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4.11
4.11 AGREEMENTS\GTM PaNToll Services—Affordable Care Act Reportnig Requirements—9-28-15 RESOLUTION AUTHORIZING SERVICE REQUEST FORM/AGREEMENT BETWEEN TOWN OF QUEENSBURY AND GTM PAYROLL SERVICES, INC. REGARDING AFFORDABLE CARE ACT REPORTING SOLUTIONS RESOLUTION NO.: ,2015 INTRODUCED BY: WHO MOVED ITS ADOPTION SECONDED BY: WHEREAS, by Resolution No.: 463,2014, the Queensbury Town Board authorized engagement of GTM Payroll Services, Inc., (GTM) for provision of professional payroll services, and WHEREAS, the Town wishes to enter into an Agreement with GTM for additional services to ensure the Town's compliance with the additional reporting requirements of the Affordable Care Act, and WHEREAS, a proposed Service Request Form/Agreement between the Town and GTM is presented at this meeting and is in form acceptable to Town Counsel, NOW, THEREFORE, BE IT RESOLVED, that the Queensbury Town Board hereby authorizes the GTM—Affordable Care Act Reporting Service Request Form/Agreement between the Town and GTM Payroll Services, Inc., (GTM) to ensure the Town's compliance with the additional reporting requirements of the Affordable Care Act, and BE IT FURTHER, RESOLVED, that the Town Board further authorizes and directs the Town Supervisor to sign the GTM-Affordable Care Act Reporting Service Request Form/Agreement substantially in the form presented at this meeting along with any other needed documentation and the Town Supervisor and/or Town Budget Officer to take any and all action necessary to effectuate the terms of this Resolution. Duly adopted this 28h day of September, 2015, by the following vote: AYES NOES ABSENT: • g1n �$� GTM Payroll Services Inc. 7 Executive Park Drive Grri\if _ Clifton Park.NY 12065 ivy = , wvvw.GTM.com ,A � � " � 518 373.4111 payroll services '11 Affordable Care Act Reporting Solutions ` -'44 GTM understands the complexity behind this health care legislation,and through our payroll software,we have new reports and tools to ensure our clients'compliance with the Affordable Care Act(ACA)reporting requirements. GTM's ACA Reporting Package makes it easy to determine the impact the ACA will have on your business with these three main features: 1. Determining whether your company is an ALE(Applicable Large Employer) This is made easy with single and multi-client reports that determine whether your rl�E. company is an ALE based on your full time and full time equivalent(FTE)employees. ' 2. Healthcare Eligibility for your employees 4 A T caw • The ACA Eligibility Analysis Report makes it simple to determine which employees are eligible for healthcare. • Inactive Employee Report shows employees that have been inactive for a period of time, including suspended employees, those on leaves of absence, and those _ w serving in the military. • The ACA Rule of Parity Report determines which employees can be treated as new hires or must keep their current healthcare plans when rehired. 3. Compliance Reporting • The 1095 ACA Preview Report ensures your records are accurate by allowing you to review the necessary 1095 form information before processing. • Annual report information on IRS forms 1095 and 1094 (B or C) streamlines managing dependent information with our payroll software enrollment process. Pricing GTM's ACA Reporting Package includes both a monthly monitoring program and the annual 1095/1094 IRS forms using the reports listed above. Cost:$1 per employee per month Set-Up Fee:$5 per employee Penalties If your business is an ALE,failure to comply with the ACA reporting requirements could result in financial penalties,including: • $100 per return for failure to file information returns, with a yearly maximum penalty of$1,500,000. • $100 to$250 for each failure to provide returns required to be filed after December 31,2015,with a yearly maximum of$3,000,000. • $100 for each failure to provide a correct payee statement,with a yearly maximum of$1,500,000. • $100 to$250 for each failure to provide a correct payee statement required to be provided after December 31,2015,with a yearly maximum of$3,000,000. For more information or to sign up for this service,please contact your GTM Account Manager or Sales Representative. ©2015 GTM Payroll Services Inc. GTM-Affordable Care Act Reporting Service Request Form Company Name: Client Number: Federal ID Number: Client and GTM Payroll Services Inc (GTM) agree to amend Client's then current Service Agreement by adding the Affordable Care Act Eligibility Tracking Agreement to Client's Agreement, subject to the terms and conditions of this Addendum and the Client's Agreement. In the event Client is executing this addendum on behalf of related entities,Client shall include the Company named above and each Company listed on the Controlled Group Information Schedule which shall be incorporated and made a part of this Addendum. 