93-71 I
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I ILLINOIS MUNICIPAL RETIREMENT FUND
M 100 South Wacker Drive-Chicago,Illinois 60606-4093 312/346-6722
R OMITTED SERVICE CREDIT VERIFICATION
F (See instructions on reverse side) Resolution No. 9 3-71
, MBERS NAME SOCIAL SECURITY NUMBER
Roger K. Dahlstrom 360-40-8149
' MAILING ADDRESS CITY STATE ZIP+4
1171 Florimond Drive Elgin Illinois 60123
DATE OF BIRTH TELEPHONE NO. 'OPTIONAL:ANTICPATED RETIREMENT DATE:
1/11/49 _( 708 ) 742-4069 _
NAME OF CURRENT RETIREMENT SYSTEM CURRENT POSITION DATE PARTICIPATION BEGAN
IMRF Planning Director IN CURRENT SYSTEM 10/29/73
_
A NO
EMPLOYER FOR WHOM SERVICE WAS RENDERED OMITTED POSITION EMPLOYER NUMBER(STATE SS .)
City of Elgin Planning Aide 69-033- -AZ.
VERIFICATION BY AUTHORIZED AGENT
I certify that the following statement of earnings for the above member are in agreement with the governmental unit's
payroll records and represents the entire qualifying employment period determined by the governing body.
MONTHS OF CREDITABLE SERVICE MONTHS OF CREDITABLE SERVICE
CALENDAR WITH WITHOUT CALENDAR WITH WITHOUT
YEAR EARNINGS EARNINGS EARNINGS* YEAR EARNINGS EARNINGS EARNINGS*
1973 385.16 2 .
1974 5,378.58 12
'SE-(seasonal leave explalned on reverse side) D � .
February 10, 1993 71 %0 - '
DATE S$GNATUR AUTHORIZED AGENT I
RESOLUTION BY GOVERNING BODY J
WHEREAS,Ow manor should have been but was not reported to the Bknols Muniopal RNMamsrd Fund bra period of 14 months.
WHEREAS,inverter contributions for the omitted seMoe are payable to Moe Municipal Retirement Fund through an eclustmsnI to future enpbysr
I oonbbuifon Hies.
RESOLVED,r is the fUdkg d this City of Elgin that:
• --or omm ee beep
1; 1. The member worked In an Illinois Municipal Retirement Fund quaking g position teeing the years and months sat forth above.
2. The member is curter*employed in an IMRF qualifying position or a',stern trot has reciprocity with IMRF.
j' FURTHER RESOLVED,that the authorized agent is directed to as a oerilled copy al this t esoMAlon and any pertinent forms and documents with the
1 Illinois Municipal Retirement Fund.
CERTIFICATION BY CLERK OR SECRETARY OF GOVERNING BODY
), Dolonna Mecum ,the City Clerk a
WOE CLERK ermeaonETARY
City of Elgin ,,tb hereby codify thee Iam the keeper dis
awre or eov miner A.uST
aeoorde and tat the foregoing is a true and coned copy of a resolution dug adopted by Its governing body et a meeting held on the 10th day of
March , ,fe 93 •
March IL , 1993 City Clerk c
MY! aslec on MdITARY Tuw
i CERTIFICATION BY MEMBER
I fury understand that under the Illinois Pension Coda I have the right to establish the period.This is to co that I was
employed and received the above earnings horn the above governmental unit from 11•44 • 1 S/7 S
and;that I QI agree,or 0 disagree(please send letter of explanation)with the period • by the ••T , • ' • body.
r
February 10, 1993 A - A ■ .e) / .i _ _
\.., DATE .141:1 0 KR
111 1
IMRF Form 6.05(Rev.7/91)
OMITTED SERVICE CREDIT VERIFICATION
INSTRUCTIONS FOR USE
WHEN TO USE THIS FORM:
If the entire omitted period falls within the current calendar year or can be reported prior to February 15 of the following year,you
may use IMRF Form 3.20,'Employers Report of Adjustments to IMRF Earnings'If the entire omitted period does not fall wthin the
current year,you should use this form.
REQUIREMENTS FOR OMITTED SERVICE CREDIT:
1. The service was rendered by a member in a position qualified for IMRF membership. Do not apply for omitted service credit for
members who are now in qualifying positions but ask for credit for service they previously rendered in non-qualifying positions.If
the member previously worked in a nonqualifying position that was properly classified as such,the member and position should
not now be reclassified as qualifying.
