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( <br /> EMPLOYER VANTAGECARE RETIREMENT HEALTH SAVINGS (RHS) PLAN <br /> ADOPTION AGREEMENi <br /> Plw Numbu: 8Q� c'3'�5 Check one ❑ New Piw � endmeat ro Fsirting Plan <br /> Employer Rairemrnt Hn Savings Plan Name: . <br /> I. HmployerName: l�l�v D� �d.4�n� CI Smx. <br /> II. The Employer bereby azrnu t6u a L a mh of a smte or loeal go�ernmmt or aa agency or in�t�omentallry of one <br /> or mom onia of a etete or loeal government <br /> ID. Bffeccive Date of eLe 1Maa: <br /> N. The Employer inrcnds m atilitt the T �1/� O!� PJ dy � beue6n porsuane w the foJlowiag wclfare bme6t <br /> plm(s) e�uWis6ed bY �O �P�%�+= � <br /> V. HlipWe Groope, PartieiP�� � �aP�� ��7 �mb <br /> A. Blig�ble G�oup <br /> The kllowing group or gmups oFEmployea ue eli�ble ro paztidpaa in d�e Vanssge(',ue Retiremmt Healt6 Savinpj <br /> Plan (checic all appGcable boxes): <br /> ❑ � �PbS� <br /> ❑ All Pull-Time EmP�oyeee <br /> ❑ Non-Union Emplayors <br /> ❑ �� �Y �P�oS'� lblice <br /> C ❑ Public Sakty Employ«s — Firefight«a <br /> � �❑� / Genenl Employea /ry n <br /> L'7 �����Y �P�Y�+ (SpeaCy unit(a)� � 2 C V�( Lf.6"S � YC.560Gi �]D1� ��� <br /> �O�her (aP�Y ��P(g)) � <br /> The Empbya Broup(s) speci5ed mus� corrapond m a goup(s) of �he same designuion thaz is defined in the e�anues. <br /> ordinancu, rules, rcgulationa. pasonnel manuals or otha documenu or provisiona in dFec� in the state or loraliry of <br /> [6e Employer. <br /> B. Pactidpatioa . <br /> Mmdatory Partieipmtlen: All Enployees in r6e mvered goup(s) a�e required to panidpau in <br /> . the Plan aud ahall ceaive conrribudom punwn[ ro Seaion VI. <br /> If fie Employer'a mdulying welFare benefic plan or funding under rLia VnnngeCam Reriremenc Healrh Snvings Plan is in <br /> whok or part a �mn-collectively bugained. self-insucd plaq che mudi�crimimtion `eyuicemenn of Interoal Revewc Code <br /> (1RG� Seaion 105(h) will apply. Thett rulc may impou runtion on [6e benefita receivcd by highly compensated individuals <br /> if [he Plan disaiminatts in fawr of highly mmpeosa[ed individuala in oerms of digi6iliry m benefin. The Employer ahould <br /> dittuu thae nila wich appmpriate counael. <br /> C. Pnrt�°tEli6lbiliqReqaleamwu <br /> 1. Minimum auvice: T6e minimum period of awice xequired for PutidPuion u�(wci[e N/A if no <br /> minimum service ia required). <br /> - 2. Minimum age: Thc minimum age tequiced for digibiliry ro partidpare ia �(wrim N/A if no minimum <br /> age is �Muire�• <br /> � <br /> y� u, /' r Y `� °�j 'r'a. �r� a .� � a "'�� h c � � � j 'ay �, [vu . `�, ' <br /> :# �` z r� C�f.�,t.� �' t S� '° 6£. � �.. a. s a��t ay + L �� � f' r„�,F <br /> �" � � �S �* s E� -c c -�' �- -� � p�a: r 4� .� � � � � <br /> . �.�- � �' � ..� ?� � Tr'��r $�� t s„'E3' n r `�, g" m , r � �A 'h�-� t .r'$�;� ",a xrs,a-r,. <br /> xt x / 4 � +ir fi %�'. :- {"k !� .. �, u rx �.`,�i <, �, " "�'t� 7 3 � ar'v� �kF -Y .4N'a §'�wGY <br /> . .. fw.�..''.n.�'5:�. �., ,.,.., n� ,_,. '�,'a�v R. �r' " ,�1 _.. _„4 ..� e*- � ' a.,�' �. x� r�����k�� �� <br />