HomeMy WebLinkAbout11 FLEX BENE PLAN 09-16-02AGENDA REPOR'T
NO. 11
09-16-02
MEETING DATE:
TO:
FROM:
SUBJECT:
SEPTEMBER 16, 2002
520-40
WILLIAM A. HUSTON, CITY MANAGER
HUMAN RESOURCES DEPARTMENT
APPROVE RESOLUTIONS AMENDING THE CITY'S FLEXIBLE BENEFITS
PLAN AND ADDING A TRANSIT EXPENSE REIMBURSEMENT PROGRAM
FOR ELIGIBLE CITY EMPLOYEES
SUMMARY:
Adoption of Resolution 02-88 amends the City's Flexible Benefits Plan to increase the
allowable Medical Care Expense Reimbursement from $3,000 per calendar year to
$5,000 per calendar year effective January 1,2003.
Adoption of Resolution 02-89 authorizes the establishment of a Transit Expense
Reimbursement Program for eligible City employees effective January 1,2003.
RECOMMENDATION:
.
Approve Resolution No. 02-88 to amend the City's Flexible Benefits Plan
("Plan") for eligible City employees.
.
Approve Resolution No. 02-89 to establish a Tax Free Transportation Plan
("Transit Plan"), or Transit Expense Reimbursement Program, pursuant to
Internal Revenue Code Section 132(f) for eligible City employees.
FISCAL IMPACT: $250.00 one-time set up fee for the Transit Expense Reimbursement
Program and approximately $150.00 per calendar year for administration of same. The
amendment to the City's Flexible Benefits Plan will result in a small savings to both the
City and its employees.
BACKGROUND AND DISCUSSION:
In 1984 the City Council adopted a Flexible Benefits Plan (the "Plan"), pursuant to
Section 125 of the Internal Revenue Code of 1986 (IRC) for eligible City employees.
Over the years the "Plan" has been amended to ensure consistency with State and
Federal law.
In general terms the "Plan", commonly referred to as a "cafeteria" benefits plan, allows
eligible employees to choose between cash and health care and related benefits and
provides employees with the ability to utilize pre-tax dollars for medical and related
premium elections. The "Plan" also provides a vehicle for reimbursement of eligible
expenses for dependent and/or medical care on a pre-tax basis.
S:\City Council Agenda Items\CAFETERIA PLAN 2002.doc
City Council Agenda
September 16, 2002
Page 2
Our current "Plan" allows an employee to participate in a medical care reimbursement
program on a pre-tax basis. The City currently limits participation in this "Plan"
component to $3,000 per calendar year. Because medical insurance rates and
prescription and other co-payments have increased employees' out-of-pocket expenses
in past years, and we anticipate additional increases in future years, increasing the
amount employees can contribute to the medical reimbursement account to $5,000 per
calendar year will allow the City and its employees to take full advantage of the tax
benefits associated with participation in this component of the "Plan".
Approval of Resolution 02-88 will amend the City's Flexible Benefits Plan to increase
the allowable Medical Care Expense Reimbursement from $3,000 per calendar year to
$5,000 per calendar year effective January 1, 2003.
The City also has a number of employees that live quite a distance from the City and
utilize the Metrolink as a means of transportation to and from work. Because there are
now programs available that can provide tax incentives for utilization of mass transit,
Staff is recommending establishment of a Tax Free Transportation Expense
Reimbursement Program pursuant to Section 132(f) of the Internal Revenue Code.
This program functions in a manner similar to our Medical and Dependent Care
Expense Reimbursement Programs. It allows eligible employees to set aside dollars on
a pre-tax basis to pay for eligible expenses (transit passes) incurred for the purpose of
transportation between an Employee's residence and the City.
Approval of Resolution 02-89 establishes a Tax Free Transportation Plan, pursuant' to
Internal Revenue Code Section 132(f), for eligible employees allowing them to pay for
eligible transportation expenses with pre-tax dollars through a salary reduction
agreement. Participation in the plan is limited to a maximum of $100 per month.
These programs provide our employees with flexibility and tax advantages in the
administration of their individual benefit programs. Further, they maintain the City's
benefit program at a competitive level and increases our ability to recruit and retain
highly qualified employees.
Arlene Marks, SPHR
Director of Human Resources
Attachments
S:\City Council Agenda Items\CAFETERIA PLAN 2002.doc
RESOLUTION NO. 02-88
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20
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2.8
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TUSTIN, CALIFORNIA,
AMENDING ITS FLEXIBLE BENEFITS PLAN
WHEREAS, the City adopted a Cafeteria Flexible Benefits Plan (Plan)in
1994 within the context of Section 125 of the Internal Revenue Code for the benefit of
eligible City employees; and
WHEREAS, such Plan as been amended when appropriate; and
WHEREAS, the City Council wishes to amend the Cafeteria Flexible Benefits
Plan within the context of Section 125 of the Internal Revenue Code for the benefit of
eligible City employees.
NOW, THEREFORE, the City Council of the City of Tustin, California does
hereby amend its Flexible Benefits Plan (consisting of the flexible benefits plan
document, the Adoption Agreement, and component benefit plans and policies) by
increasing the allowable Medical Care Expense Reimbursement from $3,000 per
calendar year to $5,000 per calendar year for the City of Tustin effective January 1,
2003.
Resolved further, that the City Manager or his designee may, without a
further Resolution, execute the Adoption Agreement and any related documents or
amendments which may be necessary or appropriate to adopt the plan or maintain its
compliance with applicable federal, state and local law.
Passed and adopted by the City Council of the City of Tustin at a regular
meeting held on the 16th day of September, 2002.
ATTEST:
JEFFERY THOMAS, MAYOR
CITY CLERK
S:\City Council Agenda Items\CAFETERIAPLANRESO2002.DOC
ADOPTION AG REEMENT FOR: CITY OF TUSTIN
FLEXIBLE BENEFITS PLAN
ESTABLISHMENT OF THE PLAN
The Employer named below established as set forth herein, a Flexible Benefits Plan (the "Plan") as of the Effective Date
consisting of this Adoption Agreement, the Plan Document and the Benefit Plans and Policies specifically referred to herein
including the Dependent Care Expense Reimbursement Plan and/or a Medical Care Expense Reimbursement Plan. The
purpose of the Flexible Benefits Plan is to provide eligible employees a choice between cash and the specified welfare benefits
described in this Adoption Agreement. Pre-tax premium elections under the Plan are intended to qualify for the exclusion from
income provided in Section 125 of the Internal Revenue Code of 1986.
EMPLOYER INFORMATION
Name and Address of Employed
CITY OF TUSTIN
Plan Ad mi nistrator:
2) Employer's Telephone Number:
3) Employer's Federal Tax ID Number:
4) 125 Start Date:
5) Effective Date of the Plan:
6) Last Day of the Plan Year:
Subsequent Plan Years:
7) Name and Address of the Plan
Service Provider:
8) Name and Title of Registered Agent
for Service of Legal Process:
9) Affiliated Employers which will Participate in the
ARLENE MARKS
300 CENTENNIAL WAY
TUSTIN, CA 92780
(714) 573-3052
95-6000804
01/01/02
01/01/02
12/31/02
01101-12/31
CLAIMS PROCESSOR: FLEX ONE
1932 WYNNTON ROAD
COLUMBUS, GA 31999
WILLIAM A HUSTON
CITY MANAGER
Plan:
0
0
Amendpgs
10) Employer's Type of Business: OTHER
ELIGIBILITY
All Employees employed by the Employer shall be eligible to participate under the Plan except the following: (Describe)
TEMPORARY OR SEASONAL OR NON-REGULAR PART-TIME
An eligible Employee may become a Participant in the Plan:
( ) Immediately, upon the first day of employment (but not prior to the Effective Date of the Plan).
( ) On the day following commencement of employment.
( X ) On the first day of the month following 30 days of employment.
( ) OTHER
provided the Employee completes a Salary Redirection Agreement. However, eligibility for coverage under any given
Benefit Plan or Policy shall be determined by the terms of that Benefit Plan or Policy, and reductions of the Employee's
Compensation to pay Pre-tax or After-tax Premiums shall commence when the Employee becomes covered under the
applicable Benefit Plan or Policy.
An eligible Employee may become a Participant in the Dependent Care and/or Medical Expense Reimbursement Plan(s) (if
elected below):
( ) On the same day such Employee is eligible for the Pre-Tax Premium benefits under the Plan.
( ) On the day following commencement of employment.
( ) On the first day of the month following days of employment.
( ) OTHER
provided the Employee completes a Salary Redirection Agreement selecting such benefits.
BENEFITS PROVIDED UNDER THE PLAN
The Employer elects to offer to eligible employees the following Benefit Plans and Policies subject to the terms and conditions of
the Plan. These component Benefit Plans and Policies are specifically incorporated herein by reference. The maximum Pre-tax
Premiums a Participant can contribute via the Salary Redirection Agreement is the aggregate cost of the applicable Benefit Plans
or Policies selected minus any Non-elective Contribution made by the Employer. It is intended that such Pre-tax Premium
accounts shall, for tax purposes, constitute an Employer contribution, but may constitute Employee contributions for State
insurance law purposes. Copies of the Benefit Plans or Policies (or a list of eligible Policy numbers) shall be attached as an
appendix to this Plan.
( X ) Group Medical Coverage
(x)
( )
(x)
(x)
(x)
( )
(x)
(x)
(x)
(x)
(x)
(x)
(x)
( )
Vision Care Coverage
Disability Income-Short Term (A&S)
Cancer Insurance
Group Dental Coverage
Group Term Life Insurance
Disability Income-Long Term (LTD)
Intensive Care Insurance
Accident Insurance
Hospital Indemnity Insurance (HIP)
Specified Health Event
Personal Sickness Indemnity (PSI)
Medical Care Expense Reimbursement described in Section 5.01(b) of the Plan, not to exceed $ 5,000 per Plan Year
pursuant to the CITY OF TUSTIN
Medical Care Expense Reimbursement Plan.
