County of San Diego Retirement Benefit Options

Transcription

1 County of San Diego Retirement Benefit Options NDC-0619 (09/2016) For help, please all 888-DC4-LIFE mydcplan.om 1

2 Things to Remember Complete all of the setions on the Retirement Benefit Options form that apply to your request. If you are requesting a payout lasting less than 10 years (inluding a lump sum payout), omplete the enlosed Form W-4P, only if you want an additional amount withheld over the 20% mandatory withholding. Submit the ompleted Retirement Benefit Options form, and any other required doumentation in the enlosed business reply envelope (County Store, 1600 Paifi Highway, Room 102, San Diego, CA 92101) or fax the request to the County Store at All distribution requests must be approved by the County of San Diego. Please note that you will need to wait for two full payhek yles after your date of severane to distribute more than 50% of eah aount. In order to take a distribution, you must be: Separated from servie (termination of employment, retirement, disability retirement or death), OR Age 70 1/2 or older, OR Have a 457(b) aount balane of $5,000 or less, have not ontributed to the aount for 2 years, and have not had a prior distribution under this provision (de minimis). Distributions from a Roth 457(b) aount must meet the following additional riteria to be a qualified distribution*: Must be made after a 5-taxable year period of partiipation*, AND You are at least 59 1/2 years old at the time of the distribution, OR You are disabled at the time of the distribution, OR Death. *The 5 -year period is based upon the earlier of: The taxable year you made your first ontribution to your County of San Diego designated Roth aount OR The taxable year you first ontributed to another qualified designated Roth aount that was diretly rolled into your County of San Diego designated Roth aount. Unless otherwise noted in the Soure of Withdrawal setion, if appliable, your distribution request will be rejeted. You must selet a Plan Type or your distribution request will be rejeted. 2 NDC-0619 (09/2016) For help, please all 888-DC4-LIFE mydcplan.om

3 County of San Diego Retirement Benefits Options Form Personal Information Partiipant Name: Partiipant SSN or Aount #: Mailing Address: City, State*, & Zip Code: Date of Birth: Phone Number: Address: How would you like to be ontated if additional information is required? Telephone *NRS will use the state provided in your mailing address as your state of resideny for tax purposes, unless instruted otherwise. Distribution Reason (Chek the option that applies) & Ation Requested Severane of Employment Retirement Disability Required Minimum Distribution De Minimis (457(b) plan only) Death (death ertifiate attahed) Please tell us whih of your aounts - 457(b), Roth 457(b) or 401(a) - you wish to withdrawal funds from. If you want to withdrawal funds from more than one aount, you must hoose an aount for eah of your withdrawal requests. 457(b) Plan Roth 457(b) 401(a) Plan Initiate payout Stop urrent payments (Fixed Period and Fixed Dollar Payments only.) Change/Restart (Wish to hange/restart option or distribution amount.) Please note: Due to payroll audits, you will need to wait for two full payhek yles after your severane from employment date to remove more than 50% of eah aount. 50% or less may be released upon being listed as severed from employment. Severane from Employment Date Employer (Selet One): County of San Diego Severane of Employment Date: San Diego Superior Court Publi Safety Offier Signature of Deferred Compensation Representative: Date: Position & Title of Deferred Compensation Representative: Contat Phone Number: Benefiiary Designation Chek here if this is a hange of benefiiary. (Benefiiaries listed below replae 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 Contingent Benefiiary(ies) (must total 100%): Total = 100% Name/Relationship Soial Seurity # Phone # Address Date of Birth % Split Total = 100% NDC-0619 (09/2016) For help, please all 888-DC4-LIFE mydcplan.om 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: Soure of Withdrawal Sine you might have different soures of money - pre-tax (traditional) or post-tax (Roth) ontributions or rollover assets - we need to know what perentage of your withdrawal should ome from eah money soure. If you hoose ertain perentages from eah money soure, all perentages must total 100% for eah withdrawal request or we annot proess your request. If you do not hoose a soure for your withdrawal, your distribution request will be rejeted. Withdraw proportionally OR Use the following soure perentages: 457(b) traditional ontributions 457(b) traditional rollover Roth 457(b) ontributions Roth 457(b) rollover 401(a) traditional ontributions 401(a) traditional rollover TOTAL=100% Withdrawal Method & Frequeny Please selet a method of payment and fill in the appropriate information. The speified term must be for a period not greater than your life expetany. All funds will be withdrawn on a pro-rata basis aross all funding options for eah requested distribution. The only exeption to this would be a hand-written request indiating the speifi option for the withdrawal. Earnings from designated Roth ontributions will be subjet to inome taxes upon distribution if the distribution is deemed to be non-qualified. Please see the Things to Remember setion for additional information regarding Roth distributions. In addition, Designated Roth Aounts whih are rolled over into this aount may be subjet to inome taxes and penalties if they are deemed Non-Qualified. Designated qualified Roth ontributions are generally not subjet to inome taxes or penalties. Option 1 - Lump Sum To reeive a Lump Sum distribution, please selet one option: 1. Lump Sum for the entire aount balane 2. Partial Distribution in the amount of $ Option 2 - Periodi Payment a. Fixed Dollar Payment Speified amount paid to you until your aount balane is zero (final payment may be less). The number of payments you reeive will vary depending on the earnings (gains/losses) your aount experienes. Payment Amount: $ Payment Frequeny: Monthly Quarterly Semi-Annually Annually 4 NDC-0619 (09/2016) For help, please all 888-DC4-LIFE mydcplan.om

