6300Supplies & Materials84,299 140,000 97,000 85,270 (11,730) 6400Other Operating147 500 500 515 15 Total Instructional1,597,408 1,956,274 1,961,827 1,939,291 (22,536) 6100Payroll53,308 56,817 57,970 57,256 (714) 6200Contracted Services5,731 13,500 13,500 13,850 350 Total Resources & Media59,039 70,317 71,470 71,106 (364) 12 Resources & Media ,,,,() 6300Supplies & Materials550 - 275 - (275) 6400Other Operating29,336 26,000 26,000 29,870 3,870 Total Staff Development29,886 26,000 26,275 29,870 3,595 6100Payroll9,190 10,968 12,305 6,548 (5,757) 13 Staff Development 21 Instructional Leadership Total Instructional Leadership9,190 10,968 12,305 6,548 (5,757) 6100Payroll200,794 117,676 132,959 196,826 63,867 6200Contracted Services15,078 9,720 10,020 10,600 580 6300Supplies & Materials600 5,000 200 1,000 800 Total School Leadership216,472 132,396 143,179 208,426 65,247 23 School Leadership 6100Payroll26,977 92,926 93,772 125,289 31,517 6200Contracted Services14,844 18,800 18,800 21,450 2,650 6300Supplies & Materials167 200 500 515 15 Total Guidance & Counseling41,988 111,926 113,072 147,254 34,182 6100Payroll24,176 24,598 25,171 26,142 971 6200 CttdSi 755 755 800 45 31 Guidance & Counseling 33 Health Services 6200 Contracted Services 755 - 755 800 45 6300Supplies & Materials581 650 500 515 15 Total Health Services25,512 25,248 26,426 27,457 1,031 Page 6 Westlake Academy Proposed FY 2008-2009 Budget BudgetComparison-GeneralFund The image cannot be displayed. 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Budget Comparison - General Fund (Continued) Variance Adopted Estimated Proposed Proposed Actual Budget Budget Budget to FY 06-07 FY 07/08 FY 07/08 FY 08/09 Estimated 35FoodServices 6100Payroll13,519$ 14,918$ 15,839$ 17,252$ 1,413$ 6300Supplies & Materials70,716 80,650 16,300 16,791 491 6400Other Operating250 350 250 258 8 Total Food Services84,485 95,918 32,389 34,301 1,912 6100Payroll11,287 10,375 11,633 45,076 33,443 6200 ContractedServices 36,643 41,392 33,142 33,948 806 35 Food Services 36 CoCurricular Activities 6200 Contracted Services 36,643 41,392 33,142 33,948 806 6300Supplies & Materials1,140 2,000 200 500 300 6400Other Operating4,393 4,538 5,150 5,466 316 Total CoCurricular Activities53,463 58,305 50,125 84,990 34,865 6100Payroll109,106 235,922 306,101 235,735 (70,367) 6200Contracted Services58,131 95,547 154,067 144,100 (9,967) 6300Supplies & Materials6,298 8,150 10,250 9,300 (950) 41 Administrative pp () 6400Other Operating45,135 61,754 54,254 73,469 19,215 Total Administrative218,670 401,373 524,672 462,604 (62,069) 6200Contracted Services155,816 188,600 197,500 222,460 24,960 6300Supplies & Materials11,605 10,000 10,000 10,300 300 6400Other Operating27,842 34,781 32,781 34,420 1,639 Total Maintenance & Operations195,263 233,381 240,281 267,180 26,899 51 Maintenance & Operations 6100Payroll32,514 67,401 68,896 71,967 3,071 6200Contracted Services35,663 15,000 26,900 19,000 (7,900) Total Data Processing68,177 82,401 95,796 90,967 (4,829) 6100Payroll15,958 66,909 66,958 68,567 1,609 TlCiSi 198 66909 6698 686 1609 53 Data Processing 61 Community Services Total Community Services 15,958 66,909 66,958 68,567 1,609 Total Expenditures 2,615,511 3,271,416 3,364,775 3,438,560 73,785 Revenues Over (Under) Expenditures264,020 (320,105) (129,876) 15,019 144,896$ Beginning Fund Balance427,720 691,740 691,740 561,863 EndingFundBalance 691740$371635$561863$576883$Ending Fund Balance 691,740$ 371,635$ 561,863$ 576,883$ Page 7 Westlake Academy Fiscal Year 2008/2009 General Fund Revenues and Expenditures State Program Revenues 84% Local Revenues 16% GeneralFund Proposed Revenues 16% Payroll & Related Items 76% Contracted Services 16%Supplies & Materials 4% Other Operating Costs 4% GeneralFund Proposed Expenditures Page 8 Operating Expenditures including Municipal Support Fiscal Year 2008/2009 Westlake Academy Payroll and Related Items 49% Contracted Services 10% Supplies & Materials 2% Other Operating Costs 3%Municipal Payroll & Related In-kind Support Total $5,336,913 Municipal Debt Service Support 28% Municipal Facilites & Maintenance Support 4% In-kind Support 4% Academy Budgeted Expenditures 64% Municipal Support to Academy 