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Home My WebLink AboutRESOLUTION - 5-08 - 1/8/2008 - FIREFIGHTER'S VANTAGE RETIREMENT HEALTH SAVINGS PLANRESOLUTION NO. 5-08 A RESOLUTION AUTHORIZING THE VILLAGE OF ELK GROVE VILLAGE FIREFIGHTERS ASSOCIATION, LOCAL NO. 2340, INTERNATIONAL ASSOCIATION OF FIREFIGHTERS, AFL-CIO,CLC TO PARTICIPATE IN THE VANTAGE RETIREMENT HEALTH SAVINGS PLAN aCMA) WHEREAS, the Employer has employees rendering valuable services; and WHEREAS, the establishment of a retirement health savings plan for such employees serves the interests Athe 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 a retiree health savings plan to be administered by the ICMA Retirement Corporation and/or its affiliates serves the above objectives; and WHEREAS, the Employer desires that its retiree health savings plan (the "Plan") be administered by the ICMA Retirement Corporation and/or its affiliates: NOW, THF:RFFORE, BE IT RESOLVED by the Mayor and Board of Trustees of dic Village of Elk Grove Village, Counties of Cook and DuPage, Illinois as follows: SECTION 1. That the Employer hereby adopts the Plan in the form of the ICMA Retirement Corporation's VantageCare Retirement. Health Savings Plan. SECTION 2. 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 beneficiaries, and the assets of the Plan shall not be diverted to any other purpose. 1 SECTION 3. That the Human Resources Officer shall be the coordinator and contact for the Plan and shall receive necessary reports and notices. SECTION 4. This Resolution shall be in full force and effective immediately from and after its passage and approval according to law. VOTE: AYES: 6 NAYS: 0 ABSENT: 0 PASSED this 8th day of January 2008. APPROVED this 8th day of January 2008. ATTEST: Ann I. Walsh Village Clerk RESRetirementHealthSavingsPlanFireDept APPROVED: Mayor Craig B. Johnson Village of Elk Grove Village 2 1CMARC Building Retirement Security EMPLOYER VANTAGEfARE RETIREMENT HEALTH SAVINGS (RHS.) KLAN ADOPTION AGREEMENT icniaR"�Cfig EMPLOYER VANTAG ECARE RETIREMENT HEALTH SAVINGS (RHS) PLAN ADOPTION AGREEMENT � h��',..3*�,'�st "`�-,�. ;r�.,.�e�` 'mss. t'r�'•r.� .�r'� —f''Yt. :'i3� `'a•:xt� `� mss; 'a � •sr � 'ia-. �° �-rk'$.- .,g� .� ,f .' 'cam �y�. � 3'� ,t �:�,. y . S�'"r�r.' v t su ��`� w,' L �k��i�rCyti 'ins7�.t� � i'��'�� `t kiY��N�` i v i'�yy, ��^'�r��, f _ _ 'S;," '•..:. '� �'�1"-� .�` `• y��''SS'��-�. "; `-` "tea iL�.l EMPLOYER VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS) PLAN ADOPTION AGREEMENT - Plan Number: 8 _(e j I �2!'_L Check one: E3'**Ncw Plan ❑ Amendment to Existing Plan Employer Retirement Health Savings Plan Name: I. Employer Name: L" //41 e O( &- /e (''" C, V( i�q y % State: 1L H. 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 state or local government. M. Efactiv+e Date of the Plan: 0 C 1/0 (r/ 200 -7 IV. The Employer intends to utilize the Trust to fund only wdfarc /be-nefits V-1/ t to the following welfare benefit pIan (s) established by the Fmployer. _ V 1 //09 e aF t//L (r" r" e V. / 4fj'e , /A 4""d 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 Safery Employees – Police ❑ Public Safety Employees – Firefighters ❑ General Employees Collectively -Bargained Employees (Specify unit(s)) t✓ /k G'W 1/1 11g9e, ❑ Other (specifygroup(s)) The Employee group (s) specified must correspond to a groups) 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 VI. C. Participant Eligibility Requirements // A 1. Minimum service: The minimum period ofservice required for participation is (write N/A ifan Employee is eligible to participate or to elect to participate immediately upon employment). 