HomeMy WebLinkAboutContract 47185-R1 CITY SECRETARY
RECEIVED 'CONTRACT IO. -
14 2016
Cl CM StRETARY
TH
HEALTH COST MANAGER SUBSCRIPTION SERVICES
RENEWAL ADDENDUM TO CITY SECRETARY CONTRACT NO.4718S
THIS HEALTH COST MANAGER SUBSCRIPTION SERVICES RENEWAL ADDENDUM (the
"Addendum") is made and entered into as of 9/1/2016 (the "Effective Date"), by and between
EMPLOYEE TECH, INC. ("We," "Us," "Our," or the "Company") and City of Fort Worth
("Customer," "You," or "Your"), and renews that certain HealthCost Manager Customer
Agreement (the "Agreement") between You and Us dated as of November 1, 2015.
RECITALS
You desire to renew the Agreement for the Renewal Term (defined below), and We are
agreeable to permitting You to renew the Agreement for the Renewal Term, subject to the terms
and conditions of this Addendum.
NOW, THEREFORE, in consideration of the mutual terms, agreements, and conditions
herein contained and other good and valuable consideration, the receipt and sufficiency of which
is hereby acknowledged, the parties agree as follows:
1. Renewal Term. After the end of the Term of the Agreement (as set forth in Section 10 of
the Agreement), and subject to payment by You of the Subscription Fees (as set forth in Section 7
of the Agreement), the Agreement is hereby amended to automatically renewal for consecutive
one (1) year terms (each a "Renewal Term") until either party gives written notice to terminate
no less than three (3) months prior to the end of the Renewal Term, or as provided in Section 11
of the Agreement.
2. Data Breach. In the event of a security incident wherein an unauthorized disclosure of, or
access to Your Confidential Information (as that term is defined in Section 4 of the Agreement) is
confirmed (the "Security Incident"), and provided that such Security Incident did not result from
Your breach of Your obligations, representations, and warranties made herein, We agree to: (a)
use commercially reasonably efforts to notify You no later than five (5) days of discovery of such
Security Incident; (b) Take all reasonable actions necessary to investigate, respond to, and limit
the adverse effects of the Security Incident; (c) Assume responsibility for informing all affected
individuals in accordance with applicable law (the "Incident Notification"), and bare all costs
associated with such Incident Notification.
3. Damages. EXCEPT TO THE EXTENT OTHERWISE REQUIRED BY APPLICABLE LAW, IN NO
EVENT WILL WE BE LIABLE TO YOU (WHICH EXPRESSLY EXCLUDES THIRD PARTY CLAIMS
PURSUANT TO OUR INDEMNITY OBLIGATIONS) FOR CONSEQUENTIAL, INCIDENTAL, INDIRECT,
1 OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
PUNITIVE OR SPECIAL DAMAGES (INCLUDING LOSS OF PROFITS, DATA, BUSINESS OR GOODWILL),
IN CONTRACT OR TORT OR OTHERWISE, ARISING OUT OF A SECURITY INCIDENT.
4. Limits on Liability. IF, FOR ANY REASON, WE BECOME LIABLE TO YOU OR ANY OTHER
PARTY FOR DIRECT OR ANY OTHER DAMAGES FOR ANY CAUSE WHATSOEVER, AND REGARDLESS
OF THE FORM OF ACTION (IN CONTRACT OR TORT OR OTHERWISE), THEN OUR TOTAL
AGGREGATE LIABILITY TO YOU AND ALL OTHER PARTIES IN CONNECTION WITH THIS AGREEMENT
WILL BE LIMITED TO THE AMOUNT OF FEES YOU PAID TO US UNDER THIS AGREEMENT DURING
THE TWELVE (12) MONTHS PRECEDING THE FIRST CLAIM.
