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E. Na Surviving Spousc or Snrviving Dependents <br />If thereareno living spouse or dependents at the time of death of the Participant, the account will revert in accordance <br />with the rmployvr's election tinder Section V III of the VawageCare A''I^I.SAdeption Agreemene, <br />XII,'.the Plan will operate according to the following provisions: <br />A. Employer Responsibilities <br />1. The Employer will submit all VatuageCgre Retirement health Savings Plan contribution data viaelectronie submission. <br />2. The Employer will submit all VantageCare Retirement Health Savings Plan Participant status updates or personal <br />information updates via electronic submission This includes but Is not limited to termination notification, benefit <br />eligibility, and vesting notification. <br />E. Participant account administration and asset -based fees will be paid through the redemption of Participant account <br />shares, unless agreed upon otherwise in the Administrative Services Agreement. <br />C. Assignment of benefits is not permitted. Benefits will be paid only to the Participant, his/her Survivors, the <br />Employer,or an insurance provider (as allowed by the claims administrator). Payments to a rhird-party payee (e.g., <br />medical service provider) are nor permitted with the exception of reimbursement to rho Employer or Insurance <br />provider (as allowed by the claims administrator). <br />D. An eligible dependent is (a) the Participant's lawful spouse, (b) the Participands child under the age of 2Z as defined <br />by2RC Section 152(f)(1) and Internal Revenue Service Notice 2010-38, or (c) any other individual who is a person <br />described in IRC Section 152(a), as clarified by Internal Revenue Service Notice 2004 79. <br />E. The Employer will be responsible for withholding, reporting andremitting any applicable taxes for payments which <br />are deemed to be discriminatory under IRC Section 105(h), as outlined In the VamageCare Retiremenr Health Saving <br />Employer Manual. <br />XIII. Employer Acknowledgements <br />A. The Employer hereby acknowledges it understands that failure to properly fill out this VantrrgeCam Retirement Health <br />SavinSoAdnptivn Agmane rt may result in the loss of tax exemption of the Trust and/or loss of tax -deferred status for <br />Employer contributions. <br />E. ® Check this box if you are including supporting documents that include plan provisions. <br />EMPLeOia,11C <br />, <br />Attesta <br />r <br />'�.� k A -a <br />Arthg-der o e Councii <br />11: l8 <br />APPROVED AS TO FORM <br />) .-Rfs t <br />Laura A. Rossini <br />Senior Assistant City Attorney <br />