5 Withdrawal Method & Frequeny (ontinued) Option 2 - Periodi Payment (ontinued) b. Fixed Period Payment Aount balane paid to you for the number of years seleted. The atual dollar amount will vary depending on the earnings (gains/losses) your aount experienes, and the duration requested. You must also hoose either method one or method two to determine the method of alulation of your payment. Number of Years To reeive a Fixed Period Payment, please selet one of the following alulation methods: Method One: Realulates payment periodially (as seleted below) by dividing your aount balane by number of remaining payments. Method Two: Realulates your payment amount annually by dividing your Deember aount balane by the number of remaining payments. Payment amounts will hange in January of eah year. To reeive a Fixed Period Payment, please selet one of the following payment frequenies: Monthly Quarterly Semi-Annually Annually Option 3 - Required Minimum Distribution Required Minimum Distribution: Must be at least 70 1/2 years of age to selet this option. (If the RMD S are eliminated for any given year, you must ontat us to stop the payment for that year.) Payment Frequeny: Monthly Quarterly Semi-Annually Annually Payment Method NOTE: If you do not hoose an option and ACH information is on file, your benefit payment will be sent via ACH. Send hek by first lass mail to my address of reord. Allow 5 to 10 business days from proess date for delivery. Send hek overnight at my expense to my address of reord. I understand there is an additional $25.00 fee that will be deduted from my aount. P.O. Box addresses are not eligible for overnight delivery and Saturday delivery may not be available in your area. Allow 2 to 4 business days from proess date for delivery. ACH Instrutions on File Send funds to my bank aount that NRS has on file. Diret Deposit by ACH: Chek only one option: Cheking Aount Savings Aount Bank/Credit Union Name John Doe 123 Main Street Ph. (614) Hometown, OH Date 1492 ( ) Bank/Credit Union Phone Number ABA (Routing) Number* (first nine digits only) PAY TO THE ORDER OF $ Money Bank, In. 321 Main Street Hometown, OH MEMO : : DOLLARS Aount Number 9-digit ABA routing number Cheking Aount Number Chek Number Note: Diret Deposit is only offered through members of the Automati Clearing House (ACH). We annot aept a deposit slip for banking numbers. If ACH information is not ompleted orretly a hek will be sent to your address on file. In addition, if you re distribution request is $10,000 or greater, you must provide a voided hek. Is this aount assoiated with a brokerage firm or other investment firm? If yes, have you onfirmed that the ABA and aount numbers are orret? Yes No Yes No I hereby authorize NRS to initiate automati deposits to my aount at the finanial institution named above. In the event an error is made, I authorize NRS to make a withdrawal from this aount. Further, I agree not to hold NRS responsible for any delay or loss of funds due to inorret or inomplete information supplied by me or by my finanial institution or due to an error on the part of my finanial institution in depositing funds to my aount. This agreement will remain in effet until NRS reeives a written notie of anellation from me or my finanial institution, or until I submit a new diret deposit authorization form to NRS. In the event this diret deposit authorization form is inomplete or ontains inorret information, I understand a hek will be issued to my address of reord. NDC-0619 (09/2016) For help, please all 888-DC4-LIFE mydcplan.om 5

