HomeMy WebLinkAboutres2003-040 with Agenda Bill Number CorrectedWHATCOM COUNTY COUNCIL AGENDA BILL
CLEARANCES
leitia!
Date
Date Received in Council Office
A endo Date
Assigned to:
Originator:
Karen S. Goens_
S/22/03
n „
v
June 3, 2003
Finance/Council —Consent
Agenda
Division Head:
5/22/03
Karen S. Goens
Dept. Head:
5122103
MAY 2 7 2003
—Dewey Desler
Prosecutor05/22/03
Daniell.
Uvtil�TCOM COUNTY
Purchasing/Budget
jT,lJi'COUNCIL_,..Executive:
Pete Kremen
009
SUBJECT. Amendments to Whatcom County VantageCare Retirement Health Savings (RHS) Plan
ATTACHMENTS: Resolution, Declaration of Amendment, Declaration of Revised Trust, and Revised Medical
& Dental Expense Reimbursement Plan
SEPA review required? ( J Yes ( X ) NO Should Clerk schedule a hearing ? ( ) Yes ( X ) NO
SEPA review completed? { ) Yes ( X ) NO Requested Date:
SUMMARY STATEMENT.
' These documents amend the County's existing agreement with the
ICMA Retirement Corporation ("ICMA-RC") originally set-up through
County Ordinance Number 2002-039. The amendments will:
1. Provide the Whatcom County VantageCare Retirement
Health Savings (RHS) Plan to bargaining unit employees
when specified in Whatcom County collective bargaining
agreements. The RHS Plan, as originally adopted, was only
available to Unrepresented Employees,
2. Revise existing non -health distribution features of the RHS
Plan in accordance with guidance ICMA-RC has received
from the Internal Revenue Service. ICMA-RC is requiring all
existing RHS plans to make these revisions.
I
2003 - 210 5/2012003: Pulled by the Administration
6/312003: Approved 7-0 Resolution #2003-040
Related County Contract #: 200106020-2
Related File Numbers:
Distribution Request
Indicate those who should receive a copy after
Council action.
List specific names to the right.
ADS Facilities Xtauageurent
ADS Finance Brad Bennett
ADS Human Resources Karen Goens
ADS Info Services
Auditor
District
Jail
Treasurer
Ordinance o Resolution Number
(this item):,Qf 2�, . n,-, ._n &-)
PROPOSED BY: County Executive
INTRODUCTION DATE: May 20, 2003
RESOLUTION NO. 2003-040
AMENDMENT TO WHATCOM COUNTY VANTAGECARE
RETIREMENT HEALTH SAVINGS (RHS) PLAN
Plan Number 800206
WHEREAS, Whatcom County (the "County") has employees rendering valuable services; and
WHEREAS, Whatcom County has established a retiree health savings plan in the form of the
VantageCare Retirement Health Savings Plan (the "PIan") 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 County has determined that the continuance of the Plan serves the above
objectives.,
NOW, THEREFORE BE IT RESOLVED by the Whatcom County Council that the County hereby
amends and restates the Plan as outlined in the attached Declaration of Amendment to the VantageCare
Retirement Health Savings Plan;
BE IT FURTHER RESOLVED that the assets of the Plan shall be held in trust, with the County serving
as trustee, for the exclusive benefit of Plan participants and their beneficiaries, and the assets of the Plan
shall not be diverted to any other purpose prior to the satisfaction of all liabilities of the Plan. The County
executes the revised Declaration of Trust of the Whatcom County Integral Part Trust in the form of the
model trust made available by the ICMA Retirement Corporation.
APPROVED this. 3rd' day of_ June , 2003
WHATCOM COUNTY COUNCIL
ATTEST: WHATCOM COUNTY, WASHINGTON
7
Dana Brown -Davis; erk of the Council Dan McShane, Council Chair
APPROVED AS TO FORM:
Daniel L. Gibson, Senior Civil Deputy Prosecutor
WHATCOM COUNTY
ADMINISTRATIVE SERVICES
Dewey G. Desler
Director
RECEIVED
MAy 0 9 2003
Pou nr �Rt:c�u E�
MEMORANDUM
HUMAN RESOURCES
County Courthouse
371 Grand Avenue, Suite # ] 07
Bellingham, WA 98225-4038
Phone (360) 676-6802
Fax (360) 7382521
Karen Sterling Goens
Manager
TO: Pete Kremen, County Executive
FROM: Karen Sterling Goens, A.S. Human Resources Manager
mw
RE: Whatcom County VantageCare Retirement Health Savings (RHS) Plan
DATE: May 9, 2003
Enclosed are two (2) originals of the Declaration of Amendment to the Whatcom County
VantageCare Retirement Health Savings (RHS) Plan between ICMA Retirement
Corporation (ICMA-RC) and Whatcom County for your review and signature.
Background and Purpose
The Teamsters have requested the County make available the Retirement Health Savings
Plan for the Master Collective Bargaining Unit members (Article 8.11 MCBA).
The current RHS plan must be amended to allow Teamsters' participation. The amendment
will also enable participation by other bargaining units in the future. Additionally, this plan
amendment revises the non -health distribution features in accordance with guidance ICMA-
RC received from the Internal Revenue Service.
Differences from Previous Contract
1. Eligibility: Bargaining unit employees will be eligible to participate in the RHS.
2. Death Benefit: If there are no living spouse or dependents at the time of the
Participant's death, the account will be available for medical benefits for the
Participant's designated beneficiary or beneficiaries. Assets remaining upon the
death of all designated beneficiaries shall be available for medical benefits of the
beneficiary's beneficiary. If there are no living beneficiaries, the account will revert to
the employer.
Please contact Judy Peterson, Senior Human Resources Representative, at extension
50546, if you have any questions or concerns regarding the details of this agreement.
WHATCOM COUNTY CONTRACT
INFORMATION SHEET
Whatcom County
Contract No.
Originating Department: Administrative Services — Hunian Resources
Contact Person: KarenSterling Goens, A.S. Human Resources
Contractors Name: ICAM Retirement Corporation
Is this a New Contract? If not, is this an Aniendrnent to an Existing Contract?
Yes T No X Yes X No
If an Amendment, previous number(s). 200106020-2
I,s this a renewal?
Yes No X
Contract Amount: (sum of'orig contract amt Ij'a Professional Services Agreement is more than $15, 000 or a Bid is more than
and any prior amendments) $35, 000, please submit an Agenda Bill for Council approval and a supporting
$ memo. Any amendment that provides either a 10% increase in amount or more
This Amendment Amount: than $10, 000, whichever is greater, must also go to Council and will need an
$ agenda bill and supporting memo. If less than these thresholds, just submit to
Total Amended Amount: Drecutive with supporting memo for approval.
