Pioneer Investments Retirement Plans Profit Sharing & Money Purchase Pension Plan Adoption Agreement Booklet l Opinion Letters l Amendment Summary l Instructions for Completing PPA Adoption Agreement l PPA Adoption Agreements - Profit Sharing and Money Purchase Pension Plan
Table of Contents Opinion Letters I Commonly Asked Questions 1 Instructions for Completing PPA Adoption Agreement(s) 3 PPA Adoption Agreement - Simplified Profit Sharing Plan 6 PPA Adoption Agreement - Simplified Money Purchase Pension Plan 18
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Profit Sharing & Money Purchase Pension Plan Amendment Summary Commonly Asked Questions Q1. If I am the only person in my plan do I still have to amend it? A1. Yes. All retirement plans, including Pioneer s profit sharing and money purchase pension plans, must be amended for these changes. Q2. Why do I need to restate my qualified retirement plan documents? A2. The IRS requires all employers with retirement plans using pre-approved documents to restate their plan documents every six years to reflect legislative and regulatory changes since the last restatement. Restating the plan documents in a timely manner is necessary to preserve your plan s tax-qualified status. The PPA restatement is named after the 2006 legislation passed by Congress. Q3. Which interim amendments are included in the PPA restated documents? A3. This restatement incorporates changes included in the final 415 regulations; the Pensions Protection Act (PPA); the Heroes Earnings Assistance and Relief Tax Act (HEART); the Worker, Retiree, and Employer Recovery Act (WRERA); and other optional interim amendments. Q4. What must I do to restate my qualified plan for PPA? A4. The enclosed restatement kit is designed to help you successfully update your plan. Step 1. Review, complete, and sign the enclosed Adoption Agreement. You are encouraged to review the Adoption Agreement with your attorney or competent tax advisor. Step 2. Complete and mail the Pioneer Pension Protection Act (PPA) Amendment Response Form to us at: Pioneer Funds P.O. Box 55014 Boston, MA 02205-5014 Step 3. Place the enclosed document components (Basic Plan Document, completed and signed Adoption Agreement, and the IRS opinion letter) in your files. Step 4. If your plan covers employees other than the business owner and his or her spouse, an updated Summary Plan Description (SPD) must be provided to each employee participating in the plan (as well as beneficiaries of deceased participants). Complete the enclosed SPD using your completed Adoption Agreement as a guide. Remember, you must also provide the SPD to all new employees (and beneficiaries) that become eligible to participate in the plan. Q5. What is the deadline for signing a new Adoption Agreement and completing the PPA restatement process? A5. You should restate your plan as soon as possible; however, the final restatement deadline for most plans is April 30, 2016. If you continue to operate your plan in accordance with the old plan document provisions, you will not be operating your plan in compliance with the new rules. This will potentially subject you to severe tax consequences. 1
Q6. What is the IRS opinion letter that is included in my PPA restatement kit? A6. An opinion letter is issued by the IRS to us confirming that it has approved the form of the prototype plan documents we sponsor and provide to you as an adopting employer. We are required to provide a copy of this letter to you so that you will be certain that the plan document we provide has been reviewed and approved by the IRS. An employer whose plan has been reviewed and approved by the IRS is generally said to have reliance. Essentially, reliance is the employer s automatic assurance that the plan documents meet the requirements of the tax laws and regulations that apply to qualified retirement plans. Q7. If I intend to discontinue operating my qualified plan before the April 30, 2016, deadline, must I still restate it? A7. No. There is no requirement to restate your plan if your plan will be discontinued (i.e., a plan termination) and will be liquidated before the amendment deadline. The plan documents must, however, be completely up-to-date before termination or the IRS could disqualify your plan, resulting in adverse tax consequences. Plans may wish to restate to the newly approved documents as all the language in these documents has been approved by the IRS, while the good-faith amendments for the EGTRRA document have not been approved by the IRS. Q8. Are these materials available on your website? A8. Yes. Go to us.pioneerinvestments.com and look for PSRP/MPPP PPA documents under the Download Forms tab. There you will find all of the associated pieces required to update your plan. Q9. What if I still have questions? A9. If you have any questions, please contact Pioneer s Employer Sponsored Plan Department at 866-622-7815 (Monday through Friday from 8:00 AM to 7:00 PM EST). 2
Instructions for Completing PPA Adoption Agreement(s) These instructions are designed to help you, the Employer, along with your tax advisor, amend and restate your Plan(s). If you maintain a Profit Sharing Plan and a Money Purchase Pension Plan, you must complete two Adoption Agreements. Use these instructions as a general guide as they are not intended as a substitute for a tax advisor. We recommend that you obtain the advice of your tax advisor before you sign the Adoption Agreement(s). The words and phrases that are capitalized are terms that may be found in the Plan Document. EMPLOYER INFORMATION The Adopting Employer s Federal Tax Identification Number (EIN) is the tax identification number assigned to your business. If your business does not have an EIN, complete and file an IRS Form SS-4 to obtain a number. The Plan Sequence Number is used for annual reporting to the IRS. You should use the same number you have been using for the Plan you are updating. SECTION ONE: EFFECTIVE DATES Part B. Existing Plan Amendment or Restatement Date The restatement Effective Date is generally the first day of the Plan Year in which this Adoption Agreement is signed. An amendment or restatement Effective Date after the first day of the Plan Year in which this Adoption Agreement is signed may result in a reduction or elimination of accrued benefits, violating Code Section 411(d)(6). Notwithstanding the foregoing, Effective Dates for certain items (e.g. PPA and other government pronouncements) are governed by the dates specified in the Basic Plan Document. SECTION TWO: ELIGIBILITY Part A. Age and Years of Eligibility Service Age Requirement Fill in the age an Employee must attain (no more than 21) to be eligible to receive Plan Contributions. Years of Eligibility Service Requirement Select the Years of Eligibility Service Requirement. If Option 2 is selected, insert number of months of service (no more than 12) that an Employee must complete to be eligible to become a Participant in the Plan. If Option 3 is selected, insert number of years of service (no more than 2) that an Employee must complete to be eligible to become a Participant in the Plan. If no Year of Eligibility Service requirement is selected, Option 1 will apply. Part B. Employees Employed As Of Effective Date At the time when the original plan was established, did you allow existing Employees to enter into the Plan who, as of the Effective Date, did not otherwise meet the Plan s Eligibility Requirements? If no option is selected, Option 2 shall be deemed to be selected Part C. Hours Required For Eligibility Purposes 1. Insert the number of Hours of Service required to constitute a Year of Service for eligibility purposes. The number cannot be more than 1,000. 2. Insert the number of Hours of Service that must be completed to avoid a Break in Eligibility Service. This number cannot be more than 500 and must be less than the number specified in Part C, item 1). 3