Dependent Care Expense Reimbursement described in Section 5.01(c) of the Plan not to exceed $5,000 per Plan Year or
$2,500 for married filing separate returns pursuant to the CITY OF TUSTIN
Dependent Care Expense Reimbursement Plan.
Opt-out Option: Additional taxable compensation for certain participants who opt-out of certain coverages (as described
in enrollment materials).
THE FUNDING AGENT
The Employer selects the following Funding Agent for the Plan (check one):
The Employer, which will comply with the requirements of Section 7.02 of the Plan.
The Flexible Benefits Trust created concurrently with the execution of the Plan, which shall receive contributions under
the Plan in accordance with Section 7.03 of the Plan.
ADMINISTRATIVE EXPENSES
Administrative Expenses incurred in operating the Plan shall be paid by (check one):
The Employer, except as otherwise noted in the Plan.
The Participants, except as otherwise noted in the Plan.
2 Amendpgs
EMPLOYER'S ACKNOWLEDGMENT
As evidenced by the formal execution of this Adoption Agreement, the undersigned Employer adopted and established this Plan on
the Effective Date as the Flexible Benefits Plan of the undersigned Employer. In doing so, the undersigned Employer
acknowledges that this Adoption Agreement and this Plan are important legal instruments with significant legal and tax implications.
The Employer also acknowledges that it has read this Adoption Agreement and the Plan in their entirety, has consulted
independent legal and tax counsel other than representatives of American Family Life Assurance Company of Columbus (AFLAC®),
to the extent considered necessary, and accepts full responsibility for participation of employees hereunder and the operation of the
- Plan. The Employer acknowledges that as Plan Sponsor and the Plan Administrator, it shall have sole responsibility to comply with
all filing, reporting and disclosure requirements imposed by the Department of Labor, Internal Revenue Service, or any other
government agency, specifically including, but not limited to, creating and filing Form 5500s and preparing and distributing
Summary Plan Descriptions. Furthermore, the Employer further acknowledges that it shall bear sole responsibility for amending
the Plan as necessary to ensure compliance with applicable tax, labor, and other laws and regulations. Employer acknowledges
receipt of the checklist of Plan Sponsor Responsibilities included in the Plan Document Request form and has agreed to the
obligations set forth therein.
It is also understood and agreed that Amedcan Family Life Assurance Company of Columbus (AFl_AC) and its Subsidiaries, agents,
and representatives, are not providing legal or tax advice to the undersigned Employer in connection with' this Plan and that no
representations, are made by it with respect to the operation of the Flexible Benefits Plan pursuant to the sample documents
provided by American Family Life Assurance Company of Columbus (AFLAC) to the Employer.
This Plan shall be construed and enforced according to the Internal Revenue Code of 1986, as amended from time to time, the
applicable regulations thereto and the laws of the State of the principal place of business of the Employer.
IN WITNESS WHEREOF, the Employer has caused this Plan and Adoption Agreement to be executed .on the day of
to ratify the adoption of the Plan adopted and effective as of the Effective Date.
WITNESS:
Employer:
By:
Title:
Date:
Corporate Officer
i
3 Amendpgs
RESOLUTION ADOPTING A FLEXIBLE BENEFITS PLAN
The undersigned hereby certifies that the following described Resolution was officially and legally adopted at the duly authorized
official meeting of the body with legal authority (hereafter "Authority") to pass said Resolution. Said meeting was held on the date set
forth below.
WHEREAS, the Authority wishes to adopt a cafeteria plan within the context of Section 125 of the Internal Revenue Code for the
benefit of the employer's eligible employees.
NOW, THEREFORE, BE IT RESOLVED, that the Authority hereby adopts the Flexible Benefits Plan (consisting of the flexible
benefits plan document, the Adoption Agreement, and component benefit plans and Policies) for the Employer named herein below
effective as of the date specified in the Adoption Agreement.
RESOLVED FURTHER, that any officer of the employer may, without a further resolution, execute the Adoption Agreement and any
related documents or amendments which may be necessary or appropriate to adopt the plan or maintain its compliance with
applicable Federal, State and local law.
Name:
Body With Legal Authority of Employer To Pass Resolution:
(Examples - Board of Directors, Board of Commissioner, etc.)
Date of Official Meeting of Authority
at which Resolution was Legally Passed:
Signatu re of Person with Authority to Certify that
Resolution was Legally Passed
Corp.orate Officer
Print Name and Title of Person above
[ OFFICIAL SEAL ] Date:
*Note: Legal requirements for a valid Board of Directors Resolution vary from State to State. This document is merely a suggested
form. Each Employer should consult with its own legal counsel to ensure compliance with applicable law.
4 Amendpgs
FLEXIBLE BENEFITS PLAN SUMMARY PLAN DESCRIPTION FOR:
CITY OF TUSTIN
FLEXIBLE BENEFITS PLAN
EMPLOYER INFORMATION
1) Name and Address of Employed
CITY OF TUSTIN
Plan Administrator:
2) Employer's Telephone Number:
3) Employer's Federal Tax ID Number:
4) Plan Number Assigned to Cafeteria
Plan (e.g., 501 if this is the first ERISA
plan number assigned):
5) 125 Start Date:
6) Effective Date of the Plan:
7) Last Day of the Plan Year:
Subsequent Plan Years:
8) Name and Address of the
Plan Service Provider:
9) Name and Title of Registered Agent
for Service of Legal Process:
10) Affiliated Employers which will participate in the
ARLENE MARKS
300 CENTENNIAL WAY
TUSTIN, CA 92780
(714) 573-3052
95-600O804
0110'1/02
01/01102
12131102
01/01-12131
CLAIMS PROCESSOR: FLEX ONE
1932 VVYNNTON ROAD
COLUMBUS, GA 31999
WILLIAM A HUSTON
CITY MANAGER
Plan:
11) Employer's Type of Business
OTHER
ELIGIBILITY
All Employees employed by the Employer shall be eligible to participate under the Plan except the following:
TEMPORARY OR SEASONAL OR NON-REGULAR PART-TIME
An eligible Employee may become a Participant in the Plan:
( ) Immediately, upon the first day of employment (but not prior to the Effective Date of the Plan).
( ) On the day following commencement of employment.
( X ) On the first day of the month following 30 days of employment.
( ) OTHER
provided the Employee completes a Salary Redirection Agreement. However, eligibility for coverage under any given
Benefit Plan or Policy shall be determined by the terms of that Benefit Plan or Policy, and reductions of the Employee's
Compensation to pay Pre-tax or After-tax Premiums shall commence when the Employee becomes covered under the
applicable Benefit Plan or Policy.
An eligible Employee may become a Participant in the Dependent Care and/or Medical Expense Reimbursement Plan(s) (if
elected below):
( ) On the same day such Employee is eligible for the Pre-Tax Premium benefits under the Plan.
( ) On the day following commencement of employment.
( ) On the first day of the month following days of employment.
( ) OTHER
provided the Employee completes a Salary Redirection Agreement selecting such benefits.
BENEFITS PROVIDED UNDER THE PLAN
The following Benefit Plans and Policies subject to the terms and conditions of the Plan are aVailable for election by eligible
employees. The maximum a participant can contribute via the Salary Redirection Agreement is the maximum aggregate cost of
the Benefit Plans or Policies elected minus any Non-elective Contribution made by the employer. It is intended that such Pre-tax
Premium amounts shall, for tax purposes, constitute employer contribution, but may constitute employee contributions for State
insurance law purposes. Copies of the Benefit Plans or Policies (or a list of eligible Policy numbers) shall be attached as an
appendix to this Plan.
( X ) Group Medical Coverage
(x)
( )
(x)
(x)
(x)
( )
(x)
(x)
(x)
(x)
(x)
(x)
(x)
( )
Vision Care Coverage
Disability Income-Short Term (A&S)
Cancer Insurance
Group Dental Coverage
Group Term Life Insurance
Disability Income-Long Term (LTD)
Intensive Care Insurance
Accident Insurance
Hospital Indemnity Insurance (HIP)
Specified Health Event
Personal Sickness Indemnity (PSI)
Medical Care Expense Reimbursement described in Section 5.01(b) of the Plan, not to exceed $ 5,000 per Plan Year
pursuant to the CITY OF TUSTIN
Medical Care Expense Reimbursement Plan.
Dependent Care Expense Reimbursement described in Section 5.01(c) of the Plan not to exceed $5,000 per Plan Year or
$2,500 for married filing separate returns pursuant to the CITY OF TUSTIN
Dependent Care Expense Reimbursement Plan.
Opt-out Option: See enrollment material.
THE FUNDING AGENT
The Employer selects the following Funding Agent for the Plan (check one):
The Employer, which will comply with the requirements of Section 7.02 of the Plan.
The Flexible Benefits Trust created concurrently with the execution of the Plan, which shall receive contributions under
the Plan in accordance with Section 7.03 of the Plan.
ADMINISTRATIVE EXPENSES
Administrative Expenses incurred in operating the Plan shall be paid by (check one):
The Employer, except as otherwise noted in the Plan.
The Participants, except as otherwise noted in the Plan.
6 Amendpgs
RESOLUTION NO. 02-89
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28
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TUSTIN, CALIFORNIA,
·
ADOPTING A NEW TRANSPORTATION BENEFITS PLAN
WHEREAS, the City wishes to adopt a transportation benefit plan within the
context of Section 132 of the Internal Revenue Code for the benefit of eligible City
employees; and
NOW, THEREFORE, the City Council of the City of Tustin, California does
hereby adopt the Transportation Benefits Plan (consisting of the transportation benefit
plan document and the Adoption Agreement) for the City of Tustin effective January
1,2003.
