Glendale Unified School District AR , , Administrative Regulation Page 1 of 10

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1 Glendale Unified School District AR , , Administrative Regulation Page 1 of 10 Business and Non-Instructional Operations Tax Sheltered Annuity Plan a. Board Policy The District s TSA plan will be implemented in compliance with Board Policy b. Salary Reduction and Exclusion Any permanent employee requesting a new or revised TSA plan through salary reduction will complete a Salary Reduction Agreement (SRA) TSA form as shown in attachment 1. In addition, the employee must complete a Basic Limit Worksheet (attachment 2A) and if applicable, Catch Up Contribution worksheets (attachment 2B) prior to establishing the salary reduction. The requested salary reduction amount cannot exceed the exclusion limit as shown on these worksheets. c. Terminations and Changes A Termination TSA Salary Reduction Agreement as shown in attachment 3 should be submitted only when the employee wishes to terminate his/her entire TSA plan. Requests to revise dollar amounts or to change TSA companies should be sent in on the Salary Reduction Agreement TSA form. Once the new SRA agreement is approved, the previous agreements are rescinded. d. Submission of Forms All SRA agreements, terminations, and changes must be submitted to Financial Services at least twenty (20) working days prior to the pay date for which they are to take effect. This is to ensure that all forms are properly completed and that the TSA company selected is on Los Angeles County Office of Education s (LACOE s) approved list. e. Establishing an Account It is the employee s responsibility to ensure that an account has been established with the TSA company. The District will not be held responsible or be liable for any lost or missing payments to the TSA company nor any lost interest because the account was not properly established with the TSA company.

2 Glendale Unified School District AR , , Administration Regulation Page 2 of 10 Business and Noninstructional Operations Tax Sheltered Annuity Plan f. Period of No Salary Reduction Salary reductions will be made for all months in which the SRA is in effect except July and August. If at any time the employee s monthly net pay is less than the SRA amount, no salary reduction will be made. g. Over-contribution The District reserves the right to revise or stop any salary reduction whenever it becomes apparent that the employee has or will have exceeded his/her contribution limit for any calendar year. The employee will be notified prior to such action. Rules Amended: 2/4/03 Formerly AR 3371

3 SRA SALARY REDUCTION AGREEMENT TSA/403(b) Tax Sheltered Annuities; Tax Sheltered Custodial Accounts (Hereinafter referred to as TSA/403(b)) Attachment 1A This Agreement must be signed by the Employee and received in the District payroll-personnel office no less than four weeks before the pay date for which it is to take effect. If you participate in multiple 403(b) accounts, all salary reductions must be on one SRA form. This Agreement is not effective until the District approved. This Agreement is irrevocable by the Employee as to any salary or amounts paid but may be terminated or changed as to salary not paid. DISTRICT: GLENDALE UNIFIED SCHOOL DISTRICT Employee Name: S.S. Number: Check Mark: this is an initial agreement, or this is a superseding agreement If a superseding agreement (check all of those that apply): Change of contributions Change of one or more Providers Discontinuance of contributions (contributions cannot be resumed without a new SRA) Compensation to be paid to this Employee by the District shall be reduced by the sum indicated per pay period starting with the compensation to be paid on the date stated, but shall not be effective for compensation already paid. Insert other instructions as necessary: Amount $ Starting with compensation to be paid on:, 20 (Special note: Salary reductions will begin at the first available payroll period after requirements are satisfied. That beginning date may be later than the date listed above, but in no event will it be earlier.) The above shall be transmitted by or on behalf of the District in accordance with the District s TSA/403(b) Plan in the following manner: $ $ $ To: Check: Annuity Contract, or Custodial Account To: Check: Annuity Contract, or Custodial Account To: Check: Annuity Contract, or Custodial Account In accordance with California Education Code section 44041/87040, and for the purpose of qualifying under the provisions and for the benefits of Section 403(b) of the Internal Revenue Code of 1986, as amended, Section of the California Revenue and Taxation Code and the Tax Sheltered Annuity Plan adopted by the Governing Board of the District; 1 Revised 1/2002

