HomeMy WebLinkAbout2011-10-11 CC Item No. 09REPORT TO CITY COUNCIL
TO: HONORABLE MAYOR
AND MEMBERS OF THE CITY COUNCIL
FROM: ROBERT A. BRADY
CITY MANAGER
DATE: OCTOBER 11, 2011
SUBJECT: APPROVAL AND ESTABLISHMENT OF RETIREMENT HEALTH
SAVINGS PLAN
Background
The City Council on July 26, 2011 approved a new Memorandum of Understanding
(MOU) with the United Public Employees of California, LIUNA Local 777 and a related
side agreement with the non-union represented employees for the period of July 1,
2011 to June 30, 2013. The MOU and the side agreement included the following
regarding health benefits for full-time employees and City Council members hired after
July 1, 2011:
Full-time Employees & City Council hired after July 1, 2011
Effective July 1, 2011 any new hire employee (full-time
or City Council member) will receive the statutory
medical insurance contribution pursuant to Government
Code Section 22892. The City will contribute an
additional amount to a flexible spending account
("FSA") to equal a maximum total of $700.00. Any
excess FSA will be deposited into a Health Retirement
Account ("HRA") established by the City.
To establish the HRA, a resolution must be adopted by the City.
AGENDA ITEM NO. 9
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Page 2
Discussion
A Health Retirement Account ("HRA") allows employers and employees to accumulate
assets to pay for health insurance and out-of-pocket medical expenses in retirement.
HRAs have a number of advantages including tax-deferred contributions, tax-deferred
investment earnings and tax-free withdrawals for eligible medical expenses for
participants, their spouses and dependents.
The City is proposing to establish an ICMA-RC VantageCare Retirement Health
Savings (RHS) Plan for the eligible City employees hired after July 1, 2011. ICMA-RC
is currently the City's 457 Deferred Compensation Plan administrator. An Employer
VantageCare Retirement Health Savings Plan Adoption Agreement and Administrative
Services Agreement are included for approval.
Fiscal Impact
The specific cost of the HRA will not be known until new full-time employees or City
Council members are hired after July 1, 2011. The amount would vary from employee
to employee. It is projected that over time, the City would realize an annual cost
savings due to attrition of employees hired before July 1, 2011 and their replacement
with employees hired after July 1, 2011.
Recommendation
1) Adopt Resolution No. 060 declaring its affirmative statement of adoption of the
VantageCare Retirement Health Savings (RHS) Plan.
2) Approve the Administrative Services Agreement with ICMA-RC.
3) Approve the Employer VantageCare Retirement Health Savings (RHS) Plan
Adoption Agreement.
Prepared by: James R. Ril*israt~ive Director of AdServices
Approved by: Robert A. Brady
City Manager
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RESOLUTION NO. 2011-060
A RESOLUTION OF THE CITY COUNCIL OF THE CITY
OF LAKE ELSINORE, CALIFORNIA, DECLARING ITS
AFFIRMATIVE STATEMENT OF ADOPTION OF THE
VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS)
PLAN NO. 803301
WHEREAS, the Employer has employees rendering valuable services; and
WHEREAS, the establishment of a retiree health savings plan for such
employees serves the interests of the Employer by enabling it to provide reasonable
security regarding such employees' health needs during retirement, by providing
increased flexibility in its personnel management system, and by assisting in the
attraction and retention of competent personnel; and
WHEREAS, the Employer has determined that the establishment of the retiree
health savings plan (the "Plan") serves the above objectives;
NOW, THEREFORE, BE IT RESOLVED that the Employer hereby adopts the
Plan in the form of the ICMA Retirement Corporation's VantageCare Retirement Health
Savings program.
BE IT FURTHER RESOLVED that the assets of the Plan shall be held in trust,
with the Employer serving as trustee for the exclusive benefit of Plan participants and
their survivors, and the assets of the Plan shall not be diverted to any other purpose
prior to the satisfaction of all liabilities of the Plan. The Employer has executed the
Declaration of Trust of the model trust made available by the ICMA Retirement
Corporation.
BE IT FURTHER RESOLVED that the Employer shall be the coordinator and
contact for the Plan and shall receive necessary reports, notices, etc.
PASSED, APPROVED AND ADOPTED at a regular meeting of the City Council
of the City of Lake Elsinore, California, this 11 th day of October, 2011.
