Salary Reduction Agreement. I hereby request the Treasurer to reduce my salary, on a pre-tax basis, by any Health Savings Account (HSA) contributions, Highmark FSA contributions and administrative fees, spousal costs*, and Pastor’s contributions** as applicable. (Please sign below even if no dollars are reduced from salary. Signature indicates you have read and understand this Election Sheet)
Appears in 5 contracts
Samples: Health Care and Dependent Care Election Form and Salary Reduction Agreement, Health Care and Dependent Care Election Form and Salary Reduction Agreement, Health Care and Dependent Care Election Sheet and Salary Reduction Agreement
