RE: Your Leave *******

Deshawn Jones

*/**/****

**** **** ********* *****

Tucson, AZ 85704

We received your request for a leave of absence (Leave) from your position with Everbrite, LLC for your own serious health condition. However, before we can review your requests, we need more information.

Dear Deshawn,

Continuous leave

Here's what's requested:

Beginning on

6/16/23

Ending on

6/29/23

Applicable Leave

Plan(s): FMLA

Decision:

Requested

Decision Reason:

Certification Needed

Certification due 7/5/23

Here's more information on the leave you requested The Family and Medical Leave Act (FMLA) allows eligible employees up to a total of 12 weeks of unpaid leave in a 12-month period for certain qualifying reasons. If your leave is approved and you have FMLA time available, you will be entitled to job protection under the FMLA for the dates listed above (see "beginning on" and "ending on") and your time off work will reduce your available FMLA balance. Your employer will maintain your health benefits under the same conditions as if you continued to work. If you do not return to work following FMLA for a reason other than (1) the continuation, recurrence, or onset of a serious health condition which would entitle you to FMLA; or (2) other circumstances beyond your control, you may be required to reimburse your employer for their share of health insurance premiums paid on your behalf. If your leave is approved and you have FMLA time available, your time off work will reduce your available FMLA balance.

If your leave, or a different pay replacement benefit (for example, worker's compensation, and/or paid time off) are approved during the period of time you requested they may run at the same time

(concurrently) or not, depending on the approval period and rules of that law or benefit. If you have questions

Please refer to the enclosed Your Next Steps document for more information. If you have any questions, you may call us at 877-SUN-FMLA, between 8:30 AM to 10:30 PM Eastern Time, Monday through Friday. Please reference your leave request number # 4583921 when you contact us. You may also find information and review your leave status on our website at Sunlife-ams.com. To access your record, please visit our website and create a username and password. You must have your employee ID number and the postal code (85704) on file with your employer to register. You can also:

■ Email us: ad2k49@r.postjobfree.com

■ Visit our website: Sunlife-ams.com

■ Use our mobile app: Download this from App Store using key words "Sun Life Absence Management Services"

Also, please notify us immediately if your status or return to work date changes. We are here to help.

Sincerely,

Your Support Team at Sun Life Absence Management Services Sun Life Assurance Company of Canada

cc: Marvel Ramsey, Sr HR Manager

Sun Life Financial and the globe symbol are registered trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us.

Your Rights & Responsibilities

Under the Family & Medical Leave Act

FMLA requires covered employers to provide unpaid, job protected leave to "eligible" employee for certain family and medical reasons. Employees are eligible if they have worked for a covered employer for at least one year and for 1,250 hours over the previous 12 months, work at a site with at least 50 employees within 75 miles, and have leave time available. Reasons for taking leave:

FMLA requires covered employers to provide up to 12 work weeks of unpaid, job-protected leave during a single, 12-month period rolling backward:

l To care for the employee's child after birth, or placement for adoption or foster care; l To care for the employee's spouse, son, daughter, or parent who has a serious health condition; l To address certain qualifying exigencies arising from employee's spouse, son, daughter, or parent on active duty or call to active duty in the National Guard or Reserves in support of a contingency operation; l For incapacity due to pregnancy, prenatal medical care, or post-partum recovery; l For a serious health condition that makes the employee unable to perform their job. Qualifying exigencies may include attending certain military events, arranging for alternative child-care or parental care, addressing certain financial and legal arrangements, attending certain counseling sessions, and attending post deployment reintegration briefings. Use of Leave

The employee does not need to use this leave entitlement in one block. When medically necessary, leave may be taken on an intermittent or reduced-schedule basis. Employees must make reasonable efforts to schedule leave for planned medical treatment so as to not unduly disrupt the employer's operations.

Definition of a Serious Health Condition

A serious health condition is an illness, injury, impairment, or physical or mental condition that involves either an overnight stay in a medical care facility, or continuing treatment by a health care provider for a condition that either prevents the employee from performing the functions of the employee's job, or prevents the qualified family member from participating in daily activities. Subject to certain conditions, the continuing treatment requirement may be met by a period of incapacity of more than 3 consecutive calendar days combined with at least two visits to a health care provider or one visit and a regimen of continuing treatment, or incapacity due to pregnancy, or incapacity due to a chronic condition. Other conditions may meet the definition of continuing treatment. Benefits and Protections

While on FMLA leave, the employer must maintain the employee’s health coverage under any "group health plan" on the same terms as if the employee had continued to work.

Upon return from FMLA leave, most employees must be restored to their original or equivalent positions with equivalent pay, benefits, and other employment terms.

Use of FMLA cannot result in the loss of any employment benefit that accrued prior to the start of the employee’s leave. Substitution of paid leave for unpaid leave

Employees may choose or employers may require use of accrued paid leave while taking FMLA leave. In order to use paid leave for FMLA leave, employees must comply with the employer's normal paid leave policies. Employee Responsibilities

Employee must provide 30-days advance notice of the need to take FMLA leave when the need is foreseeable. When 30 days notice is not possible, the employee must provide notice as soon as practicable and generally must comply with an employer's normal call-in procedure. Employees must provide sufficient information for the employer to determine if the leave may qualify for FMLA protection and the anticipated timing and duration of leave. Sufficient information may include that the employee is unable to perform job functions, the family member is unable to perform daily activities, the need for hospitalization or continuing treatment by a health-care provider, or the circumstances supporting the need for military family leave.