2. Minimum age: The minimum age required for eligibility to participate is (write N/A ifno minimum age is required). VI. Contribution Sources and Amounts A. Definition of Earnings The definition of Earnings will apply coal I RHS Contribution Features that reference "Earnings", including Direct Employer Contributions (Section VI.B.1.) and Mandatory Employees!9,aSe Contributions (Section V1.13.2.)..). Definition ofcarni ngs: CJZ— G -S (o,MAJIAeO,. ,1,11,A/ Se 5gI4.1 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 [l� Other (describe): ^-I Ron t s PP-- 1/,114 �C�ry 2. Mandatory Employce Compensation Contributions The Employer will make mandatory contributions of Employce 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): E> f Accrued Sick Leave S' C ��clt A'.(V, /4220 Po%.y ❑ Accrued Vacation Leave ❑ Other (specify type of leave) Accrued Leave An Employee shall nos have the right to discontinue or vary the rate of mandatory leave contributions. C. Limits on Total Contributions (check one box) ,e//1. 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 may be contributed. ElA10 % of earnings* *Definition of earnings: ❑ Same as Section VIA.. ❑ Other ❑ $ IVI for the Plan year. See Section V.B, for a discussion of nondiscrimination rules that may apply to non -collectively bargained self insuied Plans, VII. Vesting for Direct Employer Contributions LA A. Vesting Schedule (check one box) ErThe account is 100% vested at all times. 0 The following vesting schedule shall apply to Direct Employer Contributions as outlined in Section VI.B.I.: Years of Service vesting Completed Percentage % B. The account will become 100% ivested upon the death, disability, retirement*, or attainment of benefit eligibility (as outlined in Section DO 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 Ftuployrr shall not count toward the vesting schedule outlinod in A above. VIII. Fortaturc ProvidonA 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 Participant's 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: 12"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 VII.B. ❑ Other ❑ At retirement or agc Definition of retirement: ❑ Same as Section VII.B. ❑ Other ❑ Other, specified as follows (also complete Section B if applicable): B. Termination prior to general bent eligibility: In the case where the general benefit eligibility as outlined in Section DCA includes a retirement component, a Participant who separates from the servioe of the Employer prior to retirement will be eligible to rwave benefits: [elm med iately upon separation from service. ❑ At age C. A Participant that becomes totally and permanently disabled ❑ as defined by the Social Security Administration [f as defined by the Employer's 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. .. ^?cir'E'' A .x13 � i_ ��'L�r•"4 !f" � �•'i. f r�YL r 'p *-:..• rr..s�,� �` �'..E�� "� „� -�-=1�`3�'?'!. :�"�i. "_ ;s. f � � Kt7 ,',a ";� ��.�� 4vC.9`�v`• 3�1,�'�T z� ��`''^��F'��`�Sez:; iC 4a i3..::i �' 41 L ,r n, = Asap "a„��, y"x� � • � �'�•'F1'•^,.r` r33 .:' vy„Fy: ••,v'.�.Q2` �^gin. t xT� s °-t�EM1L.�T.shj X. Permissible Medical Benefit Payments Bene6ts eligible for reimbursement consist of: E(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 rules which may apply to non -collectively bargaine4 self 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 cligible dependents (as defined in Section)ULD.) of the deceased Participant are immediately eligible to maintain the account and utilize it to fund eligible medical benefits specified in Section Xabove. Upon notification ofa Participant's 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 'maybe reallocated by the surviving spouse or "dependents. `Please read the current VantagepointMuasal Funds prospectus carefcllypriorto investing. An investmtnu in this fund is neither insured norguaranseed and there can be no assurance that the Fuird will be able to maintain a stable net asset value of$L 00 per share. Vantagepoiru Mutual Funds are distributed by ICMA-RC Service, LLC, a wholly-owned broker-dealer affiliate of lvfA Retirement Corporation Member NA,SD/SIPC. If Participant's 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 accounr will revert to the Plan to be applied as specified in Section VIII. �r2.?