Sales Receipt Reimbursement - Download as PDF

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					                                    FITNESS REIMBURSEMENT PROGRAM

PURPOSE:

            The purpose of the Fitness Reimbursement Program is to encourage employees
            and their families to participate in a regular fitness program and to provide partial
            reimbursement for health club memberships or stationary exercise equipment for
            their home.

REIMBURSEMENT GUIDELINES:

            Reimbursement Limits: Employees and their families will be reimbursed at a
            rate of 50% for memberships or equipment as specified below. Reimbursement
            will be limited to a maximum of $250 per calendar year.

            Reimbursement Taxation: All reimbursements under this program are
            considered taxable income by IRS regulations and will be included on the
            employee's W-2 form. Applicable federal, state and local taxes will be withheld
            from the reimbursement. Reimbursements will not be considered income for
            benefit purposes (e.g. pensionable earnings, Employees Profit Sharing and
            Savings Plan deductions, etc.).

WHAT IS COVERED:

            Memberships: Employees will be reimbursed 50% of the cost paid by the
            employee for an individual or family membership at an incorporated health club
            or fitness center of their choice. Reimbursement will be made on the actual cost
            of an individual (employee only) or family membership. Initiation fees are eligible
            for reimbursement. Employees may also receive reimbursement for classes
            such as Jazzercise or aerobics offered by a community organization such as the
            YMCA. Reimbursement will be made after all discounts and rebates are applied.

            Equipment: Employees will be reimbursed for stationary exercise equipment
            purchased for use in their homes. This will include equipment such as treadmills,
            stationary bikes, Nordic Tracks, ellipticals, free weights, exercise machines and
            similar equipment.

WHAT IS NOT COVERED:

            Costs for extra charges such as personal trainers, shipping charges, court fees,
            league fees, spa fees, equipment rentals, weight loss programs, nutrition
            supplements, locker/towel rental, exercise apparel, sporting goods and the like
            are not eligible for reimbursement. Recreational equipment such as non-
            stationary bicycles, golf clubs, running shoes, bowling balls, racquets and other
            sports equipment are not reimbursable items. If you have questions regarding
            what is eligible for reimbursement, please contact your human resource
            representative.



Created: 12/05/05, Revised: 4/27/2007                                                          Page 1 of 4
ADMINISTRATIVE PROCEDURES:



            Memberships: To obtain reimbursement for a health club or fitness center
            membership, employees must provide a signed agreement with the club that
            includes the duration of the agreement, the cost of the membership, the type of
            membership, and the name and address of the facility.

            Equipment: To receive reimbursement for the purchase of stationary exercise
            equipment, employees must submit a sales receipt showing the date of
            purchase, the cost of the equipment, the type of equipment and where the
            equipment was purchased. Reimbursement will be made only for equipment
            purchased in the current calendar year from retail, discount, or online store.

            Administration: Documentation from the health club or a receipt for the
            exercise equipment and a completed Fitness Reimbursement Form (included
            with this document) should be submitted to your local human resource
            representative. Minimum reimbursement amount is $50.00, so you must wait
            until your expenses total $100.00 before submitting the receipts. Payments will
            be made through an employee’s regular pay. All requests for reimbursement
            must be received by your local human resource representative no later than
            March 1 for purchases or memberships incurred the previous year.




Created: 12/05/05, Revised: 4/27/2007                                                        Page 2 of 4
QUESTIONS & ANSWERS:


  If I joined a Health Club in April 2007 with a 1 year membership, will I still be
  eligible for reimbursement in 2008 for the remaining portion of my
  membership?

     Yes. If you join a fitness club in April 2007 with a one-year membership, you will
     be eligible for reimbursement of monthly membership costs from April through
     December in 2007. Then you will need to submit receipts in 2008 for January
     through March of 2008 to be reimbursed for the portion in 2008.

     If you paid the total cost of the membership with one payment then you will be
     reimbursed 50% of the cost up to $250.00 for the entire membership period.


  If I do not reach my membership reimbursement maximum in a given calendar
  year, can I purchase equipment for my home and be reimbursed?

     Yes. If you choose to be reimbursed for a club membership during a calendar
     year, you are still eligible for equipment reimbursement. Conversely, if you
     purchase home equipment, you will be eligible for reimbursement for a club
     membership if you have not received the reimbursement maximum.


  I signed up for a one year membership, but elected to make monthly
  payments. When can I get reimbursed?

     If you are making monthly payments you need to submit information that shows
     how many months you have paid for. For example: If you join a club in January
     you will not be able to submit your receipts until they equal $500.00.


  How will I receive payment?

     Reimbursement will appear in your paycheck as a "fitness” code and is taxable
     income under IRS guidelines.


  My spouse belongs to a health club, but I do not. Am I still eligible for
  reimbursement?

     No, reimbursement is only made for employee or family, not dependent only
     membership or classes.
                                                              Fitness Reimbursement Form
Completing this Form

Begin by saving this form to your computer. To save the file:
Select File>Save As from the menu bar and save the document to your desktop or your personal folder.
Close/Exit from the Benefits website.
Open the saved form from your desktop or the folder where you saved it.
Complete this form on your computer and resave.

Required Documentation for Reimbursement:

     Memberships: To obtain reimbursement for a health club or fitness center membership, employees must
     provide a signed agreement with the club that includes the duration of the agreement, the cost of the
     membership, the type of membership, and the name and address of the club or center.

     Individual Classes: To receive reimbursement for classes such as Jazzercise or other classes which are
     not part of a fitness center membership, please provide a receipt which lists the cost of the classes and
     time period for which you will be attending the classes. Minimum reimbursement amount is $50.00, so you
     must wait until your expenses total $100.00 before submitting the receipts.

     Equipment: To receive reimbursement for the purchase of stationary exercise equipment, employees
     must submit a sales receipt showing the date of purchase, the cost of the equipment, the type of equipment
     and where the equipment was purchased. Reimbursement will be made for equipment purchased in the
     current calendar year from a retail/discount store. Online purchases are accepted as long as the receipt
     meets the requirements as noted above. Shipping charges are not reimbursable.

Submitting this Form:

Submit this form along with required documentation to your HR Representative. All requests for
reimbursement must be received by your local human resource representative no later than March 1 for
purchases or memberships incurred the previous year.

Timing:
Reimbursements may take up to one (1) month to be processed.


                                                     Date:
                                           Employee Name:
                                               Employee ID:
                                                  Location:
                                          Phone Extension:
                                         HR Representative:
                                  Amount of Reimbursement:


Employee Signature                                             HR Representative Signature
                                               Human Resources Use Only

Employee Hire Date:                                           Reimbursement Year:
Prior Reimbursements:                                         Pay Process Date:
Reviewed By:                                                  Entered in Fitness Log:

Fitness Reimbursement Form-2007

				
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