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HomeMy WebLinkAboutRESOLUTION - 16-08 - 4/8/2008 - VANTAGE CARE RETIREMENTRESOLUTION NO. 16-08 A RESOLUTION AMENDING RESOLUTION NO. 22-02 AND RESOLUTION NO. 43-04 BY APPROVING A DECLARATION OF AMENDMENT TO THE VANTAGECARE RETIREMENT HEALTH SAVINGS PLAN OF THE VILLAGE OF ELK GROVE VILLAGE (ICMA) WHEREAS, the Employer; the Village of Elk Grove Village, has employees rendering valuable services: and WHEREAS; the Employer, the Village of Elk Grove Village, has established a retiree health savings plan in the form of the VantageCare Retirement Health Savings Plan (the "Plan") for such employees that serves the interest 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, the Village of Elk Grove Village, has determined that the continuance of the Plan serves the above objectives. NOW, THEREFORE, BE IT RESOLVED by the Mayor and Board of'l*rustees of the Village of Elk Grove Village, Counties of Cook and DuPage, Illinois: Section 1. That the Employer, the Village of Elk Grove Village, hereby amends and restates the Plan as outlined in the attached Declaration of Amendment to the VantageCare Retirement Health Saving Plan; and Section 2. That the assets of the Plan shall be held in trust, with the Employer, Village of Elk Grove Village, as Trustee ("Trustee") for the exclusive benefit of Plan participants and their beneficiaries; and Section 3. That the assets of the Plan shall not be diverted to any other purpose prior to the satisfaction of all liabilities of the Plan; and Section 4. That the Employer, the Village of Elk Grove Village, executes the Declaration of Trust of the Village of Elk Grove Village Integral Part Trust in the form of the model integral part trust agreement made available by the ICMA Retirement Corporation. Section 5. That this Resolution shall be in full force and effect from and after its passage and approval according to law. VOTE: AYES: 6 NAYS: 0 ABSENT: 0 PASSED this 81h day of April 2008. APPROVED this 8th day of April 2008. ATTEST: Ann I. Walsh, VillajZe Clerk ResRetirementHealth2007AmendRes43-04.doc 74 APPROVED: Mavor Craig B. Johnson Village of Elk Grove Village SUGGESTED AFFIRMATIVE STATEMENT FOR AMENDMENT OF THE VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS) PLAN Plan Number: 8-0() 1yL1 / Ila Name of Employer: Vi (1444!' o 1),-- Ureye V, `r a 9r e- State: Affirmative Statement of the above-named Employer (the "Employer"): WHEREAS, the Employer has employees rendering valuable services; and %KTHEREAS, the amendment of its existing retiree health savings plan serves the interests of the Employer and its Employees; and NOW THEREFORE, as a duly authorized agent of the Employer, I hereby: AMEND the Employer's Plan in the form of the ICMA Retirement Corporation's VantageCare Retirement Health Savings program. DATE: Village Manager Tide of Designated Aeenr I) 1 Signature 2 i cmA-RC Building Rcrircmrnr Security EMPLOYER VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS) PLAN ADOPTION AGREEMENT EMPLOYER VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS )PLAN ADOPTION AGREEMENT Amendment to Existing Plan Number: 8 U U -1 Q�j Employer Retirement Health Savings Plan Name: V( I. Employer Name: t l /, u yl E re- G"Ove- y` 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 Amendment: e e'er' bel 11 Z 009 W 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 Safer), Employees - Police ❑ Public Safety, Employees - Firefighters ❑ General Employees 10- Collectively -Bargained Employees (Specify unit(s)) ❑ Other (specify group(s)) f l%b�i C• Wo'k V gl6(\ 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 Rarticipation.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 1. Minimum service: The minimum period of service required for participation isU �/ r� (write N/A if an Employee is eligible to participate immediately upon employment). [� I. 2. Minimum age• The minimum age required for eligibility to participsce is N `� (write N/A if no miuiuiuut lgr is required). VI. Contribution Sources and Amounts A. Definition of Earnings The definition of Earnings will apply to all RHS Contribution Features that reference "Earnings", including Direct Employer Contributions (Section VI.B.1.) and Mandatory Employee Compensation Contributions (Section VI.B.2.) Definition of earnings: A/) /I Vet / &O>e �b B. Direct Employer Contributions and Mandatory Contributions 1. Direct Employer Contributions VIA 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 IV4 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 Pa}' 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 ❑ Accrued Vacation Leave or V, U e eolrc ❑ Other (specIR, type of leave) Accrued Leave An Employee shall not have the right to discontinue or vary the rate of mandator}, 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. Q� There is no Plan -defined limit on the percentage or dollar amount of earnings that may be contributed. ❑ w//1 % of earnings` 'Definition of earnings: ❑ Same as Section VI.A.. ❑ Othcr ❑ $ A/ (.4 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) O"The account is 100% vested at all times. ❑ The following vesting schedule shall apply to Direct Employer Contributions as outlined in Section VI.A.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 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). ,,/Contributions 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. 3 IK Eligibility Requirements to Receive Medical Benefit Payments from the VantageCare Retirement Health Savings Plan A. A Participant is eligible to receive benefits: Q� At retirement only (also complete Section 13.) 