DEPENDENT CARE FSA EXHIBIT C_PLAN DOCUMENT NOV 13.PDF

Cr31-11-Ott -1Y1-06
THE
IVIARICOPA COUNTY DEPENDENT CARE FLEXIBLE SPENDING ACCOUNT PLAN
(FIFTH AMENDMENT AND RESTATEMENT)
ARTICLE I
ESTABLISHMENT OF PLAN
1.1 Purpose. The purpose of this Plan is to allow Employees who become
Participants in this Plan to obtain reimbursement for certain Covered Dependent Care Expenses
on a tax free basis, as provided under Section 129 of the Code. This Plan is intended to qualify
as a "dependent care assistance program" maintained under Section 129 of the Code and
regulations issued thereunder, and as a Benefit Plan as that term is defined in the Marieopa
County Benefits Plan, and this Plan shall be interpreted and construed in accordance with that
intention. In no event shall this Plan be administered or construed to constitute a plan of deferred
compensation.
1.2 Effect Upon Other Plans. Nothing in this Plan shall be construed to affect the
provisions of the Maricopa County Benefits Plan or any other Health Plan maintained by the
County which is intended to comply with the requirements of any other provision of the Code.
1.3 Effect of Amendment and Restatement. This Maricopa County Dependent Care
Flexible Spending Account Plan (Fifth Amendment and Restatement) is amended effective July
1, 2017 to incorporate all prior amendments and to make additional amendments required to
comply with federal and state laws and/or amendments. The purpose of this amendment and
restatement is to make such amendments as determined by the County to be in the best interests
of this Plan and its Participants.

ARTICLE II
DEFINITIONS
2.1 Application of Definitions. Unless otherwise required by context, the capitalized
terms used in this Plan shall have the meanings set forth this Article. If not defined in this
Article, then capitalized terms used in this Plan shall have the meanings set forth in the Maricopa
County Benefits Plan. The masculine gender, when used herein, shall include the feminine and,
unless context indicates otherwise, the singular shall include the plural and the plural the
singular, where context requires.
2.2 Covered Dependent Care Expenses. All Dependent Care Expenses, as defined in
Section 2,5, incurred by a Participant during a Plan Year to enable the Participant to be gainfully
employed for any period during the Plan Year for which the Participant has one or more
Qualifying Individuals for whom Dependent Care Expenses are paid to a person who is not:
(a) a Dependent of the Participant with respect to whom, during such Plan
year, a deduction is allowable under Section 151(c) of the Code to the Participant;
(b) the Participant's Spouse; or
(c) a Participant's child (within the meaning of Section 151(c)(3) of the Code)
under the age of 19 at the close of the Plan Year.
2.3 Dependent. Any individual who is a dependent of a Participant within the
meaning of Section 152 of the Code.
2.4 Dependent Care Center. Any facility with a tax identification number which
(i) provides care for more than six individuals (other than individuals who reside at the facility),
and (ii) receives a fee, payment or grant for service for any of the individuals to whom it
provides services (regardless of whether such facility is operated for a profit).
2.5 Dependent Care Expenses. Expenses for the care of a Qualifying Individual that
meet all other requirements of the Code for reimbursement of such expenses. Dependent Care
Expenses that are incurred for services provided outside the Participant's household by a
Dependent Care Center shall be taken into account only if such Dependent Care Center complies
with all applicable laws and regulations of a state or unit of local government. In no event shall
the term "Dependent Care Expenses" include any amount paid for services outside the
Participant's household at a camp where the Qualifying Individual stays overnight.
2.6 Maricopa County Benefits Plan. The Maricopa County Benefits Plan (as
amended).
2.7 Participant. "Participant" means an Employee who is eligible to participate in the
Maricopa County Benefits Plan and who has executed a Benefits Purchase Order to establish a
Dependent Care Flexible Spending Account as provided in Section 3.1 of this Plan.
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2.8 Plan or DCFSA Plan. This Maricopa County Dependent Care Flexible Spending
Account Plan (Fifth Amendment and Restatement).
2.9 Qualifying Individual.
(a) Includes the following:
(i) A Dependent of the Participant who is under the age of 13 and
with respect to whom the Participant is entitled to a deduction under Section 151(c) of the Code;
(ii) A Dependent of the Participant who is physically or mentally
incapable of caring for himself who regularly spends at least 8 hours each day in the Participant's
household; or
(iii) The Spouse of the Participant who regularly spends at least 8 hours
each day in the Participant's household, if the Spouse is physically or mentally incapable of
caring for himself.