Resolved further, that the City Manager or his designee may, without further
Resolution, execute the Adoption Agreement and any related documents or
amendments which may be necessary or appropriate to adopt the plan or maintain its
compliance with applicable federal, state and local law.
Passed and adopted by the City Council of the City of Tustin at a regular
meeting held on the 16th day of September, 2002.
JEFFERY THOMAS, MAYOR
ATTEST:
CITY CLERK
S:\City Council Agenda Items\TRANSlTPLANRESO2002.DOC
SECTION 132(0 TAX FREE
TRANSPORTATION PLAN ADOPTION AGREEMENT
1)
Name and Address of Employer/
Plan Administrator:
EMPLOYER INFORMATION
City of Tustin
300 Centennial Way
Tustin CA 92780
2)
3)
Employer's Telephone Number:
Employer's Federal Tax
Identification Number:
Effective Date of this Plan:
Last Day of the Plan Year:
714-573-3052
95-6000804
4) 01/01/03
5) 12/31/03
6)
7) Affiliated Employers which will participate in the Plan: N/A
Name of Claims Service Provider for Transportation Expenses: TRANSIT ONEsM
ELIGIBILITY
All Employees employed by the Employer shall be eligible to participate under the Plan except the following:
Temporary or Intermittent employees
COVERAGE PERIODS
An Eligible Employee may become a Participant and/or change his election under the Plan monthly (unless otherwise
specified below):
(X) Annually ( ) Semi-Annually ( ) Quarterly ( ) Monthly
Provided the Employee completes a Salary Reduction Agreement and submits it in the time specified by the Plan
Administrator. Reductions of the Employee's Compensation to pay Pre-tax Transportation Expenses shall commence when
the Employee becomes covered under the Plan. Elections are irrevocable unless the request for change is made prior to the
beginning of the specified Coverage Period listed above.
BENEFITS PROVIDED UNDER THE PLAN
Eligible Transportation Expenses are available for election by Eligible Employees only.
(Benefits offered are indicated by the check in the appropriate boxes)
( ) Parking (X) Transit passes
Request for reimbursement of Qualified Transportation Expenses should be submitted to the Claims Service Provider as
outlined in #6 above of the Employer Information Section of this Adoption Agreement.
A cash reimbursement may not be provided for an Employee's mass transit expenses if a voucher (or similar item that may
be exchanged only for a transit pass) is readily available to the Employer for direct distribution to Employees. A voucher (or
similar item) is readily available if (1) the Employer can obtain the voucher on terms that are no less favorable than the terms
available to an Employee directly and (2) the Employer does not incixr a'significant administrative cost in obtaining the
voucher. An administrative cost will be determined to be "significant" if the Employer determines that the average
administrative cost imposed by a transit system (excluding the Employer's internal costs and delivery charges of $15 or less)
is more than one percent (1.0%) of the average monthly value of the vouchers for a particular transit system (i.e., train, bus,
subway). The Employer shall determine whether the reimbursement of mass transit expenses is permissible and advise
AFLAC as to which of its locations and employees are eligible for such benefits under the "significant administrative cost"
provisions of the proposed Section 132 regulations.
ADMINISTRATIVE EXPENSES
Administrative expenses incurred in operating the Plan shall be paid by (check one):
( ) The Employer, except as otherwise noted in the Plan.
( ) The Participants, except as otherwise noted in the Plan.
ACCOUNT BALANCES
Unused Account balances will be carried over to reimburse Eligible Transportation Expenses (up to the statutory limits)
incurred in subsequent Coverage Periods. Balances will only be carried over for active participants. Upon termination, any
unused Account balances will be forfeited.
EMPLOYER'S ACKNOWLEDGEMENT
As evidenced by the formal execution of this Adoption Agreement, the undersigned Employer adopted and established this
Plan on the Effective Date as the Section 132(0 Tax Free Transportation Plan of the undersigned Employer. In doing so, the
undersigned Employer acknowledges that this Adoption Agreement and this Plan are important legal instruments with
significant legal and tax implications.
The Employer also acknowledges that it has read this Adoption Agreement and the Plan in their entirety, has consulted
independent legal and tax counsel other than representatives of American Family Life Assurance Company of Columbus
(AFLAC), to the extent considered necessary, and accepts full responsibility for participation of Employees hereunder, the
operation of the Plan, the impact of the Plan on Compensation for pension, 401(k) and profit sharing plan administration
purposes, and the treatment of Plan Salary Reductions for state and local tax purposes. The Employer acknowledges that as
sponsor, it and the Plan Administrator (if different from the Employer) shall have sole responsibility to comply with all filing,
reporting, and disclosure requirements imposed by the Department of Labor, Internal Revenue Service, or any other
government agency. Furthermore, the Employer further acknowledges that it shall bear sole responsibility for amending the
Plan as necessary to ensure compliance with applicable tax, labor, and other laws and regulations.
It is also understood and agreed that American Family Life Assurance Company of Columbus (AFLAC), and its Subsidiaries,
agents, and representatives, are not providing legal or tax advice to the undersigned Employer in connection with this Plan
and that no representations are made by it with respect to the operation of the Section 132(0 Tax Free Transportation Plan
pursuant to the sample documents provided by American Family Life Assurance Company of Columbus (AFLAC) to the
Employer.
ADOPTION OF THE PLAN
As evidence of the adoption of the Plan, effective as of the date set forth in the Adoption Agreement, by the
Employer, this document is signed by its duly authorized officer.
Witness: Employer:
By:
Name and Title
Title:
Date:
SECTION 132(f) TAX FREE
TRANSPORTATION PLAN DOCUMENT
INTRODUCTION
Effective as of the date set forth in the Adoption Agreement, (the "Employer") establishes, pursuant to this
document, the "Section 132(f) Tax Free Transportation Plan."
The purpose of this Plan is to provide tax-free transportation benefits in lieu of otherwise taxable
compensation. It is intended that this Plan complies with the requirements of Internal Revenue Code
§132(f).
TABLE OF CONTENTS
ARTICLE I DEFINITIONS
1.Ol Affiliate ........................................................................................................................... 1
1.02 Anniversary Date ............................................................................................................... 1
1.03 Commuter Highway Vehicle ................................................................................................ 1
1.04 Commuter Highway Vehicle (Van Pool) Expenses ...................................................................... 1
1.05 Code ............................................................................................................................... 1
1.06 Compensation ................................................................................................................... 1
1.07 Coverage Period ................................................................................................................ 1
1.08 Effective Date .................................................................................................................... 1
1.09 Eligible Employee .............................................................................................................. 1
1.10 Eligible Transportation Expenses ........................................................................................... 1
1.11 Employee .........................................................................................................................2
1.12 Employer .........................................................................................................................2
1.13 Employment ..................................................................................................................... 2
1.14 Plan ................................................................................................................................ 2
1.15 Plan Year ........................................................................................................................2
1.16 Qualified Parking Expense ...... ~ ............................................................................................ 2
1.17 Salary Reduction Agreement ................................................................................................ 2
1.18 Transit Pass Expense .......................................................................................................... 2
ARTICLE II ELIGIBILITY
2.01 Eligibility ......................................................................................................................... 3
2.02 Rehire ............................................................................................................................. 3
ARTICLE III BENEFITS AND ELECTIONS
3.01
3.02
3.03
Election of Benefits .............................................................................................................3
Account ........................................................................................................................... 3
Time Period For Making or Modifying Salary Reduction Agreement .............................................. 4
3.04
3.05
3.06
3.07
No Return of Unused Amount in Account ................................................................................. 4
Termination of Employment ................................................................................................. 4
Substantiation of Expenses ................................................................................................... 4
Reimbursement of Eligible Expenses ....................................................................................... 4
ARTICLE IV ADMINISTRATION
4.01 Plan Administrator ............................................................................................................ 5
4.02 Procedure ........................................................................................................................5
4.03 Powers and Duties of the Plan Administrator ............................................................................ 5
4.04 No Action with Respect to Own Benefit .................................................................................... 5
4.05 Indemnification ................................................................................................................. 5
ARTICLE V AMENDMENT AND TERMINATION
ARTICLE VI MISCELLANEOUS
6.01
6.02
6.03
6.04
6.05
6.06
6.07
6.08
6.09
6.10
6.11
Right to Assets ..................................................................................................................6
No Inducement, Contract or Guarantee of Employment .............................................................. 6
Spendthrift ....................................................................................................................... 6
Conclusiveness of Records .................................................................................................... 6
Adoption By Affiliate .......................................................................................................... 6
Payment of Expenses .......................................................................................................... 6
Governing Law .................................................................................................................. 6
Right to Require Information and Reliance Thereon ................................................................... 7
Construction .....................................................................................................................7
Notification of Employees .................................................................................................... 7
Taxability of Benefits .......................................................................................................... 7
ARTICLE I
DEFINITIONS
The terms used in this Plan shall have the meanings set forth in this Article unless the context in
which they are used clearly indicates that some other meaning is intended.
1.01 Affiliate means any entity, which is a member of a group, which includes Employer and
is defined in Code {}414(b) or (c).
1.02 Anniversary Date means the first day of any Plan Year.
1.03 Commuter Highway Vehicle means any highway vehicle:
(1) which has a seating capacity of at least 6 adults (not including the driver), and
(2) at least 80 percent of the mileage use of such vehicle is reasonably expected to be
used:
1.04
1.05
1.06
1.07
(a) for purposes of transporting Employees in connection with travel
between their residences and their place of employment, and
(b)
on trips during which the number of Employees transported for such
purposes is, on average, at least one-half of the adult seating capacity of
such vehicle (not including the driver).
Commuter Highway Vehicle (Van Pool) Expenses mean expenses incurred for
transportation in a Commuter Highway Vehicle if such transportation is in connection
with travel between the Employee's residence and place of Employment.