Scope of Services Teamsters local 231 has requested that the County make available the
Retirement Health Savings Plan, following the language in 8.11 of the
current Master Bargaining Unit Contract. The current plan must be amended
to allow Teamsters participation in the RHS Plan
Nature of Contract Amt: (Check one) Fixed Amount Not to Exceed X O
Terns pen Ended
of C ontract: on -going Expiration Date: None
Renewal Option Yes No N/A Last Renewal Expires: N/A
Special Dates or clauses that require calendaring:
1. Prepared by:
2. Attorney reviewe :
3. AS -Finance reviewed;
4. Corrections made:
5..4ttorney sign(ff.-
6. Contractor signed:
Submitted to Exec Office
8. Reviewed by DCA
9. Council approved (if'necessaty)
10. Executive signed:
11. Contractor original
Returned to dept;
12. County Original to Council
Date S z.o ,Pi [electronic]
Date 5 [electronic]
Date %electronic]
Date electronic] hard copy printed
Date S 22 0-)
Date
Date fsummciry via electronic; hardeopies]
Date
Date _
Date
Date
Date this form may need to expand to more than one page
DECLARATION OF TRUST OF THE
WHATCOM COUNTY INTEGRAL PART TRUST
Revised - JUNE 3, 2003
DECLARATION OF TRUST OF THE
WHATCOM COUNTY
NAME OF EMPLOYER
INTEGRAL PART TRUST
Declaration ofTrust made as of the 3rd day of June , 20 03 ,
by and between the Whatcom Count
Washington �'a Ottrit�j (; rnm.0nt Name ofEmpioyer State
Type of Entity
(hereinafter referred to as the "Employer") and Whatcom Ci Unty _or its designee (here-
inafter referred to as the "Trustee"), Name ofTnutee
RECITALS
WHEREAS, the Employer is a political subdivision of the State of Wagh;,,gton exempt from federal income tax under the Internal Revenue Code of 1986; and State
WHEREAS, the Employer provides for the security and welfare of its eligible employees
(hereinafter referred to as "Participants"), their Spouses, Dependents and Beneficiaries by the mainte-
nance of one or more post -retirement welfare benefit plans, programs or arrangements which provide
for life, sickness, medical, disability, severance and other similar benefits through insurance and self-finid-
ed reimbursement plans (collectively the. "Plant,); and
WHEREAS, it is an essential fi>nction and integral part of the exempt activities of the
Employer to assist Participants, their Spouses, Dependents and Beneficiaries by making contributions to
and accumulating assets in the trust, a segregated fluid, for post -retirement welfare benefits under the
Plan; and
WHEREAS, the authority to conduct the general operation and administration of the
Plan is vested in the Employer or its designee, who has the authority and shall be subject to the duties
with respect to the trust specified in this Declaration ofTrust; and
WHEREAS, the Employer wishes to establish this trust to hold assets and income, of the
Plan for the exclusive benefit of Plan Participants, their Spouses, Dependents and Beneficiaries;.
NOW,THEREFORE, the parties hereto do hereby establish this trust, by executing the
Declaration ofTrust of the Whatcom County Integral Part Trust
layer
(hereinafter referred to as the "Trust"), and agree tha.tethepfollowing constitute the Declaration ofTrust
(hereinafter referred to as the "Declaration"):
ARTICLE I
Definitions
1.1 Definitions. For the purposes of this Declaration, the following terms shall have the respective
meanings set forth below unless othenvise expressly provided.
(a) "Account" means the individual recordkeeping account maintained under the Plan to record
the interest of a Participant in the Plan in accordance with Section 7.4.
(b) "Administrator" means the Employer or the entity designated by the Employer to carry out
adnunistrative services as are necessary to implement tine Plan.
(c) "Beneficiary" means the Spouse and Dependents, or the person or persons designated by the
Participant pursuant to the terms of the Plan, who will receive any benefits payable hereun-
der in the event of the Participant's death. A Beneficiary may also designate a beneficiary(ies)
to receive any benefits payable hereunder in the event of the preceding Beneficiary's death,
until the satisfaction of all liabilities under the Plan to provide benefits. In the case where
there is no designated Beneficiary, any amount of contributions, plus accrued earnings there-
on, remaining in the Account must, under the terms of the Plan, be returned to the Trust.
(d) "Code" means the Internal Revenue Code of 1986, as amended from time to time.
(e) "Dependent" means an individual who is a person described in Code Section 152(a).
(fl "Investment Fund" rneans any separate investment option or vehicle selected by the Employer
in which all or a portion of the Trust assets may be separately invested as herein provided.
The Trustee shall not be required to select any Investment Fund.
(g) "Nonforfeitable Interest" means the interest of the Participant or the Participant's Spouse,
Dependent or Beneficiary (whichever is applicable) in the percentage of Participants
Employer's contribution which has vested pursuant to the vesting schedule specified in the
Employer's Plan. A Participant shall, at all times, have a one hundred percent (100%)
Nonforfeitable Interest in the Participant's own contributions.
(h) "Spouse" means the Participant's lawfinl spouse as determined under the laws of the state in
which the Participant has his primary place of residence.
(i) "Trust" means the tnnst established by this Declaration.
(j) "Trustee" means the Employer or the person or persons appointed by the Employer to serve
in that capacity.
2
.ARTICLE II
Establishment of Trust
2.1 The'Irust is hereby established as of the date set forth above for the exclusive benefit of
Participants, their Spouses, Dependents and Beneficiaries.
ARTICLE III
Construction
3.1 This Trust and its validity, construction and effect shall be governed by the laws of the State of
Washington
State
3.2 Pronouns and other similar words used herein in the masculine gender shall be read as the feminine
gender where appropriate, and the singular form of words shall be read as the plural where appropriate.
3.3 If any provision of this Trust shall be held illegal or invalid for any reason, such determination shall
not affect the remaining provisions, and such provisions shall be construed to effectuate the purpose of
this Trust.
ARTICLE IV
Benefits
4.1 Benefits. This Trust may provide benefits to the Participant, the Participant's Spouse, Dependents,
and Beneficiary(ies) pursuant to the terms of the Plan.
4.2 Form of Benefits. This Trust may provide benefits by cash payment. This Trust nay reimburse the
Participant, his Spouse, Dependents or Beneficiary(ies) for insurance premiums or other payments
expended for permissible benefits described under the Plan. This trust may reimburse the Employer, or
the Administrator for insurance preiniutns.
ARTICLE V
General Duties
5.1 It shall be the duty of the Trustee to hold title to assets held in respect of the Plan in the Trustee's
name as directed by the Employer or its designees in writing. The Trustee shall not be raider any duty
to compute the amount of contributions to be paid by the Employer or to take any steps to collect such
amounts as may be due to be held in trust under the Plan. The Trustee shall not be responsible for the
custody, investment, safekeeping or disposition of any assets comprising the Trust, to the extent such
functions are performed by the Employer or the Administrator, or both.
5.2 It shall be the duty of the Employer, subject to the provisions of the Plan, to pay over to the
Administrator or other person designated hereunder from time to time the Employer's contributions and
Participants' contributions under the Plan and to inform the Trustee in writing as to the identity and
value of the assets titled in the Trustee's naive hereunder and to keep accurate books and records with
respect to the Participants of the Plan.
3
ARTICLE VI
Investments
6. 1 Tile Employer may appoint one or more investment managers to manage and control all or part of
the assets of the Trust and the Employer shall notify the Trustee it, writing of any such appointment.