6 Certifiation Under penalties of perjury, I ertify that: 1. The number shown on this form is my orret taxpayer identifiation number (or I am waiting for a number to be issued to me), and 2. I am not subjet to bakup withholding beause: (a) I am exempt from bakup withholding, or (b) I have not been notified by the Internal Revenue Servie (IRS) that I am subjet to bakup withholding as a result of a failure to report all interest or dividends, or () the IRS has notified me that I am no longer subjet to bakup withholding, and 3. I am a U.S. itizen or other U.S. person. 4. The FATCA ode entered on this form (if any) indiating that the payee is exempt from FATCA reporting is orret. Authorization I attest that I am not urrently, nor will be, an employee of the County of San Diego or the San Diego Superior Court. I ertify that I have reeived and read the Speial Tax Notie Regarding Plan Payments. If I elet to reeive this distribution before the end of the 30-day minimum notie period, my signature on this eletion shall onstitute a waiver of my rights to the 30-day notie requirement. Federal inome tax will be withheld from your payments as required by the Internal Revenue Code. If you selet a lump sum or systemati withdrawal lasting less than 10 years, 20% of the taxable portion of the distribution paid to you will be withheld for federal inome taxes. State taxes will be withheld where appliable. State and federal taxes withheld will be reported on a form 1099R. Some mutual funds may impose a short-term trade fee. Please read the underlying prospetuses arefully. IF YOU HAVE ANY QUESTIONS CONCERNING THIS FORM, PLEASE CONTACT US AT DC4-LIFE ( ). The Internal Revenue Servie does not require your onsent to any provision of this doument other than the ertifiations required to avoid bakup withholding. Partiipant Signature: Date: Form Return By mail: County of San Diego Deferred Compensation Plan 1600 Paifi Highway, Room 102 San Diego, CA By fax: NDC-0619 (09/2016) For help, please all 888-DC4-LIFE mydcplan.om

7 Rules & Considerations Benefit Options - The Details 1. The Benefit Commenement Date must be no later than April 1st of the alendar year following the year in whih a partiipant attains the age of 70 1/2, unless still employed. Note, if you elet to defer the required minimum distribution for the year in whih you attain 70 1/2 to the following year, you will be required to take two years of required minimum distributions in that year. 2. Distribution requests are generally proessed within 3 business days upon reeipt. The request must be ompleted aurately and in its entirety in order to be proessed. Payment will be issued upon the 4th business day. Business days are defined as days the New York Stok Exhange is open. Benefit Payment Options 1. You may wish to onsult your tax advisor before seleting any Benefit Payment Option. 2. A minimum distribution of your aount is required to begin when you attain age 70 1/2. This payment option will only pay the minimum that is required to be paid to you eah year. The amount that is required to be distributed will be alulated for eah distribution year in aordane with regulations under Setion 401(a)(9) of the Internal Revenue Code. The Required Minimum Distribution (RMD) will usually differ eah year beause of the hanges in your aount balane and the hange in your life expetany. This payment option is not available unless you have attained age 70 1/2 and annot be rolled over to another eligible retirement plan or IRA. Additionally, if RMD s are eliminated for any given year, you must ontat NRS to stop the payment for that year. 3. Benefit payments are taxable as ordinary inome when reeived, and it is reommended you submit a W-4P and State DE-4P Form with this form, if you are a California resident. If you reside in a state other than California, please submit the appliable State tax form. Inome taxes will be withheld when appliable from benefit payments. Note: Generally, Roth distributions are not subjet to inome taxes if they are a deemed Qualified. Please see the Things to Remember setion for additional information. 4. Benefit Payment Options are subjet to the terms and harges, if any, imposed by the investment options available under the Plan, and to any rules or proedures adopted by your employer. Benefiiary Information 5. a. If providing updated benefiiary information, please indiate their relationship to you, Soial Seurity number and date of birth. b. 457(b) Plan - A spousal benefiiary must selet a distribution method and frequeny, if appliable, no later than Deember 31st of the alendar year in whih you would have reahed age 70 1/2. In addition, 100% of the balane of your aount must be paid out to your spouse within his or her life expetany, based on Internal Revenue Servie life expetany tables.. 457(b) Plan - Generally, non-spousal benefiiaries must reeive all payments within five years of your death, unless they selet a distribution method and frequeny, if appliable, no later than Deember 31st of the alendar year following your death. If an eletion is made by Deember 31st of the alendar year following your death, then they must reeive 100% of your aount within their life expetany. d. 401(a) Plan - A spousal benefiiary must selet a total lump sum no later than Deember 31 of the later of the alendar year following the alendar year in whih the partiipant died or the alendar year in whih the partiipant would have attained age 70 1/2. e. 401(a) Plan - Non-spousal benefiiaries must selet a lump sum distribution no later than 12 months after the date of the partiipant s death. Still Have Questions? We want to provide you the tools to make an informed deision. Just beause you have the option to reeive a distribution does not mean you have to. It is Nationwide s goal to give you the eduation and the resoures, so the deisions you make about your retirement benefit help you meet your long-term goals. If you still have questions about reeiving a distribution from your aount, please all us at DC4-LIFE ( ). A representative an help you understand your options before reeiving a distribution. NDC-0619 (09/2016) For help, please all 888-DC4-LIFE mydcplan.om 7

8 8 NDC-0619 (09/2016) For help, please all 888-DC4-LIFE mydcplan.om