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Agenda Report - November 18, 2015 I-01
CITY OF LODI COUNCIL COMMUNICATION TM AGENDA ITEM AGENDA TITLE: Adopt Resolution Approving a Retiree Health Savings Account for Affected Members of the Lodi Police Dispatchers Association and Appropriating Funds in the amount of $76,900 MEETING DATE: November 18, 2015 SUBMITTED BY: Human Resources RECOMMENDED ACTION: Adopt resolution approving a Retiree Health Savings Account for affected members of the Lodi Police Dispatchers Association and appropriating funds in the amount of $76,900. BACKGROUND INFORMATION: Members of the Lodi Police Dispatchers Association (LPDA) and representatives from the City successfully negotiated a successor Memorandum of Understanding (MOU), covering January 2015 through December 31, 2017, approved by Council on May 20, 2015. Representatives from the City and the LPDA identified a resolution to the dispute regarding the eligibility date for the sick leave conversion benefit program referenced in the 2007-2011 MOU, which was the establishment of a Retiree Health Savings Account (RHSA) for the six LPDA members hired into the unit between July 9, 1994 and November 8, 2004. The City agreed to allocate $75,000 to be distributed on a pro -rated basis, and effective with the first full pay period in January 2016 to contribute one percent of the employees' base bi-weekly salary, each pay period, into the RHSA until such time as the employee retires, resigns or separates employment with the City of Lodi. Staff reviewed and analyzed the available Retirement Health Savings programs offered by the City's deferred compensation vendors; ICMA Retirement Corporation (ICMA-RC), MassMutual, and Nationwide, and recommends that the City enter into agreement with ICMA-RC to establish a Vantagecare Retirement Health Savings Program. Staff recommends Vantagecare program in part because of lower account fees and the variety of investment options available to the program participants. Staff recommends that the Council approve the agreement to establish a Vantagecare Retiree Health Savings Program with ICMA-RC and to appropriate funds. FISCAL IMPACT: Total cost of the Retiree Health Savings program for FY 2015/16 is $76,900 composed of the negotiated settlement amount of $75,000 and $1,900 representing the one percent City contribution. Annual on-going costs of the City contribution is approximately $3,800. An appropriation is necessary for the FY 2015/16 costs. FUNDING AVAILABLE: Funding for this item for FY 2015/16 will be provided by funds in excess of the General Fund reserve target established by Council. Funding for future years will be included in each year's budget. POLott Adele Post, Human Resources Manager JordaTh Ayers, Deputy City a ager APPROVED: 1111 Step -n Sch , City Manager VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS) ADOPTION AGREEMENT Plan Number. 8 03592 Select as applicable: 0 Standalone RHS 0 Integrated RHS 0 Amendment to Existing Plan ® New Plan I. Employer Name: City of Lodi State•. CA II. The Employer hereby attests that it is a unit of a state or local government or an agency or instrumentality of one or more units of a state or local government. III. Plan Dates: A. Plan Effective Date December 1, 2015 B. Plan Year: Enter the annual accounting period for the RHS program. January 1 - December 31 W. The Employer intends to utilize the Trust to fund only welfare benefits pursuant to the following welfare benefit plan(s) established by the Employers crr d Lodi V. Eligible Groups, Participation and Participant Eligibility Requirements A. Eligible Groups The following group or groups of Employees are eligible to participate in the Employer's welfare benefits plan identified in Section IY. (check all applicable boxes): ❑ All Employees O All Full -Time Employees ❑ Non -Union Employees ❑ Public Safety Employees — Police ❑ Public Safety Employees — Firefighters ❑ General Employees O Collectively -Bargained Employees (Specify unit(s)) IZ Other (specify group(s)) Dispatcher/Jailers hired between July 9, 1994 and November 8, 2004 The Employee group(s) specified must correspond to a group(s) of the same designation that is defined in the statutes, ordinances, rules, regulations, personnel manuals or other documents or provisions in effect in the state or locality of the Employer. B. Participation Mandatory Participation: All Employees in the covered group(s) are required to participate in the Plan and shall receive contributions pursuant to Section VI. If the Employer's underlying welfare benefit plan is in whole or part a non -collectively bargained plan that allows reimbursement for medical expenses ocher than insurance premiums, the nondiscrimination requirements of Internal Revenue Code (IRC) Section 105(h) will apply. These rules may impose taxation on the benefits received by highly compensated individuals lithe Plan discriminates in favor of highly compensated individuals in terms of eligibility or benefits. The Employer should discuss these rules with appropriate counsel. II:13 C. Participant Eligibility Requirements 1. 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 N/A (write N/A if no minimum age is required). VL 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: base pay B. Direct Employer Contributions and Mandatory Contributions 1. Direct Employer Contributions The Employer shall contribute on behalf of each Participant 1 1 % of Earnings* ❑ $ each Plan Year ❑ A discretionary amount to be determined each Plan Year m Other (describe): See Attachment A 2. Mandatory Employee Compensation Contributions The Employer will make mandatory contributions of Employee compensation as follows: ❑ Reduction in Salary - % of Earnings or $ will be contributed for the Plan Year. ❑ Decreased Merit or Pay Plan Adjustment - All or a portion of the Employees' annual merit or pay plan adjustment will be contributed as follows: An Employee shall not have the right to discontinue or vary the rate of Mandatory Contributions of Employee Compensation. 