County of San Diego Participation Agreement for 457(b) Deferred Compensation Plan

Transcription

1 County of San Diego Partiipation Agreement for 457(b) Deferred Compensation Plan DC-4769 (07/16) For help, please all DC4-LIFE 1

2 Things to Remember Complete all of the setions on the Partiipation Agreement that apply to your request. Remember to have your funding options total 100%, in whole perentages, when ompleting the Funding Options setion. Complete the Authorization setion, and remember to sign and date this Partiipation Agreement. Enlose the ompleted Partiipation Agreement, and any other doumentation in the business reply envelope inluded with this booklet. Pre-tax and Roth ontributions will use the same investment eletion and alloation. If you wish to have different investment eletions and/or alloations, all us at DC4-LIFE ( ). As opposed to the withdrawal of earnings on pre-tax ontributions, the earnings on designated Roth ontributions are generally not subjet to future taxes as long as the distribution from the Roth aount satisfies the requirements to be a qualified distribution. Qualified distributions are distributions whih are made five years or more after January 1st of the first year that you made a Roth ontribution to this plan, and must be made on or after the attainment of age 59 ½, your death, or due to your disability. If you previously established another designated Roth aount in another plan and roll the funds from this plan to the other plan, the five-year period will begin from the date of the first ontribution to the first designated Roth aount. A non-qualified Roth distribution may result in an additional 10% tax on the earnings portion of the Roth distribution unless an exeption applies. Please note that one made, ontributions and/or rollovers to a designated Roth aount are irrevoable. In the event you wish to make hanges, only future ontributions and/ or rollovers an be redireted. 2 DC-4769 (07/16) For help, please all DC4-LIFE

3 Personal Information Name: Address: Date of Birth: County of San Diego Partiipation Agreement for 457(b) Deferred Compensation Plan Soial Seurity Number: City, State, & Zip Code: Work Phone Number: Gender: Male Female Home Phone Number: Address: Plan Name: County of San Diego Deferred Compensation Plan Plan Number: Plan Address: County of San Diego Deferred Compensation Plan, 1600 Paifi Highway, Room 102, San Diego, CA Payroll Center (Selet One): County of San Diego San Diego Superior Court Paperless Delivery Consent Paperless Delivery: By providing your address you are onsenting to reeive statements, onfirmations, terms, agreements and other information provided in onnetion with your retirement plan eletronially. Unless you hoose to have statements, aount douments and other douments sent in onnetion with your retirement plan delivered via US Mail to the mailing address of reord by heking the box below, these douments will be made available to you eletronially. I wish to reeive my statements and aount douments via US Mail. Contribution Eletion Contributions - 457(b) Pre-Tax Contributions - 457(b) Roth* Total The minimum ontribution amount is a total of $10. Payroll Frequeny: Bi-Weekly *Contributions to Roth are made on a post-tax basis. Your plan only allows whole dollars to be ontributed. For example, $ should be written as $423. Benefiiary Designation Chek here if this is a hange of benefiiary. (enefiiaries listed below superede any prior designation) PLEASE NOTE: Perentage split must total 100% for eah ategory of benefiiary. If additional spae for benefiiaries is required, attah additional sheets and mark this box: Primary Benefiiary(ies) (must total 100%): Name Relationship Soial Seurity # Phone # Address Date of Birth % Split Name Relationship Soial Seurity # Phone # Address Date of Birth % Split Contingent Benefiiary(ies) (must total 100%): Total = 100% Name Relationship Soial Seurity # Phone # Address Date of Birth % Split Name Relationship Soial Seurity # Phone # Address Date of Birth % Split Total = 100% DC-4769 (07/16) For help, please all DC4-LIFE 3

