HomeMy WebLinkAboutRESOLUTION - 40-16 - 11/15/2016 - VantageCare Retirement (ICMA) RESOLUTION NO. 40-16
A RESOLUTION AMENDING RESOLUTION 16-08 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 Trustees of the
Village of Elk Grove Village, Counties of Cook and DuPage, State of Illinois as follows:
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 Savings 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: 5 NAYS: 0 ABSENT: 1
PASSED this 15th day of November 2016.
APPROVED this 1511 day of November 2016.
APPROVED:
Mayor Craig B. Johnson
Village of Elk Grove Village
ATTEST:
Judith M. Keegan,Village Clerk
SUGGESTED AFFIRMATIVE STATEMENT FOR AMENDMENT OF THE
VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS) PROGRAM
Plan Number: 210 r 7j,
Name of Employer: V! //a Ci 116_1K State: 16 Z
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
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:
V »Qy �. �n46y-
Title of Designated Agent
Signature
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VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS)
ADOPTION AGREEMENT
Plan Number:8 (.7O ) l g
Select as applicable: ❑Standalone RHS ❑Integrated RHS Amendment to Existing Plan ❑New Plan
I. Employer Name: V, oqV cf U,Ilak State:
11. 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.
111. Plan Dates:
A. Plan Effective Date l /f lee& /
B. Plan Year:Enter the annual accounting period for the RHS program. ! 61 Y1
N 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 Employer's welfare benefits plan identified
in Section IV. (check all applicable boxes):
❑ All Employees
❑ All Full-Time Employees
FJf 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 VI.
If the Employer's underlying welfare benefit plan is in whole or part anon-collectively bargained plan that allows
reimbursement for medical expenses other than insurance premiums,the nondiscrimination requirements of
Internal Revenue Code(IRC)Section 105(h)will apply.These rules may impose taxation on the benefits received
by highly compensated individuals if the Plan discriminates in favor of highly compensated individuals in terms of
eligibility or benefits.The Employer should discuss these rules with appropriate counsel,
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C.Participant Eligibility Requirements �r�
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1. Minimum service:The minimum period of service required for participation is (write N/A if no minimum
service is required). N`�
2. Minimum age:The minimum a9 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 VI.13.2.).
Definition of earnings: A nnk z I trzkt S6�Gt�
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 po,r v J 1 G5 Peri t
❑ Accrued Vacation Leave
pl Other(specify type of leave)Accrued Leave
Per V,lla,Ir Q M? datdel'
An Employee shall not have the right to discontinue or vary the rate of mandatory leave contributions.
*Non-collectively bargained plans that reimburse medical expenses other than insurance premiums should consult their benefits counsel
regarding welfare plan nondiscrimination rules if the employer elects to make contributions based on a percentage of earnings.
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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 may be contributed.
❑ %of earnings
Definition of earnings: ❑ Same as Section VI.A. ❑ Other
❑ $ for the Plan year.
VII.Vesting for Direct Employer Contributions
A.Vesting Schedule(check one box)
dThe 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 includes a separation from service component and is further defined by(check one):
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
If a Participant separates from service prior to full vesting,non-vested funds in the Participant's account shall be forfeited in
accordance with the box checked under this section.
Upon the death of a participant,surviving spouse,and all surviving eligible dependents(as outlined in Section XI),funds
remaining in the Participant's account shall be revert to the Trust in accordance with the box checked under this section.
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If a Participant permanently opts out and waives future reimbursements,as allowed under IRS Notice 2013-54,all fiends in
the Participant's account at the time of waiver shall be forfeited in accordance with the box checked under this section.*
❑ 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
Program
A. A Participant is eligible to receive benefits:
At retirement only(also complete Section B.)
Definition of retirement
�Q Same as Section VII.B.
❑ Other
❑ At separation from service with the following restrictions
VV No restrictions
❑ Other
B. Termination prior to general benefit eligibility:In case where the general benefit eligibility as outlined in Section
IKA includes a retirement component,a Participant who separates from service of the Employer prior to retirement
will be eligible to receive benefits:
0 Immediately upon separation from service
❑ Other
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 account under the Employer's
welfare benefits plan.
D.Upon the death of the Participant,benefits shall become payable as outlined in Section XI.
*If the Employer's RHS Program does not limit eligibility to participants who have separated from service, the employer will be required
to provide further direction to ICMA-RC regarding the treatment ofpossible contributions that are required to be made following the
participant's waiver.
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X. Permissible Medical Benefit Payments
Benefits eligible for reimbursement consist of:
[d All Medical Expenses eligible under IRC Section 213 other than(i)direct long-term care expenses,and(ii)
expenses for medicines or drugs which are not prescribed drugs(other than insulin).
❑ 'Pie following Medical Expenses eligible under IRC Section 213 other than(i)direct long-term care expenses,and(ii)
expenses for medicines or drugs which are not prescribed drugs(other than insulin).Select only the expenses you wish to
cover under the Employer's welfare benefits 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)*
* Non-collectively bargained plans that reimburse medical expenses other than insurancepremiums should consult their benefits
counsel regarding welfare plan nondiscrimination rules if the employer elects to make contributions based on a percentage of
earnings.
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
Upon the death of a participant,the surviving spouse and/or surviving eligible dependents(as defined in Section XILD.)
of the deceased Participant are immediately eligible to maintain the Participant's RHS account and utilizing the remaining
balance 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 Dreyfus Cash
Management fund** (or another fund selected by the Employer).The account balance may be reallocated by the
surviving spouse or dependents.
** An investment in the Dreyfus Cash Management money market fund is not insured or guaranteed by the Federal Deposit
Insurance Corporation or any othergovernment agency.Although the fund seeks to preserve the value ofyour investment
at$1.00 per share, it is possible to lose money by investing in the fund. Investors should consider the investment objectives,
risks, charges, and expenses of the fund carefully before investing. You may visit us at www.icmarc.org or call
800-669-7400 to obtain a prospectus that contains this and other information about the fund. Read the prospectus
carefully before investing.
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 in accordance with the Employer's election under Section VIII of the VantageCare RHS Adoption
Agreement.
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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 in accordance
with the Employer's election under Section VIII of the VantageCare RHS Adoption Agreement.
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,benefit
eligibility,and vesting 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 a 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(a)the Participant's lawful spouse,(b) the Participant's child under the age of 27,as defined
by IRC Section 152(f)(1)and Internal Revenue Service Notice 2010-38,or(c)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
Employer Manual.
XIII.Employer Acknowledgements
A. The Employer hereby acknowledges it understands that failure to properly fill out this VantageCare Retirement Health
Savings Adoption Agreement may result in the loss of tax exemption of the Trust and/or loss of tax-deferred status for
Employer contributions.
B. OCheck this box if you are including supporting documents that include plan provisions.
EMPLOYER SIGNATURE
By: Date:
Title•
Attest: Date:
Title:
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Addendum,Amendment to the Village of Elk Grove Village RHS Plan,800178
For Village Employees that are in Merit Pay Plan Positions(referenced in 4.2A1 of Village Policy and
outlined in the Merit Pay Plan),the Village will place the hourly rate of pay value of any remaining
Floating Holiday time(with a limit of 4 Floating Holidays)at the calendar year end (December 311t) into
the Retiree Health Savings program. Employees who separate before the end of the calendar year will
not be eligible.
Payroll inquires will not be eligible for any payroll changes to Floating Holidays starting December 11t