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 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: L7 Immediately upon separation from service. ❑ At age C. A Participant that becomes totally and permanently disabled ❑ as defined by the Social Security Administration das 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. 4 K Permissible Medical Benefit Payments Benefits eligible for reimbursement consist of: dtill 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)' * Nondiscrimination rules may apply to non -collectively bargained, sef 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 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 may be reallocated by the surviving spouse or dependents. *Please read the current Vantagepoint Mutual Funds prospectus carefully prior to investing. An. investment in this fund is neither insured nor guaranteed 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 distributed by 10M -RC Services, LLC, a wholly-owned broker-dealer affiliate of ICMA Retirement Corporation. Member NASD/SIPC. If a 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 account will revert to the Plan to he 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. 5 XIL The Plan will operate according to the following provisions: A. Employer Responsibilities 1. TheEmployerwillsubmitallVancageCareRecirementHealthSavingsPlancontributiondataviaelectronicsubmission. 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 nor 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 char include plan provisions. EMPLOYER SIGNATURE JBy: _ Date: Tide: Village Manager Accepted: VANTAGEIPOINT TRANSFER AGENTS, LLC B Md '� Date: Assis&nt Secretary C.7 (F) Sick Leave Abuse Abuse of the sick leave benefit shall be cause for disciplinary action. Presentation of a false.medical document in an attempt to justify what would otherwise be an un -excused absence shall be an additional cause for disciplinary action. SECTION 12.2: RETIREE HEALTH AWARD PROGRAM Employees covered by this Agreement who retire from the service of the Village of Elk Grove Village with at. least twenty (20) years of service at the time of their retirement, shall be compensated upon retirement for certain unused sick days as described below: (A) Threshold: In order to qualify for any retiree health award benefit, the employee must have accrued at a minimum 80. days (640 hours) of full accrued sick leave days at the time of retirement. (B) Amount of Retiree Health Award Benefit: Employees qualifying for this Retiree Health Award Benefit shall receive the following percentage payments of the value of each sick leave day, or portion thereof to be bought back by the Village, at the employee's rate of pay at the time of retirement: (C) Qualified Medical Savings Plan: The.affected bargaining unit member'.s retiree health. award and benefits payments shall be deposited in a qualified medical savings plan in pre-tax dollars. The use of said funds shall be regulated by the plan, and any administrative costs shall be paid by the plan or plan participants. Payments.to the fund shall be made on the first of the month following the month the employee retires. -22- Effective Date - of signing Years of Employment at 5/.1/2009 through 5/1/2007 through the Time of Retirement 4/30/2011 4/30/2009 20 40% 456/o 50% 25 40% 45% 50% 30 40% 45% 50% 35 40% 45% 50% (C) Qualified Medical Savings Plan: The.affected bargaining unit member'.s retiree health. award and benefits payments shall be deposited in a qualified medical savings plan in pre-tax dollars. The use of said funds shall be regulated by the plan, and any administrative costs shall be paid by the plan or plan participants. Payments.to the fund shall be made on the first of the month following the month the employee retires. -22- SUGGESTED AFFIRMATIVE STATEMENT FOR AMENDMENT OF THE VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS) PLAN Plan Number: 8 00 179 j Name of Employer: � ` `'� e OF C I iC 6joy e, y ` I ( a � c' State: Affirmative Statement of the above-named Employer (the "Employer"): WHEREAS, the Employer has employees rendering valuable services; and WHEREAS, the amendment of its existing retiree health savings plan serves the interests of the Employer and its Employees; and MOW THEREFORE, as a duly authorized agent of the Employer, I hereby: AMEND the Employer's Plan in the form of the ICMA Retirement Corporation's VantageCare Retirement Health Savings program. DATE: �i / U Village Manager Title of Designated Agent 44A bA Signature t i cmA-RC Building Rr6"--t Sff rity EMPLOYER VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS) PLAN ADOPTION AGREEMENT EMPLOYER VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS )PLAN ADOPTION AGREEMENT Amendment to Existing Plan Number: 8 Uro M Employer Retirement Health Savings Plan Name: mf % I. • Employer Nae: U, t 1 G. 6 �. O { -. I IG � I e�y_ V !'G fl ( State: 1 y 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. / 11I. Effective Date of the Amendment: J a 17 V 4 M ( GU 6 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 Safery 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 Partieipation.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 1. Minimum service: The minimum period of service required for participation is 0 �(I! (write N/A if an Employee is eligible to participate immediately upon employment). A / 2. Minimum age: The minimum age required for eligibility to participate is / (write N/A if no minimum age is required). VI. Contribution Sources and Amounts A. Definition of Earnings The definition of Earnings will apply to all RHS Contribution Features that reference "Earnings", including Direct Employer Contributions (Section VI.B.1.)and Mandatory Employee Compensation Contributions (Section V1.13.2.)