4 IT IS HEREBY AGREED by the District and the Employee that the certain valid existing employment contract (written or otherwise) made and entered into by and between the District and Employee be amended by salary reduction in the manner described above, and that this Agreement be incorporated therein by reference and made a part thereof as if set out therein in full, as of the date of this Agreement. This Agreement supersedes and replaces all previous Agreement(s) naming the issuer(s) and/or custodian(s) designated above. The Employee shall have no more than one SRA in effect at any time, listing all annuity contracts and/or custodial accounts to which payments are made by the District. The Employee understands that, in accordance with the regulations under the Internal Revenue Code this agreement may only be effective with respect to compensation received by or made available to the employee subsequent to the effective date (and the district approval) of the Agreement and shall not apply to compensation paid or made available before such date. 1. The Employee releases any and all rights, present and future, to receive payment from the District of the sums resulting from such salary reduction in any form except (a) the right of the Employee s estate to receipt of sums so paid at death, or (b) the right to the Employee upon termination of employment by reason other than death, personally to receive all or any part of the amount specified for which service has been rendered but which has not been transmitted to a life insurance company or custodian. 2. This Agreement shall automatically apply to the employment contract entered into between the District and the Employee for each succeeding school year unless amended or terminated by a thirty (30) day written notice to the District. 3. The Employee acknowledges that: Attachment 1B a. For purposes of this Agreement, the Accommodating Parties are the District, its governing board the Los Angeles County Superintendent of Schools, and officers and employees respectively. The Accommodating Parties do not recommend to any individual employee participation in any such program. The fact that a particular annuity contract or custodial account may be available under the District s TSA/403(b) Plan does not constitute an endorsement, recommendation or approval of any kind by any of the Accommodating Parties and they do not warrant any particular tax consequence to the employees who elect to participate. b. The Employee has elected to participate, and has determined the amounts of salary reduction and the annuity contracts, custodial accounts and individual funds in which such amounts shall be invested, without relying in any manner on the Accommodating Parties and that a loss of all or a portion of such investment may result. c. If the Employee has selected an annuity contact and the contract is cashed in, surrender charges may apply; and in the case of a variable annuity, cash values are based upon equity-type securities and are not guaranteed. d. The Salary Reduction contributions on behalf of a participant for a Taxable Year shall not exceed the maximum amount that may be excluded from the Employee s taxable income. 2 Revised 1/2002

5 Attachment 1C e. If for any Taxable Year of the Employee, this plan applies to two or more TSA/403(b) accounts, such accounts shall be treated as one TSA/403(b) account for purpose of computing the maximum contribution applicable to the Employee. f. The TSA/403(b) accounts shall provide for corrective distributions of Salary Reduction contributions in excess of the maximum allowable reduction, and in excess of the maximum contribution amount in accordance with the Regulations and/or the specific Correction Programs set forth in IRS Revenue Procedure or IRS Revenue Procedures that supersede it. g. This Agreement may be terminated by the District at any time in the event the employee, issuer, or custodian fails to comply with the TSA/403(b) Plan, procedures and/or rules of the District, or with respect to the issuer or custodian, the applicable agreements. Employee certifies that he or she has received a prospectus or similar disclosure document for the annuity contract and/or mutual funds to be purchased through the custodial account, and understands the applicable sales and management charges. 4. The Employee agrees that Accommodating Parties shall have no liability whatsoever for any loss suffered by the Employee with regard to the selection of an insurance or investment company, or the solvency, operation of, or benefits provided by said insurance or investment company. The Employee further agrees that the Accommodating Parties shall have no liability whatsoever for any loss suffered by the Employee by reason of the transmittal of any funds pursuant to this or any other Agreement. 5. The Employee acknowledges that there are rules set forth in Section 403(b), Initial Section 415(c), Section 402(g), and Section 414(v) of the Internal Revenue Code, that limit contributions on behalf of the Employee to the Plan and limit the maximum amount of salary reduction that can be made that will reduce Employee s taxable income. Some of these rules involve calculations that require salary and employment histories, as well as knowledge of the Employee s current and past participation in elective deferral programs of this Employer. 6. The Employee agrees that all computations in connection with the determination of the Initial amount of the salary reduction hereby authorized, including but not limited to the amount of includible compensation and years of service pursuant to Section 403(b) or 415(c) of the Internal Revenue Code, shall be the responsibility of the individual Employee and the broker, agent or insurance, annuity or investment company. Employee agrees to provide such certification of the correctness of such computations as the District may require, to be signed by the Employee and to provide accurate information to the party performing and/or certifying calculations as may be required by it for such purpose(s). In no event shall such computations be the responsibility of the Accommodating Parties, nor of any officer or employee of the Accommodating Parties assigned any duties in connection with the District TSA/403(b) Plan. 3 Revised 1/2002