S. Effect of Addendum. The Agreement will govern the relationship between You and Us for
the duration of the Renewal Term, unless You and We agree to modifications to the Agreement
in writing. Except as otherwise set forth in this Addendum, the Agreement will remain in full
force and effect according to their terms. The parties agree that the Agreement shall be renewed
as set forth herein, and to the extent of any inconsistencies, notwithstanding anything set forth
to the contrary in the Agreement, the provisions of this Addendum shall control. You agree that
this Addendum shall apply to any further executed Agreements, or Addendums by You.
6. Miscellaneous. This Addendum was drafted by both parties, and in no event will any
adverse construction of this Addendum be attributed to Us as the drafting party. In any dispute
related to this Addendum, including any dispute related to the making hereof, the non-prevailing
party will pay the prevailing party, on demand, its costs, including its reasonable attorneys' fees.
This Addendum, including the making of it,will be construed and enforced in accordance with the
laws of the State of Illinois, county of Lake, applicable to agreements made and to be entirely
performed within such state, which laws will prevail in the event of any conflict of laws. In the
event of any dispute related to this Addendum, such dispute shall be resolved in the same
manner as set forth in the Agreement.
7. Counterparts; Electronically reproduced signature. This Addendum may be executed in
one or more counterparts, each of which when so executed and delivered shall be considered an
original, but such counterparts shall together constitute one and the same instrument and
addendum. Any signature delivered by a party by facsimile or other electronic transmission
(including email transmission of a portable document file (pdf) or similar image) shall be deemed
to be an original signature hereto.
SIGNATURE AND PRICING PAGE FOLLOWS
2
SIGNITURE AND
Mall payment to: PRICING PAGE:
EmployeeTech Y.
Elmwood Ave
Deerfield,IL 60015
Tax ID:45-5000666 HC'IA"l
Healthcu—stIvinagor
CUSTOMER INFORMATION BILLING INFORMATION (IF DIFFERENT)
Contact Name:Joanna Hilton Contact Name:
Phone Number:817-392-6275 Phone Number:
Company:City of Fort Worth Company:
Address:1000 Throckmorton Street Address:
City/State/Zip:Fort Worth, TX, 76102 City/State/Zip:
Contract Effective Date:11/1/2016
TOTAL NUMBER OF SERVICE PURCHASED DESCRIPTION AND FEE STRUCTURE ANNUAL TOTAL*
HEALTH ELIGIBLE
EMPLOYEES
Up to 8250 Employees Implementation and delivery of HCM File See HCM File proposal attached $18,500.00
solution. 2016 Filing.
Optional Mailing Cost $1.50 per 1095 B or C Form $12,249.00
Total Fees Add mailing fees to implementation for
total $30,749.00
*Total fees are based on the total number of benefit eligible employees for the current tax year for the services purchased—listed above. If final
employee count increases,customer will be responsible for the additional fees owed.Any additional requested services outlined in the proposal will be
covered under this agreement and billed at their date of request.
IN WITNESS WHEREOF, the parties hereto have duly executed and delivered this Addendum
as of the Effective Date.
Us: You (Customer):
EMPLOYEE TE�INC.
13144e--' By:
Y:
Title: Principal Titl :Ass! ant City Manager
Date: 7/11/2016 Date: , 3 4
APPROVED AS TO FORM AND LEGALITY:
1\10403806.2
A $`400"013,E Asst. CITY ATTORNEY
�X(S
OFFICIAL RECORD
IV m J. Ka ser, Ci S Lary 3 CITY SECRETARY
FNO M&C REQUIRED FT. WORTH, TX
HCPfFile
Hu,ntthCo.tM*oaQu.,
Proposal for:
City of Fort Worth
June 15, 2016
Contact: Michael Weiskirch, Principal, EmployeeTech, Inc.
Direct+1847 236 1932 1 mweiskirch@employeetech.com
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Summary
HealthCostManager(HCM) is an easy-to-use software solution for IRS 1094/1095 reporting which
provides a streamlined, cost-effective way to fulfill Affordable Care Act(ACA) reporting requirements.