SECTION THREE: CONTRIBUTIONS Part A. Employer Contributions Check the allocation formula that pertains to your plan(s). If no option is selected, Option 1 is deemed to be selected. Part B. Qualifying Participants Select Option 1 if participants who terminated during a Plan Year are required to have completed a minimum number of Hours Of Service prior to termination to be eligible to share in Employer Profit Sharing Contributions or Employer Money Purchase Pension Contributions, select Option 1. This number cannot be more than 500. If no option is selected, Option 1 and a 500 Hours of Service requirement will apply with no additional waivers. SECTION FOUR: VESTING AND FORFEITURES Part A. Vesting Schedule for Employer Contributions Please choose your vesting schedule. If you do not select an option, you will be deemed to have 100% immediate vesting. Part B. Year of Vesting Service 1 and 2. Please choose Hours of Service. SECTION FIVE: DISTRIBUTIONS AND LOANS Note: Generally, Code Section 411(d)(6) prohibits the elimination of protected benefits. Protected benefits include the timing of payout options. If the Plan is restating a Prior Plan that permitted a distribution option described below that involves the timing of a distribution, the selections must generally be at least as favorable as under the Prior Plan. Certain forms of distributions (e.g., redundant forms of distribution) may, however, be eliminated. Refer to Code Section 411(d)(6) and the corresponding Treasury regulation for details pertaining to the elimination of otherwise protected benefits. Part A. Form of Distribution If this Plan is restating a Prior Plan, the forms of distribution under this Plan must generally be at least as favorable as under the Prior Plan. SECTION SIX: DEFINITIONS Part A. Hour of Service If no option is selected, Option 2 will apply. Your Plan will be deemed to use actual hours for which an Employee is paid or entitled to payment to determine an employee s service. Part B. Normal Retirement Age If no option is selected, Option 1 and age 59½ will apply. Part C. Plan Year Means If no option is selected, your plan year will be deemed to coincide with your business s fiscal year. Part D. Predecessor Employer Service Select all that apply and complete as applicable. 4
SECTION SEVEN: MISCELLANEOUS Part B. 404(c) Compliance Select an option. If no option is selected, Option 1 will apply. SECTION EIGHT: TRUSTEE AND CUSTODIAN Part A.3. Limited Trustee Employer may complete and sign this section or leave blank. SECTION NINE: EMPLOYER SIGNATURE Please sign and date this section. Supply name and title of individual signing. 5
Pioneer Funds Simplified Profit Sharing Plan - Standardized Adoption Agreement PPA EMPLOYER INFORMATION Name of Adopting Employer Address City State Zip Telephone Adopting Employer s Federal Tax Identification Number Adopting Employer s Tax Year End (specify month and day) Type of Business (select one) Sole Proprietorship Partnership C Corporation S Corporation LLC Other (specify a legal entity recognized under federal income tax laws) Name of Plan Plan Sequence Number Trust Identification Number (if applicable) Account Number Related Employers If the Adopting Employer is part of a controlled group of corporations (as defined in Code section 414(b) as modified by Code section 415(h)), a group of commonly controlled trades or businesses (as defined in Code section 414(c) as modified by Code section 415(h)) or an affiliated service group (as defined in Code section 414(m)) of which the Adopting Employer is a part, or any other entity required to be aggregated with the Adopting Employer pursuant to Code section 414(o), then all Related Employers of the Adopting Employer will participate in this Plan. SECTION ONE: EFFECTIVE DATES Complete Part A or B Part A. Part B. New Plan Effective Date This is the initial adoption of a profit sharing plan by the Adopting Employer. The Effective Date of this Plan is. (Must be on or after January 1, 2007.) NOTE: The Effective Date is usually the first day of the Plan Year in which this Adoption Agreement is signed and may not be earlier than such date. Existing Plan Amendment or Restatement Date This is an amendment or restatement of an existing qualified plan. The Initial Plan Document was effective on. This Plan is a frozen Plan effective on. If this Plan is a frozen Plan, no Employer Contributions may be made to the Plan with respect to Compensation earned on or after the Effective Date that the Plan is frozen. In addition, no additional contributions (e.g., rollover, transfer) may be accepted by the Plan on or after the date that the Plan is frozen. Depending on the facts and circumstances surrounding the freezing of the Plan, other Plan provisions may be affected (e.g., vesting, availability of loans.) The Effective Date of this amendment or restatement is. (Must be on or after January 1, 2007.) NOTE: Specifying an amendment or restatement Effective Date as any day other than the first day of the Plan Year following the Plan Year in which this Adoption Agreement is signed may result in a reduction or elimination of accrued benefits, violating Code section 411(d)(6). Notwithstanding the foregoing, Effective Dates for certain items (e.g., PPA and other legislative and regulatory guidance) are governed by the terms specified in the Basic Plan Document. #4220 (Pioneer) (4/2014) 6
SECTION TWO: ELIGIBILITY Complete Parts A through D Part A. Age and Eligibility Service 1. Age Requirement. An Employee will be eligible to become a Participant in the Plan for purposes of receiving an allocation of any Employer Profit Sharing Contributions made pursuant to Section Three of the Adoption Agreement, after attaining the following age (not more than 21). NOTE: If no age is specified there will be no age requirement. 