Agenda 03/27/2012 Item #16E23/27/2012 Item 16.E.2.
EXECUTIVE SUMMARY
Recommendation to approve Amendment #1 to the Agreement #12 -5866 with Matrix Absence
Management, Inc. to clarify the scope of payroll tax services for the County's Short Term
Disability Insurance Program.
OBJECTIVE: To clarify the scope of payroll tax services provided by the vendor, Matrix Absence
Management, Inc. for the County's Short Term Disability Insurance Program.
CONSIDERATIONS: The Board of County Commissioners through its Risk Management Department
administers a Group Insurance Program for its employees and their eligible dependents. As part of this
program, the County provides a 40% short term disability benefit. Employees may also purchase
additional short term disability coverage to a maximum benefit of 66 2/3% (a 26 2/3% buy -up benefit).
The Short Term Disability Insurance program is self funded.
The Board entered into an agreement with Matrix Absence Management Inc. (a /k/a Matrix) on January
1, 2010 to provide third party administration claims services to the program. The duties of Matrix
includes determining the eligibility of claimants, the determination of benefits, the coordination of claims
management with medical providers, the payment of claims and the remission of appropriate taxes to
the Federal Government.
Certain claims administrators assume the duty to remit payroll taxes to the Federal Government on
behalf of the Plan Sponsor while others do not. In this instance, Matrix is assuming this responsibility.
The appropriate IRS forms have been completed for this purpose. The Clerk's Finance staff is
recommending that the Agreement also be amended to reflect these duties more specifically should
penalties be assessed as a result of non - compliance on the part of the vendor. The Risk Management
staff concurs with this recommendation.
No other provisions of the Agreement will change.
FISCAL IMPACT: There is no fiscal impact as a result of this Amendment to the Agreement.
GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this
item.
LEGAL CONSIDERATIONS:This item has been reviewed and approved by the County Attorney's
Office, is legally sufficient for Board action and only requires a majority vote for approval —SRT.
RECOMMENDATION: It is recommended that the Board of Commissioners approves Amendment #1
to Agreement #12 -5866 with Matrix Absence Management, Inc. to clarify the provision of payroll tax
services for the County's Short Term Disability Insurance Program and authorizes the Chairman to
execute the Amendment.
PREPARED BY: Jeff Walker, CPCU, ARM, Director Risk Management
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COLLIER COUNTY
Board of County Commissioners
Item Number: 16.E.2.
3/27/2012 Item 16.E.2.
Item Summary: Recommendation to approve Amendment #1 to the Agreement #12 -5866
with Matrix Absence Management, Inc. to clarify the scope of payroll tax services for the
County's Short Term Disability Insurance Program.
Meeting Date: 3/27/2012
Prepared By
Name: WalkerJeff
Title: Director - Risk Management,Risk Management
3/7/2012 11:29:08 AM
Approved By
Name: WardKelsey
Title: Manager - Contracts Administration,Purchasing & Ge
Date: 3/7/2012 5:43:02 PM
Name: WoodLyn
Title: Contracts Specialist,Purchasing & General Services
Date: 3/8/2012 11:42:38 AM
Name: Markiewiczioanne
Title: Manager - Purchasing Acquisition,Purchasing & Gene
Date: 3/9/2012 4:21:18 PM
Name: pochopinpat
Title: Administrative Assistant,Facilities Management
Date: 3/12/2012 9:57:17 AM
Name: TeachScott
Title: Deputy County Attomey,County Attorney
Date: 3/12/2012 11:17:03 AM
Name: PriceLen
Title: Administrator, Administrative Services
Date: 3/14/2012 5:36:46 PM
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3/27/2012 Item 16.E.2.
Name: TeachScott
Title: Deputy County Attorney,County Attorney
Date: 3/15/2012 4:52:24 PM
Name: KlatzkowJeff
Title: County Attorney
Date: 3/16/2012 3:32:14 PM
Name: FinnEd
Title: Senior Budget Analyst, OMB
Date: 3/20/2012 9:20:08 AM
Name: IsacksonMark
Title: Director -Corp Financial and Mgmt Svs,CMO
Date: 3/20/2012 11:03:28 AM
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3/27/2012 Item 16.E.2.
Amendment to Contract #1
The August 1, 2010 Service Agreement #12 -5866 Administrative Services Agreement for
Short Term Disability by and between Matrix Absence Management, Inc.