HCM's web-based platform is flexible enough to meet the reporting needs of a variety of clients and
evolves as health care reporting requirements change over time. HCM is part of a suite of reporting
solutions designed by EmployeeTech,a leading benefits technology advisory firm. HCM leverages the
knowledge of leading benefit consultants,actuaries and technology professionals with many years of
experience in the employee benefits field.
Why Health Cost Manager? Meeting Affordable Care Act(ACA) reporting requirements can be a daunting
challenge. Data resides in multiple
locations,and the IRS reports can be
complex and difficult to understand.
All ALES(employers with 50 or more
full time equivalent employees)are
required to file,and many are looking
for a practical method for collecting
ACA information without consuming
N substantial internal resources.
While other solutions require complex
monthly data collection, HCM is
i designed for employers with simpler
reporting needs;who do not require
44 active management of their hourly
employee population. By focusing just on the data required for ACA reporting,the HCM process and
timeline are streamlined,allowing it to be offered at a lower cost.
How it Works
Using HCM File is very straightforward. First we set-up the
client account, inputting the required corporate data. This =;i`=-ter=— =-_• ��-_—��_
includes contact information and factors driving ACA �`"•"'`" _ �`�`� `- --z
calculations,such as lowest cost plan details. Next, HCM File • -- -- •- -- -- -- -- -- •- --
_...r.- ........... —
requires only a single year-end employee census upload with
..�____
just the data required for the filing. HCM File's proprietary - - "- -' -�•' - =<- �Ta
• i C i^oEr,C.040 C7 G G G C;O
--
algorithm then produces the correct coding for IRS forms 1094- - r_ ❑�O ��El 0 0 a i 13
.................................................................. _ . ..:.......
Etc
B or C and 1095-B or C. It happens instantaneously,and clients o'o o e�,o
can download and view PDFs of their forms,or an excel i.. "" p C OO
summary report, before mailing and efiling their formsF_ .0 C]
5
Capabilities
One-Click Access to Reporting
HCM provides expedient creation of 6055 and 6056
reporting with minimal amount of work for the client.
Clients are assigned an Account Manager to support
them throughout the process:from account set-up
through workbook creation,data validation,filing, A
forms distribution,and post-filing support. Clients can
also access Client Advisory expertise as needed.
e
i
Once data is uploaded and the HCM algorithm run,
employers can generate 6055/56 reports. Individual
reprints of the 1095-B or C forms can be downloaded
at any time. A Summary Report provides an overview ; ,
of the company's filing from a corporate perspective
and includes all employee data.
HCM-File Features:
Calculation
■ Completes Employer form 1094-B or C
■ Batch completes Employee form 1095-B or C
■ Completes Section III for self-funded plans
■ Calculates employee count monthly and#of forms for 1094-B or C
■ Generates Summary Report In Excel
Built In Logic and Security
■ Determines Correct Indicator Codes
■ Streamlines Process
■ Reduces Errors
■ Assigns Correct Plan Effective Dates
■ Interprets Safe Harbor and Transition Relief Designations
■ Multi-level security for personal information
■ Data at rest at the database level
■ Encrypted logins and data management process
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1094/1095 Delivery Options
HCM offers a variety of methods for clients to retrieve 1094 and 1095 B or C forms. For clients who have a
smaller number of forms,it is easy to download the PDF of each form in real time. Employee forms can be
printed on regular copy paper and do not require any special form for printing.
Making changes to employee forms is easy. Simply make the change in the workbook and it will
automatically update the form in our system. HCM also offers an Excel report that can be used for mail
merge and printing purposes.
Employers may choose our mail/eFile bundle and offload the entire employee form distribution process to
us. Employee forms are mailed in a secure, pressure sealed envelope directly to employees' homes.
All filing to the IRS is done electronically, including the initial filing and any post-filing corrections.
