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Attachment 2 <br />SUGGESTED AFFIRMATIVE STATEMENT 17OMA <br />FOR THE VANTAGECARE RETIREMENT HEALTH SAVINGS PLAN <br />AMENDMENT FOR DEFINITION OF SPOUSE <br />Plan Number: 80 3 2 32 r 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 VantageCare Retirement Health Savings program, as amended (the "Plan"); <br />WHEREAS, the assets of the Plan are held in crust For the exclusive benefit of Plan participants and their spouses and <br />dependents, and. shall not be diverted to any otter purpose prior to the satisfaction of all liabilities of the Plan; <br />WHEREAS, the 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 tined 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. 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 using earlier dare) <br />Name of Authorized Official (please print): <br />Signature: <br />Title: City Manager <br />Dare: O 5,( ;1.0 d a� <br />Nlonefi! Day / Year <br />PROVE S FORM <br />Jose Sando <br />nior Assistant City Attorney <br />Fax tot <br />1CMA-RC <br />ATTN: Workflow Management Team <br />202-682-6439 <br />ATTEST <br />c��� �� <br />{N1dARIA D. HUIZAR <br />CLERK OF THE COUNCIL <br />Mail to: <br />ICMA-RC <br />OR ATTN: Workflow Management Team <br />P.O. Box 96220 <br />Washington, D.C, 20090-6220 <br />