2. Eligibility Service Requirement. An Employee will be eligible to become a Participant in the Plan for purposes of receiving an allocation of any Employer Profit Sharing Contributions made pursuant to Section Three of the Adoption Agreement (select one). Option 1: No Eligibility Service Required. Option 2: After completing consecutive Months of Eligibility Service (not more than 24) beginning on the Employee s date of hire. Option 3: After completing Years of Eligibility Service (Periods of Service, if applicable) (enter 0, 1, or 2). NOTE: If no option is selected, Option 1 will apply. If more than one Year of Eligibility Service (Period of Service, if applicable) is selected in this Section Two, Part A, the immediate 100 percent vesting schedule in Section Four will automatically apply for Employer Profit Sharing Contributions. Part B. Employees Employed as of a Specified Date Will an Employee listed below (other than an Employee who is part of an excluded class of Employees) and employed on (specify a month, day, and year) who has not otherwise met the age and eligibility service requirements be considered to have met those requirements and be eligible to become a Participant in the Plan for purposes of receiving an allocation of any Employer Profit Sharing Contributions, as applicable, made pursuant to Section Three of the Adoption Agreement (select one)? Employees subject to the waiver (define classifications and prior employers):. Option 2: Not applicable. NOTE: If no option is selected, Option 2 will apply. If Option 1 is selected but no date is specified, no additional age and eligibility service waivers will apply. If Option 1 is selected but no Employees are specified, all Employees employed on the specified date will be subject to the waiver. This age and eligibility service waiver may be used either when this Plan is adopted or when the Plan is subsequently amended (e.g., to add a previously excluded group of Employees). Part C. Entry Dates The Entry Dates will be (select one): Option 1: Immediately upon meeting age and eligibility service The day the age and eligibility service requirements in Section Two, Part A, are satisfied. Option 2: Monthly The first day of each month of the Plan Year. Option 3: Quarterly The first day of the Plan Year and the first day of the fourth, seventh and tenth months of the Plan Year. Option 4: Semi-Annually The first day of the Plan Year and the first day of the seventh month of the Plan Year. Option 5: Annually The first day of the Plan Year. (Refer to the NOTE at the end of this Part C for restrictions that may apply.) Option 6: Other. (Define Entry Date(s).) (Refer to the NOTE at the end of this Part C for restrictions that may apply.). NOTE: If no option is selected, Option 4 will apply. Option 5 or Option 6 can be selected only if the eligibility requirements and Entry Dates are coordinated such that each Employee will become a Participant in the Plan by the earlier of 1) the first day of the Plan Year beginning after the date the Employee satisfies the age and eligibility service requirements of Code section 410(a) and ERISA section 202, or 2) six months after the date the Employee satisfies such requirements. #4220 (Pioneer) (4/2014) 7
Part D. Service Required for Eligibility Purposes (Select one) Option 1: The Hours of Service method of determining service applies. (May only be selected if one or two Years of Eligibility Service or a fractional year service with hours is required in Part A above.) (Complete the following.) (a) Hours of Service (not more than 1,000) will be required to constitute a Year of Eligibility Service. (b) Hours of Service (not more than 500 and less than the number specified in Option 1(a), above) must be exceeded to avoid a Break in Eligibility Service. Option 2: Not applicable. Either (1) the Plan has either a fractional year service requirement with no hours or no service requirement to participate in the Plan or (2) the Elapsed Time method of determining service applies. NOTE: If no option is selected and the Hours of Service method of determining service applies or if Option 1 is selected and no hours are specified, 1,000 and 500 will apply for (a) and (b), respectively. SECTION THREE: CONTRIBUTIONS Complete Parts A through C Part A. Employer Profit Sharing Contributions Allocation Formula Employer Profit Sharing Contributions will be allocated to the Individual Accounts of Qualifying Participants as follows (select one): Option 1: Pro Rata Formula. In the ratio that each Qualifying Participant s Compensation for the Plan Year bears to the total Compensation of all Qualifying Participants for the Plan Year. Option 2: Integrated Formula. Pursuant to the excess integrated allocation formula described in Plan Section 3.04(B)(2). The integration level will be The integration level will be (select one): Suboption (a): The Taxable Wage Base. Suboption (b): percent (not more than 100) of the Taxable Wage Base. NOTE: If no suboption is selected, Suboption (a) will apply. NOTE: If no option is selected, Option 1 will apply. Part B. Part C. Additional Conditions for Receiving Employer Profit Sharing Contributions A Participant will be a Qualifying Participant, and thus entitled to share in Employer Profit Sharing Contributions for any Plan Year if the Participant has satisfied all of the eligibility requirements described in Section Two of this Adoption Agreement on at least one day of such Plan Year and has not incurred a Termination of Employment. If the Participant has incurred a Termination of Employment during the Plan Year, the following additional condition will apply (select one): Option 1: Service Requirement. The Participant completes at least (complete one): (not more than 500) Hours of Service during the Plan Year, if the Hours of Service method of determining service applies; or (not more than six) months of service if the Elapsed Time method of determining service applies. Option 2: No additional condition will apply. NOTE: If no option is selected, Option 1 will apply. If Option 1 applies and no hours or months are specified, a 500 Hours of Service requirement will apply if the Hours of Service method of determining service applies and a six months of service requirement will apply if the Elapsed Time method of determining service applies. Benefit Accrual in the Case of Death or Disability Resulting from Qualified Military Service Will the benefit accrual provisions under Code section 414(u)(9) apply to individuals who are unable to be reemployed on account of death or Disability while performing qualified military service as defined in Code section 414(u) (select one)? Option 2: No. NOTE: If no option is selected, Option 2 will apply. #4220 (Pioneer) (4/2014) 8
SECTION FOUR: VESTING AND FORFEITURES Complete Parts A through C Part A. Vesting Schedule For Employer Profit Sharing Contributions A Participant will become Vested in the portion of their Individual Account derived from Employer Profit Sharing Contributions, if applicable, made pursuant to Section Three of the Adoption Agreement as follows. YEARS OF VESTING SERVICE (PERIODS OF SERVICE, IF VESTED PERCENTAGE APPLICABLE) Profit Sharing Option 1 Option 2 Option 3 Option 4 (Complete if chosen) Option 5 (Complete if chosen) Less than One 100% 0% 0% % % 1 100% 0% 0% % % 2 100% 0% 20% % (not less than 20%) % 3 100% 100% 40% % (not less than 40%) 100% 4 100% 100% 60% % (not less than 60%) 100% 5 100% 100% 80% % (not less than 80%) 100% 6 100% 100% 100% 100% 100% NOTE: If no option is selected as of the first date on which such contributions may be made to the Plan, Option 1 will apply. A Participant with accrued benefits derived from Employer Profit Sharing Contributions who has not completed at least one Hour of Service under the Plan in a Plan Year beginning after December 31, 2006, will be subject to the vesting schedule in effect after January 1, 2007, unless otherwise