4 Spousal/Domesti Partner Benefiiary Dislosure Note: If you are married or in a registered domesti partnership and do not name your spouse/partner as at least fifty perent (50%) primary benefiiary, you should have your spouse/partner sign below. I hereby onsent to the foregoing designation of benefiiary(ies): Spouse s/registered Domesti Partner s Signature: Date: Funding Options (for New Business or Alloation Changes only) Pre-tax and Roth ontributions will use the same investment eletion and alloation. If you wish to have different investment eletions and/or alloations ontat a Customer Servie Representative at DC4-LIFE ( ). Balaned/Asset Alloation Amerian Funds - Amerian Balaned Fund (Class R4) T.Rowe Prie Retirement Inome Fund T.Rowe Prie Retirement 2015 Fund T.Rowe Prie Retirement 2020 Fund T.Rowe Prie Retirement 2025 Fund T.Rowe Prie Retirement 2030 Fund T.Rowe Prie Retirement 2035 Fund T.Rowe Prie Retirement 2040 Fund T.Rowe Prie Retirement 2045 Fund T.Rowe Prie Retirement 2050 Fund T.Rowe Prie Retirement 2055 Fund Global/Foreign/International EuroPaifi Growth Fund (Class R4) Oppenheimer Developing Markets Fund (Class Y) Large Cap Value Hartford Dividend & Growth HLS Fund (Class IA) Blend Columbia Contrarian Core Fund (Class R5) Vanguard Institutional Index Fund Growth MFS Growth Fund (Class R4) Mid Cap Value T. Rowe Prie Mid Cap Value Fund Blend Dreyfus Mid Cap Index Fund Fidelity Low Pried Stok Fund Growth Hartford Midap HLS Fund (Class IA) Small Cap Value Wells Fargo Small Cap Value Fund (Institutional Class) Blend Vanguard Small Cap Index Fund (Institutional Class) Growth T. Rowe Prie New Horizons Fund, In. Government Bond/Corporate Bond Columbia High Yield Bond Fund (Class R4) Metropolitan West Total Return Bond Fund (Class M) Please send me a opy of the Informational Brohure/Prospetus(es). Please ontat me regarding transferring my other pre-tax retirement plans. Please ontat me regarding the Cath-Up provision. Other/Speialty Nuveen Real Estate Seurities Fund Money Market/Stable Value Stable Value Fund 100% Total for both olumns must equal 100% 1 1. If the total investment option alloation perentage is greater than 100%, your appliation will be rejeted and your alloations will not be proessed. If it is less than 100%, the differene will be alloated to the T.Rowe Prie Retirement Fund based upon my birth year. Authorization I hereby elet the ontribution amount stated above. I understand my ontribution will be effetive the first pay period of the month following reeipt by the Administrative Servie Provider and will ontinue until otherwise authorized in aordane with the Plan. The ontributions will be alloated to the funding options in the perentages eleted above. I have read and understand the terms ontained in this form. I aept these terms and understand that these terms do not over all the details of the Plan or produts. Partiipant Signature: Retirement Speialist Name: Date: Agent Number: Please return your ompleted appliation to: Nationwide Retirement Solutions P.O. Box Columbus, OH Fax Number: DC-4769 (07/16) For help, please all DC4-LIFE