6 Attachment 1D 7. Initial The Employee agrees to hold harmless and indemnify the Accommodating Parties from any and all damages that my result from Employee s participating in the District s TSA/403(b) Plan, including the incorrect calculation of the Employee s contribution limits. Indemnification from damages shall include any tax, interest, penalties or assessments or related costs that may be incurred by or imposed upon the Accommodating Parties. The Employee agrees and authorizes the District to recover indemnification through payroll deduction or, at the option of the District, through any other legal process. IN WITNESS WHEREOF, this Agreement has been executed by and on behalf of the parties hereto. Employee: District Representative: Signature Date Name Date Title 4 Revised 1/2002

7 Worksheet A - Basic Salary Limit Tax Sheltered Annuity (TSA) - 403(b) Plan (For catch up options, also submit Worksheet B) For Calendar Year Attachment 2A Employee Name: Social Security # Address: 1. Total compensation for the most recent 12-month period of service $ (This will usually be your salary for the current tax year) 2. Subtract your STRS/PERS reductions for the same 12-month period $ ( ) 3. Result: Includible Compensation $ 4. Enter the lesser of 100% of line 3 or $40,000 (Section 415(c) limit for calendar year ) $ 5. Enter the lesser of line 4, or $ (Section 403 (b) limit for calendar year ) $ 6. Projected amount of any contributions made while employed with an employer other than GUSD to a TSA/403(b) plan, 401(k) plan, SAR SEP, or a SIMPLE IRA/401(k) plan for the current calendar year. $ ( ) 7. BASIC SALARY LIMIT - Subtract line 6 from line 5 - This is the total contribution permitted to your TSA/403(b) $ For Catch Up Provisions See Worksheet B Employee s Certification and Indemnification The undersigned employee of Glendale Unified School District (GUSD) does hereby certify that the contributions that are made by GUSD (by employee contributions) to the TSA/403(b) account are, to the best of employee s knowledge, within the eligible contribution limits permitted under the Internal Revenue Service Code and Regulations. This certification applies to Worksheet A, and, if applicable, Worksheet B which supports eligibility for catch up contributions. Employee further acknowledges that GUSD, its officers, employees, or agents, and the School District Governing Board bear no responsibility for the calculations. Employee bears the sole responsibility for any IRS assessed income taxes, excise taxes (in the case of IRC TSA/403(b)(7) Custodial Accounts), or penalties. Employee Signature Date 4 Revised 1/2002