selected by the Employer in an amendment adopting provisions of the Pension Protection Act of 2006 (PPA). In addition, all Employer Profit Sharing Contributions made to the Plan for Plan Years beginning before January 1, 2007, that were previously subject to a less favorable vesting schedule will be subject to the vesting schedule in effect after January 1, 2007, unless otherwise selected by the Employer in an amendment adopting provisions of PPA. Please list the pre-ppa vesting schedules, if applicable, on a Protected Benefits and Prior Plan Document Provisions Attachment. Part B. Service Required for Vesting Purposes (Select one) Option 1: Integrated Formula. Pursuant to the excess integrated allocation formula described in Plan Section 3.04(B)(2). The integration level will be The integration level will be (select one): (a): Hours of Service (not more than 1,000) will be required to constitute a Year of Vesting Service. (b): Hours of Service (not more than 500 but less than the number specified in Option 1(a), above) must be exceeded to avoid a Break in Vesting Service. Option 2: Not applicable. The Elapsed Time method of determining service applies. NOTE: If no option is selected and the Hours of Service method of determining service applies or if Option 1 is selected and no hours are specified, 1,000 and 500 will apply for items (a) and (b), respectively. Part C. Exclusion of Service for Vesting All of an Employee s Years of Vesting Service (Periods of Service, if applicable) with the Employer are counted to determine the Vested percentage in the Participant s Individual Account except (select all that apply): Years of Vesting Service (Periods of Service, if applicable) before the Employee reaches age 18. Years of Vesting Service (Periods of Service, if applicable) before the Employer maintained this Plan or a predecessor plan. SECTION FIVE: DISTRIBUTIONS AND LOANS Complete Parts A through C Part A. Eligibility for Distributions 1. Distributions During Employment a. In-Service Availability for Employer Profit Sharing Contributions Will a Participant be entitled to request an in-service distribution of their Individual Account attributable to Employer Profit Sharing Contributions (select one)? #4220 (Pioneer) (4/2014) 9
Option 2: Yes, with respect to a Participant who is 100 percent Vested in their Individual Account attributable to such contributions. Option 3: No. NOTE: If no option is selected, Option 1 will apply. b. Hardship Availability for Employer Profit Sharing Contributions Will an Employee be entitled to request a hardship distribution of their Individual Account attributable to Employer Profit Sharing Contributions (select one)? Option 2: Yes, with respect to an Employee who is 100 percent Vested in their Individual Account attributable to such contributions. Option 3: No. NOTE: If no option is selected, Option 3 will apply. Part B. Form of Voluntary Distribution 1. Lump Sum a. In-Service Availability for Employer Profit Sharing Contributions Will a Participant be entitled to request a payment of the Vested portion of their Individual Account in a lump sum, subject to Plan Section 5.02 (select one)? Option 2: No. NOTE: If no option is selected, Option 1 will apply. 2. Partial Payments Will a Participant be entitled to request a non-recurring partial payment from the Vested portion of their Individual Account, subject to Plan Section 5.02 (select one)? Option 2: No. NOTE: If no option is selected Option 1 will apply. Partial payments may be made from the Plan either prior to Termination of Employment or to satisfy the requirements of Code section 401(a)(9) even if Option 2 applies. 3. Installment Payments Will a Participant be entitled to request a series of regularly scheduled recurring payments from the Vested portion of their Individual Account, subject to Plan Section 5.02 (select one)? Option 2: No. NOTE: If no option is selected, Option 1 will apply. 4. Annuity Contracts Will a Participant be entitled to apply the Vested portion of their Individual Account toward the purchase of an annuity contract, subject to Plan Section 5.02 (select one)? Option 2: No. NOTE: If no option is selected, Option 1 will apply. NOTE: Generally, Code section 411(d)(6) prohibits the elimination of protected benefits. Protected benefits include the timing of payout options. If the Plan is restating a Prior Plan Document that permitted a distribution option described above that involves the timing of a distribution, the selections must generally be at least as favorable as under the Prior Plan Document. Certain forms of distributions (e.g., redundant forms of distribution) may, however, be eliminated. Refer to Code section 411(d) (6) and the corresponding Treasury Regulation for details pertaining to the elimination of otherwise protected benefits. Part C. Loans Will a Participant be entitled to request a loan pursuant to Plan Section 5.16 (select one)? Option 2: No. NOTE: If no option is selected, Option 1 will apply. #4220 (Pioneer) (4/2014) 10
NOTE: Generally, Code section 411(d)(6) prohibits the elimination of protected benefits. Protected benefits include the timing of payout options. If the Plan is restating a Prior Plan Document that permitted a distribution option described above that involves the timing of a distribution, the selections must generally be at least as favorable as under the Prior Plan Document. Certain forms of distributions (e.g., redundant forms of distribution) may, however, be eliminated. Refer to Code section 411(d) (6) and the corresponding Treasury Regulation for details pertaining to the elimination of otherwise protected benefits. SECTION SIX: DEFINITIONS Complete Parts A through D Part A. Method of Determining Service Service will be determined on the basis of (select one): Option 1: Elapsed Time. An Employee will generally be credited for the aggregate of all time periods commencing with the Employee s first day of employment and ending on the date a Break in Service begins. Option 2: Hours of Service. An Employee will be credited for Hours of Service determined on the basis of (select one): Suboption (a): Actual hours for which an Employee is paid or entitled to payment. Suboption (b): Suboption (c): Suboption (d): Suboption (e): Equivalency days worked. An Employee will be credited with 10 Hours of Service if under the definition of Hours of Service such Employee would be credited with at least one Hour of Service during the day. Equivalency weeks worked. An Employee will be credited with 45 Hours of Service if under the definition of Hours of Service such Employee would be credited with at least one Hour of Service during the week. Equivalency semi-monthly payroll periods worked. An Employee will be credited with 95 Hours of Service if under the definition of Hours of Service such Employee would be credited with at least one Hour of Service during the semimonthly payroll period. Equivalency months worked. An Employee will be credited with 190 Hours of Service if under the definition of Hours of Service such Employee would be credited with at least one Hour of Service during the month. NOTE: If no option is selected, Option 2 will apply. If Option 2 applies and no suboption is selected, Suboption (a) will apply. Part B. Normal Retirement Age The Normal Retirement Age under the Plan will be (select and complete one): Option 1: Age (not to exceed 65 or such later age as may be allowed in Code Section 411(a)(8)). Option 2: The later of age (not to exceed 65 or such later age as may be allowed in Code Section 411(a)(8)) or the (not to exceed fifth) anniversary of the first day of the first Plan Year in which the Participant commenced participation in the Plan. NOTE: If no option is selected, Option 1 and age 59½ will apply. Part C. Plan Year Means Option 1: The 12-consecutive month period which coincides with the Adopting Employer s tax year. Option 2: The calendar year. Option 3: Other 12-consecutive month period (Specify a 12-consecutive month period selected in a uniform and nondiscriminatory manner.). NOTE: If no option is selected, Option 2 will apply. If the initial Plan Year or any subsequent Plan Year is less than 12 months (a short Plan Year) specify such Plan Year s beginning and ending dates.. #4220 (Pioneer) (4/2014) 11
