TRANSACTION FORM. Nationwide Trust company, FSB. Participant Accounting Case Deposit (Form APO-3940-L)

Transcription

1 TRANSACTION FORM Nationwide Trust Company, FSB Participant Accounting Case Deposit (Form APO-3940-L) Please send this form when submitting all hard copy, tapes, diskettes or direct transmission deposit detail. Use Attachment C - Employee Loan Repayment Allocation form to send loan repayment detail. This form must be submitted with all participant accounting deposits and can be located in the last section of the Participant Accounting Case Deposit form (APO-3940-L). If an adjustment is necessary to the participant accounting case deposit or if the contribution is unusual, please submit the Paytape Adjustment form (APO-4264) along with the Participant Accounting Case Deposit form (APO-3940-L). If the Plan Sponsor is submitting the deposit detail directly to Nationwide, the contractholder must also submit the Participant Accounting Case Deposit form (APO-3940-L). Send check, wire or ACH deposits (with a case number reference) via one of the following methods: Mail checks to: Nationwide Trust company, FSB P. O. Box Columbus, OH Send wires to: Send ACH to: Send express mail to: JP Morgan Chase, NA Columbus, Ohio ABA#: Nationwide Trust Company, FSB Account #: Case Number: XXX-7XXXX (Include in OBI field ) [For custodial cases, use XXX-8XXXX] JP Morgan Chase Columbus, Ohio ABA # Nationwide Trust Company, FSB Account #: Case Number: XXX-7XXXX (Include in OBI field) [For custodial cases, use XXX-8XXXX] Nationwide Retirement Plans 3400 Southpark Pl Suite A DSPF-F6 Grove City, OH When you are not submitting a contribution electronically, please use one of the following attachments which is included in the last section of this form: Attachment D Employee Contribution Allocation Attachment C Employee Loan Repayment Allocation Note: A charge of $1 per participant (with a $25 minimum) will be billed to your firm for each hard copy participant contribution/loan repayment allocation you submit.

2 Participant Accounting Case Deposit Step 1: Complete the Case Information section. List your Case Number and Case Name. Indicate method of payment. If deposit is made by check, form APO-3940 must accompany check. If deposit is by ACH or wire, form APO-3940 must be faxed in advance of deposit. Step 2: Complete the Case Deposit Information section. List how your paytape data will be sent. If being sent via direct transmission, list the date of transmission. List the pay period end date. If there are multiple pay period end dates on the deposit breakdown, list each one along with the amount of each. The pay period end date on the deposit breakdown will determine the fiscal year. If money is to be taken from the forfeiture account, please indicate the source. Step 3: Complete the Retainer Account Information section. If this deposit is intended for the retainer account, check the box yes and list the investment option used to fund the retainer account, amount and source. If deposit is intended for a fund other than the Nationwide Money Market Fund, contact your case service specialist. Step 4: Complete the Participant Rollover Information section. Indicate if this deposit should be reported as a contribution or transfer. List the participant name, Social Security Number and the source of the deposit. Indicate if this deposit is to be allocated to the participant s investment mix. If no, indicate the fund(s) to which the deposit amount should be invested. The maximum that can be allocated to the Nationwide Bank FDIC Insured Account is 90% of participant s total asset balance.

3 Participant Accounting Case Deposit Step 5: Complete the Expense Credit section. If you intend for an expense credit to be applied to a contribution, check the appropriate box. To determine whether an expense credit applies, refer to the contract(s). If this box is checked no or left blank, Nationwide will not apply an expense credit. If an expense credit does apply, indicate the dollar amount or percentage. Remember, a contract cannot have an expense credit in excess of disclosable commission for a given contract year. Also, remember to check to which contract(s) the expense credit applies. The signature of the Plan Representative or Authorized Representative must be included. If an expense credit is applied, the contract holder s Authorized Representative must sign and date the form. If you have any questions regarding the completion of this form, please contact your case service specialist.

4 Nationwide Trust Company, FSB Participant Accounting Case Deposit Nationwide Retirement Plans P.O. BOX Columbus, Ohio Phone: FAX: Case Number: Case Name: METHOD OF PAYMENT Check # Wire ACH (Form must accompany deposit check) (Form must be faxed in advanced of deposit) Check/Wire/ACH Amount: $ CASE DEPOSIT INFORMATION Deposit Breakdown Sent By: Hard Copy Diskette Tape Direct Transmission Dated: $ / / Pay period end date $ / / Pay period end date $ / / Pay period end date $ Amount from forfeiture account Source $ Grand Total (The pay period end date determines the fiscal year.) RETAINER ACCOUNT INFORMATION Money Market fund will be used unless a fund is otherwise specified. No fixed contracts allowed. Other restrictions may apply. Deposit to retainer account Yes List fund Amount to retainer account $ Source 9 PARTICIPANT ROLLOVER INFORMATION Show on report : Contribution Transfer Participant Name: Participant SSN: Source: Amount(s) will be deposited to current investment mix or default fund direction on file unless fund(s) are otherwise specified. Fund Fund Symbol Amount Please include enrollment form for new plan participants. EXPENSE CREDIT Does an expense credit apply? Yes No If yes, indicate: $ or % Contract(s) affected: Variable Indexed Fixed Fixed Short Term Indexed Fixed Fixed Select Signature of Plan Representative or Authorized Representative Date

5 Attachment C Employee Loan Repayment Allocation (For use with a participant accounting case deposit only. A charge of $1 per participant [with a $25 minimum] will be billed to your firm for each hard copy loan repayment allocation that you request.) Pension Operations FAX: CASE INFORMATION Page of Case Number - Case Name Current Plan Year Prior Plan Year PARTICIPANT ACCOUNT DETAIL (Mark either or indicate the specific fund codes.) Participant Name/ Social Security Number Source Fund Code Principal Interest Source Fund Code Principal Interest Total $ Total $ Signature of Contractholder s Authorized Representative Date

6 Attachment D Employee Contribution Allocation (For use with a participant accounting case deposit only. A charge of $1 per participant [with a $25 minimum] will be billed to your firm for each hard copy allocation that you request.) Pension Operations FAX: Page of CASE INFORMATION Case Number - Case Name For pay period ending / / For plan year PARTICIPANT ACCOUNT DETAIL (Mark either or indicate the specific fund codes.) Participant Name/ Social Security Number Fund Code (List if not applying mix) Employer Discretionary (Pre-Tax) Employer Salary Deferral Employer Matching Employee Voluntary (Post-Tax) Total Other Total Grand Total $. Signature of Contractholder s Authorized Representative Date