5 Memorandum of Understanding 1. I understand that my partiipation in the Plan is governed by the terms and onditions of the Plan Doument. The produt information brohure and fund prospetuses are available at or upon request by alling DC4-LIFE ( ). 2. The earliest your enrollment or ontribution hange an start is the first day of the month following your ompleted request. Please remember, your employer s proessing shedule will determine the atual effetive date of the ontribution. 3. I understand that no hanges will be effetive until they are proessed by the Administrative Servies Provider. 4. I understand I must ontribute a minimum of $10 per pay into the Plan to satisfy minimum plan requirements. Your plan only allows whole dollars to be ontributed. For example, $ should be written as $423 or The maximum annual ontribution amount to all 457(b) plans is the lesser of $18,000 or 100% of inludible ompensation. This amount may be adjusted annually. Additional amounts above the limit may be ontributed to the Plan if (1) I am age 50 or older during the urrent alendar year, or (2) I am within the three years prior to my Normal Retirement Age and I did not ontribute the maximum amount in prior years. Contributions in exess of maximum amounts are not permitted and will be onsidered taxable inome when refunded. It is my responsibility to ensure my ontributions do not exeed the annual limit. 6. I understand that if my total investment option alloation perentage is greater than 100%, my appliation will be rejeted and my alloations will not be proessed. If it s less than 100%, the differene will be alloated to the T. Rowe Prie Retirement Fund based upon my year of birth. Birth Date/Year Range Fund T. Rowe Prie Retirement 2055 Fund T. Rowe Prie Retirement 2050 Fund T. Rowe Prie Retirement 2045 Fund T. Rowe Prie Retirement 2040 Fund T. Rowe Prie Retirement 2035 Fund T. Rowe Prie Retirement 2030 Fund T. Rowe Prie Retirement 2025 Fund T. Rowe Prie Retirement 2020 Fund T. Rowe Prie Retirement 2015 Fund 1947 or before T. Rowe Prie Retirement Balaned Fund 7. I understand that I may make hanges among the investment within my aount, but any hanges may be subjet to restritions. Changes may be made by alling DC4-LIFE ( ) or by logging on to 8. I understand that all amounts ontributed to the Plan and earnings on those amounts ontributed are held in a trust, ustodial aount or annuity ontrat for the exlusive benefit of the partiipants and their benefiiaries until suh time as the ontribution amount is made available to the partiipant or benefiiary. 9. I understand that any benefiiary designation I made on this form will superede any prior benefiiary designation and shall beome effetive on the date aepted by the Administrative Servies Provider, provided that this designation is aepted by the Administrative Servies Provider prior to my death. My death benefits will be paid first to my Primary Benefiiaries. If some of my Primary Benefiiaries predeease me, then my death benefits will be paid to the remaining Primary Benefiiaries. Contingent Benefiiaries will only reeive benefits if no Primary Benefiiary survives me. If no benefiiary designation is on file, benefits will be paid as set forth in the Plan Doument. 10. All 457 ontributions are subservient to required taxes. The payroll enter is only able to take the full amount of the ontribution or they will not take any ontribution amount. DC-4769 (07/16) For help, please all DC4-LIFE 5

