R-05-15RESOLUTIONNO. R -05 -15
ADOPTING AN AMENDED VANTAGECARE RETIREMENT HEALTH
SAVINGS PLAN
WHEREAS, pursuant to Resolution R -00-06 the Village established a Retiree Health Care Plan; and
WHEREAS, the establishment of a retiree health savings plan for village employees serves the
interests of the Village by enabling it to provide reasonable security regarding 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, employees have requested the opportunity to make voluntary contributions to the plan
to assist in their retirement planning; and
WHEREAS, such voluntary, irrevocable contributions may be permitted upon the amendment of the
current Village plan as administered by the ICMA Retirement Corporation; and
WHEREAS, it is in the best interest of the Village of Deerfield to allow for employees to voluntarily
contribute to this plan for their own benefit; and
NOW, THEREFORE, BE IT RESOLVED BY THE PRESIDENT AND BOARD OF TRUSTEES
OF THE VILLAGE OF DEERFIELD, LAKE AND COOK COUNTIES, ILLINOIS, in the exercise of its
home rule powers, that the Village of Deerfield Retiree Health Plan, adopted April 17, 2000, is hereby
amended to permit voluntary, irrevocable employee contributions.
BE IT FURTHER RESOLVED, that the amended plan adoption agreement, attached hereto and
made a part hereof, are hereby adopted and approved.
BE IT FURTHER RESOLVED, that the Director of Finance and Administrative Services shall be
coordinator and contact for the Plan.
Resolution R -05 -15
ADOPTED this _ 5TH day of -------------------------- December I 2005.
AYES: Benton, Feldman, Rosenthal, Seiden, Struthers, Wylie (6)
NAYS: None (0 )
ABSENT: None (0)
ABSTAIN: None (0)
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EMPLOYER VANTAGECARE RETIREMENT HEALTH
SAVINGS (RHS) PLAN ADOPTION AGREEMENT
Plan Number: 8 00003
AMENDMENT
Employer Retirement Health Savings Plan Name: Village of Deerfield Retiree Health Plan
1. Employer Name: Village of Deerfield State: IL
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. The Effective Date of the Plan: 05/01/2000; amendments — 01/01/2006
IV. The Employer intends to utilize the Trust to fund only welfare benefits pursuant to the following welfare ben-
efit plan(s) established by the Employer:
Village of Deerfield Health Savings Plan
V. Eligible Groups and Participant Eligibility Requirements
A. The following group or groups of Employees are eligible to participate in the VantageCare Retirement Health
Savings Plan:
All Employees
x All Full -Time Employees
Non -Union Employees
Public Safety Employees - Police
Public Safety Employees Firefighters
General Employees
Collectively- Bargained Employees (Specify unit)
Other (specify below)
The group specified must correspond to a group of the same designation that is defined in the statutes, ordi-
nances, rules, regulations, personnel manuals or other material in effect in the state or locality of the Employer
❑ If this box is checked, in lieu of mandatory participation, the Employer provides for a one -time irrevoca-
ble election by eligible Employees to participate in RHS. Until such time as the election is made, the
Employee shall not participate in the Plan or receive contributions pursuant to Section VI.
Newly eligible Employees shall be provided an election window of days (no more than 60
calendar days) from the date of initial eligibility during which they may make the election to participate.
Participation may begin no earlier than the calendar month following the end of the election window.
If the Employee does not make the election in the year of initial eligibility, the election to participate may
be made in a later year. An annual election window of days (no more than 60 calendar
days) shall be provided during which the election may be made. The election window shall run from
to (insert your annual time frame for the election window, e.g. October 1 to
November 29). Participation may begin no earlier than the calendar year following the year of the elec-
tion.
Once made, the election is irrevocable and may not be revoked while the participant is a member of the
group covered by the RHS plan.
If the Employer's underlying welfare benefit plan or funding under this VantageCare Retirement Health Savings
Plan is in whole or part a non - collectively bargained, self - insured plan, the nondiscrimination requirements of
Internal Revenue Code (IRC) Section 105(h) will apply. These rules may impose taxation on the benefits received
11
AMENDMENT
by highly compensated Employees if the Plan discriminates in favor of highly compensated Employees in terms
of eligibility or benefits. The Employer should discuss these rules with appropriate counsel.
B. Participant Eligibility
1. Minimum period of service required for participation is N/A (write N/A if an Employee is eligible to partici-
pate or to elect to participate immediately upon employment).
2. Minimum age required for eligibility to participate is N/A (write N/A if no minimum age is required).
VI.Contribution Sources and Amounts
A. Mandatory Contributions
❑ 1. Direct Employer Contributions
The Employer shall contribute on behalf of each Participant N/A % of earnings or $ N/A for the Plan
Year.