1.Services. Client employs GTM to provide Tracking and Monitoring Services and ACA End of Year Reporting Services which consists of either the Electronic Filing to IRS & Employee Ready Form Service or File Ready&Employee Ready Form Service (collectively the"ACA Services").Client must elect either the Electronic Filing to IRS & Employee Ready Form or File Ready & Employee Ready Form by checking below.The terms and conditions of the ACA Services are described in Section 2 of this Addendum. ACA End of Year Reporting ❑ Electronic Filing to IRS&Employee Ready Form OR ❑ File Ready&Employee Ready Form GTM will not commence any of the ACA Services until GTM receives all documents necessary to begin each of the Services and notifies Client of the date GTM will commence each of the Services ("Service Effective Date"). Client acknowledges that each of the ACA Services may have separate Service Effective Dates and GTM may commence performance of one (1) or more ACA Services without obligating itself to commence all ACA Services selected by Client.Until the ACA Services Effective Date, Client shall continue to provide for itself the ACA Services requested of GTM. GTM assumes no responsibility for ACA Services prior to the ACA Services Effective Date. By signing this Addendum, Client warrants that it possesses full power and authority to enter into this Addendum to its Agreement and the Agreements of each Company listed on the Controlled Group Information Schedule to this Addendum,and has read and agrees to the terms and conditions listed in this Addendum as set forth in Sections 1-3 and the Controlled Group Information Schedule if applicable.This Addendum shall supersede any previous GTM ACA Services Addendum.The person signing below as the Client's representative warrants,as an individual,that he or she is the Client's representative authorized to sign this Addendum for the Company listed above and each Company listed on the Controlled Group Information Schedule to this Addendum and that his or her signature is genuine. Authorized Officer's Name Title Authorized Officer's Signature Title 1 Agreement shall refer to the then current service agreement between GTM,located in,Clifton Park,New York and the Company identified on the GTM Service Agreement for the provision of payroll,TLM,tax or human resource services. • 2.ACA Services Product Terms and Conditions.Client acknowledges and understands that,to the extent that it is an entity that is treated as a single employer under Internal Revenue Code (IRC) section 414(b),(c),(m),or(o) ("Controlled Group"),the parent entity of the Client's Controlled Group will receive ACA reporting which includes all of the reporting GTM provides Client as part of the ACA Services if the parent company elects to receive the ACA Services. 2.1.ACA Tracking and Monitoring Services.If Client selects ACA Tracking and Monitoring Services, Client authorizes and directs GTM to perform the ACA Services set forth below. GTM is not rendering legal or financial advice in connection with the ACA Services nor shall GTM be deemed a fiduciary of Client or the employer or co-employer of Client's employees for purposes of providing the ACA Services.GTM shall not be responsible for Client's compliance with federal,state,or local statutes,regulations,or ordinances.The ACA Tracking and Monitoring Services consist of the Services set forth below. 2.1.1 Employee Eligibility Tracking and Monitoring. GTM will provide Client reporting that monitors all current and new employees within Client's selected measurement,administrative,and stability periods and calculate whether an employee is a full-time employee. 2.2 ACA End of Year Reporting Services. GTM will (i) provide Client reporting that monitors full time employee status and coverage offered information for each employee active during the current calendar year; and (ii) estimate how many full time employees Client will be required to furnish 1095-C form information.Client acknowledges that the report provided is subject to the information provided by Client and may require additional input to finalize the calculations of employee status and information related to coverage offered. GTM will evaluate full calendar year information and provide Client reporting that communicates potential errors and omissions that may hinder GTM ability to assist in filing 1094-C and 1095-C form information. Client authorizes and directs GTM to provide either the Electronic Filing to IRS & Employee Ready Form Service or File Ready Form & Employee Ready File Service checked above pursuant to IRC Section 6056 for reporting information related to health insurance coverage offered under employer-sponsored plans. GTM shall not be responsible for Client's compliance with federal,state,or local statutes,regulations,or ordinances. 