FOR THE COMPANY OF ENVISION, LLC

COMPENSATION REDUCTION AGREEMENT

Hourly (Plus Benefits) Employee

NAME OF PARTICIPANT:

Insurance will become effective July 1, 2013, provided all necessary paperwork has been promptly returned to Envision, LLC.

I elect to reduce my compensation by the following amount (s): (Check One)

|UnitedHealthcare |Guardian |
| | |
|Employee Coverage |Employee Coverage |
|$10.00 per pay period ($20.00 per month) for my coverage under the |$16.78 per pay period ($33.56 per month) for my coverage under the |
|Group Health Insurance Plan. |Group Health Insurance Plan. |
| | |
|Employee and Spouse Coverage |Employee and Spouse Coverage |
|$179.22 per pay period ($358.44 per month) for coverage of myself and |$34.27 per pay period ($68.54 per month) for coverage of myself and |
|my spouse under the Group Health Insurance Plan. |my spouse under the Group Health Insurance Plan. |
| | |
|Employee and Child(ren) Coverage |Employee and Child(ren) Coverage