BRIAN TISDALE, MAYOR
ATTEST:
VIRGINIA BLOOM, CITY CLERK
APPROVED AS TO FORM:
BARBARA ZEID LEIBOLD
CITY ATTORNEY
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ADMINISTRATIVE SERVICES AGREEMENT
Type: VantageCare RHS
Account Number: 803301
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Plan # 803301
ADMINISTRATIVE SERVICES AGREEMENT
This Agreement, made as of the day of 20 (herein referred to as
the "Inception Date"), between The International City Management Association Retirement
Corporation ("ICMA-RC" a nonprofit corporation organized and existing under the laws of the
State of Delaware; and the City of Lake Elsinore ("Employer") a local governmental
instrumentality organized and existing under the laws of the State of California with an office at
130 South Main, Lake Elsinore, California 92530-4109.
RECITALS
Employer acts as a public plan sponsor for a retiree health plan with responsibility to obtain
investment alternatives and services for employees participating in that plan;
Employer desires to make the VantageCare Retirement Health Savings Plan ("RHS Plan" or
"Plan") provided by ICMA-RC available to its employees;
ICMA-RC makes available the Vantagepoint Funds, a no-load, diversified mutual fund, for
investment of public employer plan assets, including RHS Plan assets;
ICMA-RC provides a complete offering of services to public employers for the operation of
employee retirement and retiree health savings plans including, but not limited to,
communications concerning investment alternatives, account maintenance, account record-
keeping, investment and tax reporting, form processing, benefit disbursement and asset
management.
Acceptance of RHS Plan
AGREEMENTS
Employer agrees to make the RHS Plan provided by ICMA-RC available to its employees. The
details of the RHS Plan shall be as mutually agreed between the Employer and ICMA-RC, and in
general shall be as set forth in the RHS Plan materials developed by ICMA-RC and provided to
Employer. The RHS Plan materials are hereby incorporated by reference and made a part of this
Agreement, except that Employer and ICMA-RC may from time to time mutually agree in
writing to terms that vary from the RHS Plan materials. RHS plan materials shall include the
PantageCare RHS Employer Manual, available electronically through the EZ Link System upon
plan adoption.
The functions to be performed by ICMA-RC and its agents include:
(a) allocation in accordance with participant direction of individual accounts to
investment funds ("Funds") made available to Plan participants;
(b) maintenance of individual accounts for participants reflecting amounts contributed,
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Plan # 803301
income, gain, or loss credited, and amounts disbursed as benefits;
(c) provision of periodic reports to the Employer and participants of the status of Plan
investments and individual accounts;
(d) communication to participants of information regarding their rights and elections under
the Plan;
(e) disbursement of benefits as agent for the Employer in accordance with terms of the Plan;
and
(f) performance of tax withholding and reporting in conjunction with the Employer for each
RHS account.
2. Employer Duty to Furnish Information
Employer agrees to furnish to ICMA-RC on a timely basis such information as is necessary for
ICMA-RC to carry out its responsibilities with respect to the Plan, including information needed
to allocate individual participant accounts to Funds, and information as to the benefit eligibility
and employment status of participants, and participant ages, addresses, beneficiaries and other
identifying information (including tax identification numbers). ICMA-RC shall be entitled to
rely upon the accuracy of any information that is furnished to it by a responsible official of the
Employer or any information relating to an individual participant, dependent, or beneficiary that
is furnished by such participant, dependent, or beneficiary, and ICMA-RC shall not be
responsible for any error arising from its reliance on such information. ICMA-RC will provide
account information in reports, statements or accountings.
3. Certain Representations and Warranties
ICMA-RC represents and warrants to Employer that:
(a) ICMA-RC is a non-profit corporation with full power and authority to enter into this
Agreement and to perform its obligations under this Agreement.
(b) ICMA-RC is an investment adviser registered as such with the Securities and Exchange
Commission under the Investment Advisers Act of 1940, as amended. ICMA-RC
Services, LLC (a wholly owned subsidiary of ICMA-RC) is registered as a broker-dealer
with the Securities and Exchange Commission (SEC) and is a member in good standing
of the Financial Industry Regulatory Authority (FINRA).
Employer represents and warrants to ICMA-RC that:
(c) Employer is organized in the form and manner recited in the opening paragraph of this
Agreement with full power and authority to enter into and perform its obligations under
this Agreement and to act for the Plan and participants in the manner contemplated in this
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Plan # 803301
Agreement. Execution, delivery, and performance of this Agreement will not conflict
with any law, rule, regulation or contract by which the Employer is bound or to which it
is a party.
