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Attaehrnent 2 <br />SUGGESTED AFFIRMATIVE STATEMENT DOAM <br />FOR THE VANTAGECARE RETIREMENT HEALTH SAVINGS PLAN <br />AMENDMENT FOR DEFINITION OF SPOUSE <br />Plan Number: 80 3 2 3 7 a $03550, 803551, <br />Name of Employer: City of Santa Ana State: A <br />WHEREAS, the Employer has established and maintains a retiree health savings plan in die form of the ICMA <br />Retirement Corporation's VantageCare 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, the plan has operated in accordance with federal recognition ofsame-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 law&d spouse as determinedunder the laws o£the jurisdiedan 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 Part Trust and Retiree Welfare Benefits documents, as applicable, <br />to include the federal recognition of same -sex spouses. Tic 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 using earlier dare) <br />Name of Authorized Official (please print) <br />Signature: 9 <br />Title: City Manager <br />Date: 05'/ 0 qj j-0 1 S7 <br />Warta / Day / Year <br />S FORM <br />ose SandoJPROVED <br />or Assistant City Attorney <br />Fax to: <br />ICIv1A,-RC <br />ATTN: Workflow Management Team <br />202-682-6439 <br />ATTEST' <br />MARIAD. HUIZAR <br />CLERK OF THE COUNCIL <br />Mail to: <br />ICMA-RC <br />OR ATTN: Worldlow Management Team. <br />P.O. Box 96220 <br />Washington, D.C. 20090-6220 <br />