Part D. Predecessor Employer Service In addition to the service credited when an Employer maintains the plan of a predecessor employer, service with a predecessor employer will be credited for the following purposes where the Employer does not maintain the plan of a predecessor employer (select all that apply): Eligibility. Vesting. Allocation of Contributions. Name of Predecessor Employer(s):. If service with a predecessor is taken into account for one or more of the items listed above, specify any additional limitations on crediting service that apply (e.g., limitations by business classification, length of service, etc.):. SECTION SEVEN: MISCELLANEOUS Complete Parts A and B Part A. Part B. Life Insurance Will life insurance investments be permitted under the Plan (select one)? Option 2: No. NOTE: If no option is selected, Option 2 will apply. Participant Direction 1. Authorization Will a Participant be responsible for directing any or all of the investment of their Plan assets pursuant to Plan Section 7.22(B) (select one)? Option 2: No. NOTE: If no option is selected, Option 1 will apply. Complete the remainder of Part B only if Option 1 is selected. 2. ERISA 404(c) Compliance Does the Adopting Employer intend to operate this Plan in compliance with the requirements pertaining to Participant direction of investment in ERISA section 404(c) as set forth in Plan Section 7.22(B) (select one)? Option 2: No. NOTE: If no option is selected, Option 1 will apply. #4220 (Pioneer) (4/2014) 12
SECTION EIGHT: TRUSTEE AND CUSTODIAN Complete Parts A and B (as applicable) Part A. Trustee 1. Trustee Appointment a. Trustee(Select one) Option 1: Financial Organization as Trustee. Option 2: Individual Trustee. Option 3: Not applicable, a Trustee is not required to be named for this Plan (select one). Suboption (a): Plan assets are invested solely in annuity contracts or insurance policies provided by an Insurer. Name of Insurer Address Telephone Name of Trustee Title Telephone Signature Suboption (b): This Plan is exempt from the trust requirements under ERISA section 403 (e.g., the Plan covers one or more selfemployed individuals as defined in Code section 401(c)(1)). NOTE: If Suboption (b) is selected, a Custodian must be named in Part B below. b. Type of Trustee Will the Trustee of this Plan be a Directed or Discretionary Trustee (select one)? Option 1: Option 2: Option 3: Directed Trustee. Discretionary Trustee. Not applicable, Option 3 was selected in Part 1(a) above. c. Trustee Signature NOTE: If you are an individual Trustee and no Limited Trustee is named in Part A, item 3 below you will also be deemed to be a Limited Trustee. Name of Trustee: Pioneer Investment Management USA Inc. Address: 60 State Street, Boston, MA 02109 Telephone: 1-866-622-7815 Signature Title Senior Vice President Name (type or print name if different from name of Trustee above) Tracy Connelly 2. Trust Agreement If a Trustee is designated in Part A, item 1 above, which trust agreement will apply to the Plan (select one)? Option 1: Option 2: Trust provisions contained in Plan Section Eight. Separate executed trust agreement attached hereto. NOTE: If no option is selected, Option 1 will apply. If Option 2 is selected, the attached trust agreement must be on file with the IRS for use by the Prototype Document Sponsor listed in Section Nine below. If Option 2 is selected and a Limited Trustee is named below, the separate trust agreement will not replace Plan Section 8.09. #4220 (Pioneer) (4/2014) 13
3. Limited Trustee The Limited Trustee appointed solely for the purposes of ensuring the timely collection and deposit of Employer Contributions will be: Option 1: Option 2: The individual Trustee named above. The party named below. Name of Limited Trustee Address Telephone Name (type or print name if different from name of Trustee above) Title Signature NOTE: A Trustee, including a Limited Trustee, must be an individual or corporation. A corporate Trustee must be a bank, trust company, broker, dealer, or clearing agency as defined in Labor Regulation section 2550.403(a)-1(b). Part B. Custodian (Both a Custodian and Trustee may be appointed for the Plan. This Part B must be completed if the Plan is exempt from the Trustee requirements under ERISA section 403 and neither a Trustee nor an Insurer is appointed in Part A, item 1 above.) 1. Custodian Appointment N/A Financial Organization N/A Address N/A N/A Type Name (type or print) Title N/A Signature 2. Custodial Agreement If a Custodian is designated in Part B, item 1 above, which custodial agreement will apply to the Plan (select one)? Option 1: Option 2: Custodial provisions contained in Plan Section Eight. Separate executed custodial agreement attached hereto. NOTE: If no option is selected, Option 1 will apply. If Option 2 is selected and the separate custodial agreement is being used in place of a trust agreement under Code section 401(f), the attached custodial agreement must be on file with the IRS for use by the Prototype Document Sponsor listed in Section Nine below. SECTION NINE: EMPLOYER SIGNATURE Prototype Document Sponsor Pioneer Investment Management USA, Inc. Name of Prototype Document Sponsor 60 State Street, Boston, MA 02109 Address 1-866-622-7815 Telephone Check the applicable box if there is an attachment(s) that applies to this Plan other than a separate trust or custodial agreement. Protected Benefits and Prior Plan Document Provisions Attachment. Other Plan Information Attachment. (If this box is checked, please describe the attachment(s).) #4220 (Pioneer) (4/2014) 14
Authorized Employer Signature I am an authorized representative of the Adopting Employer named above and I state the following: 1. I acknowledge that I have relied upon my own advisors regarding the completion of this Adoption Agreement and the legal tax implications of adopting this Plan; 2. I understand that my failure to properly complete this Adoption Agreement may result in disqualification of the Plan; 3. I understand that the Prototype Document Sponsor will inform me of any amendments made to the Plan and will notify me should it discontinue or abandon the Plan; and 4. I have received a copy of this Adoption Agreement, the corresponding Basic Plan Document and, if applicable, any separate trust or custodial agreement used in lieu of the trust or custodial agreement contained in the Basic Plan Document. Signature of Adopting Employer Type Name Date Signed Title NOTE: The Adopting Employer may rely on an opinion letter issued by the Internal Revenue Service as evidence that the Plan is qualified under Code section 401 except to the extent provided in Revenue Procedure 2011-49. An Employer who has ever maintained or who later adopts any plan (including a welfare benefit fund, as defined in Code section 419(e), which provides post-retirement medical benefits allocated to separate accounts for key employees, as defined in Code section 419A(d)(3), or an individual medical account, as defined in Code section 415(l)(2) in addition to this Plan may not rely on the opinion letter issued by the Internal Revenue Service with respect to the requirements of Code sections 415 and 416. If the Employer who adopts or maintains multiple plans wishes to obtain reliance with respect to the requirements of Code sections 415 and 416, application for a determination letter must be made to Employee Plans Determinations of the Internal Revenue Service. The Employer may not rely on the opinion letter in certain other circumstances, which are specified in the opinion letter issued with respect to the Plan or in Revenue Procedure 2011-49. This Adoption Agreement may be used only in conjunction with Basic Plan Document #03. #4220 (Pioneer) (4/2014) 15
Protected Benefits And Prior Plan Document Provisions Attachment This attachment may be used by an Adopting Employer to document protected benefits and other Prior Plan Document provisions that apply to some or all of the assets of the Adopting Employer s Plan. ADOPTING EMPLOYER PLAN INFORMATION Name of Adopting Employer Name of Plan Plan Sequence Number Trust Identification Number (if applicable) Account Number PROTECTED BENEFITS AND PRIOR PLAN PROVISIONS Provision 1: Source of Provision (e.g., plan name and sequence number, good faith amendment): Provision 2: Source of Provision (e.g., plan name and sequence number, good faith amendment): Provision 3: Source of Provision (e.g., plan name and sequence number, good faith amendment): #4220 (Pioneer) (4/2014) 16
Other Plan Information Attachment This attachment may be used by the Plan to specify additional information to be included in the Plan s Adoption Agreement (e.g., to provide more information than can be included on an other selection line). ADOPTING EMPLOYER PLAN INFORMATION Name of Adopting Employer Name of Plan Plan Sequence Number Trust Identification Number (if applicable) Account Number OTHER PLAN INFORMATION #4220 (Pioneer) (4/2014) 17
Pioneer Funds Simplified Money Purchase Pension Plan - Standardized Adoption Agreement PPA EMPLOYER INFORMATION Name of Adopting Employer Address City State Zip Telephone Adopting Employer s Federal Tax Identification Number Adopting Employer s Tax Year End (specify month and day) Type of Business (select one) Sole Proprietorship Partnership C Corporation S Corporation LLC Other (specify a legal entity recognized under federal income tax laws) Name of Plan Plan Sequence Number Trust Identification Number (if applicable) Account Number Related Employers If the Adopting Employer is part of a controlled group of corporations (as defined in Code section 414(b) as modified by Code section 415(h)), a group of commonly controlled trades or businesses (as defined in Code section 414(c) as modified by Code section 415(h)) or an affiliated service group (as defined in Code section 414(m)) of which the Adopting Employer is a part, or any other entity required to be aggregated with the Adopting Employer pursuant to Code section 414(o), then all Related Employers of the Adopting Employer will participate in this Plan. SECTION ONE: EFFECTIVE DATES Complete Part A or B Part A. Part B. New Plan Effective Date This is the initial adoption of a profit sharing plan by the Adopting Employer. The Effective Date of this Plan is. (Must be on or after January 1, 2007.) NOTE: The Effective Date is usually the first day of the Plan Year in which this Adoption Agreement is signed and may not be earlier than such date. Existing Plan Amendment or Restatement Date This is an amendment or restatement of an existing qualified plan. The Initial Plan Document was effective on. This Plan is a frozen Plan effective on. If this Plan is a frozen Plan, no Employer Contributions may be made to the Plan with respect to Compensation earned on or after the Effective Date that the Plan is frozen. In addition, no additional contributions (e.g., rollover, transfer) may be accepted by the Plan on or after the date that the Plan is frozen. Depending on the facts and circumstances surrounding the freezing of the Plan, other Plan provisions may be affected (e.g., vesting, availability of loans.) The Effective Date of this amendment or restatement is. (Must be on or after January 1, 2007.) NOTE: Specifying an amendment or restatement Effective Date as any day other than the first day of the Plan Year following the Plan Year in which this Adoption Agreement is signed may result in a reduction or elimination of accrued benefits, violating Code section 411(d)(6). Notwithstanding the foregoing, Effective Dates for certain items (e.g., PPA and other legislative and regulatory guidance) are governed by the terms specified in the Basic Plan Document. #4221 (Pioneer) (4/2014) 18
SECTION TWO: ELIGIBILITY Complete Parts A through D Part A. Age and Eligibility Service 1. Age Requirement. An Employee will be eligible to become a Participant in the Plan for purposes of receiving an allocation of any Employer Profit Sharing Contributions made pursuant to Section Three of the Adoption Agreement, after attaining the following age (not more than 21). NOTE: If no age is specified there will be no age requirement. 2. Eligibility Service Requirement. An Employee will be eligible to become a Participant in the Plan for purposes of receiving an allocation of any Employer Profit Sharing Contributions made pursuant to Section Three of the Adoption Agreement (select one). Option 1: No Eligibility Service Required. Option 2: After completing consecutive Months of Eligibility Service (not more than 24) beginning on the Employee s date of hire. Option 3: After completing Years of Eligibility Service (Periods of Service, if applicable) (enter 0, 1, or 2). NOTE: If no option is selected, Option 1 will apply. If more than one Year of Eligibility Service (Period of Service, if applicable) is selected in this Section Two, Part A, the immediate 100 percent vesting schedule in Section Four will automatically apply for Employer Profit Sharing Contributions. Part B. Employees Employed as of a Specified Date Will an Employee listed below (other than an Employee who is part of an excluded class of Employees) and employed on (specify a month, day, and year) who has not otherwise met the age and eligibility service requirements be considered to have met those requirements and be eligible to become a Participant in the Plan for purposes of receiving an allocation of any Employer Profit Sharing Contributions, as applicable, made pursuant to Section Three of the Adoption Agreement (select one)? Employees subject to the waiver (define classifications and prior employers):. Option 2: Not applicable. NOTE: If no option is selected, Option 2 will apply. If Option 1 is selected but no date is specified, no additional age and eligibility service waivers will apply. If Option 1 is selected but no Employees are specified, all Employees employed on the specified date will be subject to the waiver. This age and eligibility service waiver may be used either when this Plan is adopted or when the Plan is subsequently amended (e.g., to add a previously excluded group of Employees). Part C. Entry Dates The Entry Dates for purposes of Employer Money Purchase Pension Contributions will be (select one): Option 1: Immediately upon meeting age and eligibility service The day the age and eligibility service requirements in Section Two, Part A, are satisfied. Option 2: Monthly The first day of each month of the Plan Year. Option 3: Quarterly The first day of the Plan Year and the first day of the fourth, seventh and tenth months of the Plan Year. Option 4: Semi-Annually The first day of the Plan Year and the first day of the seventh month of the Plan Year. Option 5: Annually The first day of the Plan Year. (Refer to the NOTE at the end of this Part C for restrictions that may apply.) Option 6: Other. (Define Entry Date(s).) (Refer to the NOTE at the end of this Part C for restrictions that may apply.). NOTE: If no option is selected, Option 4 will apply. Option 5 or Option 6 can be selected only if the eligibility requirements and Entry Dates are coordinated such that each Employee will become a Participant in the Plan by the earlier of 1) the first day of the Plan Year beginning after the date the Employee satisfies the age and eligibility service requirements of Code section 410(a) and ERISA section 202, or 2) six months after the date the Employee satisfies such requirements. #4221 (Pioneer) (4/2014) 19
Part D. Service Required for Eligibility Purposes (Select one) Option 1: The Hours of Service method of determining service applies. (May only be selected if one or two Years of Eligibility Service or a fractional year service with hours is required in Part A above.) (Complete the following.) (a) Hours of Service (not more than 1,000) will be required to constitute a Year of Eligibility Service. (b) Hours of Service (not more than 500 and less than the number specified in Option 1(a), above) must be exceeded to avoid a Break in Eligibility Service. Option 2: Not applicable. Either (1) the Plan has either a fractional year service requirement with no hours or no service requirement to participate in the Plan or (2) the Elapsed Time method of determining service applies. NOTE: If no option is selected and the Hours of Service method of determining service applies or if Option 1 is selected and no hours are specified, 1,000 and 500 will apply for (a) and (b), respectively. SECTION THREE: CONTRIBUTIONS Complete Parts A through C Part A. Employer Money Purchase Pension Contributions Allocation Formula For each Plan Year Employer Money Purchase Pension Contributions will be allocated to the Individual Accounts of Qualifying Participants as follows (select one): Option 1: Nonintegrated Formula. An amount equal to percent (not to exceed 25) of the Qualifying Participant s Compensation for the Plan Year. Option 2: Integrated Formula. An amount equal to the sum of the amounts determined in Step 1 and 2: Step 1. An amount equal to percent (the base contribution percentage) of the Participant s Compensation for the Plan Year up to the integration level; plus Step 2. An amount equal to percent (the excess contribution percentage, which is the base contribution percentage plus an additional percentage that cannot exceed the base contribution percentage by more than the lesser of: (1) the base contribution percentage, or (2) the money purchase maximum disparity rate as described in Plan Section 3.04(B)(2)) of such Participant s Compensation for the Plan Year in excess of the integration level. The integration level will be (select one): Suboption (a): The Taxable Wage Base. Suboption (b): percent (not more than 100) of the Taxable Wage Base. NOTE: If no suboption is selected, Suboption (a) will apply. NOTE: If no option is selected, Option 1 will apply. Part B. Part C. Additional Conditions for Receiving Employer Money Purchase Pension Contributions A Participant will be a Qualifying Participant and thus entitled to share in Employer Money Purchase Pension Contributions for any Plan Year if the Participant has satisfied all of the eligibility requirements described in Section Two of this Adoption Agreement on at least one day of such Plan Year and has not incurred a Termination of Employment. If the Participant has incurred a Termination of Employment during the Plan Year, the following additional condition(s) will apply (select one): Option 1: Service Requirement. The Participant completes at least (complete one): (not more than 500) Hours of Service during the Plan Year, if the Hours of Service method of determining service applies; or (not more than six) months of service if the Elapsed Time method of determining service applies. Option 2: No additional condition will apply. NOTE: If no option is selected, Option 1 will apply. If Option 1 applies and no hours or months are specified, a 500 Hours of Service requirement will apply if the Hours of Service method of determining service applies and a six months of service requirement will apply if the Elapsed Time method of determining service applies. Benefit Accrual in the Case of Death or Disability Resulting from Qualified Military Service Will the benefit accrual provisions under Code section 414(u)(9) apply to individuals who are unable to be reemployed on account of death or Disability while performing qualified military service as defined in Code section 414(u) (select one)? Option 2: No. NOTE: If no option is selected, Option 2 will apply. #4221 (Pioneer) (4/2014) 20
SECTION FOUR: VESTING AND FORFEITURES Complete Parts A through C Part A. Vesting Schedule for Employer Money Purchase Pension Contributions A Participant will become Vested in the portion of their Individual Account derived from Employer Money Purchase Pension Contributions made pursuant to Section Three of the Adoption Agreement as follows. YEARS OF VESTING SERVICE (PERIODS OF SERVICE, VESTED PERCENTAGE IF APPLICABLE) Money Purchase Option 1 Option 2 Option 3 Option 4 (Complete if chosen) Option 5 (Complete if chosen) Less than One 100% 0% 0% % % 1 100% 0% 0% % % 2 100% 0% 20% % (not less than 20%) % 3 100% 100% 40% % (not less than 40%) 100% 4 100% 100% 60% % (not less than 60%) 100% 5 100% 100% 80% % (not less than 80%) 100% 6 100% 100% 100% 100% 100% NOTE: If no option is selected as of the first date on which such contributions may be made to the Plan, Option 1 will apply. A Participant with accrued benefits derived from Employer Money Purchase Pension Contributions who has not completed at least one Hour of Service under the Plan in a Plan Year beginning after December 31, 2006, will be subject to the