2.2.1 Electronic Filing to IRS&Employee Ready Forms.GTM will prepare and (i)file form 1094- C for Client; (ii) file form 1095-C for each individual considered a full time employee under IRC section 4980H with the proper taxing authorities.GTM is not responsible for the payment of penalties for incorrect information reported,as the information is driven by data provided by Client. OR 2.2.2 File Ready & Employee Ready Forms. GTM will provide Client a form 1094-C for the employer to file themselves and 1095-C for each individual considered a full time employee under IRC section 4980H.; 3.Fees and Electronic Funds Transfer. 3.1 Fees.Client will pay all applicable fees for the ACA Eligibility Tracking Agreement("Fees"),unless otherwise included in their Agreement's Fees,through an Electronic Funds Transfer(EFT),or such other payment method as required by GTM when due. Controlled Group Information Schedule GTM Affordable Care Act Eligibility Tracking Agreement Addendum Client ID# Company Name FEIN Client ID# Company Name FEIN Client ID# Company Name FEIN Client ID# Company Name FEIN Client ID# Company Name FEIN Client ID# Company Name FEIN Client ID# Company Name FEIN Client ID# Company Name FEIN Client ID# Company Name FEIN Client ID# Company Name FEIN Client ID# Company Name FEIN Client ID# Company Name FEIN Client ID# Company Name FEIN Client ID# Company Name FEIN Client ID#, Company Name FEIN Client ID# Company Name FEIN Client ID# Company Name FEIN GTM Payroll Services Inc ACA TAX REPORTING WAIVER In accordance with section 6056, the regulations provide for each Applicable Large Employer(ALE)member to file a section 6056 return with respect to its full-time employees. Similar to the separate Form W-2,Wage and Tax Statement, filed by an employer for each employee and the Form W-3,Transmittal of Wage and Tax Statements,filed as a transmittal form for the Forms W-2,these regulations provide that a separate return is required for each full-time employee,accompanied by a single transmittal form for all of the returns filed for a given calendar year. Accordingly,as a general method,these regulations provide that the section 6056 return be made by filing Form 1094-C (a transmittal) and Form 1095-C (an employee statement). Form 1095-C will be used by ALE members to satisfy the section 6055 and 6056 reporting requirements,as applicable.An ALE member that sponsors a self-insured plan will report on Form 1095-C, completing both sections to report the information required under both sections 6055 and 6056. These regulations provide that section 6056 returns must be filed with the IRS annually,no later than February 28 (March 31 if filed electronically-required if you have more than 250 w2's) of the year immediately following the calendar year to which the return relates. This is the same filing schedule applicable to other information returns with which employers are familiar, such as Forms W-2 and 1099. In addition,the regulations provide that the section 6056 employee statements be furnished annually to full-time employees on or before January 31 of the year immediately following the calendar year to which the employee statements relate.This means that the first section 6056 employee statements (meaning the statements for 2015) must be furnished no later than February 1, 2016 (January 31,2016,being a Sunday). GTM has informed you of your responsibility for ACA tax reporting and requirements for providing all Full Time Employees with a 1095-C form and the requirement to file a 1094-C form. By signing this waiver you are waiving "GTM" of all ACA tax reporting and liability,"GTM"will not provide forms 1095-C or 1094-C."GTM"has offered to provide these services at an additional cost,however, at this time you have elected not to use our services to provide these mandatory reporting forms. "GTM" is fully capable of tracking, reporting and producing 1095-C and 1094-C forms and filings. If you should require GTM to provide this service at a later date we require a 60 day written notice. Backdating of information may also create additional set up fees. Client Name: Print Name: Authorized Signature: Date: GTM Payroll Services Inc Authorized Signature: