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( <br /> EMPLOYER VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS► PLAN <br /> ADOPTION AGREEMENT <br /> Plan Number. 8(�3 a��5 Check onc ❑ Ncw Plan � endmwt m Paisung Plan <br /> Employer Retiremrne Hea Snvings Plsn Name: ^ . <br /> L HmployvNama l.l�u D�d 4it�rr� 1���, Snra <br /> II. T6e Bmployer hereby attesu tl�at h b a mh of a state or loea[ governmrnt or an agenry or iarvommnliry of ine <br /> or mo�e miu of a stnm or loeal govemmw� <br /> 111. 8ffeccive Date of eLe Plan: <br /> N. The Emplqer intead� ro urlllze tAe T M fopd dy i 16re bme6n punuant to rLa followiag welfare beuefit <br /> plm(s) e�nblis6ed by tLe HmPloyen _ Od ��� <br /> V. ElipWe Groope, Participation aad ParticiPsn� F�i�bilit7 RM°"�mmts <br /> A. Elig�'hle Gtoupe <br /> The kllnwing group or gmups of Faiploym ue eligiWe ro paztidpam in ihe VantageCam tt...v........t Hm(th Savinga <br /> Plan (check all applicable bara): <br /> ❑ � �P�3'� <br /> ❑ All Pull-Time PmP�oyen <br /> ❑ Non-Union Employees <br /> ❑ p"� ��9 �P��Y� — Pbli« <br /> C ❑ PubGc Safery Employus — Fre6ghtcrs <br /> ❑�� /Gmaal EmP��Y� /� n <br /> L�'7 V�IGe4'S� f't"SSOcie.�7Df1 � �� <br /> �y �ther (specify group(a)) <br /> The Empbyee group(a) ape�5ed must wrcupond ro a group(a) of the same designazioo that is defined in [he emnua, <br /> otdinsnca, nilu. regdatiom, penonnd manuala or aha documwu or provisions in effxt in rhe stare or locality of <br /> [he Employer. <br /> B. Partidpation <br /> Mandacory Partieipatlaui All Employeea in die cnve�ed group(s) ue required w puricipaa in <br /> the Plan and a6al! recave wnaibuuons punuan[ w Sxtion VI. <br /> IF[he Employeri mdulying welfue beneSc plan or funding under [hie VnnngeCa�e Nt�ircmen� Hcal�h Savinga l'lan i� in <br /> w6ole or part a mn-collec[ivtly ba�ined. tdf-innued plan, �he mndiuriminarion rcquiremenn of Interml Revenue Code <br /> (IRC) Seaion ]OS (h) will apply. 1'hese rukc wy impose raxarion on the 6enefin ccceived by highly compcmated individuals <br /> if tAe Plan disaiminaas in 6vor of highly mmpensaed individuals in cerma af eligibiliry w benefin. The Employer ahould <br /> dim�cv tlieae n�la wich appropriate counael. <br /> C. PunaPantEltgibilhpBe4airemeau <br /> 1. Minimum aavice: The minimum period of service rcquired for par[icipuion is �Q (wri[e N/A ff no <br /> minimum service ia requi�ed). <br /> 2. Minimum age: T6e minimum age requieed for digibiliry m parcidpaoe is �(vvriu N/A if no minimum <br /> age is a9uire�• <br /> � <br /> s 2 - <br /> r ti" . : y r t� �" s i a n , � T :� <br /> � � � * n . r f� i .� r � r f <br /> �;' � ' �? � i x � K t 9' a � ' � � �i t '.a � x <br /> . . ._. _. ..ta�.°'.:f.. ,.. . . . _ _i._ ,.. . . _ _ z' . .:. .� .. ..a �.� 3 � � � . <br />