3. Mandatory Employee Leave Contributions The Employer will make mandatory contributions of accrued leave as follows (provide formula for determining Mandatory Employee Leave contributions): ❑ Accrued Sick Leave O Accrued Vacation Leave O 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 premium; should consult their benefits counsel regarding we/fare plan nondiscrimination rules ifthe employer elects to make contributions based on a percentage ofearnings. 1I:14 C. Limits on Total Contributions (check one box) The total contribution by the Employer on behalf of each Participant (including Direct Employer and Mandatory Employee Contributions) for each Plan Year shall not exceed the following limit(s) below. Limits on individual contribution types are defined within the appropriate section above. ® There is no Plan -defined limit on the percentage or dollar amount of earnings that may be contributed. ❑ % of earnings Definition of earnings: 0 Same as Section VLA. 0 Other ❑ $ for the Plan year. VII. Vesting for Direct Employer Contributions A. Vesting Schedule (check one box) ® The account is 100% vested at all times. ❑ The following vesting schedule shall apply to Direct Employer Contributions as outlined in Section VI.B.1.: Years of Service Completed Vesting Percentage o� B. The account will become 100% vested upon the death, disability, retirement*, or attainment of benefit eligibility (as outlined in Section IX) by a Participant. *Definition of retirement includes a separation from service component and is further defined by (check one): O The primary retirement plan of the Employer 0 Separation from service O Other C. Any period of service by a Participant prior to a rehire of the Participant by the Employer shall not count toward the vesting schedule outlined in A above. VIIL Forfeiture Provisions If a Participant separates from service prior to full vesting, non -vested funds in the Participant's account shall be forfeited in accordance with the box checked under this section. Upon the death of a participant, surviving spouse, and all surviving eligible dependents (as outlined in Section XI), funds remaining in the Participant's account shall be revert to the Trust in accordance with the box checked under this section. II:15 If a Participant permanently opts out and waives future reimbursements, as allowed under IRS Notice 2013-54, all funds in the Participant's account at the time of waiver shall be forfeited in accordance with the box checked under this section.' ❑ Remain in the Trust to be reallocated among all remaining Employees participating in the Plan as Direct Employer Contributions for the next and succeeding contribution cycle(s). O Remain in the Trust to be reallocated on an equal dollar basis among all Plan Participants. ® Remain in the Trust to be reallocated among all Plan Participants based upon Participant account balances. ❑ Revert to the Employer. IX. Eligibility Requirements to Receive Medical Benefit Payments from the VantageCare Retirement Health Savings Program A. A Participant is eligible to receive benefits: ❑ At retirement only (also complete Section B.) Definition of retirement-. O Same as Section VII.B. O Other m At separation from service with the following restrictions m No restrictions O Other B. Termination prior to general benefit eligibility: In case where the general benefit eligibility as outlined in Section IX.A includes a retirement component, a Participant who separates from service of the Employer prior to retirement will be eligible to receive benefits: © Immediately upon separation from service O Other C. A Participant that becomes totally and permanently disabled ❑ as defined by the Social Security Administration ▪ as defined by the Employer's primary retirement plan O other will become immediately eligible to receive medical benefit payments from bis/her account under the Employer's welfare benefits plan. D. Upon the death of the Participant, benefits shall become payable as outlined in Section XL *lfthe Employer's RHS Program does not limit eligibility to participants who have separated front service, the employer will be required to provide further direction to ICMA-RC regarding the treatment of possrble contributions that are required to be made following the participant's waiver. II:16 X. Permissible Medical Benefit Payments Benefits eligible for reimbursement consist of: M All Medical Expenses eligible under IRC Section 213 other than (i) direct long-term care expenses, and (ii) expenses for medicines or drugs which are not prescribed drugs (other than insulin). ❑ The following Medical Expenses eligible under IRC Section 213 other than (i) direct long-term care expenses, and (ii) expenses for medicines or drugs which are not prescribed drugs (other than insulin). Select only the expenses you wish to cover under the Employer's welfare benefits plan: ❑ Medical Insurance Premiums ❑ Medical Out -of -Pocket Expense? ❑ Medicare Pan B Insurance Premiums O Medicare Part D Insurance Premiums ❑ Medicare Supplemental Insurance Premiums O Prescription Drug Insurance Premiums O COBRA Insurance Premiums O Dental Insurance Premiums O Dental Out -of -Pocket Expense? ❑ Vision Insurance Premiums ❑ Vision Out -of -Pocket Expenses* O Qualified Long -Term Care Insurance Premiums O Non -Prescription medications allowed under IRS guidance* O Other qualifying medical expenses (describe)* * Non -collectively bargained plans that reimburse medical expenses other than insurance premiums should consult their benefits counsel regarding welfare plan nondiscrimination rules if the employer elects to make contributions based on a percentage of earnings. XI. Benefits After the Death of the Participant In the event of a Participant's death, the following shall apply: A. Surviving Spouse and/or Surviving Dependents Upon the death of a participant, the surviving spouse and/or surviving eligible dependents (as defined in Section XII.D.) of the deceased Participant are immediately eligible to maintain the Participant's RHS account and utilizing the remaining balance to fund eligible