6.2 The Trustee shall not have any discretion or authority with regard to the irrvestmerit of the Trust and
shall act solely as a directed Trustee of the assets of which it holds title. To the extent directed by the
Employer (or Participants, their Spouses and Dependents, or Beneficiaries to the extent provided herein)
the Trustee is authorized and empowered with the following powers, rights and duties, each of which
the Trustee shall exercise in a nondiscretionary manner:
(a) To cause stocks, bonds, securities, or other investments to be registered in its name as Trustee or
in the name of a nominee, or to take and keep the saute unregistered;
(b) To employ such agents and legal counsel as it deems advisable or proper in connection with its
duties and to pay such agents and legal counsel a reasonable fee. The Trustee shall not be liable
for the acts of such agents and counsel or for the acts done in good faith and in reliance upon
the advice of such agents and legal counsel, provided it has used reasonable care in selecting such
agents and legal counsel;
(c) To exercise where applicable and appropriate any rights of ownership in any contracts of insur-
ance in which any part of the Trust may be invested and to pay the premiums thereon; and
(d) At the direction of the Employer (or Participants, their Spouses, their Dependents, their
Beneficiaries, or the investment manager, as the case may be) to sell, write options on, convey or
transfer, invest and reinvest any part thereof in each and every kind of property, whether real, per-
sonal or mixed, tangible or intangible, whether income or non -income producing and wherever
situated, including but not linuted to, time deposits (including time deposits in the Trustee or its
affiliates, or any successor thereto, if the deposits bear a reasonable rate of interest), shares of com-
mon and preferred stock, mortgages, bonds, leases, notes, debentures, equipment or collateral trust
certificates, rights, warrants, convertible or exchangeable securities and other corporate, individual
or government securities or obligations, annuity, retirement or other insurance contracts, mutual
funds (including funds for which the Trustee or its affiliates serve as investment advisor, custodian
or in a similar or related capacity), or in units of any other common, collective or corrmungled
trust fund.
6.3 Notwithstanding anything to the contrary herein, the assets of the Plan shall be field by the Trustee
as title holder only. Persons holding custody or possession of assets titled to the Trust shall include the
Employer, the Administrator, the investment manager, and any agents and subagents, but not the Trustee.
The Trustee shall not be responsible or liable for any loss or expense which may arise from or result
from compliance with any direction from the Employer, the Administrator, the investment manager, or
such agents to take title to any assets nor shall the Trustee be responsible or liable for any loss or expense
which may result from the Trustee's refusal or failure to comply with any direction to hold title, except if
the same shall involve or result from the Trustees negligence or intentional misconduct. The Trustee
may refiise to comply with any direction from the Employer, the Administrator, the investment manager,
or such agents in the event that the Trustee, in its sole and absolute discretion, deems such direction ille-
gal.
6.4 The Employer hereby indemnifies and holds the Trustee harmless from any and all actions, claims,
demands, liabilities, losses, damages or reasonable expenses of whatsoever kind and nature in connection
with or arising out of (i) any action taken or omitted in good faith by the Trustee in accordance with
the directions of the Employer or its agents and subagents hereunder, or (h) any disbursements of any
part of the Trust made by the Trustee in accordance with the directions of the Employer, or (' ") any
action taken by or orrutted in good faith by the Trustee with respect to an investment managed by an
investment manager in accordance with any direction of the investment manager or any inaction with
respect to any such investment in the absence of directions from the investment manager.
Notwithstanding anything to the contrary herein, the Employer shall have no responsibility to the
Trustee under the foregoing indemnification if the Trustee fails negligently, intentionally or recklessly to
perform any of the duties undertaken by it under the provisions of this Trust.
6.5 Notwithstanding anything to the contrary herein, the Employer or, if so designated by the
Employer, the Administrator and the investment manager or another agent of the Employer, will be
responsible for valuing all assets so acquired for all purposes of the Trust and of holding, investing, trading
and disposing of the same. The Employer will indemnify and hold the Trustee harmless against any and
all claims, actions, demands, liabilities, losses, damages, or expenses of whatsoever kind and nature, which
arise from or are related to any use of such valuation by the Trustee or holding, trading, or disposition of
such assets.
6.6 The Trustee shall and hereby does indemnify and hold harmless the Employer frorrr any and all
actions, claims, demands, liabilities, Iosses, damages and reasonable expenses of whatsoever kind and
nature in connection with or arising out of (a) the Trustee's failure to follow the directions of the
Employer, the Administrator, the investment manager, or agents thereof, except as permitted by the last
sentence of Section 6.3 above; (b) any disbursements made without the direction of the Employer, the
Administrator, the investment manager or agents thereof; and (c) the Trustee's negligence, willful nuscon-
duct, or recklessness with respect to the Trustee's duties under this Declaration.
ARTICLE VII
Contributions
7.1 Employer Contributions. The Employer shall contribute to the Trust such amounts as specified
in the Plan or by resolution,
7.2 Participant Contributions. If specified in the Plan, each Participant may make voluntary after-
tax contributions. Under no circumstances shall Participant Contributions exceed an insubstantial
amount. These contributions shall be collected by the Employer and remitted to the Trust for deposit at
such time or times as required under the terms of the Plan.
7.3 Accrued Leave. Contributions up to an amount equal to the value of accrued sick leave, vacation
leave, or other type of accrued leave, as permitted under the Plan. The Employer's Plan must provide a
formula for determining the value of the Participant's contribution of accrued leave . The Employer's
Plan roust contain a forfeiture provision that will prevent Participants from receiving the accrued leave in
cash in lieu of a contribution to the Trust.
7.4 Accounts. Employer contributions, Participant contributions, and contributions of accrued leave ,
all investment income and realized and unrealized gains and losses, and forfeitures allocable thereto will
be deposited into an Account in the name of the Participant for the exclusive benefit of the Participant,
his Spouse, Dependents and Beneficiaries. The assets in each Participant's Account may be invested in
Investment Funds as directed by the Participant (or, after the Participant's death, by the Spouse,
Dependents or Beneficiaries) from among the Investment Funds selected by the Employer.
7.5 Receipt of Contributions. The Employer or, if so designated by the Employer, the Administrator
or investment manager or another agent of the Employer, shall receive all contributions paid or delivered
to it hereunder and shall hold, invest, reinvest and administer such contributions pursuant to this
Declaration, without distinction between principal and income, The Trustee shall not be responsible for
the calculation or collection of any contribution under the Plan, but shall hold title to property received
in respect of the Plan in the Trustee's name as directed by the Employer or its designee pursuant to this
Declaration.
7.6 No amount it, any Account maintained under this Trust shall be subject to transfer, assignment, or
alienation, whether voluntary or involuntary, in favor of any creditor, transferee, or assignee of the
Employer, the Trustee, any Participant, his Spouse, Dependent, or Beneficiaries.
7.7 Upon the satisfaction of all liabilities under the Plan to provide such benefits, any amount of
Employer contributions, plus accrued earnings thereon, remaining in such separate Accounts must, under
the terms of the Plan, be returned to the Employer.