Employees must also inform their employer if the requested leave is for a reason for which FMLA leave was previously taken or certified. Employees may also be required to provide a certification and periodic recertification supporting the need for leave. Employer Responsibilities

Covered employers must inform employees requesting leave whether they are eligible under FMLA. If the employee is eligible, the notice must specify any additional information required along with a copy of this notice. If the employee is not eligible, the employer must provide a reason for the ineligibility.

Covered employers must inform employees if leave will be designated as FMLA-protected and the amount of leave counted against the employee’s leave entitlement. If the employer determines that the leave is not FMLA-protected, the employer must notify the employee. Unlawful Acts by Employers

FMLA makes it unlawful for any employer to:

l Interfere with, restrain, or deny the exercise of any right provided under FMLA; l Discharge or discriminate against any person for opposing any practice made unlawful by FMLA or for involvement in any proceeding under or related to FMLA.

Enforcement

The employee may file a complaint with the U.S. Department of Labor or may bring a private lawsuit against an employer. FMLA does not affect any Federal or State law prohibiting discrimination, or supersede any State or local law or collective bargaining agreement which provides greater family or medical leave rights.

For Additional Information

Please contact the nearest office of the Wage and Hour Division, listed in most telephone directories under US Government – Department of Labor, or contact your human resource department.

Completing the FMLA or Leave of Absence

Medical Certification Employee's Serious Health Condition Instructions for Employee

o Notify your manager of your need for leave of absence (in accordance with Everbrite, LLC's FMLA and/or leave of absence policies.)

o Ask your health care provider to complete the Medical Certification and provide it (fax number is below) to Sun Life Absence Management Services within 15 days of the date this letter was sent. Consider following up with your health care provider to confirm the Medical Certification was completed and faxed to Sun Life Absence Management Services. It is your responsibility to provide timely, complete and sufficient certification. (Note: you may need to furnish your health care provider with any necessary authorization in order for the health care provider to release a complete and sufficient certification to support the FMLA request.)

o

Sun Life Absence Management Services will notify you whether your leave has been approved or denied (via your preferred method of communication - email or postal mail) once we receive a complete and sufficient certification. Alternatively, we will notify you if additional information is required. Failure to provide a complete and sufficient medical certification may result in a denial of your FMLA request. Instructions for Health Care Provider

Please answer fully and completely the two sections on the following pages and sign the form. Step 1 - PATIENT'S CONDITION. Certify whether your patient has a "serious health condition" as the term is defined under the law (note: for more information on the definition of "serious health condition", you can refer to the U.S. Department of Labor website at http://www.dol.gov/whd/fmla/). Also include information sufficient to establish that the patient cannot perform the essential functions of the patient's job as well as the nature of any other work restrictions, and the likely duration of such inability. If your patient's condition does not meet one of the definitions under the law, please indicate that. Do not provide information related to genetic tests or services.

Step 2 - DATES OF LEAVE. Provide the frequency and probable dates needed for leave. l Consider all of the dates that your patient has had or will have to be out of work due to the serious health condition, even if the patient was initially treated by someone else (e.g., in an emergency room or ICU).

l If your patient's leave is intermittent (described in Step 2) please provide your best estimate of the frequency and duration of the patient's condition, treatments, etc. l Terms such as "lifetime," "unknown" or "indeterminate" may not be sufficient to determine whether the patient's condition qualifies for leave.

Step 3 - SIGNATURE. Sign and date the form and provide your type of practice/medical specialty. Return the completed form via fax to Sun Life Absence Management Services at 1-877-***-**** before the listed due date. If you do not complete all steps in full and return it before the due date, your patient's leave may be denied.

The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by GINA Title II from requesting or requiring genetic information of an individual or family member of the individual, except as specifically allowed by this law. To comply with this law, we are asking that you not provide any genetic information when responding to this request for medical information. "Genetic information," as defined by GINA, includes an individual's family medical history, the results of an individual's or family member's genetic tests, the fact that an individual or an individual's family member sought or received genetic services, and genetic information of a fetus carried by an individual or an individual's family member or an embryo lawfully held by an individual or family member receiving assistive reproductive services.

FMLA or Leave of Absence Medical Certification

Employee's Serious Health Condition

Employee/Patient Name: Deshawn Jones Employer: Everbrite, LLC Leave Request #: 4583921 Due Date: 7/5/2023

Request for leave due to: Employee's Serious Health Condition Dates of leave requested by employee/patient:

- Continuous leave date range request: 6/16/2023 to 6/29/2023 STEP 1 - PATIENT'S CONDITION.

(A) Describe Appropriate Medical Facts*: Provide a statement or description of appropriate medical facts regarding the patient's health condition for which FMLA leave is requested (i.e., leave is medically necessary). The medical facts must be sufficient to support the need for leave.

*Such medical facts may include information on symptoms, diagnosis, hospitalization, doctor visits, whether medication has been prescribed, referrals for evaluation or treatment (physical therapy for example) or any other regimen of continuing treatment such as the use of specialized equipment (Not required in California).

(B) Select the Appropriate Description of Condition. At least one reason from Section 1 or Section 2 must apply to qualify as a serious health condition under the FMLA and/or state law. At least one section, and all that apply, must be completed.

Section 1 – A single reason accounts for the patient's medically necessary absence from work: Inpatient care (i.e., an overnight stay) in a hospital, hospice, or residential medical care facility; or any subsequent recovery or treatment in connection with such inpatient care. o

o Permanent or long-term condition for which the patient is under continuing supervision of a health care provider but for which treatment may not be effective (e.g., Alzheimer's, a severe stroke) o Out of work to undergo multiple treatments and related recovery for one of the below:

(1) restorative surgery after an accident or other injury or

(2) a condition that would likely result in a period of incapacity of more than three (3) full, consecutive calendar days in the absence of such treatment.

Section 2 - A combination of reasons account for the patient's medically necessary absence from work: o Unable to work/perform job duties for more than three (3) consecutive, full calendar days, coupled with one of the following (select at least one and provide dates of treatment): 2 or more in-person treatments within the first 30 days of the employee's incapacity (if not provided by you, please note the medical specialty of the treating provider, e.g., nurse, physical therapist)

o

At least 1 examination/treatment followed by a regimen of continuing treatment (e.g. physical therapy or prescription medication), under the supervision of, or referral by a health care provider:

o

o A chronic health condition which continues over an extended period of time and BOTH:

(1) requires periodic visits for treatment by a health care provider (at least two (2) visits per year) and

(2) may cause episodic incapacity or flare-ups or would cause periods of reoccurrence without treatment

(e.g. asthma, diabetes, epilepsy, etc.)

The patient does not have a qualifying serious health condition o None of the reasons in Section 1 or Section 2 account for the patient's absence from work.

(C) Confirm employee cannot perform the essential functions of the job. Your patient should provide you with a description of their job functions. Is the employee unable to perform any of their job functions due to the condition? No Yes If so, identify the job functions the employee is unable to perform and the nature of the work restrictions and the duration of such inability:

Continued on next page *MC4583921*

STEP 2 - DATES OF LEAVE

Employee/Patient Name: Deshawn Jones LR#: 4583921

Consider all dates the patient has been or will be unable to work by checking and completing either of the below sections that apply. Dates requested by the patient are listed above. At least one section, and all that apply, must be completed. Answers of "unknown," "indeterminate" or "lifelong" may not be sufficient to determine FMLA coverage.

o Continuous Leave: Is the patient unable to work for a single, continuous period of time? i. Start date of incapacity / / (MM/DD/YYYY) ii. Estimated end date of incapacity / / (MM/DD/YYYY) iii. Will the employee require follow-up appointments? If so, please indicate the frequency of incapacity below in section iii under "Intermittent Leave"

Intermittent Leave:

Is the patient able to work but needs occasional time off for a single illness or injury?

AND/OR

o o Reduced Schedule Leave:

Is the patient working on a FIXED

part-time schedule or taking

predictable regularly scheduled

absences?

Start date for leave or initial appointment date

/ / (MM/DD/YYYY)

i. Start date of Leave

/ / (MM/DD/YYYY)

Probable end date for leave

/ / (MM/DD/YYYY) or

ii. Probable End Date of Leave

/ / (MM/DD/YYYY)

o Condition is lifelong (check if applicable)

Appointments/treatments - Will the patient need to miss work for appointments or treatments?

iii. Please indicate the hours of time the patient will need to miss each day.

o No Sunday

o Yes - Estimate treatment schedule: Monday Frequency: Up to times per (week/month/year) Tuesday Duration: Lasting up to hours OR days Wednesday Please include the dates of any scheduled appointments and the time required for each appointment: Friday Saturday

Thursday

Flare-ups/Episodes - Will the patient need to miss work for episodes of incapacity/flare-ups of the health condition?

iv.

o No

o Yes - Estimate of absences needed for episodes:

Frequency: Up to times per (week/month/year) Duration: Lasting up to hours OR days v. Dates you have already treated the patient for the condition:

Step 3 - SIGNATURE Health Care Provider Information: Name: Practice/Specialty/Credentials:

Street Address: Fax Number:

City, State, ZIP Code: Signature:

Phone Number: Date:

Sun Life Absence Management Services Phone: 877-SUN-FMLA Sun Life Absence Management Services Fax: 877-***-****

Sun Life Absence Management Services Email: ad2k49@r.postjobfree.com To mail: Sun Life Absence Management Services, 455 N. Cityfront Plaza Drive, Chicago, IL 60611-5322 GINA prohibits employers from requesting genetic information. See instructions on first page. *MC4583921* Sun Life Financial and the globe symbol are registered trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us.

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