medical benefits specified in Section X above. Upon notification of a Participant's death, the Participant's account balance will be transferred into Dreyfus Cash Management fund** (or another fund selected by the Employer). The account balance may be reallocated by the surviving spouse or dependents. ** An investment in the Dreyfus Cash Management money market fund is not insured or guaranteed by the Federal Deposit Insurance Corporation or any other government agency. Although the fundseeks to preserve the value ofyour investment at $1.00 per share, it is possible to lose money by investing in thefund Investors should consider the investment objectives, risks, charges, and expenses of thefiend carefully before investing. You may visit us at www.icmarc.org or call 800-669-7400 to obtain a prospectus that contains this and other information about thefund Read the prospectus carefully before investing. If a Participant's account balance has not been fully utilized upon the death of the eligible spouse, the account balance may continue to be utilized to pay benefits of eligible dependents. Upon the death of all eligible dependents, the account will revert in accordance with the Employer's election under Section VIII of the VantageCare RHS Adoption Agreement. 1I:17 B. No Surviving Spouse or Surviving Dependents If there are no living spouse or dependents at the time of death of the Participant, the account will revert in accordance with the Employer's election under Section 1/11I of the VantageCare RHS Adoption Agreement. XII. The Plan will operate according to the following provisions: A. Employer Responsibilities 1. The Employer will submit all VantageCare Retirement Health Savings Plan contribution data via electronic submission. 2. The Employer will submit all VantageCare Retirement Health Savings Plan Participant status updates or personal information updates via electronic submission. This includes but is not limited to termination notification, benefit eligibility, and vesting notification. B. Participant account administration and asset-based fees will be paid through the redemption of Participant account shares, unless agreed upon otherwise in the Administrative Services Agreement. C. Assignment of benefits is not permitted. Benefits will be paid only to the Participant, his/her Survivors, the Employer, or an insurance provider (as allowed by the claims administrator). Payments to a third -parry payee (e.g., medical service provider) are not permitted with the exception of reimbursement to the Employer or insurance provider (as allowed by the claims administrator). D. An eligible dependent is (a) the Participant's lawful spouse, (b) the Participant's child under the age of 27, as defined by IRC Section 152(0(1) and Internal Revenue Service Notice 2010-38, or (c) any other individual who is a person described in IRC Section 152(a), as clarified by Internal Revenue Service Notice 2004-79. E. The Employer will be responsible for withholding, reporting and remitting any applicable taxes for payments which are deemed to be discriminatory under IRC Section 105(h), as outlined in the VantagrCare Retirement Health Savings Employer Manual. MIL Employer Acknowledgements A. The Employer hereby acknowledges it understands that failure to properly fill out this VantageCare Retirement Health Savings Adoption Agreement may result in the loss of tax exemption of the Trust and/or loss of rax -deferred status for Employer contributions. B. Check this box if you are including supporting documents that include plan provisions. EMPLOYER SIGNATURE 8y: Date: Tim City Manager Attest: Date: Tkl rCityClerk Approved as to form City Attorney I1:18 Vantagecare Retirement Health Savings (RHS) Adoption Agreement Plan Number 803592, City of Lodi Attachment A VI. Contribution Sources and Amounts B. Other Initial lump sum contribution of $75,000.00 to be distributed amongst the six (6) Dispatcher/Jailer employees in the Dispatch Unit that were hired between July 9, 1994 and November 8, 2014, as listed in section 21.7 of the Lodi Police Dispatcher Association Memorandum of Understanding (MOU), effective January 1, 2015 — December 31, 2017. The $75,000.00 will be distributed on a pro -rated amount based on the individual employee's sick leave accrual at the time the MOU was adopted. Beginning the first full pay period in 2016, the City shall contribute one percent (1%) of the employee's base bi- weekly salary each pay period. VantageCare Retirement Health Savings Program pV i implementation Data Form — Page 1 of 3 1CMA : Instructions to Employer. Provide necessary information to establish your plan properly. Please contact your New Business Analyst at 800-326-7272, if you have my questions. ICMA-RC IM Only Employer ,# 03592 Gene Infamatian 1. 2. 3. (902) Employers Ful Name: City of Lodi (924) street Address: PO Box 3006 (925) (918) Oty. Lodi (919) Stow: CA (920) Tip cork 95241 4. (633) Primary comae: Adele Post 5. (634) Primary Contact Bic Human Resources Manager 6. (631) Primary Coraco Telephone A {241 333-67174 7. (632) Fax#: (2% 333-6816 8. (PT00) Elia Address: hrdept@lodi.gov Ibis strati talo be used to provide on ekdroaic copy of yourplan summary. 