ARTICLE VIII
Other Plans
If the Employer hereafter adopts one or more other plans providing life, sickness, accident, medical, dis-
ability, severance, or other benefits and designates the Trust hereby created as part of such other plan, the
Employer or, if so designated by the Employer, the Administrator or an investment manager or another
agent of the Employer shall, subject to the terms of this Declaration, accept and hold hereunder contri-
butions to such other plans. In that event (a) the Employer or, if so designated by the Employer, the
Adnnistrator or an investment manager or another agent of the Employer, may commingle for invest-
ment purposes the contributions received under such other plan or plans with the contributions previ-
ously received by the Trust, but the books and records of the Employer or, if so designated by the
Employer, the Administrator or an investment manager or another agent of the Employer, shall at all
times show the portion of the Trust Fund allocable to each plan; (b) the term "Plan" as used herein shall
be deemed to refer separately to each other plan; and (c) the term "Employer" as used herein shall be
deemed to refer to the person or group of persons which have been designated by the terms of such
other plans as having the authority to control and manage the operation and administration of such
other plan.
ARTICLE IX
Disbursements and Expenses
9.1 The Employer or its designee shall make such payments from the Trust at such time to such persons
and in such amounts as shall be authorized by the provisions of the Plan provided, however, that no pay-
ment shall be made, either during the existence of or upon the discontinuance of the Plan (subject to
Section 7.7), which would cause any part of the Trust to be used for or diverted to purposes other than
the exclusive benefit of the Participants, their Spouses and Dependents, and Beneficiaries pursuant to the
provisions of the Plan.
9.2 All payments of benefits under the Plan shall be made exclusively from the assets of the Accounts of
the Participants to whom or to whose Spouse, Dependents, or Beneficiaries such payments are to be
made, and no person shall be entitled to look to any other source for such payments.
9.3 The Employer, Trustee and Administrator may be reimbursed for expenses reasonably incurred by
them in the administration of the Trust. All such expenses, including, without limitation, reasonable tees
of accountants and legal counsel to the extent not otherwise reimbursed, shall constitute a charge against
and shall be paid from the Trust upon the direction of the Employer.
ARTICLE X
Accounting
10.1 The Trustee shall not be required to keep accounts of the investments, receipts, disbursements, and
other transactions of the Trust, except as necessary to perform its title -holding firrrction hereunder. All
accounts, books, and records relating thereto shall be maintained by the Employer or its designee.
10.2 As promptly as possible following the close of each year, the Trustee shall file with the Employer a
written account setting forth assets titled to the Trust as reported to the Trustee by the Employer or its
designee.
ARTICLE XI
Miscellaneous Provisions
11.1 Neither the Trustee nor any affiliate thereof shall be required to give any bond or to qualify before,
be appointed by, or account to any court of law in the exercise of its powers hereunder.
11.2 No person transferring title or receiving a transfer of title from the Trustee shall be obligated to
look to the propriety of the acts of the Trustee in connection therewith.
11.3 The Employer may engage the Trustee as its agent in the performance of any duties required of the
Employer under the Plan, but such agency shall not be deemed to increase the responsibility or liability
of the Trustee under this Declaration.
11.4 The Employer shall have the right at all reasonable times during the term of this Declaration and
for three (3) years after the termination of this Declaration to examine, audit, inspect, review, extract
information from, and copy all books, records, accounts, and other documents of the Trustee relating to
this Declaration and the Trustees' performance hereunder.
ARTICLE X1I
Amendment and Termination
12.1 The Employer reserves the right to alter, amend, or (subject to Section 9.1) terminate this
Declaration at any time for any reason without the consent of the Trustee or any other person, provided
that no amendment affecting the rights, duties, or responsibilities of the Trustee shall be adopted without
the execution of the Trustee to the amendment. Any such amendment shall become effective as of the
date provided in the amendment, if requiring the Trustee's execution, or on delivery of the amendment
to the Trustee, if the Trustee's execution is not required.
12.2 Upon termination of this Declaration arid upon the satisfaction of all liabilities under the Plan to
Provide such benefits, any amount of Employer contributions, plus accrued earnings thereon, remaining
in such separate Accounts must, under the terms of the Plan, be returned to the Employer.
ARTICLE XIII
Successor Trustees
13.1 The Employer reserves the right to discharge the Trustee for any or no reason, at any time by giv-
ing ninety (90) days' advance written notice.
13.2 The Trustee reserves the right to resign at any time by giving ninety (90) days' advance written
notice to the Employer.
13.3 In the event of discharge or resignation of the Trustee, the Employer may appoint a successor
Trustee who shall succeed to all rights, duties, and responsibilities of the former Trustee under this
Declaration, and the terminated Trustee shall be deemed discharged of all duties under this Declaration
and responsibilities for the Trust.
ARTICLE XIV
Limited Effect of Plan and Trust
Neither the establishment of the Plan and the Trust or any modification thereof, the creation of any fiend
or account, nor the payment of any benefits, shall be construed as giving to any person covered under
the Plan or other person any legal or equitable right against the Trustee, the Adnnistrator, the Employer
or any officer or employee thereof, except as may otherwise be expressly provided in the Plan or in this
Declaration.
ARTICLE XV
Protective Clause
Neither the Administrator, the Employer, nor the Trustee shall be responsible for the validity of any con-
tract of insurance or other arrangement maintained in connection with the Plan, or for the failure on
the part of the insurer or provider to make payments provided by such contract, or for the action of any
person which may delay payment or render a contract void or unenforceable in whole or in part,
IN WITNESS WHEREOF, the Employer and the Trustee have executed this Declaration by their
respective duly authorized officers, as of the date first hereinabove mentioned.
EMPLOYER:
By:
Pete Kremen
TRUSTEES:
By:
By:
By:
APPROVED AS TO FORM:
4DanlJL-GQiN s o �nSenior CivilDeputy
aDD3
Date -
9
Title: Whatcom County Executive
Title:
Ti
T
ecutor
WHATCOM COUNTY
RETIREE MEDICAL AND DENTAL EXPENSE
REIMBURSEMENT PLAN
Revised - JUNE 3, 2003
RETIREE MEDICAL AND DENTAL EXPENSE REIMBURSEMENT PLAN
Article I Preamble
1.01 Establishment of Plan
1.02 Purpose of Plan
Article II Definitions
2.01 "Beneficiary
2.02."Benefits"
2.03 "Code"
2.04 "Dependent"
2.05 "Eligible Medical or Dental Expenses"
2.06 "Employer"
2.07 "Entry Date"
2.08 "Participant"
2.09 "Plan Administrator"
2.10 "Plan Year"
2.11 "Retiree"
2.12 "Spouse"
Article III Eligibility
3.01 General Requirements
Article IV Amount of Benefits
4.01 Annual Benefits Provided by the Plan
4.02 Cost of Coverage
Article V Payment of Benefits
5.01 Eligibility for Benefits
5.02 Claims for Benefits
Article VI Plan Administration
6.01 Allocation of Authority
6.02 Provision for Third -Party Plan Service Providers
6.03 Several Fiduciary Liability
6.04 Compensation of Plan Administrator
6.05 Bonding
6.06 Payment of Administrative Expenses
6.07 Timeliness of Payments
6.08 Annual Statements
Article VI Claims Procedure
7.01 Procedure if Benefits are Denied Under the Plan
7.02 Requirement for Written Notice of Claim Denial
i
7.03 Right to Request Hearing on Benefit Denial
7.04 Disposition of Disputed Claims
7.05 Preservation of Other Remedies
Article VIII Amendment or Termination of Plan
8.01 Permanency
8.02 Employer's Right to Arriend
8.03 Employer's Right to Terminate
Article IX General Provisions
9.01 No Employment Rights Conferred
9.02 Payments to Beneficiary
9.03 Nonalienation of Benefits
9.04 Mental or Physical Incompetency
9.05 Inability to Locate Payee
9.06 Requirement of Proper Forms
9.07 Source of Payments
9.08 Tax Effects
9.09 Multiple Functions
9.10 Gender and Nurnber
9.11 Headings
9.12 Applicable Laws
9.13 Severability
2
ARTICLE I
Preamble
THIS INSTRUMENT made and published by Whatcom County
inafter called "Employer") oil the 3rdday of June (here-
Whateom , 20 03 , creates the
Retiree Medical and Dental Expense Reimbursement Plan, as follows:
1.01 Establishment of Plan
The Employer r»med above hereby establishes a Retiree Medical and Dental Expense Reimbursement
Plan as of the 3rd day of June 2003
,
1.02 Purpose of Plan
This Plan has been established to reimburse the eligible Retirees of the Employer for medical and dental
expenses incurred by them, their Spouses, Dependents, and Beneficiaries pursuant to the Employer's
VantageCare Retirement Health Savings (RHS) Plan.