Code means the Internal Revenue Code of 1986, as amended from time to time.
Compensation means the cash wages or salary paid to an Employee by the Employer.
Coverage Period means the monthly, quarterly, semi-annual, annual (or other period)
designated on the Adoption Agreement during which a Salary Reduction Agreement is in
effect and irrevocable.
1.08
1.09
1.10
Effective Date means the date the plan was adopted as indicated in the Adoption
Agreement.
Eligible Employee means all Employees who meet the eligibility requirements set forth
in Article II and III.
Eligible Transportation Expenses means those qualified expenses incurred by the
Employee to purchase or pay for Transit Pass Expenses, Commuter Highway Vehicle
Expenses or Qualified Parking Expenses incurred for purposes of transportation between
an Employee's residence and place of Employment.
1.11
1.12
1.13
1.14
1.15
1.16
1.17
1.18
Employee means an individual that the Employer classifies as a common-law employee
and who is on the Employer's W-2 payroll, but does not include any leased employee
(including, but not limited to those individuals defined in Code § 414(n)), or an
individual classified by the Employer as a contract worker, independent contractor,
temporary employee or casual employee, whether or not any such persons are on the
employer's W-2 payroll, or any individual who performs services for the Employer but
who is paid by a temporary or other employment agency such as "Kelly, .... Manpower,"
etc., or any employee covered under a collective bargaining agreement.
Employer means the employer designated on the Adoption Agreement and any Affiliate,
which has adopted this Plan pursuant to Section 6.05.
Employment means the performance of services by an Employee for the Employer.
Plan means this Section 132(0 Tax Free Transportation Plan, as set forth in its entirety in
this document, as may be amended from time to time.
Plan Year means the twelve-month period as indicated in the Adoption Agreement.
Qualified Parking Expenses means the following parking expenses, unless such
expenses are incurred for any parking on or near property used by the Employee for
residential purposes:
(1)
Expenses incurred by an Employee to park his or her car on or near the business
premises of the Employer;
(2)
Expenses incurred by an Employee to park his or her car on or near a location
from which the Employee commutes to work:
(a) by mass transit facilities, whether or not publicly owned,
(b)
by using the services of any person in the business of transporting
persons for compensation or hire if such transportation is provided in a
Commuter Highway Vehicle.
(c) by Commuter Highway Vehicle, or
(d)
by carpool (i.e., two or more individuals who commute together in a
motor vehicle on a regular basis).
Salary Reduction Agreement means the actual or deemed agreement pursuant to which
an Eligible Employee enrolls in the Plan in accordance with Article III.
Transit Pass Expenses mean expenses incurred for any pass, token, fare card, voucher,
or similar item entitling a person to transportation (or transportation at a reduced price) if
such transportation is:
(1) on mass transit facilities, whether or not publicly owned, or
(2)
provided by any person in the business of transporting persons for compensation
or hire if such transportation is provided in a vehicle with a seating capacity of at
least six adults (excluding the driver).
ARTICLE II
ELIGIBILITY
2.01
2.02
Eligibility. Employees (other than those described as ineligible in the Adoption
Agreement) who complete any applicable waiting period established by an Employer and
set forth in the Adoption Agreement shall be eligible to participate in the Plan as of the
first Coverage Period following such eligibility.
Rehire. If an Employee terminates his Employment for any reason including (but not
limited to) disability, retirement, layoff, quit, discharge, or voluntary resignation, and
then is rehired, the Employee must complete any applicable waiting period before again
becoming eligible to participate in the Plan as of the next Coverage Period.
ARTICLE III
BENEFITS AND ELECTIONS
3.01.
3.02.
Election of Benefits. Eligible Employees may enter into a Salary Reduction Agreement
with the Employer whereby the Employee agrees to reduce his or her unearned
Compensation by the amount of his or her anticipated future Eligible Transportation
Expenses for the upcoming Coverage Period. The amount elected for reduction will be
divided by the remaining payroll periods in the Coverage Period. The resulting per
payroll period reduction amount will be deducted on a pre-tax basis from the Employee's
Compensation each payroll period unless/until the Employee changes his or her election
for an upcoming Coverage Period.
Account. The Employer will create and maintain a bookkeeping account on behalf of
each Employee who enters into a Salary Reduction Agreement, which account will
reflect the accumulated amount of Compensation that has been deducted on a pre-tax
basis from the Employee's Compensation. When cash reimbursement is made to the
Employee for his or her Eligible Transportation Expenses, the balance of said account
will be reduced by the amount of the reimbursement. The amount of any reimbursement
shall not exceed the accumulated amount in said account at the time of the reimbursement
nor any of the following monthly limitations:
a.
Monthly Limitation for Qualified Parking Expenses: Reimbursements for
Qualified Parking Expenses will not exceed the monthly value as set forth in
Internal Revenue Code Section 132(t), as adjusted for inflation.
bo
Monthly Limitation for Transit Pass Expenses and Commuter Highway
Vehicle Expenses: Reimbursements for combined expenses for Transit Pass
Expenses and Commuter Highway Vehicle Expenses will not exceed the monthly
value as set forth in Internal Revenue Code Section 132(1), as adjusted for
inflation.
Special Rules for Transit Passes: A cash reimbursement may not be provided
for an Employee' s mass transit expenses if a voucher (or similar item that may be
exchanged only for a transit pass) is readily available to the Employer for direct
distribution to Employees. A voucher (or similar item) is readily available if (1)
the Employer can obtain the voucher on terms that are no less favorable than the
terms available to an Employee directly and (2) the Employer does not incur a
3.03
3.04
3.05
3.06
3.07
significant administrative cost in obtaining the voucher. An administrative cost
will be deemed to be "significant" if the Plan Administrator (in its sole
discretion) determines that the average administrative cost imposed by the fare
media provider and incurred by the Employer (excluding delivery charges of $15
or less) is more than one percent (1.0%) of the average monthly value of the
vouchers for a particular transit system (i.e., train, bus, subway).
Time Period For Making or Modifying Salary Reduction Agreement.
A Salary Reduction Agreement must be made before the earlier of: i) the Coverage
Period to which it relates; and ii) the receipt of Eligible Transportation Expense Benefits
to which it relates. Such election shall be effective the first pay period after the Employer
processes the change. Once a Salary Reduction Agreement is made, it cannot be changed
during the Coverage Period to which it relates. Salary Reduction Agreements may only
be changed for future Coverage Periods.
No Return of Unused Amount in Account.
Any unused amount in the Employee's account that has not been used to reimburse the
Employee for Eligible Transportation Expenses incurred prior to the end of the Coverage
Period to which the Employee's Salary Reduction Agreement applies will be carded over
into future Coverage Periods.
Termination of Employment
The Employee's Salary Reduction Agreement shall terminate upon termination of
Employment. Amounts remaining in the Employee's Account will be forfeited.
Substantiation of Expenses.
The Employee may claim reimbursement for Eligible Transportation Expenses by
submitting, in the manner and form approved by the Employer, a record of the expenses
incurred. The Employee shall provide information showing that the Employee in fact
incurred such Eligible Transportation Expenses. The information submitted should
generally specify the amount paid, contain evidence of payment, and specify the date of
the expenses for which reimbursement is claimed. The information submitted by the
Employee may vary depending on the facts and circumstances surrounding the expense,
including the method of payment and the particular transportation method used by the
Employee.
Reimbursement of Elieible Transportation Expenses.
The Employer will provide reimbursement of substantiated Eligible Transportation
Expenses on an administratively convenient periodic basis and will debit the Employee's
Account accordingly (at least monthly).
ARTICLE IV
ADMINISTRATION
4.01
4.02
4.03
4.04
4.05
Plan Administrator. The Plan Administrator shall be the Employer, who shall act in its
administrative capacity through an individual or committee appointed to administer this
arrangement.
Procedure. The Plan Administrator may be replaced by the Employer's Chief Executive
Officer or his designee at any time with or without cause upon giving written notice to
the person who may be serving. A Plan Administrator may resign at any time by giving
written notice to the Employer.
Powers and Duties of the Plan Administrator. The Plan Administrator shall have
exclusive responsibility for, and all powers necessary or desirable to carry out, the
administration of the Plan and, without limitation on the foregoing, shall have complete
discretionary power and authority to:
(a) Adopt any rules and regulations it deems desirable for the conduct of its affairs
and the administration of the Plan;
(b) Take any action it deems necessary or appropriate to comply with any
requirements of applicable law with respect to notice and disclosure and the
preparation and filing of reports and forms, if necessary;
(c) Construe and interpret the Plan and make determinations (including factual
determinations) under the provisions of the Plan with respect to all rights,
benefits, duties and entitlements, including but not limited to eligibility for
benefits, amounts of benefits payable, and all other matters pertaining to the
operation and administration of the Plan, all of which determinations are to be
made in the Plan Administrator's sole discretion;
(d) Appoint or employ persons to assist in the administration of the Plan; and
(e) Make any equitable adjustments to correct any error or omission discovered in
the administration of the Plan.
No Action with Respect to Own Benefit. The Plan Administrator shall not take part in
any discretionary action in connection with his or her participation as an Eligible
Employee under the Plan. All such action shall be taken by the Employer through its
Chief Executive Officer.
Indemnification. The Employer shall indemnify and hold harmless the Plan
Administrator and its Chief Executive Officer from and against any liability, loss, cost or
expense arising from any action or inaction by such parties in connection with their
responsibilities under the Plan.