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Downloadable Downloadable Mailed to eFile with the
In PDF in Excel. Employee IRS
Download 1094 and 1095 B You have access to all of your Upon request HCIA File vvi9 HCM File will electronically file
or C forms aryiime Available 1095 form data at any time in mail your 1095 forms to your 94.95 inforrnatior.with
in batch or by individual a comprehensive MS Excel employees homes using the IRS and supportan
employee. report pressure sealed envelopes. electronic corrections process.
Advanced sorting and mailing
is utilized.
7
User Experience
HCM File is designed for expedient creation of 6055 and 6056 reporting with minimal amount of work for
the client. EmployeeTech will implement the filing using a streamlined process,accounting for key factors
in the creation of the tax forms.The information required for the census upload(the second step) is
normally produced by payroll or benefits systems reporting.Additional information may be also be added,
depending on the specific needs of the employer. All work for the current reporting can be saved and
reused in subsequent years, saving time and effort.
HCM File Customer Portal
Each client will have their own customer portal where they can login, review employee forms, run and
print reports and generate their eFiling and print/mail distribution,all from the same place.Access to this
portal is through a private and secure login process.
HCM File Workbook
HCM File utilizes a simple MS Excel workbook to upload the employee demographic and coverage data.
After uploading the workbook, HCM File determines the correct codes for forms 1094-B or C and 1095-B
or C. The main requirements for the data are focused on the following key dates:
■ Date of Hire
■ Effective date of health coverage
■ Date of waiver
■ Termination or change dates
mono
y Choose an ane
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NCM 241 'AP 7, 1. Covenpe COMM
First Name MI last Name SO, Employee 10 SSN Addr l Add,553 lanai. O tMn ST Cade N iKf11 Be Int Walee Ds
1Mn 1 Samoie 351-53-9696 1.15 Mam'Ytrtr A.OW 16 60001 1 UV2013 1/1/3016
This information can be generated from a payroll, HRIS or health insurance carrier report and combined to
populate the workbook.Workbooks are generally uploaded twice during the year; once during the initial
test and a second time prior to filing.
8
HCM File Summary Report
Prior to filing with the IRS,we recommend clients review employee 1095-B or C information for accuracy.
Our Summary Report makes it easy by providing a corporate view of all company and employee data in a
concise MS Excel format.This report includes all of the data on the 1095-B or C forms including indicator
codes and plan cost information on lines 14-16 of the 1095. It is a helpful tool for assessing and validating
the company's filing after uploading the data into the system, but prior to filing with the IRS.
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Employee Forms Center
For employers that need to reissue an employee's 1095-B or C form or make small adjustments to the
employee information;the Forms Center is an invaluable resource.The Forms Center allows clients to
search by employee and print forms at anytime during the year. Last minute edits and corrections can
easily be made in real-time.
UDlwd Now Creel Overnr/041g old _ Paw ,sEMPLOYER INFO ":
GIWw�Rta'No fie cltnan DMplayh i b ,J�pb9—Pat Pal
CLASSES
EMPLOYEES -jMMM
e Name CWS Dab of Wire
1 chade Jones 1 0111505 EdR Delete Review Firm Pm(Form
2 Pete Smith 11/15115 Ea Del Review Fpm Phil Form
� 1
9 Andy Ake 1 03+7191 E*R Dela* Review Fpm Pmt Form
J Esmeralda Cook 1 08113191 EdR Delete Review Fall Print Form
5 Ill Thornbe4ry 1 091,14/91 Edit Debk Review Form Pmt Form
6 ARM Kenna 1 011115M5 EOR 0el[le Review Fpm Print Fpm
T Sage Orth 1 01115!15 EOR Delete Review Fa6m Print Form
8 Tanw la Cahn 1 03121,191 Edit Delete Retnew Fpm Pent Form
9 Tnda Domenech 1 0811391 EdR De3ete RevWW Fpm Pmt Form
10 Mac Swakn 1 09111194 Edit Delete Review Farm Pmt Fong
9
HCM File Process and Support
While HCM File only requires a single upload of data to create and reporting at the end of the plan year,
there are steps involved in the planning process that will get you ready for the reporting well ahead of the
tax reporting requirements.
