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A.ttrachment 2 <br />SUGGESTED AFFIRMATIVE STATEMENT D®NIA <br />FOR THE VANTAGECARE RETIREMENT HEALTH SAVINGS PLAN <br />AMENDMENT FOR DEFINITION OF SPOUSE <br />Plan Number: 80 3 2 3 7 , 803550, 803551. <br />Name of Employer: City of Santa Ana State: C A <br />WHEREAS, the Employer has established and maintains a retiree health savings plan in the form of the ICMA <br />Retirement Corporation's VanrageCare Retirement Health Savings program, as amended (the "Plan "); <br />WHEREAS, the assets of the Plan are held in trust for the exclusive benefit of Plan participants and their spouses and <br />dependents, and shall not be diverted to any other purpose prior to the satisfaction of all liabilities of the Plan; <br />WHEREAS, die plan has operated in accordance with federal recognition of same -sex spouses; and <br />WHEREAS, an amendment to the Employer's Plan in accordance with the federal recognition of same -sex spouses <br />is adopted to comply with Internal Revenue Service guidance issued in response to the Supreme Court's decision in <br />United States v. Windsor; <br />NOW, THEREFORE BE IT RESOLVED that the Employer hereby amends the Plan to define the term "Spouse" as <br />the Participant's lawful spouse as determined under the laws of the jurisdiction in which the Participant was married. <br />As a duly authorized agent of the above named Employer, I hereby <br />AMEND the Declaration of Trust of the Integral ParrTtusr and Retiree Welfare Benefits documents, as applicable, <br />to include the federal recognition of same -sex spouses. The Plan allows same -sex spouse to receive tax -free <br />reimbursements for all same -sex marriages that are valid as of September 16, 2013, unless the employer specifies an <br />earlier valid date hereof as <br />(Leave blank. Unless wing earlier dare) <br />Name ofAutltorizcd Official (please print): David Cavazos <br />Signature <br />Title: City Manager <br />Date: d S/ o 7, i- o I S7 <br />Monde / Day / Year <br />PROVE S FORM <br />Jose SandoYzA- <br />�)nior Assistant City Attorney <br />Fax to: <br />ICMA -RC <br />AT TN: Workflow Management Team <br />202 - 682 -6439 <br />ATTEST: <br />-/I <br />AMIOt i <br />MARIA D. HUIZAR <br />CLERK OF THE COUNCIL <br />Mail to: <br />ICiMA -RC <br />OR ATTN: Workflow ManagementTeam <br />P.O. Box 96220 <br />Washington, D.C. 20090 -6220 <br />