9. (882) Employer's Federal Tax Identification Number: 946000361 10. # of Employees: 369 11. # of Employees Eligthle for Plan Participation: 6 12. # of Employees Eligible to Receive Merkel Benefits upon plan implementation: 6 Plan Implementation 13. (611) Contribution Information: (Note: `= default) Information (8) Semi•quarterly a. Frequency (deck one): !I (0) Bi -weekly' ■ (4) Monthly ■ (9) Bi -annually • (1) Weekly • (5) Semi -Monthly • (10)Annually • (2)Semi•weekly • (6)8i -quarterly ■ (11) Semi-annually • (3111i -monthly • (7) Quarterly ■ ■ () 011ier: EFT b. Deposit Mem (624) • Check ` • Win t'� c. Dais Mediunk: EZL1nk Required to participate 6r RHS Plan d. First Contribution Date Following Implementation: 12/01/2015 ICMA RC • P.O. Box 96220 • Washington, IX 20090-6220 • Toll Free 800 669-7400 cmA R ea.r sy VantageCare Retirement Health Savings Program Implementation Data Form — Page 2 of 3 Default Investment Option The default hod will be used B a partidpattdaes not provide valid allocation instructions. If you do not make an election in this section, the Milestone Fund with the target date closest to o partidpant's 60th birthday will be used as you plan's default option. You may select the "iIEernatwe Default" option d you would like to use a fund (or funds) other than the Milestone Furls as you plan's default option. Please see ICMArRC's Standard Plan Fund Lineup atwynv ianarc.org to complete this section. Note: Prior to selecting the "Alternative Default" option, employers should carefully review the Department of Labor's find regulations on qualified default investment ahernatives (QDIAs). More information is available online at www.dol.gov or www.ianacorg/ppa. Default Fund for Investment Allocations (Select one option): U The Milestone Funds (Defauh) with a target retirement age of•. ® Age 60 (Default) 0 Age (Input the Target Retirement Age to be used for your plan) • Alternative Default (Input the fund name that nil be used as the plan's default investment option) (lain Contact Information Please indicate alternate addresses in Comments Section If item #14-17 and 19 are left blank, the Primary Contact in #4 will receive mailings. Complete item #18. 14. Pf01 (Wad Signature:6,tt..,, ad f (200) Corded Nam Adele Post (210) (ontodTtile: Human Resources Manager (420) Telephone: (2� 333-6704 (421) Fax: ( 209) 333- 6 15. PT08 Corded Signature: (--. l-% -7 (200) Coded Nam Cristlna Gonzales (210) Wed Bic Management Analyst (420) Telephone: Q� 333-6704 (421) Fax: ( 209 ) 333-6816 16. 1109 Coded Signature: (200) Corded Nam (210) Caridad Bic (420) Telephone: (J 1421) Fax ( ) CaiTtribuliari Carctaci Information 17. P102 (200) Conrad Nam Ruby Paiste (210) Camarillo: Finance Manager (420) Telephone: ir2fa 333-2591 (421) Fax:( ) ICMA-RC • P.O. Box 96220 • Washington, DC 200904220 • Toll Free 800 669.7400 II:22 ICMARC VantageCare Retirement Health Savings Program d,,;lliajlP,;,nwnuSsr►iry Implementation Data Form — Page 3 of 3 Trustee fantod Information 18. PT10 (200) (210) (215) (310) (305) (320) (401) (420) Trustee Name: City of Lodi Trustee Title: Deputy City Manager Trustee: Jordan Ayers Trustee Address•. P.O. Box 3006 Sheet 221 West Pine Street ay Lodi (325) State (330) Tip 95241 Y/N (402) Y/N Telephone: (2 333700 (421) Fax: ( ) Bring (Fees) Cariad Information 19. PT06 (200) (210) (420) fantod Name: Adele Post fantod Title: Human Resources Manager Telephone: g ti 333-6704 (421) Fax: ( 209) 333-6816 foments: (Amato Addresses far#14-19) Intend Use Only 641 912 608 074 ._ ICMA-RC • P.O. Bax 96220 • Washington, DC 20090-6220 • Toll Free 800 669-1400 II:23 icnnaR'�C� s seas RIOIVEMIS Stnnay Plan Name: City of Lodi EZLINK ACCESS FORM - PAGE 1 OF 2 Plan Numbers): 03592 (All plan numbers must be listed to avoid processing delays.) 1 Primary Contact Infonmlion 2 Mink User Information Primary Contact Name: Adele Post Primary Contact Tide: Human Resources Manager Email Address: apost@lodi.gov Daytime Phone Number. (9 _) 333 _ 6704 Select One: 71 Add New User ID O Update User ID O Remove User ID Adele Post Name: Tide: Human Resources Manager Email Address: apost@Iodi.gov Daytime Phone Number. ( 209 ) 333 _6704 Access Options (You must select either yes or no for each access option): File Transfer Participant Data Transfers Balance Inquiry Enrollments/Rehire Participant Changes m Yes 0 No m Yes 0 No (71 Yes 0 No 21 Yes m Yes 0 No 0 No Select One: O Add New User ID O Update User ID Name: Cristina Gonzales l7 Remove User ID Tide: Management Analyst Email Address: cgonzales@lodi.gov Daytime Phone Number. Access Options (You must Balance Inquiry Enrollments/Rehire Participant Changes (_209 ) 333 . 6704 select either yes or no for each access option): ® Yes 0 No File Transfer m Yes 0 No m Yes 0 No Participant Data Transfers 0Yes O Yes 0 No 0 No Select One: 0 Add New User ID O Update User ID O Remove User ID Name: Title: Email Address: Daytime Phone Number. Access Options (You must select either yes or no for each access option): Balance Inquiry 0 Yes 0 No File Transfer 0 Yes 0 No Enrollments/Rehire 0 Yes 0 No Participant Data Transfers 0 Yes 0 No Participant Changes 0 Yes 0 No II:26 rnn�RC Nxillrwr Reismast S...dy 3 EZlink user Info nation (continued) 4 Primary Contact Approval Link EZLINK ACCESS FORM - PAGE 2 OF 2 Select One•. O Add New User ID O Update User ID O Remove User ID Name: i itic: Email Address: Daytime Phone Number. (_ _ _ - Access Options (You must select either yes or no for each access option): Balance Inquiry O Yes O No File Transfer 0 Yes 0 No Enrollments/Rehire 0 Yes 0 No Participant Data Transfers 0 Yes O No Participant Changes 0 Yes 0 No Select One: O Add New User ID O Update User ID O Remove User ID Name: Title: Email Address: Daytime Phone Number. ( _ ) - Access Options (You must select either yes or no for each access option): Balance Inquiry 0 Yes 0 No File Transfer O Yes O No Enrollments/Rehire 0 Yes 0 No Participant Data Transfers 0 Yes 0 No Participant Changes 0 Yes 0 No ICMA RC considers participant information to be highly confidential, and we go to great lengths to avoid breaching that confidentiality. For this reason, ICMA-RC cannot be responsible for (i) negligent or intentional misuse of the password by the municipality's officers, employees, agents or contractors, (ii) a breach of confidentiality that may occur as a result of such negligent or intentional misuse of the password, or (iii) a breach of confidentiality that may occur as a proximate result of the municipality's access to the participant database. If the municipality uses EZLink online transaction processing, please remember to review all financial information you have entered for your partici- pants, as ICMA-RC is not responsible for incorrect data transmitted by the municipality. ICMA-RC recommends that you encourage all participants to review confirmations for accuracy. En -ink User IDs that have not been used within a consecutive eighteen month period will