ARTICLE II
Definitions
The following words and phrases as used herein shall have the following meanings, unless a different
meaning is plainly required by the context:
2.01 "Beneficiary" means the person or persons designated pursuant to the terns of the Plan, who will
receive any Benefits payable hereunder in the event of the Participant's death. A Beneficiary may also
designate a beneciary(ies) to receive any benefits payable hereunder in the event of the preceeding
Beneficiary's death until the satisfaction of all liabilities under the plan to provide benefits.
2.02 "Benefits" means any amounts paid to a Participant or Beneficiary in the Plan as reimbursement for
Eligible Medical and Dental Expenses incurred by the Participant or Beneficiary during a Plan Year by
him, his Spouse, his Dependents, or his Beneficiary.
2.03 "Code" means the Internal Revenue Code of 1986, as amended.
2.04 "Dependent" means any individual who is a dependent of the Participant within the meaning of
Code Sec. 152.
2.05 "Eligible Medical or Dental Expenses" means those expenses designated by the Employer as eligible
for reimbursement in the VantageCare Retirement Health Savings Plan Adoption Agreement.
2.06 "Employer" means the unit of state or local goverment creating this Plan, or any affiliate or succes-
sor thereof that likewise adopts this Plan.
2.07 "Entry Date" means the first day the Participant meets the eligibility requirements of Article III as
of such Date.
2.08 "Participant" means any Retiree who has filet the eligibility requirements set forth in Article III.
2.09 "Plan Administrator" means the Employer or other person appointed by the Employer who has the
authority and responsibility to manage and direct the operation and administration of the Plan.
2.10 "Plan Year" means the annual accounting period of the Plan, which begins on the 3rd day of
June , 20 03 , and ends on the _ 31 day of December 20 03
to the first Plan Year, and thereafter as long as this Plan remains in effect, the period that begins�tori expect
January 1 , and ends oil December 31
2.11 "Retiree" means any individual who, while in the service of the Employer, was considered to be in
a legal employer -employee relationship with the Employer for federal withholding tax purposes, and
who was part of the classification of employees designated as covered by the Employer's VantageCare
Retirement Health Savings Plan.
2.12 "Spouse" means the Participant's lawful spouse as deternuned under the laws of the state in which
the Participant has his primary place of residence.
All other defined terms in this Plan shall have the meanings specified in the various Articles of the Plan
in which they appear.
ARTICLE III
Eligibility
General Requirements
Each Retiree who meets the eligibility requirements outlined in the Employer's VantageCare Retirement
Health Savings Plan shall be eligible to participate in this Plan.
ARTICLE IV
Amount of Benefits
4.01 Annual Benefits Provided by the Plan
Each Participant shall be entitled to reimbursement for his documented, Eligible Medical or Dental
Expenses incurred during the Plan Year in an annual amount not to exceed the account balance of the
Participant in the Employer's VantageCare Retirement Health Savings Plan.
4.02 Cost of Coverage
The expense of providing the benefits set out if-' Section 4.01 shall be contributed as outlined in the
Employer's VantageCare Retirement Health Savings Plan.
ARTICLE V
Payment of Benefits
5.01 Eligibility for Benefits
(a) Each Participant in the Plan shall be entitled to a benefit hereunder for all Eligible Medical aac1
Dental Expenses incurred by the Participant on or after the Entry Date of his or her participation, (akd
after the effective date of the Plan) subject to the limitations contained in this Article V, regardless
whether the mental or physical condition for which the Participant makes application for benefits under
this Plan was detected, diagnosed, or treated before the Participant became covered by the Plan.
(b) In order to be eligible for benefits, the Participant must meet the benefit eligibility criteria out-
lined in the Employer's VantageCare Retirement Health Savings Plan Adoption Agreement.
(c) A Participant who becomes totally and permanently disabled (as defined by the Social Security
Administration) will become immediately eligible to receive medical benefit payments from the Plan.
Pursuant to Section 9.02 and Employer's VantageCare Retirement Health Savings Plan Adoption
Agreement, the surviving Spouse and Dependents, or Beneficiary(ies) shall become immediately eligible
to receive or to continue receiving medical benefit payments from the Plan upon the death of the
Participant.
(or as defined by a Whatcom County long-term disability
5.02 Claims for Benefits (Plan covering the participant
No benefit shall be paid hereunder unless a Participant, his Spouse,Dependent or Beneficiary has first
submitted a written claim for benefits to the Plan Administrator on a form specified by the Plan
Administrator, and pursuant to the procedures set out in Article Vl, below. Upon receipt of a properly
documented claim, the Plan Administrator shall pay the Participant, his Spouse, Dependent or
Beneficiary the benefits provided under this Plan as soon as is adnucustratively feasible.
ARTICLE VI
Plan Administration
6.01 Allocation of Authority
The Employer shall control and manage the operation and Administration of the Plan. The Employer
shall have the exclusive right to interpret the Plan and to decide all matters arising thereunder, including
the right to remedy possible ambiguities, inconsistencies, or omissions. All determinations of the
Employer with respect to any matter hereunder shall be conclusive and binding on all persons.
Without limiting the generality of the foregoing, the Employer shall have the following powers and
duties:
(a) To decide on questions concerning the Plan and the eligibility of any Employee to participate in
the Plan, in accordance with the provisions of the Plan;
(b) To deter.rlune the amount of benefits that shall be payable to any person in accordance with the
provisions of the Plan; to inform the Plan Administrator, as appropriate, of the amount of such Benefits;
and to provide a full and fair review to any Participant whose claim for benefits has been denied in
whole or in part; and
(c) To designate other persons to carry out any duty or power which would otherwise be a fiduciary
responsibility of the Plan Administrator, under the terms of the Plan.
A To require any person to furnish such reasonable information as it may request for the purpose
of the proper administration of the Plan as a condition to receiving any benefits under the Plan;
(e) To make and enforce such rules and regulations and prescribe the use of such forms as he. shall
deem necessary for the efficient administration of the Plan.
6.02 Provision for Third -Party Plan Service Providers
The Plan Adrilinistrator, subject to approval of the Employer, may employ the services of such persons as
it may deem necessary or desirable in corurection with operation of the Plan. The Plan Administrator,
the Employer (and any person to whom it may delegate any duty or power in connection with the
administration of the Plan), and all persons connected therewith may rely upon all tables, valuations, cer-
tificates, reports and opinions furnished by any duly appointed actuary, accountant, (including Employees
who are actuaries or accountants), consultant, third party administration service provider, legal counsel,
or other specialist, and they shall be fully protected in respect to any action taken or permitted in good
faith in reliance thereon. All actions so taken or permitted shall be conclusive and binding as to all per-
SOIls.
6.03 Several Fiduciary Liability
To the extent permitted by law, neither the Plan Administrator nor any other person shall incur any lia-
bility for any acts or for failure to act except for his own willful misconduct or willful breach of this
Plan.
6.04 Compensation of Plan Administrator
Unless otherwise agreed to by the Employer, the Plan Administrator shall serve without compensation
for services rendered in such capacity, but all reasonable expenses incurred in the performance of Ilis
duties shall be paid by the Employer.
6.05 Bonding
Unless otherwise determined by the Employer, or unless required by any Federal or State law, the Plan
Administrator shall not be required to give any bond or other security in any jurisdiction in connection
u ith the administration of this Plan.
M
6.06 Payment of Administrative Expenses
All reasonable expenses incurred in administering the PIan, including but not limited to adininistr;
fees and expenses owing to any third party administrative service provider, actuary, consultant, accc
ant, attorney, specialist, or other person or organization that inay be employed by the Plan Admini:
in comiection with the administration thereof, shall be paid by the Employer, provided, however d
each Participant shall bear the monthly cost (if any) charged by a third party administrator for nnai,
nance of his Benefit Account unless otherwise paid by the Employer.
6.07 Timeliness of Payment for Benefits
Payment for Benefits shall be made as soon as administratively feasible after the required forms and
utnentation have been received by the Plan Administrator.
6.08 Annual Statements
The Plan Administrator shall furnish each Participant with an annual statement of his medical and dental
expense reimbursement account within ninety (90) days after the close of each Plan Year.
ARTICLE VII
Claims Procedure
7.01 Procedure if Benefits are Denied Under the Plan
Any Participant, Spouse, Dependent, or Beneficiary, or his duly authorized representative may file a claim
for a plan benefit to which the claimant believes that he is entitled. Such a claim must be in writing on a
form provided by the Plan Administrator and delivered to the Plan Administrator, in person or by mail,
postage paid. Within thirty (30) days after receipt of such claim, the Plan Administrator shall send to the
claimant, by mail, postage prepaid, notice of the granting or denying, in whole or in part, of such claim,
unless special circumstances require an extension of time for processing the claim. In no event may the
extension exceed ninety (90) days from the end of the initial period. If such extension is necessary, the
claimant will be given a written notice to this effect prior to the expiration of the initial 30-day period.
The Plan Administrator shall have full discretion to deny or grant a claim in whole or in part. If notice
of the denial of a claim is not furnished in accordance with this Section, the claim shall be deemed
denied and the claimant shall be permitted to exercise his right to review pursuant to Sections 7.03 and
7.04.
7.02 Requirement for Written Notice of Claim Denial
The Plan Administrator shall provide, to every claimant who is denied a claim for benefits, written
notice setting forth in a manner calculated to be understood by the claimant:
(a) The specific reason or reasons for the denial;
(b) Specific reference to pertinent Plana provisions on which the denial is based;
(c) A description of any additional material of information necessary for the claimant to perfect the
claim and an explanation of why such material is necessary, and
(d) An explanation of the Plan's claim review procedure.
7.03 Right to Request Hearing on Benefit Denial
Within sixty (60) days after the receipt by the claimant of written notification of the denial (in whole or
in part) of his claim, the claimant or his duly authorized representative, upon written application to the
Plan Administrator, in person or by certified mail, postage prepaid, may request a review of such denial,
may review pertinent documents, and may submit issues and continents in writing.
7.04 Disposition of Disputed Claims
Upon its receipt of notice of a request for review, the Plan Administrator shall make a prompt decision
on the review, The decision on review shall be written in a manner calculated to be understood by the
claimant and shall include specific reasons for the decision and specific references to the pertinent plan
provisions on which the decision is based.The decision on review shall be made not later than sixty (60)
days after the Plan Administrator's receipt of a request for a review, unless special circumstances require
an extension of time for processing, in which case a decision shall be rendered not later than one hun-
dred -twenty (120) days after receipt of a request for review. If an extension is necessary, the claimant shall
be given written notice of the extension prior to the expiration of the initial sixty (60) day period. If
notice of the decision on the review is not furnished in accordance with this Section, the claim shall be
deemed denied and the claimant shall be permitted to exercise his right to legal remedy pursuant to
Section 7.05.
7.05 Preservation of Other Remedies
After exhaustion of the claims procedures provided under this Plan, nothing shall prevent any person
from pursuing any other legal or equitable remedy otherwise available.
ARTICLE V1II
Amendment or Termination of Plan
8.01 Permanency
While the Employer fully expects that this Plan will continue indefinitely, due to unforeseen, future
business contingencies, permanency of the Plan will be subject to the Employer's right to amend or ter-
minate the Plan, as provided in Sections 8.02 and 8.03, below.
8.02 Employer's Right to Amend
The Employer reserves the right to amend the Plan at any time and from time -to -time, and retroactively
if deemed necessary or appropriate to meet the requirements of the Code, or any similar provisions of
subsequent revenue or other laws, or the rules and regulations in effect under any of such laws or to
conform with governmental regulations or other policies, to modify or amend in whole or in part any
or all of the provisions of the Plan.
M
8.03 Employer's Right to Terminate
The Employer reserves the right to discontinue or terminate the Plan at any time without prejudice,
ARTICLE IX
General Provisions
9.01 No Employment Rights Conferred
Neither this Plan nor any action taken with respect to it shall confer upon any person the right to
continued in the employment of the Employer.
9.02 Payments After Death of Participant
Any benefits otherwise payable to a Participant following the date of death of such Participant shall be
paid as outlined in the Employer's VantageCare Retirement Health Savings Plan Adoption Agreement.
9.03 Nonalienation of Benefits
No benefit under the Plan shall be subject in any manner to anticipation, alienation, sale, transfer, assign-
ment, pledge, encumbrance or charge, and any attempt to do so shall be void. No benefit under the Plan
shall in any nnanner be liable for or subject to the debts, contracts, liabilities, engagements or torts of any
person. If any person entitled to benefits under the Plan becomes bankrupt or attempts to anticipate,
alienate, sell, transfer, assign, pledge, encumber or charge any benefit under the Plan, or if any attempt is
made to subject any such benefit to the debts, contracts, liabilities, engagements or torts of the person
entitled to any such benefit, except as specifically provided in the Plan, then such benefit shall cease and
terminate in the discretion of the Plan Administrator, and he may hold or apply the same or any part
thereof to the benefit of any dependent or beneficiary of such person, in such manner and proportion as
he may deem proper.
9.04 Mental or Physical Incompetency
If the Plan Administrator determines that any person entitled to payments under the Plan is incompetent
by reason of physical or mental disability, he may cause all payments thereafter becoming due to such
person to be made to any other person for his benefit, without responsibility to follow the application of
amounts so paid. Payments made pursuant to this Section shall completely discharge the Plan
Administrator and the Employer.
9.05 Inability to Locate Payee
If the Plan Administrator is unable to make payment to any Participant or other person to whonn a pay -
cause he cannot ascertain the identity or whereabouts of such Participant
ment is due under the Plan be
or other person after reasonable efforts have been made to identify or locate such person (includirng a
notice of the payment so due mailed to the last known address of such Participant or other person as
shown on the records of the Employer), such payment and all subsequent payments otherwise due to
such Participant or other person shall be escheated under the Iaws of the State of the last known address
of the Participant or other persons eligible for benefits.
9.06 Requirement of Proper Forms
All communications in connection with the Plan made by a Participant shall become effective only
when duly executed on forms provided by and filed with the Plan Admnistrator.
9.07 Source of Payments
The Employer shall be the sole source of benefits under the Plan. No Employee or Beneficiary shall
have any right to, or interest in, any assets of the Employer upon termination of employment or other-
wise, except as provided from time to time under the Plan, and then only to the extent of the benefits
payable under the Plan to such Employee or Beneficiary.
9.08 Tax Effects
Neither the Employer nor the Plan Administrator makes any warranty or other representation as to
whether any payments received by a Participant, his Spouse, Dependents, or Beneficiary(ies) hereunder
will be treated as includible in gross income for federal or state income tax purposes.
9.09 Multiple Functions
Any person or group of persons may serve in more than one fiduciary capacity with respect to the Plan.
9.10 Gender and Number
Masculine pronouns include the feniiniiic as well as the neuter gender, and the singular shall include the
plural, unless indicated otherwise by the context.
9.11 Headings
The Article and Section headings contained herein are for convenience of reference only, and shall not
be construed as defining or linuting the matter contained thereunder.
9.12 Applicable Laws
The provisions of the Plan shall be construed, administered and enforced according to the laws of the
State of Washington
9.13 Severability
Should any part of this Plan subsequently be invalidated by a court of competent jurisdiction, the
remainder thereof shall be given effect to the maximum extent possible.
10
IN WITNESS WHEREOF, we have executed this Plan Agreement the date and year first written ab(
Whatcom County
(Employer)
By:
ATTEST
Secretary
Approved as to Form:
Daniel L. Gibson, Senior Civil Deputy
Date f
osecutor
11
DECLARATION OF AMENDMENT TO THE
WHATCOM COUNTY VANTAGECARE RETIREMENT HEALTH
SAVINGS (RHS) PLAN
JUNE 3, 2003
DECLARATION OF AMENDMENT TO THE VANTRAGECARE RETIREMENT
HEALTH SAVINGS SAVINGS PLAN
Plan Number: 800206
Name of Employer: Whatcom County State: Washington
The Employer is amending its VantageCare Retirement Health Savings Plan (RHS) to
incorporate the provisions selected below. Section numbers refer to the appropriate
section of the VantageCare RHS Adoption Agreement.
Effective Date: June 3, 2003
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:
Resolution 2002-029 (and subsequent amendments) and collective bargaining_
agreements.
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:
Unrepresented employees and bargaining unit employees when specified
in collective bargaining agreements
i
DECLARATION OF AMENDMENT TO THE VANTAGECARE RETIREMENT ;
HEALTH SAVINGS PLAN
Plan Number: 8_Q Q �0 6
Name of Employer: Whatcom Count
State: Washington
The Employer is amending its VantageCare Retirement Health Savings (RHS) Plan to incorporate the
Provisions selected below. Section numbers refer to the appropriate section of the VantageCare RHS
Adoption Agreement.
add the new partkipation and/or contribution features to your RHS planet es• Complete Part I you wish to
Effective Date: June 3, 2003
(insert effective date of amendment).
V. Eligible Groups and Participant Eligibility Requirements
Use this section to allow your employees to choose to participate in th select this option, participation wine RHS program, If you do not
continue to be mandatory for the employee group(s) named in your
original RHS Adoption Agreement. If you choose this option, employees that do not opt to participate
in RHS will not receive mandatory contributions or be allowed to choose to make elective employee
contributions (see Section VI).
Irrevocable Election to Participate
13 If this box is checked, in lieu of mandatory participation, the Employer provides for a one-
time
irrevocable 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
of he RHS Adoption Agreement, to section VI
Newly eligible Employees shall be provided an election window of 30 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
election window, month following the end of the
If the Employee does not make the election in the year of initial eligibility, the election to partici-
pate may be made in a later year. An annual election window of 60
-days (no more
than 60 calendar days) shall be provided during which the election may be made. The election win-
do,x shall run. from Oct. 1 _ to Nov. 29 (insert your ual time
for the
do,..i; e.g. October 1 to November 29). Participation may begin nno earlier f frame
he calendar e win -
lowing the year of the election. year fol-
lowing
made, he election is irrevocable and may not be revoked while the participant is a member of
the group covered by the RHS plan.
Plan Nuiitber: 8 0 0 2 0 6
Existing RHS participants
If you have chosen to allow your employees to elect to participate in RHS, you trust choose one option
below with respect to existing participants.
Existing RHS Participants shall be allowed to revoke their participation in the Plan on a one-time
irrevocable basis. Participants shall be provided a 60 calendar day window from the effective date of
the plan amendment to revoke participation. Revocation shall be made on a form provided by the
ICMA Retirement Corporation and returned to the Employer. Once participation is revoked, the
Participant may not elect to participate in the Plan at any later time. Account assets of Participants
that revoke participation shall remain in the Trust to be distributed under the terms of the Plan as
outlined in the Employer's VantageCare RHS Adoption Agreement.
Existing RHS Participants shall not be allowed to revoke their participation in the Plan.
By adopting the elective participation option, the Employer acknowledges that the Internal Revenue
Service has not ruled on an irrevocable election to participate in an integral part trust. IC1\4A-RC has
obtained the advice of counsel that such an election is allowable under die, conditions outlined in this
Adoption Agreement. The Employer should discuss this issue with appropriate counsel.
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 in
taxa-
tion on the benefits received 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.
VI. Contribution Sources and Amounts
Use. sections A and/or B to define your contribution formula(i) for your RHS plan. Section C defines
your overall plan contribution maximum (if any). Check the boxes that apply, and complete your fund-
ing formula(s).
A. Mandatory Contributions
l . Direct Employer Contributions: The Employer shall contribute on behalf of each Participant
% of earnings or $ _0_ for the P1artYear.
Definition of earnings: Base Sala
Plan Number: 8 0 0 2 0 b
13 2. Mandatory Leave Contributions: The Employer will make mandatory contributions of leave
as follows:
Accrued Sick Leave* 0 Yes 0 No
Accrued Vacation* 17 Yes 3 No
Other (describe)* Yes
171 No
* Please provide the formula for determining the accrued leave contribution:
See attachment
Ali Employee shall not have the right to discontinue or vary the rate of mandatory leave contribu-
tions.
3. Mandatory Employee Compensation Contributions: The Employer will make mandato
contributions of Ernployee compensation as follows: N/A ry
Reduction in Salary — N/A ^/o of earnings (as defined in VI.A.1.) or
be contributed for the Plan Year. _ -" will
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.