5.01
ARTICLE V
AMENDMENT AND TERMINATION
The Employer may at any time (1) amend the Plan contained in this document in any
manner deemed advisable by it, (2) terminate or limit the Plan contained in this
document, or (3) terminate or limit the participation in the Plan by any Employer,
effective as of the date specified in the instrument of amendment or termination, without
the consent of any Employer, Eligible Employee or participating Employee. Such
amendments may be retroactive to the extent deemed appropriate by the Employer and
may be made in contemplation of, or with specific reference to, a particular transaction,
job elimination, reduction in force, or similar event. The Chief Executive Officer of the
Employer (or his designee) shall be authorized to adopt on behalf of the Employer all
amendments to the Plan. Amendments shall be adopted in writing by and signed by the
Chief Executive Officer and shall be effective without further action of the Employer or
its Board of Directors.
ARTICLE VI
MISCELLANEOUS
6.01
6.02
6.03
6.04
6.05
6.06
Right to Assets. Neither the establishment of the Plan nor the payment of benefits under
the Plan shall be construed as giving any legal or equitable right to any Employee or
former Employee against the Employer or its officers or employees except as expressly
provided herein, and all rights under any Plan shall be satisfied, if at all, only out of the
general assets of the Employer.
No Inducement Contract or Guarantee of Employment. The Plan does not constitute
inducement or consideration for the employment of any Eligible Employee, nor is it a
contract between any Employer and Eligible Employee. Participation in the Plan shall not
give any Eligible Employee any right to continued employment with his Employer, and
the Employer retains the right to hire and discharge any Eligible Employee at any time,
with or without cause, as if the Plan had never been adopted.
Spendthrift. Except as permitted by law and this section, no assignment of any rights or
benefits arising under the Plan shall be permitted or recognized. The Employer shall not
be liable for or subject to the debts, contracts, liabilities, or torts of any person entitled to
benefits under this Plan.
Conclusiveness of Records. The records of the Employers with respect to age, service,
employment history, employment termination, compensation, absences, illnesses and all
other relevant matters shall be conclusive for purposes of the administration of the Plan.
Adoption by Affiliate. Any Affiliate may, with the consent of the Chief Executive
Officer of the Employer (or his designee), adopt the Plan by executing a copy of the Plan
as a participating Employer, in which case its Eligible Employees shall become entitled
to the benefits designated herein.
Payment of Expenses. The Employer and, to the extent deemed appropriate by the Plan
Administrator, the participating Employers shall pay all the expenses of administration of
the Plan and the expenses of the Plan Administrator, and any other expenses incurred at
the direction of the Plan Administrator.
6.07
6.08
6.09
6.10
6.11
Governin~ Law. The Plan shall be governed, construed, administered and regulated in
all respects under the laws of Georgia.
Right to Require Information and Reliance Thereon. Each Employer and the Plan
Administrator shall have the right to require Eligible Employees to provide them and
their agents with such information, in writing, and in such form as it may deem necessary
to the administration of the Plan, and such parties may rely on that information in
carrying out their duties hereunder.
Construction. One gender includes the other, and the singular and plural include each
other when the meaning would be appropriate. The Plan's headings and subheadings
have been inserted for convenience of reference only and must be ignored in any
construction of the provisions. If a provision of this Plan is illegal or invalid, that
illegality or invalidity does not affect other provisions. Any term with an initial capital
not expected by capitalization rules is a defined term according to Article I.
Notification of Employees. The Employer shall communicate the terms and conditions
of the Plan to all Eligible Employees.
Taxability of Benefits. The Employer makes no guarantee as to the excludability of
benefits under this Plan from federal, state, or local taxes, and it shall be the Employee's
sole responsibility to pay any taxes due as a result of the payment of benefits hereunder.
SECTION 132(0 TAX-FREE TRANSPORTATION PLAN
Summary Plan Description for City of Tustin
EMPLOYER INFORMATION
Name and Address of Employer/
Plan Administrator:
City of Tustin
300 Centennial Way
Tustin, CA 92780
2)
3)
4)
5)
6)
7)
Employer's Telephone Number:
Employer's Federal Tax
Identification Number:
Effective Date of this Plan:
Last Day of the Plan Year:
714-573-3052
95-6000804
01/01/03
12/31/03
Name of Claims Service Provider for Transportation Expenses: TRANSIT ONEsM
Affiliated Employers which will participate in the Plan: N/A
ELIGIBILITY
All Employees employed by the Employer shall be eligible to participate under the Plan except the
following:
Temporary or Intermittent Employees
COVERAGE PERIODS
An Eligible Employee may become a Participant and/or change his election under the Plan monthly (unless
otherwise specified below):
(x) Annually ( ) Semi-Annually ( ) Quarterly ( ) Monthly
Provided the Employee completes a Salary Reduction Agreement and submits it in the time specified by
the Plan Administrator. Reductions of the Employee's Compensation to pay Pre-tax Transportation
Expenses shall commence when the Employee becomes covered under the Plan. Elections are irrevocable
unless the request for change is made prior to the beginning of the specified Coverage Period listed above.
BENEFITS PROVIDED UNDER THE PLAN
Eligible Transportation Expenses are available for election by Eligible Employees only.
(Benefits offered are indicated by the check in the appropriate boxes)
( ) Parking (X) Transit Passes
Request for reimbursement of Qualified Transportation Expenses should be submitted to your Employer or
the Claims Service Provider as outlined in #6 of the Employer Information Section above.
A cash reimbursement may not be provided for an Employee's mass transit expenses if a voucher (or
similar item that may be exchanged only for a transit pass) is readily available to the Employer for direct
distribution to Employees. A voucher (or similar item) is readily available if (1) the Employer can obtain
the voucher on terms that are no less favorable than the terms available to an Employee directly, and (2) the
Employer does not incur a significant administrative cost in obtaining the voucher. An administrative cost
will be determined to be "significant" if the Employer determines that the average administrative cost
imposed by a transit system (excluding the Employer's internal costs and delivery charges of $15 or less) is
more than one percent (1.0%) of the average monthly value of the vouchers for a particular transit system
(i.e., train, bus, subway). The Employer shall determine whether the reimbursement of mass transit
expenses is permissible and advise AFLAC as to which of its locations and employees are eligible for such
benefits under the "significant administrative cost" provisions of the proposed Section 132 regulations.
ADMINISTRATIVE EXPENSES
Administrative expenses incurred in operating the Plan shall be paid by (check one):
( ) The Employer, except as otherwise noted in the Plan.
( ) The Participants, except as otherwise noted in the Plan.
ACCOUNT BALANCES
Unused Account balances will be carried over to reimburse Eligible Transportation Expenses (up to the
statutory limits) incurred in subsequent Coverage Periods. Balances will only be carried over for active
participants. Upon termination, any unused Account balances will be forfeited.
SECTION 132(0 TAX-FREE TRANSPORTATION PLAN
PLAN SUMMARY
Introduction
Your Employer (the "Employer") is pleased to sponsor an employee benefit Plan known as a "Section 132(0 Tax Free
Transportation Plan" (the "Plan") for you and your fellow employees. The Employer provides you with the opportunity
to use pre-tax dollars to pay for Eligible Transportation Expenses by entering into a salary reduction arrangement
instead of receiving a corresponding amount of your regular pay. This arrangement helps you because the benefits you
elect are nontaxable; you save social security and income taxes on the amount of your salary reduction.
This Plan Summary describes the basic features of the Plan, how it operates, and how you can get the maximum
advantage from it. The booklet is only a summary of the key parts of the Plan, and a brief description of your rights as
a Participant. It is not a part of the official Plan documents. If there is a conflict between them and this booklet, the
Plan documents will apply. If you have any further questions regarding the terms of this Plan, contact the Plan
Administrator or your Human Resources supervisor.
Questions & Answers
Q-1. What is the purpose of the Plan?
The purpose of the Plan is to allow eligible employees to use funds provided by the Employer through employee salary
reduction to fund Eligible Transportation Expenses. Under the arrangement, the Employer may use such funds to pay
eligible Parking and Mass Transit Expenses directly on your behalf, or allow you to submit claims for reimbursement
of your out-of-pocket eligible Parking and Mass Transit Expenses. [Note: Transit passes may generally be purchased
by your Employer and distributed to you. You cannot generally be reimbursed for your out-of-pocket Mass Transit
Expenses unless your Employer determines that there is a significant administrative cost associated with purchasing the
passes.]
Q-2. Who can participate in the Plan?
Each employee of the Employer who meets the description of eligible Employee in the Employer Information Section
is eligible to participate in the Plan. Those employees who actually participate in the Plan are called "Participants". An
employee continues to participate until he or she: i) elects not to participate in accordance with Q~6; or ii) is no longer
employed by the Employer.
Q-3. What tax advantages are available through the Plan?
The Plan permits you to pay for Eligible Transportation Expenses with pre-tax dollars through salary reduction rather
than regular pay. The use of pre-tax dollars reduces your taxable income and you save Social Security and income
taxes on the amount of your salary reduction. Suppose your monthly gross pay is $2,500 per month and your parking
costs are $100.00 per month. Also, suppose your total withholdings (income tax and Social Security) are 22.65%.
After paying for coverage from your after-tax pay, your take home pay is $1,833.75. However, under the pre-tax
premium Plan, you will be considered to have received $2,400.00 gross pay rather than $2,500 for tax purposes with
$100.00 contributed for Eligible Transportation Expenses. This means your take home pay will be $1,856.40 with the
pre-tax premium Plan rather than $1,833.75 without it. Thus, you save $22.65 per month ($271.80 per year) by
participating in the pre-tax premium Plan. The Table below illustrates this savings.
With Transportation Plan Without Transportation
Plan
Gross Monthly Pay 2,500.00 2,500.00
Pre-Tax Parking Under Plan 100.00 --
Taxable Income 2,400.00 2,500.00
Estimated Federal Tax (15%) 360.00 375.00
FICA Tax 183.60 191.52
After-Parking 100.00
Take Home Pay 1,856.40 1,833.75
Of course, your actual tax-savings will vary depending on your circumstances.
