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R-1516 - 12/08/2015 - ICMA - Resolutions RESOLUTION 2015-ICMA-CNTRCT-R-1516 A RESOLUTION APPROVING AND AUTHORIZING AN AMENDMENT TO THE CONTRACT BETWEEN THE VILLAGE AND ICMA-RC TO PROVIDE ADDITIONAL VILLAGE EMPLOYEES AN RHS ACCOUNT PLAN OPTION WHEREAS, in 2012, the Village entered a contract with ICMA-RC ("Contract'l to provide the Village's defined employee groups with a retiree health savings (RHS) account plan option allowing certain employees to defer a percentage of their salaries to be used towards health expenses that may be incurred during retirement("Plan Option'j; and WHEREAS, a group of Village employees has requested that the Village amend its Contract with ICMA-RC to allow an additional group of employees to participate in the Plan Option ("Amendment'j; and WHEREAS, the Amendment will not have any financial impact on the Village because all costs for the Plan Option will be paid for entirely by the Village employees that choose to participate in the Plan Option; and WHEREAS, the President and Board of Trustees have determined that it is in the best interest of the Village to approve the Amendment; NOW THEREFORE, BE IT RESOLVED BY THE PRESIDENT AND BOARD OF TRUSTEES OF THE VILLAGE OF OAK BROOK, DU PAGE AND COOK COUNTIES, ILLINOIS as follows: Section 1: Recitals. The foregoing recitals are hereby incorporated into, and made a part of, this Resolution as the findings of the President and Board of Trustees of the Village of Oak Brook. Section 2: Approval of Amendment. The President and Board of Trustees hereby approve the Amendment in substantially the same form as attached as Exhibit A and in a final form approved by the Village Attorney. Section 3: Authorization and Execution of Amendment. The Village Manager and Village Clerk shall be, and hereby are, authorized to execute the Amendment upon final approval by the Village Attorney. Section 4: Effective Date. This Resolution shall be in full force and effect upon passage and approval in the manner provided by law. [SIGNATURE PAGE FOLLOWS] Resolution 2015-ICMA-AG-R-1516 Authorizing Amendment to Contract With ICMA re:RHS Account Plan Option Page 2 of 3 APPROVED THIS 8th day of December, 2015 Gopal G. Lalmalani Village President PASSED THIS 8th day of December, 2015 Ayes: Trustees Adler, Baar, Manzo, Moy, Tiesenga, Yusuf Nays: None Absent: None ATTEST: �';�, t 4 fi r, '� ✓J L11 A 3 Charlotte K. Pruss Village Clerk 2 Resolution 2015-ICMA-AG-R-1516 Authorizing Amendment to Contract With ICMA re:RHS Account Plan Option Page 3 of 3 EXHIBIT A AMENDMENT 3 VantageCare Retirement Health Savings (RHS) icnnARC PLAN AMENDMENT PACKET $Wilding Retiorment Senmiry To amend your existing RHS Plan,please complete the entire Adoption Agreement,including items that are not being amended.When you send your amendment to ICMA-RC,please summarize the changes in your cover letter. Please note that ICMA-RC does not require the use of a resolution to amend the plan.Should you require legislative action,you may use the Suggested Resolution for Amendment on the following page.If you do not require legislative action,you may complete the Suggested Affirmative Statement for Amendment which follows. Once the amendment is completed,retain a copy for your records and send the original with the cover letter and either the resolution or the affirmative statement to ICMA-RC as follows: s Via Mail ICMA-RC Attn—New Business Services Suite 600 777 North Capitol Street,NE Washington,DC 20002-4240 Via Facsimile 202-962-4601 Atm—New Business Services You will receive notification that your amendment has been received and accepted. AC 23364-0115-1Y%i12 ICAAC BaiOngRetirenreat So moily EMPLOYER VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS) ADOPTION AGREEMENT E i I t r i 1 i i VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS) ADOPTION AGREEMENT Plan Number:8 03212 Select as applicable: ❑Standalone RHS ❑Integrated RHS W Amendment to Existing Plan ❑New Plan I. Employer Name: Village of Oak Brook State: IL 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. Plan Dates: A. Plan Effective Date B. Plan Year:Enter the annual accounting period for the RHS program. 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 Employer's welfare benefits plan identified in Section IV. (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)) IAFF Local 4646 • Other(specify group(s)) Fire Command Staff 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 Particigatiion:Ali Employees in the covered group(s)are required to participate in the Plan and shall receive contributions pursuant to Section VI. If the Employers underlying welfare benefit.plan es an,whole,or parC a non Collecttyely bargaine plan tliat allows !reiim#iitcseinerit'for;iredi�al'•ex eases other thari rhsurance ptemiiims,the:nbadscririitha[tion requireirients,of Iriterrial.Revenue Code(TRG)Secc�on 10$(h)will apply'.T}ieseruies.-may.imposetaxanon on .:e :etiefirs"received'.`.::' liyl,ghly compensated mdivsduals tfthe Plan dtscnmuiates in favor of highly compensated Individuals m terms of .: :?:: ;elsgibilr.