55B - RESO AND AGMT - RETIREE HEALTH SAVINGS PLAN

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Name of Employer RETIREE WELFARE BENEFITS PLAN ARTICLE I Preamble fIIIS INSTRUMENT made and published by City of Santa Ana (hereinafter called "Employer") on he 28 day of November 2011 creates the City of Santa Ana Retiree Welfare Benefits !'Ian, is follows: 1.01 Establishment of Plan I h, finplovcr mimed above hereby establishes a Retiree Welfare Benefits Plan as of the 28 day of November 20 11 1.02 Purpose of Plan I his Plan has been established to reimburse the eligible Retirees of the Employer for medical and dental expenses incurred by t hem, their Spouses and Dependents pursuant to the Employer's VantageCare Retirement Health Savings (RHS) Plan. ARTICLE II Definitions I he following words and phrases as used herein shall have the following meanings, unless a different meaning is plainly quired be the context: 2.01 "Benefits" means any amounts paid to a Participant, Spouse or Dependents in the Plan as reimbursement for Eligible Pvled ica) and Dental Expenses incurred by the Participant during a Plan Year by him, his Spouse or his Dependents. 2.02 "Code" means the Internal Revenue Code of 1986, as amended. 2.03 "Dependent" means any individual who is a dependent of the Participant within the meaning of Code Sec. 152, as mpltlied by Intel-nal Revenue Service Notice 2004-79, 2004-49 I.R.B.898. 2.04 "Eligible Medical Expenses" means those expenses designated by the Employer as eligible for reimbursement in the VantageCtre Retiremenr Health Savings Plan Adoption Agreement. 2.05 "Employer" means the unit of state or local government creating this [']an, or any' affiliate or successor thereof that likewise adopts this Plan. 2.06 "Entry Date" means the first day the Participant meets the eligibility requirements ofArticle III as of such Date. 2.07 "Participant" means any Retiree who has met the eligibilit), requirements set forth in Article 111. 2.08 "Plan Administrator" means the Employer or other person appointed by the Employer who has the authority and ,:,Poilsibiht? to ntanagC and direct the operation and administration of the Plan. 2.09 "Plan Year" means the annual accounting period of the Plan, which begins on the 28 day of November 'tt and ends on the 31 day of December _ 20 11 with respect to the first Plan Year, and hereafter as Ion} is this Plan remains in effect, the period that begins on January 1 and ends on month/day December 31 Al, 55B-15