Resolution 10179 - 2025/12/09 - Laserfiche WebLink

Home Browse Search

MissionSquare Retirement Health Savings Program Return Book MissionSquare Retirement Health Savings (RHS) Adoption Agreement Plan Number: 8 00 lv-7 9 Select as applicable: ❑ Standalone RHS ❑ Integrated RHS Amendment to Existing Plan ❑ New Plan I. Employer Name: C }gip iV�.��1V_i �t c) _State: i L rl 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 I A B. Plan Year: Enter the annual accounting period for the RHS program. 1 /3) 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: C +4 o-f M o u n s V c uJ V. Eligible Groups, Participation and Participant Eligibility Requirements A. Eligible Groups The following group or groups of Employees are eligible to participate in the Employer's welfare benefits plan identified in Section IV. (check all applicable boxes): ❑ All Employees ❑ All Full -Time Employees X Non -Union Employees b4 Public Safety Employees - Police ❑ Public Safety Employees - Firefighters ❑ General Employees ,M Collectively -Bargained Employees (Specify unit(s)) P LL61,' c_ Works C.D)Iec-t-ve r 6,rs 1!\ i nGt U n i 4- ❑ Other (specify group(s)) 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 other 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 if the Plan discriminates in favor of highly compensated individuals in terms of eligibility or benefits. The Employer should discuss these rules with appropriate counsel.