B. Elective Contributions: If you wish to provide for elective contributions, complete sections 1
and/or 2 as appropriate.
1. The Employer will permit each Employee to make the following elections to make pre-tax contri-
butions to the Plan:
a. Irrevocable Election for Pre -Tax Contri utions fr r i Com ens lion: A one-time, irrevocable
election of the amount of Employer contributions of compensation made on his or her behalf,
4
ATTACHMENT TO
DECLARATION OF AMENDMENT TO THE
WHATCOM COUNTY VANTAGECARE RETIREMENT HEALTH SAVINGS
(RHS) PLAN
JUNE 3, 2003
VI. Contribution Sources and Amounts
2. Mandatory Leave Contributions
Formula for determining the accrued leave contribution:
Participants who have at least 960 hours in their sick leave bank at the
beginning and end of the calendar year (or at the beginning of the calendar year
and upon termination) receive an RHS contribution based upon additional hours
accrued during that year using the following formula:
Hours accrued (to a maximum of 48) minus hours used muldpled by 25%
multiplied by hourly rate of pay at year-end equals RHS contribution.
Contributions will be made during the first quarter following the year earned or
upon termination, whichever occurs first.
Hours used in this calculation are no longer available to the participant.
Attachment to Page 4
Plan Number: 8 0,0 2 0 6
The Employer limits the amount elected to either a fixed percentage or a range of percentages of
an Employee's earnings (as shown below):
1,3,5,8,10,
15 and;;.20 % of earnings (as defined in VI.A.1.) or up to N/ /o of earnings (as
defined inVI, A.l.) for the Plan Year.
Newly eligible Employees shall be provided an election window of 30
days (no
than 60 calendar days) from the date of eligibility during which they may make the electionl tore
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 con-
tribute may be made in a later year. An annual election window of 60 days more
than 60 calendar days) shall be provided during which the election may be made. Th(emelection
window shall run from Oct. 1 _ to Nov. 29 (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.
b. Irrevocable ElectiQu for Pre -Tax Contributions of ccrued Le ve: A one-time, irrevocable
election of the amount of Employer contributions of accrued
71 sick ID vacation 0 other
her behalf. NIA
(describe) leave made on his or
The Employer limits the amount elected as shown below:
100% of net cashouts
Washington State De artment of Retirement contributions have been deducted.
Newly eligible Employees shall be provided an election window of 30
days (no more
than 60 calendar days) from the date of 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 con-
tribute may be.. made in a later year. An annual election window of 60 days (o more
than 60 calendar days) shall be provided during which the election may made. de. Then
election
window shall run from. Oct. 1 to Nov. 29 (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.
5
Plan Number: 8 0 0 2 0 6
0 c. Annual Prospective Election for Pre -To-, Contributions of Leave: An annual, irrevocable elec-
tion to have his or her 0 sick 0 vacation 0 other N/A
leave to be accrued in the next calendar year, contributed to the Plan on his or her behalf tribe)
Contributions of future leave accruals will be ren-iitted to the Plan
0 as earned 0 at the end of the calendar year N/A
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 N/A _days (no more than 60 calendar days) is provided
during which eligible Employees may make the election to contribute. The election window shall
run fromN/A i to N/A of the year prior to the year contributions of leave will
begin (insert your annual tune frame for the election window).
The Employer hnuts the amount elected as shown below:
N/A
In adopting section a, b, and/or c, the Employer acknowledges that the Internal Revenue Service has
not railed 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,
02. Voluntary After -Tax Contributions: Each Employee may contribute up to 25 % of
earnings (as defined in VLA.1.) or $ N/A for the Plan Year on a voluntary after-tax basis.
In no event may aggregate Employee voluntary after-tax contributions exceed 25% of total contri-
butions in any Plan Year.
An Employee shall have the right to discontinue or vary the rate of voluntary after-tax contributions
of Employee earnings.
In adopting this section, the Employer acknowledges that the Internal Revenue Service has declined
to rule on Ernployee 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 ssue with appropriate
C. Limits on Contributions: Use this section to define your overall maximum contributions for all
contribution types you sele t d
c e . (Linuts on Individual contribution types are defined within the
appropriate sections above.)
Plan Number: 8 0 0 2 0 6
The total contribution on behalf of each Participant (including both Mandatory and Elective
Contributions) for each Plan Year shall not .exceed the following linut(s):
0 % of earrings (as defined it, VI.A,1.).
0
There is no Plan -defined limit on the percentage or dollar amount of earnings that may be
contributed,
Part II: Revision of Existing Distribution Features
You must complete Part II to incorporate the HRA-required changes into your existing RH.S Plan. ,these changes
"ll be effective immediately. Affected provisions include:
✓ Long-term care expenses are no longer a qualifying medical expense (see X)
✓ Death benefits (see XL and VIIL)
✓ Severance provision (see XII.)
✓ De minimis provision (see XIII. G.)
VHL Forfeiture Provisions: Complete Section VIII. if 1) you did not select a forfeiture provision for
Your existing plan (e.g. because vesting does not apply to your plan) or 2) you wish to change your
existing forfeiture selection.
Upon separation from the service with 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 funds
shall:
Remain in the Trust to be reallocated among all Plan Participants as Direct Employer
Contributions for the next and succeeding contribution cycles(s),
Remain ill 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.
LAP Revert to the Employer,
In the case of separation from service, the Participant's non -vested hinds shall be applied as shown above.
In the case of reversion due to the Participant's death, the remaining account assets shall be applied as
shown above.
X. Permissible Medical Benefit Payments
Long Term Care Benefits are not eligible for payment under the Plan.
Plan Nuniber: 8 0 0 2 0 6
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
XI11.F) of the deceased Participant are immediately eligible to maintain the account and utilize it to
fined 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*. The account balance may be reallocated by the surviving spouse use or
* 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 ICMA-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 dependents, 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 benefits 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.
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 benefzciary(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 beneficia ies of the Participant. Assets remaining upon
the death of all designated beneficiaries shall be available for medical benefits of the beneficiary's benefi-
ciary. If there is no living beneficiary(ies), the account
in Section VIII. will revert to the Plan to be applied as specified .
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.
X1I. Termination Prior to Benefit Eligibility
This section replaces the Severance Feature previously included in Section XII.
In the case of a Participant's termination of eniployiment in advance of retirement (as defined in Section
VII.C.) or prior to becoming eligible for medical benefits under, the plan (as defined in Section IX.), the
Plan Number: $ 6 4 2 0 6_
vested value of the Participant's account will be available for benefits:
0 Immediately upon termination of employment.
0 As outlined in Section IX.
0 At age
XHI.G. Upon termination of employment prior to a Participant becoming eligible for medical benefits
from a VantageCare Retirement Health Savings Plan account, Participant accounts that are considered de
minuius as specified below will be paid to the Participant.
17 The de minimis account value shall be $5,000 or less.
17 The de minims account value shall be
(
$ '
insert dollar amount
between $0 and $5,000) or less.
10 The Plan shall not allow de minim's account distributions.
EMPLOYER
By:
Title:
Attest:
Accepted: Vantagepoint Transfer Agents, LLC
3�" a 3
Corporate Treasurer
Approved as to Form:
Daniel L. Gibson, Senior Civil Deputy Prosecutor
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Dd t e'er—`_" '