Definition of earnings: Regular Annualized Base Salary
fl 2. Mandatory Leave Contributions
The Employer will make mandatory contributions of leave as follows:
Accrued .Sick Leave* 9 Yes ❑ No
Accrued Vacation* u Yes .❑ No
Other* (describe)
❑ Yes ❑ No
Please provide the formula for determining the Accrued Leave contribution:
Sick leave - 12 days /year accrual -- 1/2 day pay out for each sick leave
day accrued to a maximum of 160 half days at retirement
An Employee shall not have the right to discontinue or vary the rate of annual leave contributions.
❑ 3. Mandatory Employee Compensation Contributions
The Employer will make mandatory contributions of Employee compensation as follows:
❑ Reduction in Salary - N/A % of earnings (as defined in VI.A.1.) 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:
N/A
An Employee shall not have the right to discontinue or vary the rate of mandatory contributions of
Employee compensation.
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AMENDMENT
B. Elective Contributions
1. Elective Pre -Tax Contributions
The Employer will permit each Employee to make the following elections to make pre -tax
contributions to the Plan:
9 a. Irrevocable Election for Pre -Tax Contributions from Compensation: A one -time, irrevocable election of
the amount of Employer contributions of compensation made on his or her behalf.
The Employer limits the amount elected to either a fixed percentage or a range of percentages of an
Employee's earnings
1,2,3,4,5,10,15,50 or 100%
% of earnings (as defined in VI.A.1.) or up to % of earnings (as defined in
VI.A.1) for the Plan Year.
Newly eligible Employees shall be provided an election window of 60 days (no more than 60)
from the date of initial eligibility during which they may make the election to contribute. Contributions
may begin no earlier than the calendar month following the end of the election window.
If the Employee does not make the election in the year of initial eligibility, the election to contribute may
be made in a later year. An annual election window of 6n days (no more than 60) shall be
provided durring which the election may be made.. The election window shall run from Nov. 1 to
Dec. 3U (insert your annual time frame for the election window). Contributions may begin no ear-
lier than the calendar year following the year of the election.
Once made, the election is irrevocable and may not be revoked.
❑ b. Irrevocable Election for Pre -Tax Contributions of Accrued Leave: A one -time, irrevocable election of
the amount of employer contributions of Employee accrued
❑ sick ❑ vacation ❑ other (describe) leave made on his or her behalf
C3 Yes C3 No
The Employer limits the amount elected as shown below:
Newly eligible Employees shall be provided an election window of days (no more than 60
calendar days) from the date of initial eligibility during which they may make the election to contribute.
Contributions may begin no earlier than the calendar month following the end of the election window.
If the Employee does not make the election in the year of initial eligibility, the election to contribute may
be made in a later year. An annual election window of _ days (no more than 60 calendar
days) shall be provided during which the election may be made. The election window shall run from
to (insert your annual time frame for the election window). Contributions may
begin no earlier than the calendar year following the year of the election.
Once made, the election is irrevocable and may not be revoked.
❑ c. Annual Prospective Election for Pre -Tax Contributions of Leave: An annual, irrevocable election to
have his or her ❑ sick ❑ vacation ❑ other
calendar year contributed to the Plan on his or her behalf .
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(describe) leave to be accrued in the next
AMENDMENT
The Employer limits the amount elected as shown below:
Contributions of future leave accruals will be remitted to the Plan
❑ as earned 0 at the end of the calendar year.
The election to contribute must be made in the calendar year before the year in which contributions are to
begin. Once made, the election shall apply to succeeding calendar years unless otherwise revised or
revoked by the Employee on an annual basis.
An annual election window of days (no more than 60 calendar days) is provided during which eligible
Employees may make the election to contribute. The election window shall run from to
(insert your annual time frame for the election window).
In adopting section a, b, and /or c, the Employer acknowledges that the Internal Revenue Service has not
ruled on irrevocable election contributions in an integral part trust. ICMA -RC has obtained the advice of
counsel that such contributions are allowable under the conditions outlined in this Adoption Agreement. The
Employer should discuss this issue with appropriate counsel.
2. Voluntary After -Tax Contributions
Each Employee may contribute up to NSA % of earnings (as defined in VI.A.1.) or $ -- for the Plan Year on
a voluntary after-tax. basis. In no event may aggregate Employee voluntary after -tax contributions exceed 25%
of total contributions in any Plan Year.
An Employee shall have the right to discontinue or vary the rate of elective after -tax contributions of Employee
earnings.
By adopting this section, the Employer acknowledges that the Internal Revenue Service has declined to rule on
Employee after tax contributions in an integral part trust. ICMA -RC has obtained the advice of counsel that such
contributions are allowable in an insubstantial amount (i.e. no more than 25% of total contributions in any Plan
Year). The Employer should discuss this issue with appropriate counsel.
C. Limits on Total Contributions
The total contribution on behalf each Participant (including both Mandatory and Elective
Contributions) for each Plan Year shall not exceed the following limit(s):
❑ % of earnings (as defined in VI.A.1.).
$
® There is no Plan- defined limit on the percentage or dollar amount of earnings that may
be contributed.
Limits on individual contribution types are defined within the appropriate section above.
See Section V.A. for a discussion of nondiscrimination rules that may apply to non - collectively bargained self -
insured Plans.