HCM File Timeline
■
4
!� 0�_
Client Set-up Testing Deliver Forms IRS eFile Corrections
Clients will be assigned a dedicated Account Manager to support them from the outset,all the way
through the implementation process, including data requirements and tax filing guidance. The HCM
process works most effectively when the Account Manager,Client,and the Client's Benefits Advisor work
together to complete the Workbook.The steps in this process are detailed below:
EmployeeTechInitial Engagement Client
Stage
Client Setup F R Client works with EmployeeTech EmployeeTech works with the client during
dedicated Account Manager in the initial data gathering stage,and advises
account setup, including client client on selections. Account Manager may
contact information and drive entire set up process.
configuration of health plan
details.
EmployeeTechTesting Stage Client
Data Collection The client will complete the EmployeeTech Account Manager will assist the
Census Workbook with employee client through the process of completing the
census including hiring and census workbook.
coverage dates for employees.
Dependent census is also
completed, if applicable.
Data 1Pa111datio The client will either load the EmployeeTech will conduct a review call when
census file or send to Account workbook is complete, provide next steps and
Manager for loading. Data will timeline,and answer questions on the project.
be validated upon loading. EmployeeTech will review the HCM File
summary report with the client to identify any
gaps in the data.
10
Testing Stage Client EmployeeTech
Corrections to data Client will make necessary EmployeeTech will work with the client to
changes to census and either re- make any relevant changes to the workbook.
upload into HCM File or send to EmployeeTech can upload new census
Account Manager. workbook with changes.
Forms Delivery . .
Stage
Distribution of 1095 Once the reporting is complete EmployeeTech will support client technical
C forms to the client will log into to system questions and overall support concerning HCM
employees and download forms at no cost, File.
or initiate the mailing of 1095-B
or C forms to employee's home.
Reprints and For reprints,the client will log EmployeeTech will offer support concerning
corrections into HCM File to access reprints HCM File reprints and corrections.
and update employee
information for revisions to the
form.
IRS eFile Stage Client . .
Electronic filing Client will initiate their filing with EmployeeTech will support client technical
with the 1R5 the IRS directly from the HCM questions and overall support concerning HCM
Portal, at no additional cost. File.
Corrections Stage Client EmployeeTech
Distribution of 1095 Client will respond to all IRS EmployeeTech will support client technical
C forms to requests for corrections or questions and overall support concerning HCM
employees refilings,through the HCM File File.
system.Corrections can be made
directly through the HCM Portal
at no additional cost.
11
Pricing
HCM Full Service Model—The HCM Account Manager supports the client throughout the entire
process from Initial discovery and account set-up,through workbook completion,data upload,
filing,and post-filing corrections:
Accou!Set-Up and Testing
• Assigned ACA Account Manager(ongoing) • Data Validation
• Client Advisory(ongoing) • Unlimited Workbook Updates
• Initial Discovery Session • Summary Report Review
• Client class structure and design • Client login and support
Forms DistributTon and eFf Ing
• 1094 Forms Completion(B or C) • Downloadable Forms
• 1095 Forms Completion(B or C) • Electronic IRS Filing(B or C)
F-End MR5u�port
• IRS Audit Assistance • Online Corrections
supportAnnual Service
(includes Implerheritation And on- Ing 90
Included services in above table
1 EIN(s),Up to 82501095 forms $18,500.00
Later Implementations(%increase by date) 20% After 10/1
This date is determined by when the contract payment is 30% After 11/1
received. 50% After 12/1
Print Mail and Postage—Pricing is per employee and is $1.50 Perform.
based on total number of 1095-B or C forms or 1095 B forms
delivered at tax time.Mailing fees are estimated and will be
reconciled post filing.Additional amounts may be due.
Additional Services
EmployeeTech Data Consulting Services.Includes:Data Additional consulting will be provided at the rate of
manipulation for File Preparation Workbook,support for $150/hr
payroll data.
12