6 Memorandum of Understanding 11. I may withdraw funds from the Plan only upon severane from employment; disability retirement; at age 70 1/2; upon an unforeseeable emergeny approved by NRS and/or my employer; or I may take a one-time eletion to reeive a small amount withdrawal if my aount value is $5,000 or less (as adjusted) and I have not ontributed to the Plan for two or more years. Withdrawal for purhase or repayment of servie redits in a Governmental Defined Benefit Plan may also be permitted. Additionally, funds may be withdrawn upon my death. All withdrawals of funds must be in ompliane with the Internal Revenue Code, appliable regulations, and the Plan Doument. 12. As opposed to the withdrawal of earnings on pre-tax ontributions, the earnings on designated Roth ontributions are generally not subjet to future taxes as long as the distribution from the Roth aount satisfies the requirements to be a qualified distribution. Qualified distributions are distributions whih are made five years or more after January 1st of the first year that you made a Roth ontribution to this plan, and must be made on or after the attainment of age 59 ½, your death, or due to your disability. If you previously established another designated Roth aount in another plan and roll the funds from this plan to the other plan, the five-year period will begin from the date of the first ontribution to the first designated Roth aount. A non-qualified Roth distribution may result in an additional 10% tax on the earnings portion of the Roth distribution unless an exeption applies. Please note that one made, ontributions and/or rollovers to a designated Roth aount are irrevoable. In the event you wish to make hanges, only future ontributions and/ or rollovers an be redireted. 13. My distributions from the Plan must begin no later than the April 1st following the later of the year I reah 70½ or have a severane from employment (inluding retirement). All pre-tax distributions are taxable as ordinary inome and are subjet to inome tax in the year reeived. A non-qualified Roth distribution may result in an additional 10% tax on the earnings portion of the Roth distribution unless an exeption applies. My distributions must be made in a manner that satisfies the minimum distribution requirements of Internal Revenue Code Setion 401 (a)(9), whih urrently requires benefits to be paid at least annually over a period not to extend beyond my life expetany. Failure to meet minimum distribution requirements may result in a 50% federal exise tax on the amount of the requirement minimum distribution. 14. The funds in my aount may be eligible for rollover to a traditional or Roth IRA or to an eligible retirement plan. The Speial Tax Notie Regarding Plan Payments provides detailed information about my options. Due to important tax onsequenes related to distributions, I am advised to onsult a tax advisor. I expressly assume the responsibility for tax onsequenes relating to any distribution, and I agree that neither the Plan nor the Administrative Servies Provider shall be responsible for those tax onsequenes. INVESTMENT OPTIONS 1. I understand that the Net Asset Value of a mutual fund hanges on a daily basis and that there is no guarantee of prinipal or investment return. 2. I have reeived and reviewed the partiipating fund prospetus and/or been provided a ontat phone number to obtain the fund prospetus. 3. I understand that pursuant to the Plan Doument, ontributions will be invested per my seletion of funding options speified on the Partiipation Agreement or as otherwise amended. 4. I understand some mutual funds may impose a short-term trading fee and/or purhase blok. (Please read the fund prospetuses arefully.) MUTUAL FUND PAYMENTS DISCLOSURE Nationwide Retirement Solutions, In. and its affiliates (Nationwide) offer a variety of investment options to publi setor retirement plans through variable annuity ontrats, trust or ustodial aounts. Nationwide may reeive payments from mutual funds or their affiliates in onnetion with those investment options. Additionally, Nationwide may enter into arrangements to alloate all or a portion of these payments to plan sponsors for plan expenses. For more detail about the payments Nationwide reeives, please visit ENDORSEMENT DISCLOSURE Nationwide Retirement Solutions, In. and Nationwide Life Insurane Company have endorsement relationships with the National Assoiation of Counties and the International Assoiation of Firefighters-Finanial Corporation. More information about the endorsement relationships may be found online at 6 DC-4769 (07/16) For help, please all DC4-LIFE

7 Memorandum of Understanding CONSENT TO PAPERLESS DELIVERY AND ACCESS By providing your address on this form, you are agreeing and onsenting to reeive and view plan benefit statements, orrespondene and onfirmations, and other ommuniations eletronially. These materials will be provided through an message notifying you that eletroni douments are available online for you to view and print. This replaes all written ommuniation assoiated with your Retirement Plan(s) servied by Nationwide and you will no longer reeive these douments via U.S. Mail. By providing your onsent to paperless delivery, you are aknowledging and onfirming that you are onsenting to reeive plan ommuniations eletronially, as they are now available or as they may be required or beome available in the future and that you have aess to view and print your douments eletronially from the website and to save them from your omputer or other eletroni devie. If you would like to reeive the above referened douments in paper form via U.S. Mail you an do so by ontating Customer Servie at DC4-LIFE and requesting paper. You may opt out of paperless delivery of your plan related douments at any time. There is no additional ost to reeive douments in paper format via U.S. Mail. CHANGING YOUR ADDRESS AND YOUR PAPERLESS DELIVERY PREFERENCES You are able to update your address or hange your Paperless Delivery Preferenes anytime either on the website or via Customer Servie. YOUR RIGHT TO REVOKE CONSENT You have the right to revoke your onsent to reeive douments eletronially. Your onsent shall be effetive until you revoke it by hanging your delivery preferenes via Customer Servie or on the website by seleting U.S. Mail delivery. DC-4769 (07/16) For help, please all DC4-LIFE 7

8 8 DC-4769 (07/16) For help, please all DC4-LIFE