+- 'S"'�"�'r ��"`r..;`,.'.r�!. d"�.E,�.aF"'L�3 =+:v"'..�`? -"r i?`_-�'�n„��7y.axr�%u'vx�.�c,-:�.,a•�.-_ '`k _ � .i'.' �”. .�„�''y,y #�'�, s,.r�;,,r , II2.7 : .i WIN, . IN, 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 Pian 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 chgibilirr nod fication. 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 Heilth Savings Plan Employer Manual. XIII. Employer Aclnomledgements A. The Employer hereby acknowledges it understands that failure to properly fill out this Employer VantageCare Redrement Health Savings Plan Adoption Agreement may result in the loss of taxexemption 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. Q H M I'LOYER SIGNATURE By:_, Tide: Attest: Title: 14OW4—t!`i[1:1 {C1_��/S Date: l L� -:cam Date: lL 10012007 Accepted: VANTAGEPOINT TRANSFER AGENTS, LLC Assistant Secretary EMPLOYER IMPLENTATION DATA FORM INSTRUCTIONS FOR COMPLETING THE VANTAGECARE RETIREMENT HEALTH SAVINGS PLAN IMPLEMENTATION DATA FORM Please ensure that each section of this form is completed before returning it to ICMA-RC along with the other RHS Plan adoption materials. You may contact Employer Services at 1-800-326-7272 if you have questions. The following list of designations should help you while completing the Implementation Data Form: 5. Primary Contact This person is responsible for the day-ro-day administration and processing of RHS transactions. This is the person we call if general questions arise concerning your RHS Plan. ICMA-RC will also call this person regarding all EZLink transmission questions with the exception of questions regarding contributions. 16. Claims Contact This person(s) will be responsible for coordinating with the RHS third -party claim administrator. 19. Contribution Contact This person is responsible for sending contributions to ICMA-RC. If there are discrepancies in the actual EFT, check or wire amounts and the corresponding detail transmitted via EZLink, this is the person we will contact to resolve the issue. This person should have access to all payroll/contribution information to ensure efEeieni processing of contributions. 20. Trustee The tide of this person is designated in the resolution, if required by state or local law. If a different person obtains the same title, you may use this form to update the name change. If your state or local law requires a resolution, you must have your legislative body pass a new resolution to update the title of the person designated as Trustee. This person will receive all quarterly statements as well as confirmations for each contribution received and confirmations for all reinvested dividends. 21. Billing (Fees) IFICMA-RC charges any employer paid fees to your account, this person will receive the invoices. vantageCare Retirement Health Savings Plan Implementation Data Form - Page. l �cRC Instructions to Employer. Provide necessary information to establish your plan properly. Please contact your New Business Analyst at 1-800-326-7272, if you have arty questions. ICMA=RC the Only Employer d 0 General Information 2 (902) Employees full Rome: [/1 /1401 t;71k (rive, 3. (924) StreetAddress: /O� `tJl ��ti {ova /it L (925) 1 4. (418) Chir I(a 9 L (914) State: 1 L (920) lip Code: e0o 5. (633) Primary (ontad m �C/�qGZ eI201G 6. (63 4) Primary (ontod Title: tlum i+ j OeSQdQCt' (-CVIOIA14 74/L 7. (63 1) Primary (ontod Telephoned (Lql) 3Y7—VO4 8. (632)Fax#- (R_) 3S-7- kld ZL 9. (PT00) E-mail Address: r`'1 � t c, lG a W A00 . Col., 10. (882) Employer's Federal Tax Identification Number: 11. # of Employees: 12 # of Employees Eligible for Plan Participation: 13. # of Employees Eligible to Reaeire Medical Benefits upon plan implemartation: 14. Plan Leyel Quarterly Statements: (Note: " = defauh) �� fi� 11 Plan lmplementation Information � a Sort Order: (624) ❑ S=SSN" ❑ N=Name M � b. Output Media: (627) ❑ P=Paper' ❑ M=Microfiche ❑ B=Bound c Type: (626) ❑ S=Summary' ❑ D=Detail 15. (611) Cuidiibution Information: (Note:' = default) a Frequency: (diedk one): ❑ (0) Biweekly' (4) Monthly ❑ (8) Semiquaderly ❑ (1) Weekly ❑ (5) SomMonthly ❑ .(9) &annually ❑ (2) SemFweekly ❑ (6) Biquarterly ❑ (10) Annually ❑ (3) Bimonthly ❑ (7) Quarterly ❑ (11) SemFannually ❑ () Other. b. Deposa Medium: (624) ❑ CheckWire ❑ EFT C Data Medium: Mink Required to participate in RHS Plan d. First Contribution Date Following Implementation: r 'Xis f�yu ps�� r nx v �t ` h' sG'zNEW- 5 ' t ,. ;-r�K" 3 s�>- �'+,a., �" � `�^c!y€ice+- , ',�fi-,�±.3: '.x -:`t d''15 �',3�'�'4at�,�Ks.-_ Vantage(are Retirement Health Savings Plan Implementation Data Form - Page 2 Plan Contacts (Complete item #20. If item #16-19 and 21 are left blank, the Primary (ontad in #5 will receive mailings.) Claims (ontad 16. PTOI (ordad Signature: _ 99 n4 S/17 a /Gc� Information (200) (ordad Name: Please indicate (200) (ordad Title. Do Dy �x F, none L Arte. i alternate addresses _ -in-Commends (420) Telephone: (�S] _ GSL Fax: { ) �;,S77? �n Sedion 17. P108 (ordad Signature: (200) (ordad Name: (200) (ordad Title: (420) Telephone: ( ) Fax: { ) 18. P709 CordodSignature: (200) Cord ad Name: (200) Contact Idle: (420)- Telephone: ( ) Fax: ( ) Contrdnrtion Contact 19. P102 (200) Contact Name: S4 hc�y �M Information h / (200) (ordad Title: I / fee kr (420) TelephoneS_ - y0 AW,5Z Fax: (f) 3.9 -7 'A/ Trustee Contact 20. PT 10 (200) Trustee Name: %11 t I' 111t1-- L /<"ecllz Information (210) Trustee Title: (:GIjAv 12&-f0c12ftj idOQDrh1i02 (310) Trustee Address: • l (/(' 4e && A (305) Street (320) City K%ere- �ir!�4�, (325)State (330)Zgr df% (420) Telephone: (f�j) �-S 7- '-101q Fax: ( x`17 ) _ 7 4/D Z- 2- Billing BiQauct (Fres) (ontad 21. PF06 (200) (ordact Name: hdormafion -(200) (ordad Title: (420) Telephone: ( ) Fax: ( ) (omments: (A6emrde Addresses for #16-21) Internal Use Only 641 912. 608 ICMA Retirement Corporation • P.O. Box 96220 • Washington, DC 20090-6220 • Toll Free 1-800 669-1400 F ��.' 1 '?:fw..K' '"?Tl1 �'-+'l'.rr:F '�S. � 1 x ~ .�•'� � a'1�� ,�� ..� F .IP Y^•_':?' ' � c = cm1 Shy, �l1 � .'�'1 �"Ga ''� � '� T _� r� ,��:�� L; i s1= "�s*r�,S,� 3 � ; � "� '. � '. � � •% ":ii�F.-��,i�s� � iF �N. `��'i'-� F u�-�,`kr$��iv'�,1t'''�� y��'r��?,�'''�`..'�.,rr{f'• LJ `} 3� vw'"''U• y Y� `w.;.;^t!-=!S; Et.+iL.fin;av1•^-J�+3'+��'��:h�+'+�'3a�c�i.:�'� A ".,1--.. :�SK+x�•••It��os�^-�.r.�nc�.SB'i��nE':.��x'��.:::+�-��=v ADMINISTRATIVE SERVICES AGREEMENT Type: VantageCare RHS Account Number: 801860 Plan # 801860 ADMINISTRATIVE SERVICES AGREEMENT This Agreement, made as of the Z 3.-6( day of 20 1-1 (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 Village of Elk Grove Firefighters ("Employer") a local governmental instrumentality organized and existing under the laws of the State of Illinois with an office at 901 Wellington Avenue, Village of Elk Grove, Illinois 60007. 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. AGREEMENTS Acceptance of RHS Plan 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 VantageCare 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, wa Plan 4 801860 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 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. 