be systematically deleted to further protect the security of your plan and participant data. ICMA-RC's website is normally available 24 hours a day, seven days a week. However, service availability is not guaranteed. Neither ICMA-RC or its affiliates, the VantageTrust Company, nor The Vantagepoint Funds will be responsible for any loss (or forgone gain) you may incur as a result of service being unavailable. Please signify your agreement to these terms by signing in the space indicated below. We will provide you with User ID(s) and Password(s) to begin using EZLink. Should you have questions, please call our EZLink Team at 1-800-326-7272. Agreed: Date: Print your name: Adele Post For ICMA-RC Internal Use Only: EZLink Primary NBS EZLink QA Dara Security _ II:27 DECLARATION OF TRUST OF THE City of Lodi NAME OF EMPLOYER INTEGRAL PART TRUST 22812-0115.1276 1I:28 DECLARATION OF TRUST OF THE City of Lodi (NAME OF EMPLOYER) INTEGRAL PART TRUST Declaration of Trust made as of the 18th day of November , 20 15 , by and between the City of Lodi California a Public Agency (Name of Employer) (Stat.) (Type of Eotlty) (hereinafter referred to as the "Employer") and Deputy City Manager (Nime OF Title of Tonkel or its designee (hereinafter referred to as the "Trustee"). RECITALS WHEREAS, the Employer is a political subdivision of the State of California federal income tax under the Internal Revenue Code of 1986; and (Slate) exempt from WHEREAS, the Employer provides for the security and welfare of its eligible employees (hereinafter referred to as "Participants"), their Spouses and Dependents by the maintenance 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-funded reimbursement plans (collectively the "Plan"); and WHEREAS, it is an essential function and integral part of the exempt activities of the Employer to assist Participants, their Spouses and Dependents by making contributions to and accumulating assets in the trust, a segregated fund, for post- retirement ostretirement welfare benefits under the Plan; and WHEREAS, the authority to conduct the general operation and administration of the Plan is vested fn the Employer or its designee, who has the authority and shall be subject to the duties with respect to the trust specified in this sample Declaration of Trust 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 and Dependents; NOW, THEREFORE, the parties hereto do hereby establish this trust, by executing the sample Declaration of Trust of the City of Lodi [Name of Employee) to as the "Trust"), and agree that the following constitute the sample Declaration of Trust (hereinafter referred to as the Integral Part Trust (hereinafter referred "Declaration"): II:29 ARTICLE Definitions 1.1 Definitions. For the purposes of this Declaration, the following terms shall have the respective meanings set forth below unless otherwise 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 7.3. (b) "Administrator" means the Employer or the entity designated by the Employer to carry out administrative services as are necessary to implement the Plan. (c) "Beneficiary" means the Spouse and Dependents, who will receive any benefits payable hereunder in the event of the Participant's death. In the case where there is no Spouse or Dependents, any amount of contributions, plus accrued earnings thereon, remaining in the Account must revert in accordance with the Employer's election under Section VIII of the VantageCare RHS Adoption Agreement. (d) (e) "Code" means the Internal Revenue Code of 1986, as amended from time to time. "Dependent" means (a) the Participant's lawful spouse, (b) the Participant's child under the age of 27, as defined by IRC Section 152(f)(1) and Internal Revenue Service Notice 2010-38, or (c) any other individual who is a person described in IRC Section 152(a), as clarified by Internal Revenue Service Notice 2004-79. (0 "Investment Fund" means 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 and Dependent (whichever is applicable) in the percentage of Participant's 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 lawful spouse as determined under the laws of the jurisdiction in which the Participant was married. (i) "Trust" means the trust established by this Declaration. (j) "Trustee" means the Employer or the person or persons appointed by the Employer to serve in that rapacity. ARTICLE II Establishment of Trust 2.1 The Trust is hereby established as of the date set forth above for the exclusive benefit of Participants, their Spouses and Dependents. 11:30 ARTICLE I11 Construction 3.1 This Trust and its validity, construction and effect shall be governed by the laws of the State of California . 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 and Dependents pursuant to the terms of the Plan. 4.2 Form of Benefits. This Trust may reimburse the Participant, his Spouse and Dependents 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 premiums. ARTICLE V General Duties 5.1 It shall be the duty of the Trustee to hold tide 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 under 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 CO the identity and value of the assets titled in the Trustee's name hereunder and to keep accurate books and records with respect to the Participants of the Plan. ARTICLE VI Investments 6.1 The 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 in writing of any such appointment. 6.2 The Trustee shall not have any discretion or authoriry with regard to the investment of the Trust and shall act solely as a directed Trustee of the assets of which it holds tide. To the extent directed by the Employer (or Participants or their Spouses and Dependents 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 same unregistered; 11:31 (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 k 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 insurance 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, 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, personal or mixed, tangible or intangible, whether income or non -income producing and wherever situated, including but not limited 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 common 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 commingled trust fund. 6.3 Notwithstanding anything to the contrary herein, the assets of the Plan shall be held by the Trustee as title holder only. Persons holding custody or possession of assets titled to the Trust shall indude 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 tide 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 Trustee's negligence or intentional misconduct. The Trustee may refuse 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 illegal. 