I hereby authorize a payroll deduction of Plan contributions in accordance with the levels I have indicated. I understand this consitutes a "cash or deferred arrangement" under section 401(k) of the Internal Revenue Code and that my contributions are subject to the withdrawal restrictions of the Plan. By authorizing a payroll deduction, I understand I am electing to defer a portion of my salary to the Pediatric Advanced Therapy 401(k) Profit Sharing Plan and Trust. I understand that certain limitations are imposed on my constributions by Federal law and that my contributions may be refunded to comply with these laws. I further agree that neither Lolly Therapeutics LLC, the Plan Trustee, nor their affiliates will be liable for any loss when acting upon my instructions believed to be genuine.
I understand I have a duty to review my pay records (pay stub, etc.) to confirm the Plan Administrator has properly implemented my contribution election(s). Furthermore, I have a duty to infrom the Plan Administrator in writing if I discover any discrepancy between my pay records and the election(s) I have made in this Enrollment/Change Form. I understand I may modify my deferral rate prospectively, at the time I notify Plan Adminstrator in writing, consistent with the Plan terms.