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 thisAgreement. (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 -3- Plan # 801860 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. (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. Participation in 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 more: A $30 annual account fee will he charged to each Accountholder's account upon attainment of Benefit Eligibility by the Accountholder. Benefit Eligibility shall be transmitted electronically to,ICMA-RC by -Employer through the EZ Link System. Benefit Eligibility shall mean the quarter in which the Accountholder becomes eligible to use of the account for reimbursement of medical expenses under the -4- terms of the Employer's RHS Plan account on a quarterly basis. Plan # 801860 The account fee will be charged against the In addition to the annual account fee, 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. (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: A $30 annual account fee will be charged to each Accountholder's account upon attainment of Benefit Eligibility by the. Accountholder. Benefit Eligibility shall be transmitted electronically to ICMA-RC by Employer through the EZ Link System. Benefit Eligibility shall mean the quarter in which the Accountholder becomes eligible to use of the account for reimbursement of medical expenses under the terms of the Employer's RHS Plan. The account fee will be charged against the account on a quarterly basis. In addition to the annual account fee, 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. (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 for advisory and other services furnished to the Vantagepoint Funds. The fees referred to in this subsection are disclosed in the Vantagepoint Funds Prospectus. 6. Custodv 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. -5- Plan # 801860 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. (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 fRS will not provide express interpretive guidance. 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 Adjustments (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 Plan # 801860 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 effect. 12. Goveming Law This agreement shall be governed by and construed in accordance with the laws of the State of Illinois 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. VILLAGE OF ELK GROVE FIREFIGHTERS Vt 1)a9 It are V, e Name of Em loyer Signature ate kR"I MOA0 K- /f v rn A e l l V 1. l /a q e mgf n 4yPr Name and Title (Please Print) INTERNATIONAL CITY/COUNTY MANAGEMENT ASSOCIATION RETIREMENT CORPORATION -7- �Ck&- RrC Plan Name* V, t1w, EZIINK ACCESS FORM - PAGE 1 OF 2 of ele Ct*rcvL V,1141e- Number' 10?6ff2�, lOi 77 4 3a0914, S7097Z j S-0078, S'00 qd3 j ka0'Y,0q srw l7$ j S -pa rn Other Plan Numbers If A licableI ll 9 0'/799 If 90 `/03 X90 ya'/ dO/��, �8/AGO. S- A;0 III PP ---, �---- nis,information must be completed to amid processing delays.) '' r5ioeo2tltrc'cir of Fna+r'e- Plan Coordinator Name: CY1rT- T)g Title: Ph (oor&rmtor Phone Number: Oql) 35-7- ws-6 Fax: ^eyl) -�51- ` ky Information Email Address: C o n14 P/e 1 Imre - orl Mailing Address: 90 rre A, / "45 ) /7n Ale- GCity: City:FGratte- ViIla ge State: _ Zip: 6417,117_ 2 ❑ We hereby adopt Online Withdrawals and authorize ICMA-RC to perm I disbursements from part icipart accounts upon Adaption of receipt of termination dales. Add iondly, we understand Online Withdrawals are orly av6lable for 401 and 457 plans, Online Withdrawal termination dates should be submitted in a i finely manner, and employer appravd is not reTired for ndiiiduol ddixssement Approval . requests. (Note: Please contact an EZlnk Specialist at 1$00-3267272, for information on submiting term indion dates) 3 Select One: ❑ Add New User ID ❑" Reassign User ID ❑ Update User ID ❑ Remove User ID Password Holder Name: 0)6>/I e / ®/r+P Current