AMERICAN RED CROSS SAVINGS PLAN ROLLOVER CONTRIBUTION FORM INSTRUCTIONS

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1 ROLLOVER CONTRIBUTION FORM INSTRUCTIONS Please read the following and complete the attached Rollover Contribution Form and return the required documentation to contribute your rollover proceeds to the American Red Cross Savings Plan. An eligible and active American Red Cross Savings Plan participant may transfer pre-tax assets from another qualified plan such as a 401(k), 403(b), 401(a), 401(c), 403(a), and 457 plans or conduit IRA to the American Red Cross Savings Plan. If needed by your previous employer/plan or to facilitate your distribution from your transferring record keepers, a Letter of Acceptance or a Letter of Determination is attached. Please be aware that the Savings Plan will not be held responsible for any tax penalties that occur for an incomplete submission. Do not use these form to enroll in the Plan. To enroll, access the Red Cross Savings Plan website at or call the American Red Cross Savings Plan Information Line at USE THE FOLLOWING CHECKLIST AND INSTRUCTIONS: Read and complete the "Rollover Contribution Form" in its entirety Enter your name, the first 5 digits of your social security number and provide your daytime phone number. Enter rollover amount and source of funds (name of plan or conduit IRA). Select your investment election for your rollover proceeds and ensure the allocation totals 100%. You must sign and date the form as indicated. Make rollover check payable to State Street, Trustee for the American Red Cross Savings Plan FBO (your name). Your rollover check must be accompanied by a copy of your Tax Distribution Statement from your former plan. This statement must identify the full amount as taxable or that the full amount contains no after-tax money. If you are transferring assets from another qualified plan, submit proof that the previous plan is tax qualified according to the Internal Revenue Code. This proof is usually a prepared letter from your previous employer or a copy of the company s Plan Determination Letter (a.k.a. "Letter of Determination"). If you are transferring assets from a conduit IRA, submit copy(ies) of your IRA statement clearly showing the beginning deposit balance and ending balance. A conduit IRA is used to temporarily hold the transfer of retirement assets being rolled over from one qualified plan to another. The enclosed Rollover Contribution Form should accompany your rollover check. Please send the required documents and check to: NOTE American Red Cross Savings Plan P.O. Box Jacksonville, FL Please be aware that any rollover funds (i.e. 403(b), 457 plans, or any other plans) transferred to the American Red Cross Savings Plan will inherit 401(k) taxability. You must be an active employee of the American Red Cross and eligible to participant in the Savings Plan. No personal checks will be accepted. If the original payment is not made payable to the Plan or Trustee and must be reissued then the rollover checks must be received by the Savings Plan within 60 days of the original check. Shares of stock will not be accepted. After-tax money will not be accepted. Rollover contributions will be processed after check and proper documents have been received and approved. If you have any questions please call the American Red Cross Benefits Center at Participant Service Representatives are available Monday through Friday, 8 a.m. to 8 p.m. ET, except on New York Exchange holidays or you can obtain additional plan or account information at

2 ROLLOVER CONTRIBUTION FORM Name (First) (MI) (Last): - - ( ) Social Security Number (1st 5 digits only) Daytime Phone Number I am an active employee of American Red Cross and I am eligible to participant in the Savings Plan. I elect to make a rollover contribution to the American Red Cross Savings Plan in the amount of: $,. As evidenced by the attached documentation, this amount does not exceed the taxable amount, which I received from: Name of plan or conduit IRA I direct that this rollover contribution be invested in one or more of the following funds: (Investments must be in increments of 1 percent. The total investment elections must equal 100 percent.) % Morley Stable Value Fund % SSgA Russell Small Cap Index % Vanguard Intermediate Bond Index % RS Small Cap Growth Fund % Wilmington Multi-Manager Real Asset % Harbor International Fund % Eaton Vance Large Cap Value % Wasatch International Growth Fund % SSgA S&P 500 Index Fund % Lazard Emerging Market Fund % Calvert Social Investment Equity % T. Rowe Price Retirement Fund 2010 % T. Rowe Price Large Cap Growth % T. Rowe Price Retirement Fund 2020 % Lord Abbett Mid Cap Value Fund % T. Rowe Price Retirement Fund 2030 % Artisan Mid Cap Fund % T. Rowe Price Retirement Fund 2040 % RS Partners Fund % T. Rowe Price Retirement Fund % TOTAL Please Note: If no election is made, assets will be invested 100% in the T. Rowe Price Retirement Fund closest to the year in which you turn age 60. I have attached a copy of the distribution statement from my prior plan (and, if applicable, a withdrawal statement from my conduit IRA) and my check made payable to State Street, Trustee for the American Red Cross Savings Plan FBO (your name). I certify that all of the assets to be invested as specified above are eligible for rollover into the American Red Cross Savings Plan as evident by the attached tax distribution statement and Plan Determination Letter (if funds are being transferred from another qualified plan). Employee s Signature Date Please send this completed form and required documentation to: American Red Cross Savings Plan, P.O. Box 57908, Jacksonville, FL

3 LETTER OF ACCEPTANCE Dear Distributing Record Keeper: The American Red Cross Savings Plan is a qualified 401(k) Plan which will accept rollovers for it participants, from the following types of plans/sources: - 401(a) plans - 401(k) plans - 401(c) Keogh plans - 403(a) Qualified Annuity Plan - 403(b) Tax Sheltered Annuities - 457(b) Governmental Deferred Compensation Plans - Conduit Individual Retirement Account (Conduit IRA is funded from money coming from a 401(a) plan, a 403(b) plan or a 401(k) plan. If additional contributions were added to that account which were not from the same source as the original rollover amount, the IRA no longer qualifies as a conduit IRA.) The participant must be an active employee of American Red Cross and eligible to participant in the Savings Plan. Further, the participant must submit: 1) An American Red Cross Savings Plan Rollover Contribution Form; 2) Proof that the previous plan is tax qualified according to the Internal Revenue Code; 3) If Conduit IRA, opening and closing statements; and 4) The rollover check must be submitted to the address below within 60 days: American Red Cross Savings Plan P.O. Box Jacksonville, FL Sincerely, The American Red Cross Savings Plan If you have any questions please call the American Red Cross Benefits Center at Participant Service Representatives are available Monday through Friday, 8 a.m. to 8 p.m. ET, except on New York Exchange holidays or you can obtain additional plan or account information at

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