(b) If Sections 152(e)(2) or (4) of the Code apply to any child of the
Participant with respect to the Plan Year and such child is under the age of 13 or is physically or
mentally incapable of caring for himself, such child shall be treated as a "Qualifying Individual"
described in subsections 2.9(a)(i) or (ii) of this Plan (whichever is appropriate) with respect to
the custodial parent (within the meaning of Section 152(e)(1) of the Code), and shall not be
treated as a "Qualifying Individual" with respect to the noncustodial parent.
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ARTICLE III
BENEFITS PURCHASE ORDER
3.1 Benefits Purchase Order.
(a) An Employee eligible to participate in this Plan may participate hereunder
by executing a Benefits Purchase Order authorizing the County to reduce his Compensation by
the dollar amount specified in such Benefits Purchase Order. The amount of Compensation to be
reduced must be specified as a whole dollar amount of Compensation. The Participant's
Compensation specified in the Benefits Purchase Order shall be credited to the Participant's
Dependent Care Flexible Spending Account. The Participant's Benefits Purchase Order shall be
governed by Article IV of the Maricopa County Benefits Plan.
(b) The minimum and maximum Compensation a Participant may elect to
contribute to his Dependent Care Flexible Spending Account during any Plan Year shall not
exceed the amount set by the Board for the Plan Year or the permissible amounts under the
Code. In no event shall a Participant's total reduction of Compensation under a Benefits
Purchase Order for any Plan Year exceed the Participant's Compensation for that Plan Year.
12 Benefits Unfunded. The credit balance of any Participant's Benefits Funding
Account at any time shall evidence only an unfunded obligation of the County in accordance
with the terms of this Plan. The interest of any Participant or Dependent under a Benefit Plan or
in any benefits provided through such Benefit Plans shall be only that of a general, unsecured
creditor of the County, and no greater. No Participant, Spouse, or Dependent of a Participant (or
any other person claiming through any such person) shall have any right or claim to any specific
property of the County to satisfy any claim for benefits hereunder. Notwithstanding the
foregoing, the County may, in the County's sole discretion, elect to transfer all or any portion of
a Participant's Benefits Funding Account to the Benefits Trust or other trust fund the County has
created pursuant to Arizona Revised Statutes § 11-981. Any amounts transferred to such trust
shall be held under the provisions of the trust, but shall be subject to the payment of benefits
under this Plan and the Benefit Plans maintained hereunder. Any amounts transferred to such
trust shall not be considered "funded" for purposes of the Code, this Plan or any Benefit Plan
since the County can terminate such trust at any time and revert all funds held thereunder to the
County, subject only to the payment of benefits by the County as required under this Plan and the
Benefit Plans.
3.3 Effect of Termination of Employment.
(a) A Participant shall cease to participate in the DCFSA Plan effective as of
the termination of his employment.
(b) If a Participant resumes employment within 30 days following his
Severance Date and without any other intervening event(s) that would permit a change in the
Participant's Benefits Purchase Order, such Participant shall return to the elections in effect prior
to his Severance Date and benefits coverage shall be retroactive to the Severance Date. If more
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than 30 days have elapsed, Participant shall make new benefits elections and a new Benefits
Purchase Order in accordance with the Maricopa County Benefits Plan.
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ARTICLE IV
PAYMENT OF PLAN BENEFITS
4.1 Submission of Claims.
(a) It shall be a Participant's responsibility to insure that all Covered
Dependent Care Expenses for which the Participant seeks reimbursement are eligible expenses
under the Code. Each Participant shall file with the Plan Administrator, at such time as the Plan
Administrator may prescribe by rule or regulation, but not later than November 30 th following
the close of a Plan Year, a claim statement on a form provided by the Plan Administrator, setting
forth all Covered Dependent Care Expenses incurred by the Participant for such Plan Year, as of
the date of such filing and for which the Participant seeks reimbursement under this Plan. As
part of any such claim statement, each Participant shall submit a written statement from an
independent third party stating that the Dependent Care Expense has been incurred and the
amount of such expense and a written statement signed by the Participant to the effect that the
Dependent Care Expense for which reimbursement is sought has not been reimbursed or is not
reimbursable under any other plan. Benefits under this Plan shall be paid if the Dependent Care
Expenses were incurred while the Employee was a Participant in this Plan and to the extent they
were incurred during the Plan Year to which they relate. In addition, any claim for Dependent
Care Expenses that are incurred on or before September 15 th following the close of a Plan Year
may be submitted for payment from the Participant's Benefits Funding Account for the
preceding Plan Year and, if that account balance is exhausted, may be submitted for payment for
the current Plan Year. For purposes of this Plan, an expense is treated as having been incurred
by the Participant when the Participant is provided with the service that gives rise to the expense
and not when the Participant is finally billed, charged for, or pays the expense.