Q-4. How do I become a Participant?
You become a Participant by signing an individual Salary Reduction Agreement electing to participate in the Plan, as
well as agreeing to a salary reduction in order to fund your Reimbursement Account after you become eligible. You
will be provided a Salary Reduction Agreement when you first become eligible to participate.
You must complete the form and turn it in to the Personnel Office before you can become a Participant, whereby you
agree to reduce your unearned salary/compensation by the amount of your future Eligible Transportation Expenses for
the applicable Coverage Period (e.g., the monthly or pay period specified above). The Coverage Period amount elected
for reduction will be divided by the remaining payroll periods in the Coverage Period. The resulting per payroll period
reduction amount will be deducted on a pre-tax basis until you change your election.
Q-5. What are the enrollment periods for entering the Plan?
The initial period for enrolling in the Plan is the period specified by the Plan Administrator immediately proceeding the
Plan's Effective Date. After the initial enrollment period, you may enroll in the Plan prior to any applicable Coverage
Period on regular enrollment periods conducted as set forth in the Employer Information Section, by following the
procedures for becoming a Participant before the next enrollment period. The Plan AdminiStrator may re~ffiiy6u to
complete enrollment procedures within a specified time period before the enrollment period. :~;~ ~'?
Q-6. Can I change my election during a Coverage Period?
No. Once a Salary Reduction Agreement is made, it cannot be changed during the Coverage Period to which it relates.
Changes may be made to your election, however, for future Coverage Periods provided the change is made before the
earlier of: i) the Coverage Period to which it relates; and ii) the receipt of Eligible Transportation Expense Benefits to
which it relates. Such election shall be effective the first pay period after the Employer processes the change.
Q-7. What is my "transportation expense reimbursement account"?
If you elect benefits under the Plan, your employer will establish and maintain a non-interest bearing transportation
expense reimbursement account ("Account") to keep a record of the reimbursements you are entitled to.
Q-8. How is my Account funded?
When you complete the Salary Reduction Agreement, you specify the amount of Qualified Transportation Expense
benefits for which you wish to pay with your salary reduction. Thereafter, your Account will be credited with that
portion of your gross income you have elected to forego through salary reduction. These portions will be credited as of
each pay period.
Benefit Elected
$100/month for Qualified Parking
Annual Cost
$1200
Assuming you are paid twice a month, the cost of the above benefits per paycheck would be $50.00. The tax-~o~:total~'~':
of $1200 would be spread equally over 24 paychecks, or $50.00 per pay period. Thus, each pay period, the ~: ~
corresponding amounts would be as follows:
Total Withheld per Pay Period
$ 50.00
The maximum aggregate level of benefits that may be elected is the maximums set forth in Section 132(f) of the
Internal Revenue Code
Q-9 What is an "Eligible Transportation Expense"?
Eligible Transportation Expenses include:
Qualified Parking Expenses defined as expenses incurred to park your car on or near the business premises of
the Employer or expenses incurred to park your car at a location from which you commute to work by (a)
mass transit facilities, (b) a Commuter Highway Vehicle, or (c) by carpool.
Transit Pass Expenses defined as expenses incurred for a pass, token, fare card, voucher, or similar item (a
"Pass") for transportation (1) on mass transit facilities, whether or not publicly owned, or (2) provided by
any person in the business of transporting persons for compensation or hire if such transportation is provided
in a vehicle with a seating capacity of at least six adults (excluding the driver).
Request for reimbursement of Qualified Transportation Expenses should be submitted to your
Employer or the Claims Service Provider as outlined in the Employer Information Section.
SPECIAL RULES FOR TRANSIT PASSES: A cash reimbursement may not be provided for an Employee's mass
transit expenses ifa voucher (or similar item that may be exchanged only for a transit pass) is readily available to the
Employer for direct distribution to Employees. Thus, if Transit Passes are readily available, the Plan will purchase the
Transit Pass directly and charge the cost against the Account of the employee requesting a Transit Pass. A voucher (or
similar item) is readily available if(l) the Employer can obtain the voucher on terms that are no less favorable than the
terms available to an Employee directly and (2) the Employer does not incur a significant administrative cost in
obtaining the voucher. An administrative cost will be determined to be "significant" if the Plan Administrator (in its
sole discretion) determines that the average administrative cost incurred by the Employer (excluding delivery charges
of $15 or less) is more than one percent (1.0%) of the average monthly value of the vouchers for a particular transit
system (i.e., train, bus, subway). Your Employer, in enrollment materials, will tell you whether reimbursement for mass
transit expenses is possible.
Commuter Highway Vehicle (Van Pool) Expenses defined as expenses incurred for transportation in a
,commuter highway vehicle" if such transportation is in connection with travel between the
Employee's residence and place of Employment. A Commuter Highway Vehicle is any highway
vehicle with a seating capacity of at least 6 adults (not including the driver), and at least 80 percent of
the mileage of which vehicle is for purposes of transporting employees in connection with travel
between their residences and their place of employment and on trips during which the number of
employees transported for such purposes is, on average, at least one-half of the adult seating capacity
of the vehicle (not including the driver)
Q-10. What is the maximum Qualified Transportation Expense benefit I may elect?
The maximum amount you may contribute to the Account cannot exceed the maximum amount specified in
SeCtion 132(0 of the Internal Revenue Code. For 2002, the maximum amount is:
For Qualified Parking Expenses
$185/month
For Transit Passes and Commuter Highway
Vehicle Expenses (combined total)
Q-11. How do I receive reimbursement under the Plan?
$100/month
When you incur an expense that is eligible for payment, you must complete and submit a Request for
Reimbursement Form (which will be supplied to you) to your Employer or the Claims Service Provider as outlined in
the Employer Information Section. As a general rule, you must submit a receipt (or other third party verification) along
with your claim form. For Eligible Transportation Expenses, you will be reimbursed for your eligible expenses up to
the amount that has been deducted from your pay check, not to exceed $185 a month for Parking or $100 for Mass
Transit Passes, following submission of the Request for Reimbursement.
What if I Overestimate My Expenses: If your reimbursement request was for less than your current Account
balance, the unused amounts in your Account will roll over and be available for future reimbursements. You may need
to adjust the election for the next Coverage Period in order to use up your surplus Account balance. For example, if
your monthly parking election (and anticipated monthly expense) is $100, but you only incur $75 worth of Eligible
Parking Expenses in January, you might want to change your election for February to $75 in order to use up the $25
surplus from January. Then, you can increase your election back to $100 for March prior to March 1St.
What if I Underestimate My Expenses: If your reimbursement request was for an amount that was less than $185,
but more than your current Account balance, the excess part of the reimbursement will be carried over into the
following months; to be paid out as your balance becomes adequate (subject to the monthly maximum described
above). Remember, though, that you can't be reimbursed for any total expenses above your available credits to your
Account. You may not be reimbursed for any expenses that arise before your Salary Reduction Agreement becomes
effective.
If you are provided a Transit Pass that is purchased directly by the Employer or Plan Administrator, your Account will
be debited directly for the cost of the Transit Pass. You will not need to submit a Request for Reimbursement Form.
If you submit a request for reimbursement that is less than $15.00, it will be carried forward and combined with future
requests until the reimbursable amount is greater than $15.00. If your account balance is less than $15.00, then the
entire amount of the reimbursable requests shall be paid after the close of the Plan Year.
In addition, you will have 90 days after the end of the Plan Year in which to submit a Request for Reimbursement form
for Eligible Transportation Expenses incurred during the previous Plan Year. You will be notified in writing if any
request for reimbursement is denied.
Q-12. What if I have an account balance and I terminate my employment?
If you have any funds in your Account at the time you terminate employment, any amounts not applied for Eligible
Transportation Expenses incurred prior to the termination will be forfeited.
Q-13. Will I have any administrative costs under the Plan?
Unless otherwise indicated in the Employer Information Section, the Employer is bearing the entire cost of
administering the Plan.
Q-14. How long will the Plan remain in effect?
Although the Employer expects to maintain the Plan indefinitely, it has the right to modify or terminate the Plan at any
time. It is also possible that future changes in state or federal tax laws may require that the Plan be amended
accordingly.
Q-15. What happens if a request for reimbursement is denied?
If you are denied a benefit under this Plan, the Plan's Administrator will notify you in writing within 90 days of the
date you submitted your request. Such notification will set out the reasons your request was denied, and further advise
you of what steps, if any, you might take to validate the request. It will further advise you of your right to request an
administrative review of the denial of the request; you may request a review any time within the 60-day period after
you have received notice that the request was denied. You will have the opportunity to review any important
documents held by the Plan Administrator, and to submit comments and other supporting information. In most cases, a
decision will be reached within 60 days of the date you request a review.
Q-16. What effect will Plan participation have on Social Security and other benefits?
Plan participation will reduce the amount of your taxable compensation. Accordingly, there could be a decrease in
your Social Security benefits and/or other benefits (e.g., pension, disability and life insurance) which are based on
taxable compensation.