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 (ii) any disbursements of any part of the Trust made by the Trustee in accordance with the directions of the Employer, or (iii) any action taken by or omitted 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 from any and all actions, claims, demands, liabilities, losses, 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 misconduct, or recklessness with respect to the Trustee's duties under this Declaration. I1:32 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 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 must contain a forfeiture provision that will prevent Participants from receiving the accrued leave in cash in lieu of a contribution to the Trust. 7.3 Accounts. Employer contributions, including mandatory 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 and Dependents. 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 or Dependents) or the Employer, as required under the Plan, from among the Investment Funds selected by the Employer. 7.4 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. 7.5 No amount in 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, or Dependent. 7.6 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, disability, 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 an -other agent of the Employer shall, subject to the terms of this Declaration, accept and hold hereunder contributions to such other plans. In that event (a) the Employer or, if so designated by the Employer, the Administrator or an investment manager or another agent of the Employer, may commingle for investment purposes the contributions received under such other plan or plans with the contributions previously 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. 1I:33 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 payment shall be made, either during the existence of or upon the discontinuance of the Plan (subject to Section 7.6), 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 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 or Dependents 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 fees 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 (idle 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 function 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. II:34 ARTICLE XII 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 and 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 giving 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 fund 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 Administrator, the Employer or any officer or employee thereof, except as may otherwise be expressly provided in the Plan or in this Declaration. 1I:35 ARTICLE XV Protective Clause Neither the Administrator, the Employer, nor the Trustee shall be responsible for the validity of any contract of insurance or other arrangement maintained in connection with the Plan, or for the failure on the pan of the insurer or provider to make payments provided by such contract, or for the action of any per -son 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: rule: City Manager TRUSTEE(S): By: Tick: By: Tick: By: Title•. Deputy City Manager Approved as to toren City Attorney II:36 City of Lodi NAME OF EMPLOYER RETIREE WELFARE BENEFITS PLAN 22872-0115.1277 1I:37 ICIN/kRC RETIREE WELFARE BENEFITS PLAN Table of Contents Article I Preamble 1.01 Establishment of Plan 1.02 Purpose of Plan Article II Definitions 2.01 "Benefits" 2.02 "Code" 2.03 "Dependent" 2.04 "Eligible Medical or Dental Expenses" 2.05 "Employer" 2.06 "Entry Date" 2.07 "Participant" 2.08 "Plan Administrator" 2.09 "Plan Year" 2.10 "Retiree" 2.11 "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 Ihird-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 II:38 Table of Contents (continued) Article VII Claims Procedure 7.01 Procedure if Benefits are Denied Under the Plan 7.02 Requirement for Written Notice of Claim Denial 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 Amend 8.03 Employer's Right to Terminate Article IX General Provisions 9.01 No Employment Rights Conferred 9.02 Payments to Survivor 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 Number 9.11 Headings 9.12 Applicable Laws 9.13 Severability II:39 City of Lodi Name of Employer RETIREE WELFARE BENEFITS PLAN ARTICLE 1 Preamble THIS INSTRUMENT made and published by City of Lodi the 16th day, of November , 20 15 creates the City of Lodi Plan ("Plan"), as follows: (hereinafter called "Employer") on Retiree Welfare Benefits 1.01 Establishment of Plan The Employer named above hereby establishes a Retiree Welfare Benefits Plan as of the 18 day of November, 2015 20 . 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 and Dependents through the Employer's VantageCare Retirement Health Savings (RHS) Program. ARTICLE 11 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 "Benefits" means any amounts paid to a Participant, Spouse or Dependents in the Plan as reimbursement for Eligible Medical and Dental Expenses incurred by the Participant during a Plan Year by him, his Spouse or his Dependents. 2.02 "Code" means the Internal Revenue Code of 1986, as amended. 2.03 "Dependent" means any individual who is a dependent of the Participant within the meaning of Code Sec. 152, as amplified by Internal Revenue Service Notice 2004-79, 2004-49 I.R.B.898 and Internal Revenue Service Notice 2010-38. 