R-1714 - 03/27/2018 - ICMA - Resolutions Supporting Documents (2) SUGGESTED AFFIRMATIVE STATEMENT FOR AMENDMENT OF THE
VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS) PROGRAM
Plan Number: d 3 0� t "a r
Name of Employer: V I )I a (k , a K FI-C)04 State: I�---
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: I v1. 3"
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Ti e o Design ed Age r
Signature '
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C.Participant Eligibility Requirements
I. Minimum service:The minimum period of service required for participation is N/A(write N/A if no minimum
service is required).
2. Minimum age:The minimum age required for eligibility to participate is NSA(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.B.2.).
Definition of earnings:Gross Wages
B. Direct Employer Contributions and Mandatory Contributions
1. Direct Employer Contributions
The Employer shall contribute on behalf of each Participant
Er3%of Earnings* _f_PU 60r)VTUTU '" C f ,�}j Ll
❑ $ each Plan Year
❑ A discretionary amount to be determined each Plan Year
Other(describe): see attached contribution for IAFF 4646
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):
8 Accrued Sick Leave 100%Accured Leave at Separation
40i
❑ Accrued Vacation Leave
❑ Other(specify type of leave)Accrued Leave
An Employee shall not have the right to discontinue or vary the rate of mandatory leave contributions.
*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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Resolution 2015-[CMA-AG-R-1516
Authorizing Amendment to Contract
With ICMA re:RHS Account Pian Option
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EXHIBIT A
AMENDMENT
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