14
AMENDMENT
VII. Vesting Schedule
A. The account is 100% vested at all times, unless specified otherwise in B. below.
B. The following vesting schedule applies to Direct Employer Contributions outlined in VI.AA:
Years of Specified
Service Percent
Completed Vesting
C. The account will become 100% vested upon the death, disability, retirement, or attainment of
benefit eligibility by a Participant.
Definition of retirement: Drawing a 42ensio1 from a Villagp retirement f„nri/nlan.
D. 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 B. above.
Vlll. Forfeiture Provisions
Upon separation from the service of the Employer 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:
❑ Remain in the Trust to be reallocated among all Plan Participant's 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 bal-
ances.
9 Revert to the Employer.
In the case of separation from service, the Participant's non - vested funds shall be applied as shown above. In the
case of reversion due to the Participant's death under Section XI, the remaining account assets shall be applied
as shown above.
IX. Eligibility Requirements to Receive Medical Benefit Payments from the VantageCare Retirement Health
Savings Plan
A. A Participant is eligible to receive benefits:
X At retirement only (as defined in Section VII.C.)
At separation from service with the following restrictions
At age only
At retirement and age
At retirement or age _
15
AMENDMENT
B. Termination prior to general benefit eligibility: A Participant who separates from the service of the Employer
prior to attaining benefit eligibility as outlined in Section IX.A. or C. will be eligible to receive benefits:
7 Immediately upon separation from service.
❑ At age
C. A Participant who dies or becomes totally and permanently disabled (as defined by the Social Security
Administration) will become immediately eligible to receive medical benefit payments from his /her VantageCare
Retirement Health Savings Plan account.
X. Permissible Medical Benefit Payments
Benefits eligible for payment consist of:
A. X All Medical Expenses eligible under IRC Section 213 other than direct long -term care
. expenses, OR
B. 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 Supplement Insurance Premiums
COBRA Premiums
Dental Insurance Premiums
Dental Out -of- Pocket Expenses*
Long Term Care Insurance Premiums
Other (Must be eligible under IRC Section 213)*
* See Section V.A. for a discussion of nondiscrimination rules which may apply to non - collectively bargained,
self- insured Plans.
Xi. Death Benefit
In the event of a Participant's death, the following shall apply:
Account Transfer: The surviving spouse and /or surviving eligible dependents (as defined in Section XIII.F.) of the
deceased Participant are immediately eligible to maintain the account and utilize it to fund eligible medical bene-
fits 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 *. The account balance may be reallocated by the surviving spouse or
dependents.
* Please read the current 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 1CMA -RC Services, LLC, a controlled 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 depend-
ents, the balance will be available for medical benefits for the designated beneficiary of the last dependent or
spouse to die. Assets remaining upon the death of a designated beneficiary shall be available for medical bene-
fits of the beneficiary's designated beneficiary. If there is no living beneficiary(ies), the account will revert to the
Plan to be applied as specified in Section VIII.
16
amendment
There will be no elective withholding of federal, state, or local taxes for medical benefit payments to the
Participant's spouse's or dependent's designated beneficiary(ies).
If there are no living spouse or dependents at the time of death of the Participant, the account will be available
for medical benefits for the designated beneficiary(ies) of the Participant. Assets remaining upon the death of all
designated beneficiaries shall be available for medical benefits of the beneficiary's beneficiary. If there is no liv-
ing beneficiary(ies), the account will revert to the Plan to be applied as specified in Section VIII.
There will be no elective withholding of federal, state, or local taxes for medical benefit payments to the
Participant's beneficiary(ies) or any beneficiary's beneficiary.
XII. De Minimis Accounts
Upon separation from the service of the Employer prior to a Participant becoming eligible for medical benefits
from a VantageCare Retirement Health Savings Plan account, Participant accounts that are considered de min -
imis as specified below will be paid to the Participant.
❑ The de minimis account value shall be $5,000 or less.
❑ The de minimis account value shall be $ (insert dollar amount between $0 and
$5,000) or less.
The Plan shall not allow de minimis account distributions.
Mill. 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. Participant status updates and /or changes or personal information updates and /or changes (Participants'
termination dates, Participants' benefit eligibility dates, etc.) will be provided via electronic submission.
B. Participant account administration fees will be paid through the redemption of Participant account shares,
unless agreed upon otherwise in the Administrative Services Agreement.
C. Employer plan fees will be paid by the Employer as outlined in the Administrative Services Agreement.
D. Assignment of benefits is not permitted.
E. Payments to an alternate payee (payee other than a Participant) are not permitted with the exception of reim-
bursement of health insurance premiums to the Employer.
F. An eligible dependent is the Participant's lawful spouse and any other individual who is a person described in
IRC Section 152(a).
G. The Employer will be responsible for withholding, reporting and remitting any applicable taxes, as outlined
in the VantageCare Retirement Health Savings Plan Employer Manual.
XIV. 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.
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Accepted: Vantagepoint Transfer Agents, LLC
Corporate Treasurer
18
AMENDMENT