8 Worksheet B - Catch Up Contributions TSA - 403(b) Plan (Submit with Worksheet A) Attachment 2B For Calendar Year Employee Name: Social Security Number: Part I: IRC 414(v) 50 + Catch Up Contribution If you will attain age 50 or older before the end of the current calendar year, you are permitted to make employee contributions in excess of the BASIC SALARY LIMIT result in Worksheet A. The additional contribution amounts are permitted regardless of whether you terminate employment during the current year. Calculation and Verification for Age 50+ Catch Up Contribution A. My age at the end of the calendar year is: (must be 50 years or older) B. Section 403 (b) 50+ Catch Up limit for calendar year $ C. Total amount of any age 50+ Catch-Up Contributions you are making to any other employer s 401(k) plan, TSA/403(b) plan, SAR SEP, or SIMPLE IRA/401(k) plan $ ( ) D. Subtract line C from B (this is the maximum 50+ Catch-Up you may $ take with GUSD for calendar year ) E. Enter the BASIC SALARY LIMIT from Worksheet A, line 7 $ F. Add lines D and E - This is the total employee contribution you can make to all TSA/403(b) accounts with GUSD using the BASIC SALARY LIMIT and the 50+ Catch Up Contribution option. $ If you are utilizing both the 50+ Catch Up and the 15+ Years of Service Limit, complete Part II and Part III.

9 Part II: IRC 402(g)(7) 15+ Years of Service Increased Limit Attachment 2C NOTE: The 15+ Years of Service calculation is only necessary if the full BASIC SALARY LIMIT ($11,000 in 2002) will also be taken in the current year. If you have 15 or more years of service with GUSD before the end of the current calendar year, you may be eligible to increase the BASIC SALARY LIMIT result from Worksheet A by as much as $3,000. However, IRC 402(g)(7) requires that you consider all employee contributions made with GUSD in years prior to the current one, and permits you to use the increased limit only until you have utilized an extra $15,000 with GUSD. The following calculations take those requirements into consideration. G. Enter the total number of Years of Service with GUSD through the current calendar year H. Multiply line G by $5,000 $ I. Enter total contributions made by you in prior years of service with GUSD to any TSA/403(b) plan plus all contributions to any Section 457(b) plan* $ ( ) J. Subtract line I from line H $ K. Maximum total deferral for 15+ Years of Service $ 15, L. Enter the sum of the amounts by which your BASIC SALARY LIMIT was increased in prior years beginning with GUSD after 1986 due to previous use of the IRC 402(g)(7) 15+ Years of Service Limit $ ( ) M. Subtract the amount on line L from line K $ N. 15+ Years of Service Option: Enter the lesser of line J, line M, OR $3,000 $ O. Enter the BASIC SALARY LIMIT from Worksheet A, line 7 $ P. Add lines N and O - This is the total employee contribution permitted during $ the current calendar year using the BASIC SALARY LIMIT and the 15+ Years of Service Limit. If you are using both the 15+ Years of Service Limit and the 50+ Catch Up, complete Part III. Part III: Combining the Catch up Contribution Options Q. Enter the amount from line F $ R. Enter the amount from line N $ S. Add lines Q and R - This is the maximum amount you can contribute to your TSA/403(b) plan with GUSD this calendar year, using both catch up options $ Note: Your signature on Worksheet A contains the certifications necessary for Worksheet B. * Because of the different treatment of 457(b) deferred compensation plans, any contributions made to a 457(b) plan, even if with another employer during your years of service with GUSD, must be taken into consideration in applying this catch-up option. This includes both employer contributions and employee contributions.

10 TSA/403(B) TERMINATION Attachment 3 Salary Reduction Agreement - Termination TO: ATTENTION: GLENDALE UNIFIED SCHOOL DISTRICT Payroll Office This form is used to completely terminate all salary reduction under the District Tax Sheltered Annuity Plan. It must be filed with the District payroll office at least four weeks prior to the pay date for which it is to be effective. If late, it may not be processed until the next pay period. NOTE: If your intent is to only change a company or a salary reduction amount (to other than zero), a new Salary Reduction Agreement is required. Employee Acknowledgment and Instructions I have previously entered into a Salary Reduction Agreement with the District for the purpose of participating in the District's Tax Sheltered Annuity Plan. By this authorization, all salary reduction TSA/403(B) amounts are terminated with the pay date of:, 20 EMPLOYEE USE DISTRICT USE Employee Name (Print or Type) Date Approved By District Social Security Number Approved by Date Signature of Employee