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Tax Services Agreement <br /> Long Term Disability(LTD) <br /> POLICYHOLDER/EMPLOYER NAME:City of Rancho Palos Verdes <br /> POLICY NUMBER:886646 <br /> EFFECTIVE DATE OF REQUEST(current or future date only):01/01/2019 <br /> A.Policyholder/Employer has provided the following information to The Hartford*regarding who bears the cost <br /> of premiums,whether the costs are incurred pre-tax or post-tax,and the taxability of benefits. <br /> The following tax treatment applies to the following group of employees:ALL <br /> • Policyholder/Employer pays the premium costs and does not include such costs in Employee's gross income. All <br /> disability benefits are 100%taxable. <br /> B.STANDARD TAX SERVICES <br /> • The Hartford will withhold and deposit applicable and properly elected additional United States federal income taxes(FIT) <br /> and state income tax(SIT)as well as applicable Employee FICA taxes from disability benefits/sick pay. The Hartford will <br /> make timely filings with the appropriate United States federal and state agencies. <br /> • The Hartford will deposit the taxes using The Hartford's tax identification number and will timely notify <br /> Policyholder/Employer of these payments. This notification is provided to you on the EOB(Explanation of Benefits). <br /> • The Hartford assumes no responsibility for the Policyholder/Employer's share of FICA(unless FICA Match and W-2 Services <br /> are elected). <br /> • The Hartford assumes no responsibility for any other payroll or employment related tax,fee,premium or the like including <br /> Federal Unemployment Insurance(FUTA)and State Unemployment Insurance(SUTA),State Disability Insurance,State or <br /> Local Occupational Taxes,other jurisdictional taxes such as municipal,city or county taxes,or any Workers'Compensation <br /> Tax which may be applicable to the disability benefits The Hartford is paying. <br /> • The Hartford will prepare and deliver to Policyholder/Employer the annual summary reports of benefits paid. <br /> C.OPTIONAL SELECTED TAX SERVICES <br /> • If you have a payroll vendor,to avoid duplication of services,it is your responsibility to provide that vendor with notice of <br /> the applicable services The Hartford will provide as identified and selected below. <br /> • Unless you specifically request different Optional Tax Services for different sub-groups of employees,we will apply the <br /> Optional Selected Tax Services as identified in Sections C.1 and C.2 below to all employees. <br /> 1. W-2 SERVICES <br /> The following tax treatment applies to the following group of employees:ALL <br /> • Policyholder/Employer authorizes The Hartford to prepare Forms W-2 for payees and file such forms with the <br /> appropriate United States federal and state agencies. <br /> • The Hartford will postmark by January 31st of each year,or such other date required by law,Forms W-2 <br /> containing sick pay information to payees and make information return filings in accordance with federal and <br /> state requirements regarding income tax,Social Security,and Medicare tax. <br /> • The Hartford will issue Forms W-2 using The Hartford's tax identification number. <br /> • If the Policy is terminated,The Hartford will continue to provide Forms W-2 and make information return filings <br /> for disability benefits/sick pay payments on all claims incurred prior to termination of the Policy. <br /> 2. FICA MATCH SERVICE(W-2 Services must be authorized above if Policyholder/Employer authorizes FICA <br /> Match Services.) <br /> The following tax treatment applies to the following group of employees:ALL <br /> The following tax treatment applies to the following plan(s):Fully Insured LTD <br /> • Policyholder/Employer authorizes The Hartford to prepare Forms W-2 as selected in section C.1,and to pay <br /> Policyholder/Employer's share of FICA taxes(FICA Match Service). <br /> 1 <br /> LTDTSA v.2018.1 <br /> *The Hartford®is The Hartford Financial Services Group,Inc.and its subsidiaries. <br />