( "Administrator ") and Collier County Board of County Commissioners, a political
subdivision of the State of Florida ( "Client ") is this day of , 20_
amended to add an Exhibit C to the Agreement:
Exhibit C
Payroll Tax Service
(1) Matrix Payroll Services, Inc. is a wholly owned subsidiary of Matrix
Absence Management, Inc. The Client has provided IRS Form 2678,
Employer Appointment of Agent, authorizing Matrix Payroll Services to
act as agent on Client's behalf.
(11) Once an executed copy of this form is received, Matrix will send it to the
proper IRS office.
(III) Matrix will ensure the withholding of Federal Income Taxes, Social
Security Taxes, and Medicare Taxes from Short Term Disability payments
administered by Matrix.
(IV) Matrix will deduct these amounts from Client's Account, including the
employer portion of the Social Security and Medicare taxes, and transmit
the funds to the IRS by Electronic Funds Transfer.
(V) Matrix will be responsible for any late filing penalties to the IRS to the
extent Client has fully funded their liability.
(VI) Matrix will prepare the quarterly Form 941 and annual W2's.
(VII) All reporting is done under the Matrix Payroll Services FEIN.
Page 1 of 2
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All other terms and conditions of the Agreement remain in effect.
ATTEST:
Dwight E. Brock, Clerk of Courts
By:
Dated:
(SEAL)
First Witness
Type / print witness name
Second Witness
Type / print witness name
Approved as to form and
Legal sufficiency:
&sistant County Attorney C"--
Print Name
3/27/2012 Item 16.E.2.
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By:
Fred W. Coyle, Chairman
Matrix Absence Management, Inc.
Contractor
By:
Signature
Typed signature and title
Page 2 of 2
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F. 21578 Employer /Payer Appointment of Agent
(Rev. May 2007) CIVertment of the Treasury — Internal Revenue Service
Use this form if you want to request approval to have an agent file returns and make
deposits or payments of employment or other withholding taxes or if you want to
revoke an existing appointment
e If you are an employer or payer who wants to request approval, complete Parts 1 and
2 and sign Part 2. Then give it to the agent. Have the agent complete Part 3 and sign
it.
Note: This appointment is not effective until we approve your request. See the
instructions for your reporting, deposit, and payment requirements while we are
processing your request.
• If you are an employer, payer, or agent who wants to revoke an existing appointment,
complete all three parts. In this case, only one signature is required.
3/27/2012 Item 16.E.2.
OMB No. 1545.0748
(Check one)
❑✓ You want to appoint an agent for tax reporting, depositing, and paying.
❑ You want to revoke an existing appointment.
appoint i Part 2: Employer or Payer Information: It you want to .
1 Employer identification number (Elt4 R] — ® ® a
2 Employer's or payer's name )
(not your trade name) I 4fC O
3 Trade name (f any)
4 Address D � ?f"+ & AV4 F
Nunber Street Suite or room number
city State LP code
For ALL For SOME
5 Forms for which you want to appoint an agent or revoke the agent's appointment to file. employees/ employees)
(Check al/ that app(y.) Payees payees
Form 941, 941 -PR, 941 -SS (Employer's QUARTERLY Federal Tax Return)
Q
Form 943, 943 -PR (Employer's Annual Federal Tax Return for Agricultural Employees)
❑
❑
Form 944, 944 -PR, 944 -SS, 944(SP) (Employer's ANNUAL Federal Tax Return)
❑
❑
Form 945 (Annual Return of Withheld Federal Income Tax)
❑
❑
Form 1 D42 (Annual Withholding Tax Return for U.S. Source Income of Foreign Persons)
❑
❑
Form CT -1 (Employer's Annual Railroad Retirement Tax Return)
❑
❑
Form CT-2 (Employee Representative's Quarterly Railroad Tax Return)
❑
❑
Note: You may NOT appoint an agent to report, deposit, and pay taxes reported on Form 940, Employer's
Annual Federal
Unemployment (FUTA) Tax Return.
I am authorizing the IRS to disclose otherwise confidential tax information to the agent relating to the authority granted
under this appointment, including disclosures required to process Form 2678. The agent may contract with a third party,
such as a reporting agent or certified public accountant, to prepare or file the returns covered by this appointment, or to
make any required deposits and payments. Such contract may authorize the IRS to disclose confidential tax information
of the employer /payer and agent to such third party. If a third party fails to file the returns or make the deposits and
payments, the agent and employer /payer remain liable.
�� Print your name here �" 4%b aV • COY (..IC
Sign your n .n " �
name here Print your title here n At (? -& Ct tv of VC
Date / / 2011D Best daytime phone (t 35) 25'L - 150211
Now give this form to the agent to complebL
Cat No. 187700 Form 2678 (Rev. 5 -2007)
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