/ Definition of earnings: /� /1 ri V N &I SQ /d B. Direct Employer Contributions and Mandatory Contributions ] . Direct Employer Contributions%(r 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 N/4' 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): dAccrued Sick Leave Alf V' ❑ Accrued Vacation Leave ❑ Other (specify type of leave) Accrued Leave An Employee shall nor 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. LJ There is no Plan -defined limit on the percentage or dollar amount of earnings that may be contributed. ❑ N�� % of earnings' 'Definition of earnings: ❑ Same as Section V1.A.. ❑ Other ❑ $ A for the Plan year. See Section V.B. for a discussion of nondiscrimination rules that may apply to non-collecrively bargained self-insured Plans. 2 VII. Vesting for Direct Employer Contributions A. Vesting Schedule (check one box) G'1 The account is 100% vested at all times. ❑ The following vesting schedule shall apply to Direct Employer Contributions as outlined in Section VIA].: 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 DX) by a Participant. Definition of retirement (check one box): 9 Retiremenras defined in the primary retirement plan of the Employer ❑ Separation from service ❑ Ocher 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 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). L, 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 Employcr. 3 IX Eligibility Requirements to Receive Medical Benefit Payments from the VantageCare Retirement Health Savings Plan A. A Participant is eligible to receive benefits: EY At retirement only (also complete Section B.) Definition of retirement: 19 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 rn 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 rx.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 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. 4 X_ Permissible Medical Benefit Payments Benefits eligible for reimbursement consist of: 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 -Tenn Care Insurance Premiums ❑ Non -Prescription medications allowed under IRS guidance` ❑ Ocher qualifying medical expenses (describe)' `. Nondiscrimination rules may apply to non -collectively bargained, sef insured Plans. M. 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 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 may be reallocated by the surviving spouse or dependents. ` Please read the current Vantagepoint Mutual Funds prospectus carefully prior to investing An investment in this fund is neitber insured nor guaranteed and there can be no assurance that the Fund will be able to n aintain a stable net asset value of $1.00 per share, Vantagepoint Mutual Funds are distributed by ICAM-RC Services, LLC, a wholly-owned broker-dealer affiliate of/CAM Retirement Corporation. Member NASDISIPC. If a 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 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. 5 XII. The Plan will operate according to the following provisions: A. Employer Responsibilities I. TheEmployenvillsubmitallVantageCareRetirementHealthSavingsPlancontributiondataviaelectronicsubmission. 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 -parry 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. LK EMPLOYER SIGNATURE (/ By: i Date: Title: Village Manager Accepted: VANTAGEPOINT TRANSFER AGENTS, LLC B Date: Assistlant Secretary ELK GROVE VILLAGE EMPLOYEE RETIREMENT HEALTH AWARD BENEFIT PROGRAM WHAT IS THE BENEFIT? This mandatory benefit program, sponsored by the Village provides eligible employees with a monetary award, at retirement, to offset retiree health care costs. WHO IS ELIGIBLE? Retiring Non -Union Full Time and Part Time Employees ELIGIBILITY REQUIREMENTS 1. Have a minimum of twenty (20) years of service (IMRF service credits earned for unused sick time do not apply to the determination of twenty _years service) 2. Be eligible to draw retirement benefits 3. Be retiring in good standing as determined by the Village of Elk Grove 4. Must have accrued at a minimum, the following number of sick leave days by the date of retirement: (excludes IMRF creditable service days) For 37.5/40 Hour Workweek For 24 Hour Shift 80 days 40 days After twenty (20) }rears of service, starting on January 1, 2008, an employee will receive 45% of accrued sick time at the hourly rate in effect at retirement. On January 1; 2009, an employee will receive 50% of the accrued sick time at the hourly rate in effect at retirement. If any of the above eligibility requirements are not met by the employee upon retirement, the employee is ineligible for the Retirement Health Award Benefit Program. WHEN WILL THE ELIGIBLE RETIRING EMPLOYEE RECEIVE THE BENEFIT AWARD? On the first of the month following their retirement date. HOW WILL THE BENEFIT BE PAID? The benefit will be deposited by the Village, in the name of the employee, in the Vantage Care Retiree Health Savings Account. CAN AN EMPLOYEE CLOSE THEIR RETIREE HEALTH CARE ACCOUNT? If the tax- free amount placed in the employee's account by the Village is less than $5,000.00, the employee has the option of leaving the money in the account or withdrawing the amount. If the amount is withdrawn it becomes taxable as ordinary income. If the amount placed in the employee's account by the Village is $5,000.00 or more, There is no withdrawal option except for qualified, medical expenses.