User ID: Information Title: Dir r-frr aF F-goeer Phone #: fit 460 VG- Email Address: Y06 rrwst provide the Access: Inquiry- Balances & Reports ✓ Y _ N Contributions & Loan Repays _ Y ` N 'AnswordXolder Enrollments/Rehires ✓ Y _ N Participant Data Transfer: _ Y _ N -7y lnformotiarfto Participant Changes _ N establish Userto's (name, address, etc.) ond passwords forad0onal Select One: ❑ Add New User M ['Reassign User ID ❑ Update User ID C3 Remove User ID members of Yo�r sta$ Name: QU 09/1 CM 41C& `1 - Current User ID: Title: he C,e r 0� �nAnrL Phone #: 1� �) 35 7- '-/OSL Email Address: S'S r) a ��i-jT eliCGj/rP-fE- Lf. trGs Access: Inquiry - Balances & Reports Y — N Contributions & Loan Repayc —Y —N Enrollments/Rehires f Y _ N Participant Data Transfer: —Y —N Participant Changes Z Y ! N (name, addros;, cic.) Select One: ❑ Add New User ID ❑ Reassign User ID ❑ Update User ID ❑ Remove User ID Name: Current User ID: Title: Phone #: Email Address: Access: Inquiry- Balances & Reports _ Y _ N Contributions & Loan Repays —Y —N Enrollments/Rehires _Y —N Participant Data Transfer: —Y —N Participant Changes _ Y _ N (name, address, etc.) Please fox your completedEllinkAccess Form toThe'EiUnkAdministrotor'of1-202-962.4601. FRM000-014.loosos Lind EZLINK ACCESS FORM - PAGE 2 OF 2 3 Select One: ❑ Add New User ID ❑ Reassign User ID ❑ Update User ID ❑ Remove User ID Pusswort)fiolder Name: Current User ID: Information Title: Phone #: Email Address: -Access: Inquiry– Balances & Reports _ Y _ N Contributions & Loan Repays —Y —N Enrollments/Rehires —Y —N Participant Data Transfer: —Y —N Participant Changes _ Y _ N (name, address, etc.) Select One: ❑ Add New User ID ❑ Reassign User ID ❑ Update User ID ❑ Remove User ID Name: Current User ID: Title: Phone #: Email Address: Access: Inquiry– Balances & Reports—Y _ N Contributions & Loan Repays Y _ N _ Enrollments/Rehires _ Y _ N Participant Data. -Transfer: _ Y _ N Participant Changes Y N _ _ (name, address, etc.) 4 ICMA-RC considers participant information to be highly confidential, and we go to great lengths to avoid Plan Coordinator breaching that confidentiality. For this reason, ICMA-RC cannot be responsible for (i) negligent or intentional Approval misuse of the password by the municipality's officers, employees, agents bi contractors, (ii) o breach of (Plan confidentiality that may occur as a result of such negligent or intentionoh*.Misuse of the password, or (iii) a (oordtrtakr U1serIDand breach of confidentiality that may occur as a proximate result of the'r66',cipality's access to the participant password database. If the municipality usrs Mink online transaction procossing,"pfeose remember to review all automalicolry find cial information you have entered for your participants, as.ICMA-RC is not responsible for incorrect data genemkd.) trarismitied-by the municipality. ICMA-RC recommends that you encourage all participants to review statements and ` 'nfirmations for accuracy. ICMA-RC's Web site is normally available 2A hours a day, seven days a week. However, service availability is not guaranteed. Neither ICMA-RC or its affiliates, the VontageTrust Company, nor The Vdntagepoini Funds will be responsible'for any loss (or forgone gain) yco may incur as a result of service being unavailable. Please signify your agreement to these terms by signing in Ike space indicated below. You may fax th6 signed form to the Mink Administrator at 1-202-962-4601. We will provide you with User ID(s) and Passwords) to begin using Mink. Should you have questions regarding Mink, please contact an EZI.ink Specialist at 1-800-326-7272. f 1f �i� / /'Q l n Agreed: / r Date: / < Plan Coordi or SC", .'. M.) �/e%.i Print Your Name Please fax your completed MIA Access farm to the'E1t1nk Adrrinistratar at 1-202-962-4601. IRM000.0i 9-200508