Page 8 - E3 Policies

The E3 Adoption Assistance Program will reimburse an eligible full‐time active employee up to a maximum of $1,500 for qualified adoption
expenses associated with the adoption of an eligible child, whether through private adoption or an adoption through a licensed adoption
agency.
E3 intends that its Adoption Assistance Program qualify as a plan providing adoption assistance under Internal Revenue Code Section 137
and that reimbursements made under the Adoption Assistance Program be eligible for exclusion from participating employees’ income
under IRC Section 137(a) or taxable for a Highly Compensated Employee (HCE) as defined under IRC Section 414(q)(1). Highly Compensated
Employee (HCE) includes any employee who:
 Was a more‐than‐5% owner of E3 during the year in which the adoption was finalized or during the prior year (or is the spouse, child or
dependent of such an owner); OR

Had gross compensation in excess of the threshold amount determined by the Internal Revenue Service
for the year immediately prior to the year during which the adoption was finalized. (The threshold earnings amount is indexed annually by
the IRS.)
Eligibility
An eligible employee is a full‐time employee with at least 180 days of continuous service prior to the date of the final adoption decree(s)
who is in an eligible class of employees to whom E3 offers the Adoption Assistance Program. “Full‐time” means scheduled to work a
minimum of thirty two (32) hours per week (or any lower number required under an applicable state law).
Employees who permanently reside outside the United States are not eligible for reimbursement under the program.
Qualified Expenses
“Qualified adoption expenses” mean expenses, such as:
 reasonable and customary public, private, international agencies and independent adoption fees
 reasonable and customary legal and court costs

medical maternity expenses for the child’s biological mother not covered by insurance
 reasonable and customary charges for necessary medical expenses not covered under any other available flexible benefits option
 temporary foster care charges when their payment is required immediately preceding the child's placement
 immigration fees
 immunization costs
 translation services
 transportation and lodging expenses related to the adoption
 and other such expenses directly related to and with the principal purpose of adoption of an eligible child.
Qualified adoption expenses do not include:
 medical exams for the adopting parents
 costs of personal items, i.e. clothing, food, and expenses incurred while not an employee

An “eligible child” is any individual who:
 Has not attained age 18; OR
 Is physically or mentally incapable of caring for him‐or herself.

Assistance will be provided only for adoptions that are determined by E3 to comply with all applicable rules, regulations and laws relating to
adoption.
Exclusions
No assistance is available for any of the following:
 The adoption of a stepchild or stepchildren of the employee or the children of the employee’s spouse/domestic partner.
 Expenses incurred in any surrogate parenting arrangement.
 Expenses already reimbursed to an employee for the adoption of the eligible child.
Maximum Reimbursement Amount
An employee may be reimbursed up to a maximum of $1,500 for qualified adoption expenses directly related to and with the principal
purpose of the adoption of an eligible child.
Reimbursement Procedures
To request adoption assistance, you must:
 Complete an Adoption Assistance Reimbursement form.