TRANSPORTATION EXPENSE REIMBURSEMENT SERVICES AGREEMENT
This Agreement, effective upon execution for the Plan Year, by and between City of Tustin and American
Family Life Assurance Company (AFLAC)
WITNESSETH:
WHEREAS, the Employer has adopted a Section 132(f) Tax Free Transportation Plan for its
Employees to be adopted and administered in accordance with Section 132 of the Internal
Revenue Code of 1986, as amended (the "Code"); and
WHEREAS, the Employer will serve as the Plan Administrator; and
WHEREAS, the Employer desires that AFLAC, as its agent, furnish reimbursement services for
eligible Qualified Transportation Expenses within a framework of policies, interpretations, rules,
practices and procedures (the "reimbursement practices and procedures") made and established
by the Employer in (i) receiving and processing requests for Qualified Transportation Expenses
under the Plan ("Requests") and (ii) disbursing benefit payments from Employer funds (as provided
for in Section II.A) for eligible Qualified Transportation Expenses under the Plan; and
WHEREAS, the Employer is to administer all aspects of the Plan other than the reimbursement of
Qualified Transportation Expenses and pay all Plan benefits owed or established under the Plan to
its Participants, and AFLAC is to provide the agreed upon services to the Plan without assuming
any such liability;
NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, it is
hereby agreed as follows:
Section I. Enrollment and Determination of Eligibility
A. The Employer shall:
(1)
determine whether the reimbursement of mass transit expenses is permissible and advise
AFLAC as to which of its locations and employees are eligible for such benefits under the
"significant administrative cost" provisions of the proposed Section 132 regulations. A
cash reimbursement may not be provided for an employee's mass transit expenses if a
voucher (or similar item that may be exchanged only for a transit pass) is readily available
to the Employer for direct distribution to Employees. A voucher (or similar item) is readily
available if (1) the Employer can obtain the voucher on terms that are no less favorable
than the terms available to an Employee directly, and (2) the Employer does not incur a
significant administrative cost in obtaining the voucher. An administrative cost will be
determined to be "significant" if the Employer determines that the average administrative
cost imposed by a transit system (excluding the Employer's internal costs and delivery
charges of $15 or less) is more than one percent (1.0%) of the average monthly value of
the vouchers for a particular transit system (i.e. train, bus, subway).
(2)
be responsible for interpreting the Plan and its provisions, its terms, conditions and
operations; and
(3)
(4)
notify Plan Participants of their ability to apply for Qualified Transportation Expense
reimbursement benefits and supply them with Request forms (to be provided by AFLAC)
and Request filing instructions; and
provide AFLAC with the names, addresses, Social Security Numbers, and elected
amounts of all participants in the Qualified Transportation Expense Plan; and
B.
(5)
immediately inform AFLAC (via Telefax) as to any new Participants (or election changes
by existing Participants), or of any other change which will affect AFLAC's responsibilities
hereunder.
In determining any person's right to Qualified Transportation Benefits under the Plan, AFLAC shall
rely on the eligibility information furnished by the Employer, and any signed statements by
Participants regarding the eligibility of their Requests under the Plan. It is mutually understood that
the effective performance of this Agreement by AFLAC will require that it be advised on a timely
basis by the Employer during the continuance of this Agreement of the identity of individuals
eligible for benefits under the Plan. Information modifying a Participant's eligibility or status/election
under the Plan shall identify the effective date of eligibility and the termination date of eligibility and
shall be provided to AFLAC (via telefax) prior to the effective date of such modification in order to
be considered by AFLAC in making benefit determinations hereunder. AFLAC shall not be
responsible for Requests paid in error where, the Employer has failed to inform AFLAC (in a form
and with such information as may reasonably be required by AFLAC) of a Participant's eligibility
change prior to the release of the benefit payment.
Section II. Fundinq and Payment of Requests for the Plan Benefits
A. Select one below:
O Daily Processing Option. The Employer shall:
(i)
make sufficient funds available from its general assets for amounts allocable to
eligible reimbursement benefits under its Plan by depositing a "Maintenance Deposit"
(in amounts specified by AFLAC from time to time) in an Employer-owned and named
account (the "Account") in a financial institution selected by Employer and AFLAC to
facilitate the timely processing of Requests under the Plan; and
(ii)
.grant AFLAC withdrawal authority over the Account (to establish a zero balance
arrangement see next option) to enable payment of reimbursement benefits under
the Employer's Plan; and
deposit additional funds (at the request of AFLAC) in order to reestablish the
Maintenance Deposit at the end of each Request processing cycle (or such earlier
time specified by AFLAC); and
(iv)
telefax copies of all deposit verification receipts, Account Statements, and other
correspondence relating to the Account to AFLAC upon receipt of such
correspondence from the financial institution; and
(v)
during the term of this Agreement, the Employer shall not withdraw funds from the
Account; except at the request of or to the extent approved by AFLAC. The Employer
bears sole responsibility for any fees imposed with respect to the Account by the
financial institution, including, but not limited to: Account maintenance fees,
insufficient funds fees, fees with respect to voided checks, etc.
O No Confirmation of Funds Option. The Employer shall:
(i)
make sufficient funds available from its general assets for amounts allocable to
eligible reimbursement benefits under its Plan; and
(ii)
grant AFLAC withdrawal authority over the Account and establish a zero balance
arrangement with the financial institution selected by the Employer, which guarantees
AFLAC that there will be sufficient funds available in the Account to facilitate the
timely processing of Requests under the Plan. Under this arrangement AFLAC will
automatically release funds from the Account without a confirmation of funds
approval from the Employer.
B,
X
Self-Pay Option. The Employer shall:
(i)
(ii)
make sufficient funds available from its general assets for amounts allocable to
eligible reimbursement benefits under its Plan; and
review AFLAC's initial reimbursement determinations and issue reimbursement
checks from its general assets within seven days of the receipt thereof for those
Requests which are reimbursable pursuant to the terms of its Plan; and
upon request, provide AFLAC with proof of timely benefit check disbursements in a
form and manner deemed acceptable by AFLAC (e.g., bank issued account
statements or check register).
If, at any time, the amount of reimbursement benefits payable under the applicable Plan provisions
exceeds the amount deposited by the Employer in the Account, the Employer shall transfer an
amount necessary to the Account to fulfill its reimbursement obligations under the applicable Plan
before any further reimbursement benefit payment is made. AFLAC is under no obligation to
advance funds on behalf of the Employer.
In accordance with the terms and conditions of the Plan, and any reimbursement practices and
procedures prescribed by the Employer, AFLAC, as agent for the Employer shall:
(1)
provide Employer with a sample Plan document to be reviewed by the Employer and its
legal counsel; and
(2)
provide the Employer with a sample Plan summary for distribution to each Plan
Participant; and
(3)
assist the Employer in explaining the reimbursement feature of the Plan to employees
(Employer shall be responsible for explaining and administering any features of the Plan
other than reimbursement - e.g., direct pay of parking .charges or distribution of transit
passes); and
(10)
provide the Employer with salary redirection agreement forms to be used during the
enrollment process for current and new employees; and
(11)
provide each Participant with reimbursement forms and instructions for filing
reimbursement requests; and
(12)
provide the Employer with written monthly reports summarizing the previous period's
reimbursement activities; and
(7)
upon receiving instructions from the Employer on an election change, make the change
requested by the Employer; and
Co
(8)
(9)
receive Requests for reimbursement, and expeditiously review such Requests to
determine what amount, if any is due and payable with respect thereto; and
disburse the benefit payments it determines to be due (provided the Employer transfers
sufficient funds to AFLAC or has sufficient funds in the Account) or if Self-Pay is elected
above, notify Employer of the benefit determination in accordance with the provisions of
the Plan and the following procedure(s):
valid reimbursement for benefits shall be paid by AFLAC on the date funds are
received from the Employer (with respect to Such Requests) by mailing a check
in the appropriate amount(s) directly to the Participants at their home addresses;
and
(iv)
reimbursements for an amount that was more than the current Account balance,
the excess part of the reimbursement will be carried over into following months;
to be paid out as the balance becomes adequate (subject to the monthly
maximum described above). Expenses that adse before the Salary Redirection
Agreement becomes effective, or for any expense incurred after the close of the
Plan Year cannot be reimbursed.
Requests of less than $15.00 may be carried forward and aggregated with future
Requests until the reimbursable amount is greater than $15.00, provided,
however, that the entire amount of the reimbursable Requests shall be paid after
the close of the Plan Year without regard to the $15.00 threshold; and
(10)
notify claimants as to any Requests which are denied because of inadequate Request
substantiation or improper Request form submission and give affected claimants the
opportunity to resubmit their Requests; and
(11)
provide to the claimant within ninety (90) days following receipt of a Request, written
notification (A) as to the disposition of the Request, or (B) of an anticipated delay beyond
ninety (90) days in the disposition of the Request together with an explanation of the
delay; and
(12)
notify the claimant and refer to the Employer (with an analysis of the issues affecting the
Request) for final decision any Requests which AFLAC deems not to be reimbursable
pursuant to the terms of the Plan and/or the reimbursement practices and procedures
established by the Employer, setting forth the applicable review procedure available to the
claimant through the Employer.
AFLAC shall not be obligated or responsible for any duty with regard to the administration of the
Plan (imposed by the Plan or otherwise) except as specifically provided above. It shall be the
Employer's sole responsibility and duty to:
(1)
amend the Plan as necessary to comply with future changes in applicable Internal
Revenue or Labor statutes and regulations or other federal, state, or local statutes or
regulations; and
(7)
make a full and fair review of any unpaid Requests as described above, and required by
the Plan, and notify the claimant in writing of its decision on review; and
(8)
prepare and submit Plan summary descriptions to each Employee as may be required;
and
(9)
(10)
execute and return the Adoption Agreement to AFl_AC Administration;
allow AFLAC, by and through independent associates, a reasonable opportunity to meet
with each employee to discuss AFLAC supplemental benefits;
(11)
(13)
(14)
disburse or retain any funds remaining in the Account as set forth in Section 4.04 of the
Adoption Agreement;
determine whether the reimbursement of mass transit expenses is permissible and advise
AFLAC as to which of its locations and employees are eligible for such benefits under the
"significant administrative cost" provisions of the proposed Section 132 re. gulations. A
cash reimbursement may not be provided for an employee's mass transit expenses if a
voucher (or similar item that may be exchanged only for a transit pass) is readily available
to the Employer for direct distribution to Employees. A voucher (or similar item) is readily
available if (1) the Employer can obtain the voucher on terms that are no less favorable
than the terms available to an Employee directly, and (2) the Employer does not incur a
significant administrative cost in obtaining the voucher. An administrative cost will be
determined to be "significant" if the Employer determines that the average distribution cost
imposed by a transit system (excluding the Employer's internal costs and delivery charges
of $15 or less) is more than one percent (1.0%) of the average monthly value of the
vouchers for a particular transit system (i.e. train, bus, subway).
determine the impact (if any) of the Section 132 Transportation Plan on the administration
of its qualified pension and profit sharing plan. Pre-tax salary reductions are used to
purchase qualified transportation fringe benefits may have an unintended impact on § 415
and § 401(a)(4) and other qualified plan nondiscrimination testing, because that salary
may not count as compensation.
