1989-46
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SUPPORTING PLAN DOCUMENT
SECTION 125 CAFETERIA PLAN ARRANGEMENT
CITY OF CLERMONT, FLORIDA
EMPLOYEE HEALTH AND WELFARE BENEFIT PLAN
This Supporting Plan Document sets out the provisions of the
Cafeteria Plan Arrangement for the City of Clermont, Florida
Employee Health and Welfare Benefit Plan, as effective January 1,
1990.
The purpose of this Cafeteria Plan Arrangement is to provide
qualified benefits to eligible employees on a pre-tax premium
basis.
This Cafeteria Plan Arrangement is intended to qualify as a
Cafeteria Plan under Internal Revenue code Section 125, as amended,
and is to be interpreted in accord with the requirements of that
provi sion.
Neither the Administrator nor the Planholder makes any guarantee
tha t amounts paid for the benef it of any Participa ting Employee are
excludable from the Participating Employee's income for federal or
state income tax purposes, or from wages for FICA purposes.
upon adoption of this Supporting Plan Document for the Cafeteria
Plan Arrangement~ Planholder will promptly notify all employees of
its existence and eligibility requirements, and of the terms of the
Cafeteria Plan Arrangement.
The Planholder specifically reserves the right and authority to
amend the provisions of this Supporting Document for the Cafeteria
Plan Arrangement to the extent and in the manner that the
Planholder deems advisable, by written amendment signed by the
Mayor or his designated agent, thereto. In addition, the
Planholder specifically reserves the right and authority to
terminate this Cafeteria Plan Arrangement. Participa ting Employees
must be given 30 days advance notice in the event of such
termination.
I.
DEFINITION OF TERMS
A.
WELFARE PLAN: The City of Clermont, Florida,
Employee Health and Welfare Benefit Plan.
B.
CAFETERIA PLAN ARRANGEMENT: The Section 125
Cafeteria Plan Arrangement established by this
Supporting Plan Document.
C.
PLANHOLDER: City of Clermont, Florida,
employer establishing this Section
Cafeteria Plan Arrangement.
the
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D.
II.
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PLANHOLDER'S BUSINESS ADDRESS:
P.o. Box 120219
Clermont, FL 34712-0219
#1 westgate Plaza
Clermont, FL 34712-0219
E.
PLAN YEAR: The date that the Cafeteria Plan
Arrangement begins up to the date of the next
following year.
F.
PLAN ANNIVERSARY: The date that the Cafeteria
Plan Arrangement begins in any calendar year.
G.
DESCRIPTION OF WELFARE PLAN BENEFITS AND
COVERAGE PERIODS: See attached policy (ies)
Welfare Plan Document(s).
H.
1.
INSURED BENEFITS UNDERWRITTEN
Vision Service Plan.
BY:
2.
SELF-FUNDED BENEFITS ADMINISTERED
BY: First Benefits of Florida, Inc.
I.
ADMINISTRATOR: The Planholder or any other
person or committee which may be appointed by
the Planholder to supervise the administration
of the Cafeteria Plan Arrangement.
J.
PARTICIPATING EMPLOYEE ELIGIBILITY: All
permanent employees regularly scheduled to work
40 hours or more per week.
EFFECTIVE DATE:
A.
The effective date of this Supporting Document
for those employees eligible on that date; or
B.
The date following eligibility, but coinciding
with satisfaction of eligibility requirements
under the Welfare Plan for those employees who
become eligible subsequent to the effective
date of this Supporting Document Cafeteria Plan
Arrangemen t.
III. TERMINATION DATE: Termination of participation in the
Cafeteria Plan Arrangement shall be the earlier of:
A.
The date the Participating Employee (an
employee participating in the Cafeteria Plan
Arrangement) terminates employment; or
B.
The date the Participating Employee no longer
meets the eligibility requirements; or
C.
The date the Participating Employee is placed
on lay-of f or an approved leave of absence; or
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D.
E.
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The date the Participating Employee retires;
or
The date this Cafe teria Plan Arrangement is
terminated.
IV.
ADMINISTRATION
The Administrator shall supervise the administration of
the Cafeteria Plan Arrangement to see that it is carried
out, in accordance with its terms, for the exclusive
benef it of employees el igible to participate, without
discrimination. The Administrator has the power and
authority to administer the Cafeteria Plan Arrangement,
subject to its terms and to the requirements of
applicable laws. The powers of the Administrator
include, but are not limited to, the following:
A.
