BOARD OF SUPERVISORS

County of Linn, Iowa

Directive Number:
Fitness Reimbursement Policy

Approval Date: Effective Date: Revision No: Policy Section & Number:

06/25/2007 06/25/2007 3 PM-010

Reference: BOS Minutes: 06/25/2007; 08/13/2003; Distribution: Elected Officials, Department

09/25/2002; 07/28/1997; Heads, County Employee Handbook, Intranet
06/10/1996
Initially Adopted: 12/14/1994
Purpose
The Fitness Reimbursement program is offered by Linn County to encourage employees
to become physically fit, with the anticipation of lower health care claims and less frequent
utilization of sick leave benefits. Linn County has a policy to reimburse employees for
joining or belonging to a health/fitness facility. The County will reimburse a maximum of
twenty dollars ($20) per month for a single membership for the employee, or if the
employee has a family membership, the County will reimburse a single membership rate
up to and not to exceed twenty dollars ($20) per month per employee.

Scope
This policy is applicable to all full-time and part-time, regularly scheduled twenty (20)
hours a week or more, Linn County employees responsible to the Board of Supervisors;
employees responsible to an elected official, including the elected official and their
deputies; and the Conservation Department. Also included are employees of
Emergency Management and the County Assessor’s Office. Reimbursement for part-
time employees will be prorated based on the number of hours regularly scheduled per
week.

Exceptions
The Fitness Reimbursement is not available to part-time employees that are scheduled
to work less than twenty (20) hours per week or temporary employees.

Specific Policy Provisions

A. The following are approved health/fitness facilities:
• Alive and Well Fitness Center • Northside Fitness and Tanning
• College/University based facilities • Curves for Women
• Open Court • Total Fitness
• Rockwell Recreation Center • North Dodge Athletic Club
• YMCA • Power Plant
 • Lawrence Community Center • Gold’s Gym
• Oak Moor • Inches-A-Weigh
• City of Cedar Rapids • Troy Mills Wellness
• Ellis Community Center • Aspen Fitness
• The MAC • Carousel Fitness
• Riviera Health Club • Shaping Up
• Mercy Hospital • Trim and Tone
• Hummel’s Total Workout • Elliott Uptown Fitness
• Linn County Physical Therapy, P.C. • Slimmin’ Women
• Cindy K’s Gym • Core Fitness
• CC Fitness for Women ● Oxford Fitness Center
● Snap Fitness ● Elite Fitness
● Jym’s 24 Total Fitness

B. If the facility of your choice is not on the above list and is considered a health/fitness
facility, submit information about the facility to the Human Resources Department for
review by the Health Awareness Committee.
C. To receive a fitness reimbursement, a claim form provided by the Health Awareness
Committee and available at the Human Resources Department must be completed
by the employee. A claim may be filed on a quarterly or semi-annual basis for
reimbursement of fees to a health/fitness facility for a quarterly or semi-annual period.
The claim form along with a receipt from the fitness center or bank statement
(showing your automatic deduction from your checking account) is required to be
submitted to the Human Resources Department.
1. Each claim form will have a choice of statements which will need to be read
and verified with the employee’s signature. The employee will need to select
the proper statement for his/her claim. The choice of statements are as
follows:
a. Claim for Prepayment of Fees
The fee incurred and paid for prior to receiving service which will state “I,
(employee’s name), will attend (health/fitness facility’s name) an average
of eight (8) times per month for the following (# of months).”
b. Claim for Payroll Deduction, Bank Draft or Monthly Payments
The fee incurred after the service has been provided and payment made,
will state “I (employee’s name), have attended (health/fitness facility’s
name) an average of eight (8) times per month the previous (# of
months).”
c. Claim for Second Installment of Yearly Fees Paid
The second installment of the yearly fee incurred and paid prior to receiving
service, will state “I, (employee’s name), have attended (health/fitness
facility’s name), an average of eight (8) times per month the last (# of
months), and will continue to attend (health/fitness facility’s name) an average
of eight (8) times per month the following (# of months).”

Policy PM010 2
Rev. 3
D. Employees that are current members of a health/fitness facility can receive
reimbursement for the balance of their membership according to the policy
requirements.
E. Employees may request reimbursement at any time during the benefit year. All
claims for reimbursement, with accompanying documentation, must be submitted to
the Human Resources Department prior to the last work day of February
following the end of the calendar year of reimbursement. (Ex: receipts for
calendar year 2007 must be turned into the Human Resources Department prior to
the last working day in February, 2008).

Policy PM010 3
Rev. 3
 FITNESS REIMBURSEMENT CLAIM FORM

Employee Name: ____________________________________________

Department: ___________________ Social Security #: _____________

Work Status: Full or Part Time (circle one) Hours per week: _______

Amount Requested: _________________________________________

(the maximum request is $20/month for full time employees)

-------------------------------------------------------

Please complete the appropriate statement:

Installment of Annual Fee:

I , __________________________ will/have (circle one) attend/ed ________________

(employee name) (facility name)

an average of eight (8) times per month for _________________________________.

(list months and year)

Claim for Bank Draft or Monthly Payments:

I , ____________________________ have attended ___________________________

(employee name) (facility name)

an average of eight (8) times per month for __________________________________

(list months and year)

Reminder: Attach proof of Payment - (receipt or bank statement).

__________________________________________ ________________________________
Employee Signature Date
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