PSFCA Membership Agreement

APPLICATION FOR MEMBERSHIP AND PARTICIPATION AGREEMENT
Applicant Group Name:
School Name (ex: Primrose School of USA):
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person:
Phone:
Format: (000) 000-0000.
Title:
Email:
example@example.com
Applicant hereby applies to become a member of Primrose Schools Franchisee Cooperative Alliance, Inc. ("Alliance"), a Texas nonprofit corporation.

Membership may only be approved for employers that are Primrose School franchisees in good standing. Approval as a member is determined in the sole discretion of the Board of Directors (the "Board") of the Alliance. The Board will review this application and other relevant information about the Applicant and will notify the Applicant if it is accepted as a member.
1. Purpose
The purpose of this Agreement is to set forth the terms and conditions of the undersigned Member's membership in the Alliance, including but not required or limited to the Member's participation in the Alliance's Franchisee Health Plan (the "PSFHP").
2. Membership Eligibility
Upon acceptance as a Member, as such term is defined by the Articles of Incorporation and Bylaws of the Alliance, the Member agrees by signing this Agreement that they:
- Meet the Alliance's membership eligibility requirements, as outlined in the Bylaws of the Alliance.
- Are engaged in the trade, profession, or industry represented by the Alliance.
- Will maintain active membership status for a minimum of two years in the Alliance and the PSFHP.

3. Member Obligations
The Member agrees to:
1. Pay a one-time membership fee to join the Alliance by ACH auto draft and to pay any ongoing renewal or other membership fees as determined in the sole discretion of the Board of Directors of the Alliance.
2. Comply with Articles of Incorporation and Bylaws of the Alliance and all other Alliance.
If the Member is also enrolled in the PSFHP, the Member also agrees to:
3. Pay all insurance premiums and monthly administration fees related to the PSFHP by ACH autopay.
4. Provide accurate and complete information for enrollment and continued eligibility in the Alliance and the PSFHP.
5. Comply with PSFHP rules, guidelines, and participation requirements.
6. Comply with applicable laws including the Affordable Care Act and its notification requirements with respect to Member's participation in the PSFHP.
7. Maintain active membership status for a minimum of two years in the Alliance and the PSFHP.
8. Promptly report any changes in eligibility status to the Alliance President or Vice President, Communications.
If any Member fails to make any payment required with respect to its participation in the Alliance within thirty (30) calendar days after the date on which Member receives written or electronic notice from the Alliance of a delinquency in payment, the Board will have the right to immediately terminate the Member's participation in the Alliance and the PSFHP, effective as of the date determined by the Board. Nothing herein will relieve the terminating Member of its responsibilities for payments attributable to any period of its Membership before the termination.
4. Association Obligations
The Alliance will be organized and operated in accordance with its Articles of Incorporation and Bylaws and in furtherance of the purpose for which the Alliance is established. The purpose for which the Alliance is established is to:
- Advance the interests and promote the development of the Primrose Schools brand;
- Provide a unified medium for Members whereby their interests may be safeguarded and advanced;
- Provide shared leadership and promote communications among Members for the purpose of gathering information and best practices from peers and disseminating profitable business practices;
- Develop and share tools, benchmarks, and resources to improve school performance, collaborate on solutions to common operational challenges, and identify and promote innovations that enhance the Primrose Schools brand; and
- Negotiate prices and develop programs with third-party suppliers and service providers for the collective benefit of the Members
With respect to the PSFHP, the Alliance will:
- Administer the PSFHP in compliance with applicable laws and regulations.
- Provide the Member with access to plan information, coverage options, and enrollment materials.
- Maintain the confidentiality of Member health and personal data in accordance with applicable law.

5. Term & Termination
- This Agreement remains in effect as long as the Member maintains active membership and participation in the Alliance.
- The Agreement may be terminated by:
  - The Member, following their first 2 consecutive years of participation, with written notice to the Alliance provided by November 1 to end participation effective as of December 31 of that year.
  - The Association, for non-payment of dues, loss of eligibility, or violation of Alliance or PSFHP rules.
- Upon termination, the Member’s participation in the Alliance will result in the termination of insurance coverage for Member’s employees under the PSFHP effective as of the date the Member’s participation in the Alliance terminates. In that event, neither the Alliance or PSFHP will have liability to the Member or its employees.
6. Dispute Resolution
Any disputes arising under this Agreement will first be addressed through good faith negotiation. If unresolved, disputes will be handled in accordance with the Alliance's Bylaws and applicable law.
7. Indemnification by Member
The Member shall defend, indemnify, and hold the Alliance and its officers, directors, and agents and the PSFHP (each, an "Alliance Indemnified Party" and collectively, the "Alliance Indemnified Parties") harmless from any and all liabilities and claims, including but not limited to damages, court costs, reasonable legal fees and costs of investigation, which arise from the Member's (i) failure to perform (whether in whole or in part) any obligation required to be performed by the Member (or any person or representative designated by the Member) under the Agreement or any of the documents governing the PSFHP; (ii) incorrect or incomplete data provided by the Member (or any person or representative designated by the Member) to the Alliance; (iii) a failure to follow the terms of the Articles of Incorporation or Bylaws of the Alliance or any of the documents governing the PSFHP; (iv) any breach of applicable state or federal privacy or data security law that occurs as a result of the Member's actions or inactions with respect to its membership in the Alliance or participation in the PSFHP.

8. Acknowledgement
By signing below, the Member acknowledges:
- Receipt of the Application for Membership and Participation Agreement and the Articles of Incorporation and Bylaws of the Alliance.
- That the Alliance is not the insurer of the PSFHP, and plan benefits are subject to the terms of the group insurance policies applicable to the benefit programs offered under the PSFHP.
- The Member agrees to abide by the terms of this Agreement and the Articles of Incorporation and Bylaws of the Alliance.
- Should the Member's participation in the Alliance terminate for any reason, the Member will not be eligible to reapply for membership for a period of 2 years from the effective date of the termination.
- Authorizes the Primrose Schools Franchisee Cooperative Alliance, Inc. to draft the Member account for the one-time membership fee to join the Alliance by ACH auto draft.
- By signing below, Applicant hereby applies to become a Member of the Alliance and agrees that if admitted by the Board it will be bound by the provisions of this Participation Agreement.
Member Signature:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Printed Name & Title:
Financial Institution:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:
Format: (000) 000-0000.
Checking Account Number:
Nine-Digit Bank Routing Number:

Authorization Agreement for ACH Contributions

Employer Recurring and Non-Recurring ACH Contributions
I, blanks*(employer), hereby authorize American Benefit Services, LLC to draft my account for premiums for the plans established on behalf employees. I authorize American Benefits Services, LLC to make these drafts at the specified periods named in the Employer Application and Agreement.
Applicant Group Name:
Federal ID #:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Financial Institution:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:
Format: (000) 000-0000.
Checking Account Number:
Nine-Digit Bank Routing Number:
Authorized Representative Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name

First NameLast Name
Title:
Should be Empty:

APPLICATION FOR MEMBERSHIP AND PARTICIPATION AGREEMENT

1. Purpose

2. Membership Eligibility

3. Member Obligations

4. Association Obligations

5. Term & Termination

6. Dispute Resolution

7. Indemnification by Member

8. Acknowledgement

Membership Information Form

**The above contribution amounts will be for each of the Health Insurance Plans Offered

Authorization Agreement for ACH Contributions