2. The service was not previously reported to IMRF. The earnings for this period may or may not have been reported for Social
Security.
3. The service was rendered by the member after the date the governmental unit joined IMRF.Use Form 6.07,'Application for Prior
Service Credit;for eligible service rendered prior to the date the governmental unit joined IMRF.Refer to Form 6.07 for specific
requirements.
4. This form must be received by IMRF while the member is currently participating in IMRF or another retirement system covered
by the lUinois Retirement Systems Reciprocal Act.
5. The omitted service resolution on the front of this form is adopted by the governing body,certified by the clerk or secretary.
6. The form is certified by the Authorized Agent and member.
7. The member pays IMRF contributions on the omitted earnings. Interest is calculated on the contribution from the end of the
omitted period through December 31st of the year preceding the current year.
EARNINGS:
Enter in the space provided on this form the annual gross earnings for the entire qualifying period, not previously reported for IMRF
coverage. Service credit can only be granted in the month a member worked and received payment An exception to this rule will
be made for members in seasonal positions or members paid irregularly such as elected officials. EXAMPLE:A member hired on
January 15,but first paid in February would not be entitled to service credit for January.
SEASONAL LEAVE:
The member may receive service credit for the periods without earnings provided the member.
1.was employed in a seasonal position,
2.had six consecutive months of earnings within a 12-month period,
3.remained in an employment relationship during the seasonal leave period and the member received earnings after the leave
period.
If the member did not receive earnings after the seasonal leave period,please explain why and we will determine whether service
should be granted.
SOCIAL SECURITY WAGE ADJUSTMENTS:
If Social Security wages we also omitted,see Section 4 of the Manual for Authorized Agents.
PAYMENT OF CONTRIBUTIONS AND INTEREST:
IMRF will mail to the member a Past Service Payment Schedule which offers two payment plan options for establishing the past
service.Option 1 is the Lump Sum Payment Plan and Option 2 is the Unit Payment Plan.The Lump Sum Payment allows members
to pay the total cost with a single payment and purchase all past service at once. The Unit Payment Plan allows members to
purchase one or more months at a time. Members may pay as often as they like, buying back credit from the latest month to the
earliest month of eligible service.However,they may not buy more months than indicated on the Past Service Payment Schedule.
Note:Members who have terminated IMRF participation can make one payment only for past service.
INFORMATION FOR MEMBERS UNDER THE RECIPROCAL ACT:
A minimum of 12 months of service credit with any single reciprocal pension system is required by the lainois Retirement Systems
Reciprocal Act. Smaller amounts of service with any one system will not be counted in the computation of a reciprocal pension.A
list of the 13 systems covered by the Act are listed in Section 5 of the Manual for Authorized Agents.Local police and fire pension
funds are not covered by the Act.
PENSION ESTIMATES:
Members who want to know how the omitted service will affect their pension, should wait until they receive the Past Service
Payment Schedule and decide how many months of service to purchase. Then they can write or cell their current system for a
pension estimate.
EMPLOYER'S COST:
The governmental unit's contribution for omitted service is made through future contribution rates.Therefore,a separate payment is
not required.The actuary will take the omitted service into account when annually determining the employer contrbution rate.This
is the rate shown on IMRF Form 3.10,'Monthly Deposit Report'
IMRF Form 6.05(Rev.7/61)
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Agenda Item No. 61
+fearer.
February 10, 1993
TO: The Mayor and Members of the City Council
FROM: Larry Rice
SUBJECT: Omitted Service Credit for Roger K. Dahlstrom
Purpose: This is to request Council 's authorization to
endorse and send in the necessary papers to obtain service
credit for Mr. Roger K. Dahlstrom.
Background: Mr. Dahlstrom was employed as a planning aide
,.+r. by the City of Elgin from October 29, 1973 through January 5,
1975. No contribution was made to IMRF by the City for Mr.
Dahlstrom during this period because he was considered a
part-time employee. However, IMRF law requires that an
employee working more than 600 hours annually participate in
the fund and Mr. Dahlstrom worked more than 600 hours during
1973 and 1974 .
Financial Impact: The exact cost to the City can not be
determined because the employer contributions for the omitted
service are payable to IMRF through an adjustment to the
City's future contribution rate.
Recommendation: Since Mr. Dahlstrom worked the required
hours and was entitled to contribution by the City for the
period in question, it is recommended that council approve the
request to take the necessary action to obtain the omitted
service credit or Mr. Dahlstrom.
glIPIA „. .
Larry'7'ice
LR/vls
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