36% $3,438,560 Total $5,336,913 $1,898,353 Page 9 Westlake Academy Revenue and Expenditure Comparison Page 10 Fiscal Year 03/04 through 08/09 $3,000,000 $3,500,000 $1,500,000 $2,000,000 $2,500,000 08 31, 8 9 8 $2, 4 0 7 , 5 2 6 $2 , 8 7 9 , 5 3 1 $3 , 2 3 4 , 8 9 9 $3 , 4 5 3 , 5 8 0 57 12, 1 9 8 2, 2 1 1 , 8 9 7 $2 , 6 1 5 , 5 1 1 $3 , 3 6 4 , 7 7 5 $3 , 4 3 8 , 5 6 0 $0 $500,000 $1,000,000 FY 03/04 actual FY 04/05 actual FY 05/06 actual FY 06/07 actual FY 07/08 estimated FY 08/09 projected $1 , 0 9 4 , 6 0 $1 , 8 3 $ $1 , 0 6 8 , 8 5 $1 , 6 1 $ actual actual actual actual estimated projected Revenues Expenditures Page 10 Adopted Estimated Proposed Audited Budget Budget Budget FY 06/07 FY 07/08 FY 07/08 FY 08/09 Beginning Fund Balance-$ -$ -$ -$ State Revenue33,855 28,288 54,061 61,768 Expenditures (Staff Development)33,855 28,288 54,061 61,768 Net Revenues over (under) Expenditures- - - - Ending Fund Balance -$ -$ -$ -$ WESTLAKE ACADEMY Special Revenue Fund IDEA-B Reimbursement Grant - 224 Program Summary Page 11 Adopted Estimated Proposed Audited Budget Budget Budget FY 06/07 FY 07/08 FY 07/08 FY 08/09 Beginning Fund Balance-$ -$ -$ -$ State Revenue 2,250 - 5,750 5,750 Expenditures (Staff Development)2,250 - 5,750 5,750 Net Revenues over (under) Expenditures- - - - Ending Fund Balance -$ -$ -$ -$ WESTLAKE ACADEMY Special Revenue Fund Advanced Placement/IB - 397 Program Summary Page 12 Adopted Estimated Proposed Audited Budget Budget Budget FY 06/07 FY 07/08 FY 07/08 FY 08/09 Beginning Fund Balance-$ -$ -$ -$ State Revenue 8,988 10,212 10,420 10,500 Expenditures (Supplies)8,988 10,212 10,420 10,500 Net Revenues over (under) Expenditures- - - - Ending Fund Balance -$ -$ -$ -$ Special Revenue Fund Technology Allotment - 411 Program Summary WESTLAKE ACADEMY Page 13 Adopted Estimated Proposed Audited Budget Budget Budget FY 06/07 FY 07/08 FY 07/08 FY 08/09 Beginning Fund Balance-$ -$ -$ -$ State Revenue 8,821 7,603 7,603 26,400 Expenditures (Supplies)8,821 7,603 7,603 26,400 Net Revenues over (under) Expenditures- - - - Ending Fund Balance -$ -$ -$ -$ Program Summary WESTLAKE ACADEMY Special Revenue Fund FSP/High School Allotment - 428 Page 14 8. BOARD CALENDAR. - Special Board of Trustees Meeting o 8/21/08, 9:30 a.m., Town Hall offices, Municipal Court Room - Back to School Night o 8/21/08, time TBD - Teacher Welcome Back Breakfast o 8/22/08, 8 a.m. – 9 a.m., Academy Dining Hall - Corporate Neighbors Reception o 5:30 – 7:30 p.m. @ the home of Doug and Laura Wheat - Joint Board of Aldermen/Planning & Zoning Commission land use/zoning training o 9/29/08, 6-8 p.m., Town Hall offices, Municipal Court Room - Texas Municipal League Annual Conference and Exhibition o 10/28 – 10/31/08, San Antonio, Texas Westlake  Academy  Item # 8 –   Board Calendar  9. FUTURE AGENDA ITEMS: Any Board member may request at a workshop and / or Board meeting, under “Future Agenda Item Requests”, an agenda item for a future Board meeting. The Board member making the request will contact the Town Manager with the requested item and the Town Manager will list it on the agenda. At the meeting, the requesting Board member will explain the item, the need for Board discussion of the item, the item’s relationship to the Board’s strategic priorities, and the amount of estimated staff time necessary to prepare for Board discussion. If the requesting Board member receives a second, the Town Manager will place the item on the Board agenda calendar allowing for adequate time for staff preparation on the agenda item. - None Westlake  Academy  Item # 9 –   Future Agenda  Items  10. EXECUTIVE SESSION. A. The Board will conduct a closed session under Texas Government Code section 551.071 to seek advice of counsel on legal matters involving pending or contemplated litigation, settlement offers, or other legal matters not related directly to litigation or settlement, specifically related to the Texas Education Agency ruling. Westlake  Academy  Item # 10 –  Executive Session   Back up material has not  been provided for this item.  Westlake  Academy  Item # 11 –   Reconvene Meeting Westlake  Academy  Item # 12 –  Adjournment  Back up material has not  been provided for this item.