E.
(15)
determine the impact of pre-tax salary reduction under the Section 132 Transportation
Plan on state and local income and employment tax withholding and reporting
requirements.
In the event AFl_AC pays any person less than the amount to which he or she is entitled under the
Plan, AFl_AC will adjust the underpayment at the end of the next reimbursement period for which a
total payment of $15.00 would result or at the end of the Plan Year. In the event that AFl_AC
overpays any person entitled to benefits under the Plan, or pays benefits to any person who is not
entitled to them, AFLAC shall take all reasonable steps to recover the overpayment except that
AFLAC shall not be required to initiate court proceedings to recover an overpayment. AFLAC shall
promptly notify the Employer if it is unsuccessful in recovering any overpayment.
Section III. Liability and Indemnity
A0
In performing its obligations under this Agreement, AFLAC neither assumes nor underwrites any
liability of the Employer under the Plan, but, with respect to the Employer, acts only as provider of
those services specifically described in Section ll.B. of this Agreement and with respect to Plan
Participants, acts only as the agent of the Employer. The services to be performed by AFl_AC shall
be ministerial in nature and shall be performed within the framework of policies, interpretations,
rules, practices, and procedures made or established by the Employer. AFLAC shall have no
discretionary authority or discretionary control over any assets of the Employer, the Plan, or Plan
Participants.
B,
AFLAC shall have no duty or obligation to defend any legal action or proceeding brought to recover
a Request for Plan Benefits. AFLAC shall, however, make available to the Employer and its
counsel, such evidence relevant to such action or proceeding as AFLAC may have as a result of its
processing of the contested benefit determination.
Co
D.
Except as otherwise explicitly provided in this Agreement, the Employer shall retain the liability for
all Plan benefit Requests and all expenses incident to the Plan and agrees to indemnify AFLAC for
and hold it, its directors, officers, and employees, harmless from all amounts and expenses
(including reasonable attorneys' fees and court costs) for which AFLAC may become liable:
In consequence of any acts or omissions by AFLAC or the Employer (and their
employees, agents, or affiliates) arising out of this Agreement, or the
administration of the Plan, unless such act or omission is attributable to willful
and intentional misconduct by AFLAC;
- Arising from any legal action or proceeding to recover benefits under the Plan; or
This indemnity shall survive the termination of this Agreement.
AFLAC shall use ordinary and reasonable care in the performance of its duties, but shall not be
liable to the Employer for mistakes of judgment or other actions taken in good faith unless such
error results directly from an intentionally wrongful or grossly negligent act of AFLAC, its officers or
employees.
Section IV. Reimbursement Request Processin_a Service Fee
Ao
B,
C,
The Employer shall pay AFLAC a fee for services performed under this Agreement in the amount of
$1.75 per Participant per month with a minimum monthly fee of $25.00. This amount shall be due
by the tenth (10th) of each month (or portion thereof) for which this Agreement is in effect and is in
addition to and separate from (i) any Account Establishment (or "Set Up") fee assessed by AFLAC
of $250.00 to initiate the reimbursement arrangement: and (ii) the Employer's obligation to make
available sufficient funds to satisfy its obligations under the Plan and to make benefit disbursement
in accordance with section II.A. abOve. The Employer is responsible for paying the Service Fee to
AFLAC. AFLAC is authorized to withdraw the Service Fee from the Account. Failure to pay any
applicable monthly Service Fee by the next monthly Requests processing cycle shall result in a
cessation of Request processing services until such fees are received by AFLAC. If Request
processing services are pended for an entire monthly processing cycle, AFLAC may terminate this
Agreement in accordance with Section VI.
AFLAC may revise the Service Fee for services performed under this Agreement effective on each
Anniversary Date of this Agreement by giving the Employer written notice of the revised rate at
least thirty (30) days prior to the applicable Anniversary Date.
Notwithstanding any other agreement between the parties (and/or their agents), AFLAC may revise
the Service Fee set forth above at any time if revision is deemed necessary by AFLAC by reason
of: i) modification or amendment of the Plan by the Employer; ii) a suspension, limitation, or
revocation of the ability of Employees or Participants to purchase AFLAC policies. AFLAC shall
advise the Employer of the revised Service Fee at least thirty (30) days prior to its implementation.
If the Employer does not terminate this Agreement (by written notification pursuant to Section
VI.A.3.) within thirty (30) days after the receipt of a notice of such revision, the Employer shall be
deemed to have agreed to such revision for the remainder of the term of the Agreement.
Thereafter, the Service Fee on and after the implementation date shall be made on the basis of
such revised Service Fee.
D,
AFLAC may revise the Service Fee set forth above at any time if any change in law or regulations
imposes on AFLAC greater duties or obligations than contemplated by the Agreement in force at
the time of such change.
Section V. Term of Agreement
The initial term of this Agreement shall be the initial Plan Year commencing on the effective date hereof,
thereafter, this Agreement will automatically renew for successive periods of twelve (12) months unless, at
least thirty (30) days prior to the end of the then current term, the Employer or AFLAC gives written notice to
the other of its intention not to renew the Agreement. In the event of a short Plan year (other than the first
Plan year) this Agreement shall automatically renew for an additional twelve (12) months unless the
Employer or AFLAC gives written notice to the other of its intention not to renew the Agreement within three
(3) days after the Employer notifies AFLAC of the short Plan year.
Section VI. Termination of Agreement
A. This Agreement shall terminate upon the earliest of the following dates:
(1)
(2)
The end of a term of the Agreement following the delivery of written notice of termination
pursuant to Section V.
At the option of AFLAC, the date upon which the Employer fails to transfer suffici~f:funds
to AFLAC (upon request by AFLAC) i) to pay all valid Requests pending under the Plan; or
ii) to pay the Service Fee (as provided in Section II.A and IV.A., above). AFLAC shall
promptly communicate its election of this option to the Employer.
(3)
Upon the implementation date for a proposed Service Fee increase deemed to be
unacceptable by the Employer (after delivery of written notice of termination by the
Employer) pursuant to Section IV.C.
(4)
At the option of AFLAC, if no Plan Participant is an AFLAC policyholder or if the Employer
denies AFLAC a reasonable opportunity (as determined by AFLAC in its sole discretion) to
meet with Employees. AFLAC shall immediately communicate its election of this option to
the Employer.
B.
(5) Any other date mutually agreeable to the Employer and AFLAC.
Upon termination of this Agreement, AFLAC shall cease the processing of all Requests then in its
possession, return any undistributed funds to the Employer, and make all records relating to
Requests in process reasonably available to the Employer. If the termination occurs pursuant to
VI.A.1. (above), AFLAC shall process all run-off claims provided any Service fee(s) is current.
Thereafter, the Employer and/or Plan Administrator shall be responsible for all aspects of
Reimbursement Requests processing and Plan administration.
Section VII. Miscellaneous
(1)
Notices. Any notice required to be given hereunder to AFLAC shall be suffiCient if in
writing and delivered personally or by prepaid first class mail to AFLAC, Transit One
Administration, 1932 Wynnton Road, Columbus, GA 31999, or if to Employer, at the
address of the Employer denoted on the signature page attached hereto.
(2)
Applicable Law. This Agreement shall be governed by, and shall be construed in
accordance with the laws of the State of Georgia, to the extent they are not preempted by
ERISA, the Code, or any other federal law.
(3)
Legal and Tax Status. The Employer acknowledges that neither AFLAC nor its agents are
providing legal or tax advice, and that neither AFl_AC nor its agents serve as the Plan
administrator or a Plan administrator or a fiduciary under the Plan. The Employer shall be
the sole party responsible for determining the legal and tax status of the Plan under
applicable law. AFLAC shall have no power or authority to waive, alter, breach or modify
any terms or conditions of the Plan.
(4)
Assignment. This Agreement may be assigned by AFLAC to any other party, including any
successor to the business of AFLAC by merger, consolidation, purchase of assets, or
(8)
(9)
(10)
otherwise, without the prior consent of the Employer. This Agreement shall be binding
upon any corporation into which the Employer may be merged or with which it may be
consolidated, or any corporation succeeding to all or substantially all of the business of the
Employer.
Entire Contract. This Agreement constitutes the entire contract between the parties and no
modification or amendment hereto shall be valid unless in writing and signed by an officer
of the Employer and an Officer of duly authorized representative of AFl_AC.
Tax Reporting and Withholdings. The Employer has ultimate control over the payment of
Plan benefits and shall be the sole party responsible for income and employment tax
reporting and withholding obligations imposed as a result of the includability of such
payments in the gross income of recipients. AFLAC is a mere agent of the Employer for
the processing of benefit Requests.
Capitalized Terms shall have the same meaning as in the Plan documents.
IN WITNESS WHEREOF, the parties hereto have cauSed this Agreement to be executed in
duplicate and signed by an Officer of the Employer and an Officer or duly authorized Worldwide
Headquarters Employee of AFLAC to do so.
Dated at American Family Life Assurance
Company
This day of ,.
By:
Robert M. Ottman
Second Vice President
Director of Administration/Compliance
Dated at
This day of ,
By:
Street Address: