.:: Morris Associates ::.

SALARY INFORMATION
Enter your annual income:	$

HEALTH CARE REIMBURSEMENT ACCOUNT
Enter the amount you expect to pay during the plan year for eligible medical expenses:
Medical deductibles
Medical plan co-payments and co-insurance	$
Dental plan deductibles and co-payments	$
Vision Expenses Including Glasses, Contact Lens, Exams and Supplies	$
Prescription Drugs	$
Orthodontia	$
Other Eligible Expenses	$
Eligible Over the Counter Expenses	$

*Total estimated health care contributions:*:	$

DEPENDENT CARE REIMBURSEMENT ACCOUNT
Enter the amount you expect to spend on eligible dependent care expenses:
Babysitter	$
Day Care Center	$
Nursery/Pre School	$
After-School Care	$
Summer Day Camp	$
Other Eligible Expenses	$

*Total estimated dependent care contributions:*	$

ESTIMATED TAX SAVINGS
Note: Based on 15% Federal income tax, 5% State income tax and 7.65% Social Security tax.
	Without Spending Account	With Spending Account

Annual Income	$	$
Total health care contribution	$	$
Total Dependent Care Contribution	$	$
Taxable income	$	$
Net income	$	$

ESTIMATED SAVINGS:

The health information, contained in Morris Associates Web site and other web sites listed herein or linked hereto, is provided for reference purposes only and is not intended as medical advice. Since Morris Associates cares about the health of its members, we supply health information to help people make informed decisions about their health. Health information is available on this site not as a substitute for medical treatment or advice from a health care professional and we encourage you to seek qualified medical care if you think that you have a medical condition. In addition, health information supplied herein does not mean that we offer insurance coverage for any particular treatment described.

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HEALTH CARE REIMBURSEMENT ACCOUNT

DEPENDENT CARE REIMBURSEMENT ACCOUNT

ESTIMATED TAX SAVINGS