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<br />VANTAGECARE RETIREMENT HEALTH SAVINGS PLAN <br /> <br />DECLARATION OF TRUST OF THE <br /> <br />e~~ 0(::::- S;~V\.~ 1:A.es."t~1 FL <br />NAME OF EMPLOYER <br /> <br />INTEGRAL PART TRUST <br /> <br />Declaration of Trust made as of the <br /> <br />day of <br /> <br />, 20 0 '"' , <br /> <br />FL a fF21;\.'1;Glpd~ <br />State Type of EntIty <br />or its designee (hereinafter <br /> <br />by and between the C.d-"j 0 F 5 '^-~ ""'J .:r:::s. ic- ~ -geLu:.~ <br />Name 01 Employer <br />(hereinafter referred to as the "Employer") and <br /> <br />Name olTruslee <br /> <br />referred to as the "Trustee"). <br /> <br />RECITALS <br /> <br />WHEREAS, the Employer is a political subdivision of the State of <br />exempt from federal income tax under the Internal Revenue Code of 1986; and <br /> <br />F \ 0 ,u:ic"--,, <br /> <br />State <br /> <br />WHEREAS, the Employer provides for the security and welfare of its eligible employees (here- <br />inafter referred to as "Participants"), their Spouses, Dependents and Beneficiaries by the maintenance of <br />one or more post-retirement welfare benefit plans, programs or arrangements which provide for life, <br />sickness, medical, disability, severance and other similar benefits through insurance and self-funded <br />reimbursement plans (collectively the "Plan"); and <br /> <br />WHEREAS, it is an essential function and integral part of the exempt activities of the Employer <br />to assist Participants, their Spouses, Dependents and Beneficiaries by making contributions to and accu- <br />mulating assets in the trust, a segregated fund, for post-retirement welfare benefits under the Plan; and <br /> <br />WHEREAS, the authority to conduct the general operation and administration of the Plan is <br />vested in the Employer or its designee, who has the authority and shall be subject to the duties with <br />respect to the trust specified in this Declaration of Trust; and <br /> <br />WHEREAS, the Employer wishes to establish this trust to hold assets and income of the Plan <br />for the exclusive benefit of Plan Participants, their Spouses, Dependents and Beneficiaries; <br /> <br />NOW, THEREFORE. the parties hereto do hereby establish this trust, by executing the Declara- <br />, \:- S' .... . ~ i <br />tion of Trust of the e. \~ LJ' ~""'''Lj ~(r.s [)eO.(~ Integral Part Trust (hereinafter referred to <br />Name 01 Employ r <br />as the "Trust"), and agree that the following constitute the Declaration of Trust (hereinafter referred to as <br />the "Declaration"): <br /> <br />4 <br />