2.04 "Eligible Medical Expenses" means those expenses designated by the Employer as eligible for reimbursement in the VanrageCare Retirement Health Savings Adoption Agreement. 2.05 "Employer" means the unit of state or local government creating this Plan, or any affiliate or successor thereof that likewise adopts this Plat. 2.06 "Entry Date" means the fust day the Participant meets the eligibility requirements of Article III as of such Data 2.07 "Participant" means any Retiree who has met the eligibility requirements set forth in Article III. 2.08 "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. II:40 3.02 Claims for Benefits No benefit shall be paid hereunder unless a Participant, his Spouse or Dependent 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 VI, below. Upon receipt of a properly documented daim, the Plan Administrator shall pay the Participant, his Spouse or Dependent the benefits provided under this Plan as soon as is administratively 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, induding 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 determine 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 daim 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. d) 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 Administrator, subject to approval of the Employer, may employ the services of such persons as it may deem necessary or desirable in connection 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, certificates, 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 condusive and binding as to all persons. 6.03 Several Fiduciary Liability To the extent permitted by law, neither the Plan Administrator nor any ocher person shall incur any liability for any acts or for failure to act except for his own willful misconduct or willful breach of this Plan. 1I:42 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 his dudes 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 with the administration of this Plan. 6.06 Payment of Administrative Expenses All reasonable expenses incurred in administering the Plan, including but not limited to administrative fees and expenses owing to any third party administrative service provider, actuary, consultant, accountant, attorney, specialise, or other person or organization that may be employed by the Plan Administrator in connection with the administration thereof, shall be paid by the Employer, provided, however that each Participant shall bear the monthly cost (if any) charged by a third party administrator for maintenance 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 documentation 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 expense reimbursement account within ninety (90) days after the close of each Plan Year. ARTICLE VII Claims Procedure 7.01 Procedure if Benefits ars Denied Under the Plan Any Participant, Spouse, Dependent, 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 daim, unless special circumstances require an extension of rime for processing the claim. In no event may the extension exceed forty-five (45) 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. If such extension is necessary due to a failure of the Participant, Spouse or Dependent to submit the information necessary to decide the claim, the notice of extension shall describe the required information and the claimant shall be afforded at least forty-five (45) days from receipt of the notice within which to provide such information. 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 daimant shall be permitted to exercise his right to review pursuant to Sections 7.03 and 7.04. II:43 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 Plan provisions, including references to the VantageCare Retirement Health Savings Adoption Agreement, 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 one -hundred eighty (180) 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 comments 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 derision 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 ti rcumstances require an extension of time for processing, in which case a decision shall be rendered not later than one hundred -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 VIII 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 terminate the Plan, as provided in Sections 8.02 and 8.03, below. 11:44 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. 8.03 Employer's Right to Terminate The Employer reserves the right to discontinue or terminate the PIan 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 be 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 Section XI of 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, assignment, pledge, encumbrance or charge, and any attempt to do so shall be void. No benefit under the PIan shall in any manner 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 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 whom a payment is due under the PIan because he cannot ascertain the identity or whereabouts of such Participant or other person after reasonable efforts have been made to identify or locate such person (including 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 laws of the State of the last known address of the Participant or other persons eligible for benefits. 1I:45 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 Administrator. 9.07 Source of Payments The Employer shall be the sole source of benefits under the Plan. No Employee, Spouse or Dependents shall have any right to, or interest in, any assets of the Employer upon termination of employment or otherwise, 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, Spouse or Dependents. 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 or Dependents 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 indude the feminine 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 limiting the matter contained thereunder. 