B.
V.
To establish and enforce such procedures and
regulations necessary for the administration
of the Cafeteria Plan Arrangement, or as may
be required by law;
To interpret and determine questions concerning
the Cafeteria Plan Arrangement, including
eligibility of any employee to participate;
C.
To delegate responsibility under the Cafeteria
Plan Arrangement, and to designate such other
persons as may be necessary to carry out these
responsibilities, with any delegation or
designation set out in writing;
D.
To establish and maintain such records as
necessary to properly administer the Cafeteria
Plan Arrangement and as may be neces sary to
meet the requirements of law;
E.
To make available to each Participating
Employee his or her records maintained under
the Cafeteria Plan Arrangement, for examination
at reasonable times during normal business
hours.
The Administrator shall at all times exercise and act
under the power and authority granted by the Cafeteria
Plan Arrangement in a manner that is nondiscriminatory.
FUNDING
A.
Prior to the beginning of each Plan Year, the
Planholder shall determine that portion of the
monthly Welfare Plan premium contribution to
make on behalf of each employee participating
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B.
VI.
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in the Welfare Plan. Such contributions shall
be considered non-elective contributions. Any
such contribution made by the Planholder is
fixed in amount, irrespective of what election
is made by a Participating Employee in item V.
B. below.
The excess of the monthly Welfare Plan premium
over the amount contributed on behalf of each
employee by the Planholder will be made by each
employee participa ting in the plan.
Participating Employees may elect, prior to
January 1 of each year to have their portion
of the monthly Welfare Plan contribution:
1.
Contributed to the Welfare Plan on
a pre-tax basis, through the
Cafeteria Plan Arrangement, from a
corresponding reduction in salary¡
or
2.
Contributed to the Welfare Plan by
payroll deduction on an after-tax
basis. If this method of funding is
elected by Participating Employees,
an amount equal to the excess of the
monthly Wel fare Plan premi urn over
the amount contributed by the
Planholder on behalf of each
Participating Employee (as set out
in A and B above) will be included
in the employee's taxable gross pay.
C.
All contributions by the Planholder as set
forth will be available to Participating
Employees solely to purchase medical and dental
benef it s under the Wel fare Plan. The
contribution by the Planholder will not exceed
the cost of such benef its for any Participa ting
Employees.
D.
If a Participating Employee terminates as set
out in Section II above, the employee shall
forfeit all unused contributions made up to
the date of termination.
BENEFIT ELECTIONS:
A.
Participating Employees make benefit elections
prior to the beginning of each Plan Year.
These elections remain in effect until the end
of that Plan Year. Employees may change
elections prior to the beginning of each
subsequent Plan Year.
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B.
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Employees may change benefit elections during
the Plan Year only as a result of a change in
the employee's family status. Changes in
family status include: birth, adoption,
divorce, marriage, death or termination of
spouse's employment.
C.
Elections under the Cafeteria Plan Arrangement
are made on the form(s) provided by the
Administrator for making said elections, which
shall be distributed within 15 days prior to
the beginning of each Plan Year to all current
participants and to employees expected to be
eligible to participate at the beginning of
each Plan Year.
D.
Said elections are to be made in the manner
described on the form (s) so provided, which
must be completed and returned to the
Administrator prior to the beginning of each
Plan Year.
E.
Elections under the Cafeteria Plan Arrangement
for employees who become eligible to
participate during any Plan Year shall be made
in the manner described on the form (s) provided
for making said elections by the Administrator,
and shall be made prior to the start of the
firs t payroll period for which salary reduction
elections are effective.
F.
Elections made under this Cafeteria Plan
Arrangement will terminate upon the date on
which an employee ceases to be a Participating
Employee or eligible to participate, even
though coverage or benefits under the Welfare
Plan may continue to the extent provided in
the Welfare Benefit Plan and/or by law.
Participating Employees are required to provide to the Planholder
and/or Administrator any information, and to sign such documents,
as may reasonable be required for the proper administration of the
Cafeteria Plan Arrangement.
This Cafeteria Plan Arrangement will be construed, administered and
enforced according to the laws of the State of Florida.
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IN WITNESS WHEREOF, the Planholder has caused this Cafeteria Plan
Arrangement to be executed in its name and behalf on this
it- day of Ok'r~ 1989, by its duly
authorized officer.
Nmne ~ A. 'PO~
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Signature - - ~;
Title Mayor
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