(d) Information required to be retained by the Employer shall be set forth in the RHS plan
materials developed by ICMA-RC and provided to the Employer.
(e) Employer is responsible for determining that there are no state or local laws that would
prohibit it from establishing ICMA-RC's VantageCare RHS program. Employer is also
responsible for determining that the investments selected for the RHS plan fall within
state/local requirements. ICMA-RC shall not be responsible for monitoring state or
local law or for administering the Plan in compliance with local or state requirements
unless Employer notifies ICMA-RC of any such local or state requirements.
(f) Employer acknowledges that the RHS plan may be treated as a "health plan" for Health
Insurance Portability and Accountability Act ("HIPAA") purposes and therefore may be
subject to HIPAA privacy rules. If it is determined that the RHS plan is considered a
"health plan", an employer sponsoring RHS would be responsible for complying with the
HIPAA privacy and security rules regarding protected health information of RHS plan
participants.
ICMA-RC has procedures in place to safeguard the protected health information of RHS
plan participants.
4. Particinationin Certain Proceedings
The Employer hereby authorizes ICMA-RC to act as agent, to appear on its behalf, and to join
the Employer as a necessary party in all legal proceedings involving the garnishment of benefits
or the transfer of benefits pursuant to a medical child support order. Unless Employer notifies
ICMA-RC otherwise, Employer authorizes ICMA-RC to determine whether disbursement of
benefits to a former spouse, spouse or child pursuant to a medical child support order is
appropriate.
5. Compensation and Payment
(a) Absent an explicit agreement to the contrary between ICMA-RC and Employer,
participant fees and expenses shall be payable from RHS assets, in accordance with the
requirements of the RHS Plan as set forth below.
(i) Employer with ICMA-RC §401 and §457 retirement plan average participant
account balances of $25,000 or snore:
An annual asset fee of 0.30% (30 basis points) will be charged on a quarterly
basis, based on the balance in the account on the last day of the previous quarter.
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Plan # 803301
In addition to the annual asset fee, a $25 annual account fee will be charged
quarterly to each Accountholder's account.
(ii) Employer with ICMA-RC §401 and §457 retirement plan average participant
account balances of less than $25,000, or Employer who does not currently have a
retirement plan with ICMA-RC:
An annual asset fee of 0.40% (40 basis points) will be charged on a quarterly
basis, based on the balance in the account on the last day of the previous quarter.
When the average participant account balance of the Employer's §401 and §457
retirement plans with ICMA-RC totals $25,000 or more (based on the balances in
the Employer's retirement plans on the last day of the previous quarter), the
pricing detailed in paragraph 5.a. shall apply beginning in the subsequent quarter.
In addition to the annual asset fee, a $ 25 annual account fee will be charged
quarterly to each Accountholder's account.
(iii) Account administration fees are subject to change with appropriate prior
notification.
(b) Compensation for Advisory and other Services to the Vantagepoint Funds. Employer
acknowledges that certain wholly-owned subsidiaries of ICMA-RC receive compensation
from the Vantagepoint Funds for advisory and other services furnished to the
Vantagepoint Funds. The fees referred to in this subsection are disclosed in the
Vantagepoint Funds Prospectus and Statement of Additional Information.
Employer acknowledges and agrees that ICMA-RC does not assume any responsibility
with respect to the selection or retention of the Plan's investment options. Employer
shall have exclusive responsibility for the Plan's investment options, including the
selection of the applicable mutual fund share class.
6. Custody
Employer understands that amounts contributed to the RHS plan are to be remitted directly to
Vantagepoint Transfer Agents in accordance with instructions provided to Employer in the RHS
plan materials and are not to be remitted to the ICMA Retirement Trust or ICMA-RC. In the
event that any check or wire transfer is incorrectly labeled or transferred, ICMA-RC will return it
to Employer with proper instructions.
7. Responsibility
(a) ICMA-RC shall not be responsible for any acts or omissions of any person other than
ICMA-RC in connection with the administration or operation of the Plan.
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Plan # 803301
(b) The Employer understands that, as a general matter, the Internal Revenue Service ("IRS")
may decline to rule on certain design features or provisions that the Employer may
request to have added to the RHS plan materials. The Employer agrees to hold ICMA-
RC harmless in connection with the addition and administration of any RHS plan feature
or provision requested by the Employer for which the IRS will not provide express
interpretive guidance.
8. Term
This Agreement shall be in effect for an initial term beginning on the Inception Date and ending
5 years after the Inception Date. This Agreement will be renewed automatically for each
succeeding year unless written notice of termination is provided by either party to the other no
less than 60 days before the end of such Agreement year.
9. Amendments and Adiustments
(a) This Agreement may not be amended except by written instrument signed by the parties
(b) The parties agree that an adjustment to compensation or administrative and operational
services under this Agreement may only be implemented by ICMA-RC through a
proposal to the Employer via correspondence or the Employer Bulletin. The Employer
will be given at least 60 days to review the proposal before the effective date of the
adjustment. Such adjustment shall become effective unless, within the 60 day period
before the effective date, the Employer notifies ICMA-RC in writing that it does not
accept such adjustment, in which event the parties will negotiate with respect to the
adjustment.
(c) No failure to exercise and no delay in exercising any right, remedy, power or privilege
hereunder shall operate as a waiver of such right, remedy, power or privilege.
10. Notices
All notices required to be delivered under Section 9 of this Agreement shall be delivered
personally or by registered or certified mail, postage prepaid, return receipt requested, to (i)
Legal Department, ICMA Retirement Corporation, 777 North Capitol Street, N.E., Suite 600,
Washington, D.C, 20002-4240; (ii) Employer at the office set forth in the first paragraph hereof,
or to any other address designated by the party to receive the same by written notice similarly
given.
11. Complete Agreement
This Agreement shall constitute the sole agreement between ICMA-RC and Employer relating to
the object of this Agreement and correctly sets forth the complete rights, duties and obligations
of each party to the other as of its date. Any prior agreements, promises, negotiations or
representations, verbal or otherwise, not expressly set forth in this Agreement are of no force and
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Plan # 803301
effect.
12. Governing Law
This agreement shall be governed by and construed in accordance with the laws of the State of
California applicable to contracts made in that jurisdiction without reference to its conflicts of
laws provisions.
In Witness Whereof, the parties hereto have executed this Agreement as of the Inception Date
first above written.
CITY OF LAKE ELSINORE
By:
Print Name:
Title:
INTERNATIONAL CITY/COUNTY
MANAGEMENT ASSOCIATION RETIREMENT
CORPORATION
By
Angela C. Montez
Assistant Corporate Secretary
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EMPLOYER VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS) PLAN
ADOPTION AGREEMENT
Plan Number: 8
Employer Retirement Health Savings Plan Name:
1. Employer Name:
State:
II. The Employer hereby attests that it is a unit of a state or local government or an agency or instrumentality of one
or more units of a state or local government.
III. Effective Date of the Plan:
IV. The Employer intends to utilize the Trust to fund only welfare benefits pursuant to the following welfare benefit
plan(s) established by the Employer:
V. Eligible Groups, Participation and Participant Eligibility Requirements
A. Eligible Groups
The following group or groups of Employees are eligible to participate in the VantageCare Retirement Health Savings
Plan (check. all applicable boxes):
❑ All Employees
❑ All Full-Time Employees
❑ Non-Union Employees
❑ Public Safety Employees - Police
❑ Public Safety Employees - Firefighters
❑ General Employees
❑ Collectively-Bargained Employees (Specify unit(s))
❑ Other (specify group(s))
The Employee group(s) specified must correspond to a group(s) of the same designation that is defined in the statutes,
ordinances, rules, regulations, personnel manuals or other documents or provisions in effect in the state or locality of
the Employer.
B. Participation
Mandatory Participation: All Employees in the covered group(s) are required to participate in
the Plan and shall receive contributions pursuant to Section Vl.
1. Minimum service: The minimum period of service required for participation is
minimum service is required).
2. Minimum age: The minimum age required for eligibility to participate is
age is required).
Check one: ❑ New Plan ❑ Amendment to Existing Plan
(write N/A if no
(write N/A if no minimum
C. Participant Eligibility Requirements
VI. Contribution Sources and Amounts
A. Definition of Earnings
The definition of Earnings will apply to all RFiS Contribution Features that reference "Earnings", including Direct
Employer Contributions (Section VI.B.I.) and Mandatory Employee Compensation Contributions (Section VI.B.2.).
Definition of
B. Direct Employer Contributions and Mandatory Contributions
1. Direct Employer Contributions
The Employer shall contribute on behalf of each Participant
❑ % of Earnings
❑ $ each Plan Year
❑ A discretionary amount to be determined each Plan Year
❑ Other (describe):
2. Mandatory Employee Compensation Contributions
The Employer will make mandatory contributions of Employee compensation as follows:
❑ Reduction in Salary - % of Earnings or $ will be contributed for the Plan Year.
❑ Decreased Merit or Pay Plan Adjustment - All or a portion of the Employees' annual merit
or pay plan adjustment will be contributed as follows:
An Employee shall not have the right to discontinue or vary the rate of Mandatory Contributions of
Employee Compensation.
3. Mandatory Employee Leave Contributions
The Employer will make mandatory contributions of accrued leave as follows (provide formula for determining
Mandatory Employee Leave contributions):
❑ Accrued Sick Leave
❑ Accrued Vacation Leave
❑ Other (specify type of leave) Accrued Leave
An Employee shall not have the right to discontinue or vary the rate of mandatory leave contributions.
C. Limits on Total Contributions (check one box)
The total contribution by the Employer on behalf of each Participant (including Direct Employer and
Mandatory Employee Contributions) for each Plan Year shall not exceed the following limit(s) below. Limits
on individual contribution types are defined within the appropriate section above.
❑ There is no Plan-defined limit on the percentage or dollar amount of earnings that maybe contributed.
❑ % of earnings*
'Definition of earnings: ❑ Same as Section VIA. ❑ Other
❑ $ for the Plan year.
See Section V.B. for a discussion of nondiscrimination rules that may apply to non-collectively bargained self-insured Plans.
VII. Vesting for Direct Employer Contributions
A. Vesting Schedule (check one box)
The account is 100% vested at all times.
❑ The following vesting schedule shall apply to Direct Employer Contributions as outlined in Section VI.B.1.:
Years of Service Vesting
Completed Percentage
%
%
B. The account will become 100% vested upon the death, disability, retirement*, or attainment of benefit
eligibility (as outlined in Section IX) by a Participant.
*Definition of retirement (check one box):
❑ Retirement as defined in the primary retirement plan of the Employer
❑ Separation from service
❑ Other
C. Any period of service by a Participant prior to a rehire of the Participant by the Employer shall not count
toward the vesting schedule outlined in A above.
VIII. Forfeiture Provisions
Upon separation from the service of the Employer prior to attainment of benefit eligibility (as outlined in Section IX), or
upon reversion to the Trust of a Participant's account assets remaining upon the participant's death (as outlined in Section
XI), a Participants non-vested funds shall (check one box):
❑ Remain in the Trust to be reallocated among all remaining Employees participating in the Plan as Direct Employer
Contributions for the next and succeeding contribution cycle(s).
❑ Remain in the Trust to be reallocated on an equal dollar basis among all Plan Participants.
❑ Remain in the "Trust to be reallocated among all Plan Participants based upon Participant account balances.
❑ Revert to the Employer.
IX. Eligibility Requirements to Receive Medical Benefit Payments from the VantageCare Retirement Health Savings Plan
A. A Participant is eligible to receive benefits:
❑ At retirement only (also complete Section B.)
Definition of retirement:
❑ Same as Section VII.B.
❑ Other
❑ At separation from service with the following restrictions
❑ No restrictions
❑ Other
❑ At age only
❑ At retirement and age (also complete section B)
Definition of retirement:
❑ Same as Section VILB.
❑ Other
❑ At retirement or age _
Definition of retirement:
❑ Same as Section VII.B.
❑ Other
❑ Other, specified as follows (also complete Section B if applicable):
B. Termination prior to general benefit eligibility: In the case where the general benefit eligibility as outlined in
Section IX.A includes a retirement component, a Participant who separates from the service of the Employer
prior to retirement will be eligible to receive benefits:
❑ Immediately upon separation from service.
❑ At age
C. A Participant that becomes totally and permanently disabled
❑ as defined by the Social Security Administration
❑ as defined by the Employees primary retirement plan
❑ other
will become immediately eligible to receive medical benefit payments from his/her VantageCare Retirement Health
Savings Plan account.