(b) The Plan Administrator shall determine the extent to which expenses
qualify as Covered Dependent Care Expenses. Upon making a determination that all or part of
the benefit claimed is for Covered Dependent Care Expenses, the Plan Administrator shall
authorize reimbursement to the Participant in an amount equal to the amount determined by the
Plan Administrator to constitute Covered Dependent Care Expenses.
(c) Section 4.1(a) notwithstanding, if a Participant terminates employment,
such Participant must submit a claim for reimbursement of Covered Dependent Care Expenses
no later than 60 calendar days following the Participant's Benefits Termination Date. Only
Covered Dependent Care Expenses incurred on or prior to the Participant's Benefits Termination
Date are reimbursable.
4.2 Reimbursement of Expenses.
(a) Section 4.1 notwithstanding, the benefits payable to a Participant under
this Plan during a Plan Year at any time shall not exceed the lesser of:
The amount of Compensation a Participant has elected to
contribute to his Dependent Care Flexible Spending Account for such Plan Year; or
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(ii) The then credit balance, if any, of the Participant's Dependent Care
Flexible Spending Account (computed in accordance with Section 5.1 of the Maricopa County
Benefits Plan).
(iii) His Earned Income for such Plan Year; or
(iv) The Earned Income of his Spouse for such Plan Year; or
(v) $5,000, or $2,500 in the case of a married Participant who files a
separate United States Federal income tax return for such calendar year (such marital status to be
determined under the rules of paragraphs 21(e)(3) and (4) of the Code).
(b) In determining the Spouse's Earned Income, a Spouse of a Participant who
is not employed during any month in which the Participant incurs Covered Employment Related
Expenses and in which the Spouse is either a Qualified Individual or a full-time Student at an
Educational Organization shall be deemed to have Earned Income for such month of:
(i) $250, if there is one Qualified Individual for whom the Participant
incurs Covered Employment Related Expenses; or
(ii) $500, if there is more than one Qualified Individual for whom the
Participant incurs Covered Employment Related Expenses.
(c) If requested by the Board of Trustees, it shall be the duty of the Participant
to inform the Board of Trustees of the amount of the Spouse's Earned Income for a Plan Year.
(d) If for any reason, including, without limitation, mathematical or
administrative error, the aggregate charges made to a Participant's Dependent Care Flexible
Spending Account under this Plan at any time during a Plan Year, exceed the total amounts
credited to the Dependent Care Flexible Spending Account at such time during the Plan Year,
such negative balance shall constitute an indebtedness of the Participant to the County. Such
indebtedness shall be payable to the Benefits Trust by the Participant, upon demand, and each
Employee, by becoming a Participant in this Plan, authorizes the County to withhold amounts
from such Participant's current Compensation and to reimburse such amounts to the Trust or to
offset any such indebtedness against any amounts payable hereunder. If due to an administrative
or mathematical error or otherwise, the amount of Compensation deposited to the Participant's
Dependent Care Flexible Spending Account is greater than the amount authorized by the
Participant's Benefits Purchase Order, the County shall reimburse to the Participant the amount
of Compensation erroneously deducted subject to applicable taxes and withholdings.
(e) Forfeiture of Unused Accounts. Following each Plan Year after the time for
submitting claims for the Plan Year has expired as provided under the terms of this Plan, the Plan
Administrator shall aggregate the total amount of credits standing in the Participants' Benefits
Funding Accounts and, after all proper adjustments have been made in such Plan Year as
provided in this Plan and the Maricopa County Benefits Plan, all such amounts shall be forfeited
by the Participants and they shall have no grounds claiming thereto. The forfeited amounts shall
become the property of the Benefits Trust, so long as it exists, and the County may use such
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amounts for any purpose authorized by the Trust; otherwise such amounts shall revert to the
County.
4.3 Covered Dependent Care Expenses; Coordination of Benefits. Payments under
this Plan shall be made to Participants only to the extent that (i) payments are for Covered
Dependent Care Expenses and (ii) such Covered Dependent Care Expenses are not subject to
reimbursement under any similar plan or program maintained by any other employer of a
Participant or a Participant's Spouse, or under any federal, state or other governmental program
or under any policy of insurance under which a Participant or Participant's Spouse is an insured.
If, in accordance with the terms of the Maricopa County Benefits Plan, the Participant adds a
new Dependent to be covered hereunder during a Plan Year on account of a Change in Status
which relates to birth, adoption or placement for adoption, payments for Covered Dependent
Care Expenses shall be effective as of the date of such birth, adoption or placement for adoption.
