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EMPLOYER VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS) PLAN <br /> ADOPTION AGREEMENT <br /> Plan Number: 8 0 3 0 9 3 Checic one: [� New Plan ❑ Amendment to Esisting Plan <br /> Employer Retirement Health Sa��ings Plan Name: <br /> I. EmployerName: Clty Of Deeatur State: II' <br /> II. The Employer hereby attests that it is a unit of a state or local government or an agency or instrumentality of one <br /> or more units of a state or local government. <br /> III. Effective Date of the Plan: June 15 , 2��9 <br /> N The Employer intends to utilize the Trust to fund onl}�welfare benefits pursuant to the following welfare benefit <br /> plan(s) established by the Employer: C 1 ty O f De C a tuz' , I 111 ri O 1 S <br /> V. Eligible Groups,Participation and Participant Eligibility Requirements <br /> A. Eligible Groups <br /> The following group or broups of Employees are eligible to participate in the VantageCare Retirement Health Savings <br /> Plan(check all applicable boxes): <br /> ❑ All Employees <br /> ❑ All Full-Time Employees <br /> ❑ Non-Union Employees <br /> ❑ Public Safery Employees—Police <br /> ❑ Public Safet}�Employees—Firefighters <br /> ❑ General Employees <br /> ❑ Collectively-Bargained Employees (Specify unit(s)) <br /> �i'] Other(specify group(s)) NOri Barqaininc� Em���ees , Grpu� D f i nPd i n <br /> Personnel Policies. <br /> The Employee group(s)specified inust correspond to a group(s) of the same designation that is defined in the statuces, <br /> ordinances,rules, regulations,personnel manuals or other documents or provisions in effect in the state or localit}�of <br /> the Employer. <br /> B. Participation <br /> Mandatory Partzcipation:All Employees in the covered group(s) are required to participate in <br /> the Plan and shall receive contributions pursuant to Section VI. <br /> � If the EmpJnyer's underlying welfare bene6t plan or Eunding under�this VantageCare Retirement Health��Savings Plan is in���� �, <br /> �vhole or part a non-collectivelybargained,self-insured plan,the nondiscrimitiarion requireinents of Internal Kevenue Code <br /> (IRC)'Section]05(h)will apply. These�rules�may�impose taxation on the benefits received by higlily compensated i�dividuals �� <br /> if the P(an discriminares in�favor oFhigfily compensaced individuals in terms of eligibiliry or benefics.The Employer s6ould �� <br /> discuss rhese rules with appropriare counseL II <br /> C. Participant Eligibility Requirements <br /> 1. Minimum service:The minimum period of service required for participation is � (write N/A if no <br /> minimum service is required). <br /> 7.. Minimum age:The minimum age required for eligibility to participate is 1 R (write N/A if no minimum <br /> age is required). <br /> � � �, ���� <br /> �:� <br />