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<br />USING THE VANTAGECARE RETIREMENT HEALTH SAVINGS PLAN RETURN BOOKLET <br /> <br />This is one of two booklets containing information needed to establish your VantageCare Retirement Health <br />Savings (RHS) Plan with the ICMA Retirement Corporation (ICMA-RC). <br /> <br />This booklet includes: <br /> <br />"/0)( Suggested Resolution and Suggested Affirmative Statement for Adoption of the VantageCare Retirement <br />. Health Savings Plan <br />9a? Employer VantageCare Retirement Health Savings Plan Adoption Agreement <br />. VantageCare Retirement Health Savings Plan Implementation Data Form <br />. Administrative Services Agreement Addendum for the RHS Plan prepared for employers expecting to <br />adopt the Plan <br /> <br />Please return the following to ICMA-RC using the envelope provided: <br /> <br />1. A copy of the approved and executed Resolution or Affirmative Statement for adoption. <br /> <br />Your governing body may require the execution of a formal Resolution to adopt the RHS Plan. If so, you may <br />use this model Resolution. Other jurisdictions may simply require an Affirmative Statement for adoption of the <br />RHS plan. A model Affirmative Statement is also included. You may wish to speak with counsel to determine <br />which action is required in your jurisdiction. ICMA-RC cannot make this determination for you. Please return a <br />copy of the appropriate document to ICMA-RC along with the other forms in this Return Booklet. <br /> <br />2. The original completed RHS Adoption Agreement, <br /> <br />Detailed instructions for completion of the Adoption Agreement follow. You may wish to consult with your <br />ICMA-RC Retirement Plans Specialist and your benefits counsel on the various choices in the Adoption <br />Agreement. <br /> <br />If your governing body requires the execution of this Adoption Agreement at the same time as the Resolution, <br />or Affirmative Statement. please execute it prior to returning it to ICMA-RC along with the other forms in this <br />Return Booklet. <br /> <br />3. The original completed RHS Implementation Data Form. <br /> <br />This form provides ICMA-RC with the necessary contact information in order to set up your new VantageCare <br />Retirement Health Savings Plan. <br /> <br />4. Two executed originals of the Administrative Services Agreement Addendum. <br /> <br />Please execute both copies of the Administrative Services Agreement Addendum. Retain one original for your <br />records and return one original to ICMA-RC along with the other forms in this Return Booklet. <br /> <br />Please note <br /> <br />Upon receipt and processing of your Return Booklet, ICMA-RC will send you a written Notice of Plan Acceptance, <br />employee enrollment kits including an employee RHS announcement letter, employee election forms (if applica- <br />ble) and complete instructions for submitting contributions that may also be found in Chapter Three of the <br />VantageCare Retirement Health Savings Plan Employer Manual. <br /> <br />For assistance <br /> <br />Please contact the VantageCare Retirement Health Savings Plan New Business Analyst at 1-800-326-7272. <br /> <br />Please note that the information in this booklet and the documents herein take into account only the federal <br />tax rules related to ICMA-RC's VantageCare Retirement Health Savings Plan. Prior to implementing an RHS <br />plan, the employer is responsible for determining that there are no state or local laws that would prohibit it <br />from offering the plan to its employees. The employer must also determine that the options it selects in the <br />VantageCare Retirement Health Savings Plan Adoption Agreement fall within state/local requirements. <br /> <br />1 <br />