4.4 Time for Payment. The benefits which are payable hereunder shall be paid as
soon as is reasonably practicable after the Plan Administrator has obtained all information from
the Participant necessary to establish that the charges for which payment or reimbursement is
sought are Covered Dependent Care Expenses.
4.5 Reimbursements in the Event of Incompetency of a Participant. If a Participant
entitled to receive any benefits hereunder is adjudged by a court of competent jurisdiction to be
legally incapable of giving valid receipt and discharge for benefits provided under this Plan, such
benefits may be paid to the duly appointed guardian or conservator of such Participant or may be
held by the Benefits Trust for the benefit of such Participant until distribution can be made to a
duly appointed guardian or conservator or is ordered to be made by a court of competent
jurisdiction. Such payment shall, to the extent made, discharge the Trust and the County of any
liability for such payment under the Plan.
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ARTICLE V
ADMINISTRATION OF THE PLAN
5.1 Administration. The Plan shall be administered by the County, the Board of
Trustees and the Plan Administrator as provided in the Benefits Trust,
5.2 Suspension, Termination and Amendment. The County shall have:
(a) The sole power to suspend or partially terminate or completely discontinue
the benefits provided under the terms of the Plan; and
(b) The power to amend the Plan as specified in Section 6.1.
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ARTICLE VI
GENERAL PROVISIONS
6.1 Amendments. The County reserves the right to, from time to time, make any
amendments to this Plan it determines to be necessary or desirable, with or without retroactive
effect, to maintain the qualifications of the Plan under Sections 129 and 125 of the Code, and any
regulations thereunder, or to ensure the successful administration and operation of the Plan. The
County shall make all amendments in writing. Each amendment shall state the date to which it is
either retroactively or prospectively effective.
6.2 Right to Terminate. The County reserves the right to terminate or partially
terminate the Plan in its discretion in accordance with applicable laws.
6.3 No Guarantee of Employment. Neither the Plan nor any provisions contained in
the Plan shall be construed to be a contract between the County and an Employee, or to be a
consideration for, or an inducement of, the employment of any Employee. Nothing contained in
the Plan shall grant any Employee the right to continued employment or shall limit in any way
the right of the County to discharge or to terminate the service of any Employee at any time.
6.4 Right to Benefits. No Participant, or person claiming through such Participant,
shall have any right to, or interest in, any benefits provided under this Plan upon termination of
his employment or otherwise, except as provided under this Plan and the Marieopa County
Benefits Plan.
6.5 Nonalienation of Benefits. The County has created this Plan to provide certain
"cafeteria" benefits to eligible Employees and their Dependents, in accordance with the terms of
the Maricopa County Benefits Plan and this Plan. Except as provided in Section 4.2(d), no
interest in or benefit payable under the Plan shall be subject in any manner to anticipation,
alienation, sale, transfer, assignment, pledge, encumbrance or charge, except as the Plan
Administrator may otherwise permit by rule or regulation; and any action by a Participant to
anticipate, alienate, sell, transfer, assign, pledge, encumber or charge the same shall be void and
of no effect, nor shall any interest in or benefit payable under the Plan be in any way subject to
any legal or equitable process, including, but not limited to, garnishment, attachment, levy or
seizure or to the lien of any person. This provision shall be construed to provide each
Participant, or other person claiming any interest or benefit in this Plan through a Participant
with the maximum protection against alienation, encumbrance and any legal and equitable
process, including, but not limited to, attachment, garnishment, levy, seizure or other lien,
afforded his interest in the Plan (and the benefits provided thereunder) by law and any applicable
regulations.
6.6 Unknown Whereabouts. It shall be the affirmative duty of each Participant to
inform the Plan Administrator, and to keep on file with the Plan Administrator, his current
mailing address. If a Participant fails to inform the Plan Administrator of his current mailing
address, neither the Plan Administrator, the Board of Trustees or the County shall be responsible
for any late payment of or loss of benefits.
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6.7 Construction. The Plan shall be construed, enforced and administered according
to the laws of the State of Arizona and the terms of the Maricopa County Benefits Plan. In case
any provision of the Plan is held to be illegal or invalid for any reason, it shall not affect the
remaining provisions of the Plan, but the Plan shall be construed and enforced as if such illegal
or invalid provision had not been included therein.
IN WITNESS WHEREOF, the County has caused this Plan to be signed by its duly
authorized representative.
DATED this (C14- day of rittath, , 2017.
MARICOPA COUNTY, ARIZONA
By MAR 0 1 2011
Chairman, Bard of Supelisors
ATTEST:
MAR 01 2017
APPROVED AS TO FORM:
jrkgi
Deputy County Attorney
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