D. Upon the death of the Participant, benefits shall become payable as outlined in Section XI.
X. Permissible Medical Benefit Payments
Benefits eligible for reimbursement consist oL
❑ All Medical Expenses eligible under IRC Section 213* other than direct long-term care expenses, and including
non-prescription medications allowed under IRS guidance.
❑ The following Medical Expenses (select only the expenses you wish to cover under the VantageCare Retirement Health
Savings Plan):
❑ Medical Insurance Premiums
❑ Medical Out-of-Pocket Expenses*
❑ Medicare Part B Insurance Premiums
❑ Medicare Part D Insurance Premiums
❑ Medicare Supplemental Insurance Premiums
❑ Prescription Drug Insurance Premiums
❑ COBRA Insurance Premiums
❑ Dental Insurance Premiums
❑ Dental Out-of-Pocket Expenses*
❑ Vision Insurance Premiums
❑ Vision Out-of-Pocket Expenses*
❑ Qualified Long-Term Care Insurance Premiums
❑ Non-Prescription medications allowed under IRS guidance*
❑ Other qualifying medical expenses (describe)*
* See Section V.A. for a discussion: of nondiscrimination ruler which nray apply to non-collectively bargained, se/f-insured Plans.
XI. Benefits After the Death of the Participant
In the event of a Participant's death, the following shall apply:
A. Surviving Spouse and/or Surviving Dependents
The surviving spouse and/or surviving eligible dependents (as defined in Section XII.D.) of the deceased Participant' are
immediately eligible to maintain the account and utilize it to fund eligible medical benefits specified in Section X above.
Upon notification of a Participants death, the Participant's account balance will be transferred into the Vantagepoint
Money Market Fund* (or another fund selected by the Employer). The account balance may be reallocated by the
surviving spouse or dependents.
*Please read the current VantagepointMruatal Funds prospectus carefullyprior to investing. An investment in this fund is neitber
insured norguaranteed and there can be no assurance that the Fund will be able to maintain a stable net asset value of$1.00 per share.
Vantagepoint Mutual Funds are distibuted by ICMA-RCServices, LLC a wholly-owned broker-dealer affiliate afICMA Retirement
Corporation. Member FINRAISIPC.
If a Participants account balance has not been fully utilized upon the death of the eligible spouse, the account balance
may continue to be utilized to pay benefits of eligible dependents. Upon the death of all eligible dependents, the
account will revert to the Plan to be applied as specified in Section VIII.
B. No Surviving Spouse or Surviving Dependents
If there are no living spouse or dependents at the time of death of the Participant, the account will revert to the Plan to
be applied as specified in Section VIII.
XII. The Plan will operate according to the following provisions:
A. Employer Responsibilities
1. The Employer will submit all VantageCare Retirement Health Savings Plan contribution data via electronic submission.
2. The Employer will submit all VantageCare Retirement Health Savings Plan Participant status updates or personal
information updates via electronic submission. This includes but is not limited to termination notification and
benefit eligibility notification.
B. Participant account administration and asset-based fees will be paid through the redemption of Participant account
shares, unless agreed upon otherwise in the Administrative Services Agreement.
C. Assignment of benefits is not permitted. Benefits will be paid only to the Participant, his/her Survivors, the
Employer, or an insurance provider (as allowed by the claims administrator). Payments to an third-party payee
(e.g., medical service provider) are not permitted with the exception of reimbursement to the Employer or insurance
provider (as allowed by the claims administrator).
D. An eligible dependent is the Participant's lawful spouse and any other individual who is a person described in IRC
Section 152(a), as clarified by Internal Revenue Service Notice 2004-79.
E. The Employer will be responsible for withholding, reporting and remitting any applicable taxes for payments which
are deemed to be discriminatory under IRC Section 105(h), as outlined in the VantageCare Retirement Health
Savings Plan Employer Manual.
XIII. Employer Acknowledgements
A. The Employer hereby acknowledges it understands that failure to properly fill out this Employer VantageCare
Retirement Health Savings Plan Adoption Agreement may result in the loss of tax exemption of the Trust and/or loss
of tax-deferred status for Employer contributions.
B. ❑ Check this box if you are including supporting documents that include plan provisions.
EMPLOYER SIGNATURE
Date:
Attest: Date:
Accepted: VANTAGEPOINE TRANSPE-R AGENTS, LLC
Gam- ~
Assistant Secretary, ICMA-RC