9.12 Applicable Laws c.oror,e The provisions of the Plan shall be construed, administered and enforced according to the laws of the State of 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. IN WITNESS WHEREOF, we have executed this Plan Agreement the date and year first written above. EMPLOYER By: Title: City Manager Signature of Authorized Official ATTEST (if applicable) ByTide: City Clerk Signature of Attestor II:46 jApproved as to form 1�I, City Attorney 1. AA# 2. JV# CITY OF LODI APPROPRIATION ADJUSTMENT REQUEST TO: Internal Services Dept. - Budget Division 3. FROM: Jordan Ayers, Deputy City Manager 5. DATE: 4. DEPARTMENT/DIVISION: 11/18/15 8. REQUEST ADJUSTMENT OF APPROPRIATION AS LISTED BELOW FUND # ORG # OBJ # ACCOUNT TITLE AMOUNT A. SOURCE OF FINANCING 100 32205 Fund Balance $ 76,900.00 B. USE OF FINANCING 100 10031004 71031 Other Benefits $ 76,900.00 7. REQUEST IS MADE TO FUND THE FOLLOWING PROJECT NOT INCLUDED IN THE CURRENT BUDGET Please provide a description of the project, the total cost of the project, as well as justification for the requested adjustment. If you need more space, use an additional sheet and attach to this form. Increasing appropriations in Police Department to fnd one-time Retiree Health Savings Account deposit ($75,000) and one percent on-going contribution to account ($1,900) If Council has authorized the appropriation adjustment, complete the following: Meeting Date: 11/18/15 Res No: Department Head Signature: Attach copy of resolution to this form. CThIc 8. APPROVAL SIGNATURES Deputy City Manager/Internal Services Manager Date Submit completed form to the Budget Division with any required documentation Final approval will be provided in electronic copy format RESOLUTION NO. 2015-212 A RESOLUTION OF THE LODI CITY COUNCIL APPROVING THE ESTABLISHMENT OF A RETIREE HEALTH SAVINGS ACCOUNT FOR SIX LODI POLICE DISPATCHERS ASSOCIATION EMPLOYEES HIRED BETWEEN JULY 9, 1994 AND NOVEMBER 8, 2004 AND FURTHER APPROPRIATING FUNDS WHEREAS, the City Council approved revisions to the Memorandum of Understanding (MOU) with the Lodi Police Dispatchers Association (LPDA), January 1, 2015 through December 31, 2017, which included a resolution to a dispute regarding the eligibility date for the sick leave conversion benefit program referenced in the 2007-2011 MOU; and WHEREAS, as a resolution, City agreed to establish a Retiree Health Savings Account and allocate $75,000 to be distributed on a pro -rated basis among six LPDA members hired into the LPDA unit between July 9, 1994 and November 8, 2004 (Maria Butterfield, Jeff Humphrey, Andrea Patterson, Tenneill Ramirez, Jennifer Root, and Kimberly Van Tassel!), as soon as administratively possible; and WHEREAS, City further agreed to contribute one percent (1%) of the employees' bi-weekly base salary each pay period, effective with the first full pay period in January 2016; and WHEREAS, City has determined that the establishment of the Retiree Health Savings Account (the "Program") serves the above objectives; and WHEREAS, staff reviewed Retiree Health Savings Accounts offered from each of the three providers under contract with the City for 457 Deferred Compensation Plans; and WHEREAS, staff recommends ICMA's VantageCare Retirement Health Savings Program as the best option. NOW, THEREFORE, BE IT RESOLVED that the Lodi City Council does hereby adopt the ICMA Retirement Corporation's VantageCare Retirement Health Savings Program ("Program") through the Employer's Integral Part Trust ("Trust") and the Employer's Welfare Benefits Plan ("Plan") for the establishment of a Retiree Health Savings Account for the benefit of the above-named Dispatchers; and BE IT FURTHER RESOLVED that the assets of the Plan shall be held in trust, with the City of Lodi serving as trustee for the exclusive benefit of Plan participants and their survivors, 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 Employer has executed the Declaration of Trust of the City of Lodi Integral Part Trust in the form of the sample trust made available by the ICMA Retirement Corporation; and BE IT FURTHER RESOLVED that the Deputy City Manager/Internal Services Director shall be the coordinator and contact for the Program and shall receive necessary reports and notices; and BE IT FURTHER RESOLVED that the City Manager and Deputy City Manager/Internal Services Director are hereby authorized to execute all necessary forms and agreements to establish the Program through the Trust and the Plan; and BE IT FURTHER RESOLVED that funds be appropriated as shown on the attached Appropriation Adjustment Request Form. Date: November 18, 2015 I hereby certify that Resolution No. 2015-212 was passed and adopted by the Lodi City Council in a regular meeting held November 18, 2015, by the following vote: AYES: COUNCIL MEMBERS — Chandler, Kuehne, Mounce, Nakanishi, and Mayor Johnson NOES: COUNCIL MEMBERS — None ABSENT: COUNCIL MEMBERS — None ABSTAIN: COUNCIL MEMBERS — None 2015-212 • teAdaiANP-c) NNIFE'' F RE RAIOLO ity Clerk 1. AA# 2. JV# CITY OF LODI APPROPRIATION ADJUSTMENT REQUEST TO: Internal Services Dept. - Budget Division 3. FROM: Jordan Ayers, Deputy City Manager 5. DATE: 4. DEPARTMENT/DIVISION: 11/18/15 8. REQUEST ADJUSTMENT OF APPROPRIATION AS LISTED BELOW FUND # ORG # OBJ # ACCOUNT TITLE AMOUNT A. SOURCE OF FINANCING 100 32205 Fund Balance $ 76,900.00 B. USE OF FINANCING 100 10031004 71031 Other Benefits $ 76,900.00 7. REQUEST IS MADE TO FUND THE FOLLOWING PROJECT NOT INCLUDED IN THE CURRENT BUDGET Please provide a description of the project, the total cost of the project, as well as justification for the requested adjustment. If you need more space, use an additional sheet and attach to this form. Increasing appropriations in Police Department to fnd one-time Retiree Health Savings Account deposit ($75,000) and one percent on-going contribution to account ($1,900) If Council has authorized the appropriation adjustment, complete the following: Meeting Date: 11/18/15 Res No: Department Head Signature: Attach copy of resolution to this form. CThIc 8. APPROVAL SIGNATURES Deputy City Manager/Internal Services Manager Date Submit completed form to the Budget Division with any required documentation Final approval will be provided in electronic copy format