�:or,benefctss:'Ihe:,t;mployec;should,c�rs::...:>.;::::::.::,:.:.:;.,...:...:.:.:..:....Pl?:..•.p>..:....: .:::,...... :.:..:, :..:.:,::..:.;:>...:..:;.::.:: ::.....:..,.,. 1 C.Participant Eligibility Requirements 1. Minimum service:The minimum period of service required for participation is N/A(write NIA if no minimum service is required). 2. Minimum age:The minimum age required for eligibility to participate is N/A(write NIA if no minimum age is required). VI.Contribution Sources and Amounts , A. Definition of Earnings I 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.). Wages ' Definition of earnings:Gross Wa g i B. Direct Employer Contributions and Mandatory Contributions s 1. Direct Employer Contributions ! i The Employer shall contribute on behalf of each Participant ❑ 3 %of Earnings* ❑ $ each Plan Year ❑ A discretionary amount to be determined each Plan Year A Other(describe): see attached contributions sheet for mandatory employee contribution group structure 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): p Accrued Sick Leave 100%Accured Leave at Separation El Accrued Vacation Leave' p Other(specify type of leave)Accrued Leave 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. 2 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 limits)below.Limits on individual contribution types are defined within the appropriate section above. 2 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) d The account is 100%vested at all times. i ❑ The following vesting schedule shall apply to Direct Employer Contributions as outlined in Section VI.B.i.: Years of Service Vesting Completed Percentage % I % f ffo 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 Q 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. 3 If a Participant permanently opts out and waives future reimbursements,as allowed under IRS Notice 2013-54,all funds 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: ❑ Same as Section VII.B. s ❑ Other 4 1 At separation from service with the following restrictions F ■ No restrictions f ❑ Other € B. Termination prior to general benefit eligibility:In case where the general benefit eligibility as outlined in Section IX.A includes a retirement component,a Participant who separates from service of the Employer prior to retirement will be eligible to receive benefits: ❑ Immediately upon separation from service ❑ Other j I C. A Participant that becomes totally and permanently disabled ❑ as defined by the Social Security Administration j ❑ as defined by the Employer's primary retirement plan F111 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 frcrther direction to ICMA-RC regarding the treatment of possible contributions that are required to be made following the participants waiver. 4 X. Permissible Medical Benefit Payments Benefits eligible for reimbursement consist of © Ali 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). ❑ The 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 j ❑ Dental Out-of-Pocket Expenses* I ❑ 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 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. 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 XII.D.) 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 frond is not insured orguaranteed by the Federal Deposit Insurance Corporation or any other government 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 objective risks,charges,and expenses of thefund carefully before investing. You may visit us at www3cmarc.org or call 800-669-7400 to obtain a prospectus that contains this and other information about the fisnd.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 RHSAdoption Agreement. 5 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 RHSAdoption Agreement. XII.The Plan will operate according to the following provisions: A. Employer Responsibilities 1. 'Ihe Employer will submit all VantageCare Retirement Health Savings Plan contribution data via electronic submission. 2. The Employer will submit all VantageCare Retirement Health Savings PIan 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 nor 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 F 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(£)(1)and Internal Revenue Service Notice 2010-38,or(c)any other individual who is a person I 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. XM.Employer Acknowledgements i I 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.® Check this box if you are including supporting documents that include plan provisions. I EMPI.o R SIGNATURE By: Date: Title: t(►+� I/1Gt/7C� L�//C /� A JA A Date: US- Title: x/1/J I �SIb Iri Q V1 P� f S AC.•22872-0115-826 6 i icmARC BuiOng Retirement Security c SUGGESTED RESOLUTION FOR AMENDMENT AND SUGGESTED AFFIRMATIVE STATEMENT FOR AMENDMENT i 4 i l II s i i 1 i SUGGESTED AFFIRMATIVE STATEMENT FOR AMENDMENT OF THE VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS) PROGRAM Plan Number: 032 La. Name of Employer: V 1 QG't ap n/� i lD D State: j {J , 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 C 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. i f DATE: Ti o Design ed Age c I I Signature AG 22877-011.5 1 1