HEALTH & WELFARE POOL

GENERAL ASSESSMENT FORMULA

FOR THE

PURMS JOINT SELF-INSURANCE AGREEMENT

Amended and Restated as of December 7, 2001

TABLE OF CONTENTS

1. Definitions For H&W General Assessment Formula 2

1.1. Allowed H&W Claim 2

1.2. Alternate ISL Method 2

1.3. Assessment Formula 2

1.4. Average Claims Frequency Ratio 2

1.5. Benefits Check 2

1.6. Claims Experience 2

1.7. Claims Frequency Factor 2

1.8. Claims Frequency Ratio 3

1.9. Covered H&W Claim 3

1.10. Date of Membership 3

1.11. Debatable H&W Claims 3

1.12. Dependent Coverage 3

1.13. Dependents 3

1.14. Direct H&W Claims Costs 3

1.15. Eligible Employee 3

1.16. Eligible Employee Assessment Allocation 3

1.17. Eligible Employee Factor 3

1.18. Eligible Insured 3

1.19. Employee 4

1.20. Employee Demographic Categories 4

1.21. Employee Demographics 4

1.22. Fund’s Fiscal Year 4

1.23. H&W Assessments 4

1.24. H&W Assessment Share 4

1.25. H&W Claim 4

1.26. H&W Claims Costs 4

1.27. H&W Claims Experience 4

1.28. H&W Claims Experience Assessment Allocation 4

1.29. H&W Coverage 4

1.30. H&W General Assessment Formula 5

1.31. H&W Pool 5

1.32. H&W Pool Aggregate Stop Loss 5

1.33. H&W Pool Individual Stop Loss 5

1.34. H&W Pool Operational Costs 5

1.35. Incurred 5

1.36. Member Aggregate Stop Loss 5

1.37. Member Individual Stop Loss 5

1.38. Monthly H&W Assessment 5

1.39. Pool Recognized Aggregate Stop Loss Point 6

1.40. Pool Recognized H&W Claims 6

1.41. Post-Stop-Loss H&W Assessments 6

1.42. Post-Stop-Loss H&W Claims 6

1.43. PPO Charges 6

1.44. Primary ISL Method 6

1.45. Primary ISL Method Cross Check 6

1.46. Prior Monthly H&W Claims Experience 6

1.47. Prior Monthly H&W Premium 6

1.48. Recognized H&W Claim 7

1.50. Shared H&W Costs 7

1.51. Stop Loss Carrier 7

1.52. Stop Loss Coverage 7

1.53. Stop Loss Insurance 7

1.54. Stop Loss Point 7

1.55. Stop Loss Policy Year 7

1.56. Stop Loss Insurance Premium 7