Dependent Care FSA Plan or Employer Paid (Section 129)


Dependent Care FSAs allow employees to use pre-tax dollars to pay dependent care expenses. This plan can be standalone or offered in conjunction with a Section 125 Premium Only Plan or Health FSA. Single employees can set aside up to $2,500 and married couples can set aside up to $5,000 annually. If amounts are not used they will be lost under the use it or lose it clause.

Health FSA plan includes:

Resolution to Adopt a Plan- Includes minutes of the meeting to adopt the Dependent Care Plan as an employee benefit.

Plan Document – Plan Documents are personally prepared for each church and kept on file for review for IRS, etc. 

Summary Plan Description (SPD) – Explains the Plan Purpose, Who is Eligible, How To Enroll, etc. in easy to read language. Also includes all information required by the Internal Revenue regarding the Plan Year Start and End Dates, Agent for Legal Service, Fed. ID#, and information regarding COBRA, FMLA, and required DOL information. 

Election and Claim Form – Personalized for your church, it will include the Election Agreement and Claim Form to submit bills to the church for reimbursement. 

Administrative Handbook – Includes sections on  Administration, Non-Discrimination Testing, and Reporting and Disclosure information. 

Here’s what will happen next: 
Step 1: Complete the enrollment form below

Step 2: A benefit plan advisor will review your questionnaire for completeness. 

Step 3: Schedule an Appointment to finalize your plan.

Once the review is complete, we’ll prepare your Plan Document, SPD, Forms, helpful guides, and easy-to-follow signing instructions.


Type of Plan *

Effective Date *

Dependent Care FSA Annual Limit: (The IRS allows up to $5,000 per year) *



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Clergy Financial Resources
11214 86th Avenue N.
Maple Grove, MN 55369

Tel: 763.425.8778 
Fax: 888.876.5101

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