vesting schedule in effect after January 1, 2007, unless otherwise selected by the Employer in an amendment adopting provisions of the Pension Protection Act of 2006 (PPA). In addition, all Employer Money Purchase Pension Contributions made to the Plan for Plan Years beginning before January 1, 2007, that were previously subject to a less favorable vesting schedule will be subject to the vesting schedule in effect after January 1, 2007, unless otherwise selected by the Employer in an amendment adopting provisions of PPA. Please list the pre-ppa vesting schedules, if applicable, on a Protected Benefits and Prior Plan Document Provisions Attachment. Part B. Part C. Service Required for Vesting Purposes (Select one) Option 1: The Hours of Service method of determining service applies. (Complete the following.) (a): Hours of Service (not more than 1,000) will be required to constitute a Year of Vesting Service. (b): Hours of Service (not more than 500 but less than the number specified in Option 1(a), above) must be exceeded to avoid a Break in Vesting Service. Option 2: Not applicable. The Elapsed Time method of determining service applies. NOTE: If no option is selected and the Hours of Service method of determining service applies or if Option 1 is selected and no hours are specified, 1,000 and 500 will apply for items (a) and (b), respectively. Exclusion of Service for Vesting All of an Employee s Years of Vesting Service (Periods of Service, if applicable) with the Employer are counted to determine the Vested percentage in the Participant s Individual Account except (select all that apply): Years of Vesting Service (Periods of Service, if applicable) before the Employee reaches age 18. Years of Vesting Service (Periods of Service, if applicable) before the Employer maintained this Plan or a predecessor plan. SECTION FIVE: DISTRIBUTIONS AND LOANS Complete Parts A and B Part A. Form of Voluntary Distribution 1. Lump Sum Will a Participant be entitled to request a payment of the Vested portion of their Individual Account in a lump sum, subject to Plan Section 5.02 (select one)? Option 2: No. NOTE: If no option is selected, Option 1 will apply. #4221 (Pioneer) (4/2014) 21
2. Partial Payments Will a Participant be entitled to request a non-recurring partial payment from the Vested portion of their Individual Account, subject to Plan Section 5.02 (select one)? Option 2: No. NOTE: If no option is selected Option 1 will apply. Partial payments may be made from the Plan either prior to Termination of Employment or to satisfy the requirements of Code section 401(a)(9) even if Option 2 applies 3. Installment Payments Will a Participant be entitled to request a series of regularly scheduled recurring payments from the Vested portion of their Individual Account, subject to Plan Section 5.02 (select one)? Option 2: No. NOTE: If no option is selected, Option 1 will apply. 4. Annuity Contracts Will a Participant be entitled to apply the Vested portion of their Individual Account toward the purchase of an annuity contract, subject to Plan Section 5.02 (select one)? Option 2: No. NOTE: If no option is selected, Option 1 will apply. NOTE: Option 1 must be selected for at least one of items 1 through 4. If this Plan is restating a Prior Plan Document, the forms of distribution under this Plan must generally be at least as favorable as under the Prior Plan Document. Part B. Loans Will a Participant be entitled to request a loan pursuant to Plan Section 5.16 (select one)? Option 2: No. NOTE: If no option is selected, Option 1 will apply. NOTE: Generally, Code section 411(d)(6) prohibits the elimination of protected benefits. Protected benefits include the timing of payout options. If the Plan is restating a Prior Plan Document that permitted a distribution option described above that involves the timing of a distribution, the selections must generally be at least as favorable as under the Prior Plan Document. Certain forms of distributions (e.g., redundant forms of distribution) may, however, be eliminated. Refer to Code section 411(d) (6) and the corresponding Treasury Regulation for details pertaining to the elimination of otherwise protected benefits. SECTION SIX: DEFINITIONS Complete Parts A through D Part A. Method of Determining Service Service will be determined on the basis of (select one): Option 1: Elapsed Time. An Employee will generally be credited for the aggregate of all time periods commencing with the Employee s first day of employment and ending on the date a Break in Service begins. Option 2: Hours of Service. An Employee will be credited for Hours of Service determined on the basis of (select one): Suboption (a): Actual hours for which an Employee is paid or entitled to payment. Suboption (b): Equivalency days worked. An Employee will be credited with 10 Hours of Service if under the definition of Hours of Service such Employee would be credited with at least one Hour of Service during the day. Suboption (c): Equivalency weeks worked. An Employee will be credited with 45 Hours of Service if under the definition of Hours of Service such Employee would be credited with at least one Hour of Service during the week. Suboption (d): Equivalency semi-monthly payroll periods worked. An Employee will be credited with 95 Hours of Service if under the definition of Hours of Service such Employee would be credited with at least one Hour of Service during the semimonthly payroll period. #4221 (Pioneer) (4/2014) 22
Suboption (e): Equivalency months worked. An Employee will be credited with 190 Hours of Service if under the definition of Hours of Service such Employee would be credited with at least one Hour of Service during the month. NOTE: If no option is selected, Option 2 will apply. If Option 2 applies and no suboption is selected, Suboption (a) will apply. Part B. Normal Retirement Age The Normal Retirement Age under the Plan will be (select and complete one): Option 1: Age (not to exceed 65 or such later age as may be allowed in Code Section 411(a)(8)). Option 2: The later of age (not to exceed 65 or such later age as may be allowed in Code Section 411(a)(8)) or the (not to exceed fifth) anniversary of the first day of the first Plan Year in which the Participant commenced participation in the Plan. NOTE: If no option is selected, Option 1 and age 62 will apply. The Plan must specify a Normal Retirement Age that meets the requirements of Treasury Regulation section 1.401(a)-1(b)(2), or the safe harbor of age 62 or greater. If a Normal Retirement Age of less than 62 is chosen, the Plan must apply under the IRS determination letter program in order to have reliance that the Plan s Normal Retirement Age satisfies the requirements of Treasury Regulation section 1.401(a)-1(b)(2). Part C. Plan Year Means Option 1: The 12-consecutive month period which coincides with the Adopting Employer s tax year. Option 2: The calendar year. Option 3: Other 12-consecutive month period (Specify a 12-consecutive month period selected in a uniform and nondiscriminatory manner.). NOTE: If no option is selected, Option 2 will apply. If the initial Plan Year or any subsequent Plan Year is less than 12 months (a short Plan Year) specify such Plan Year s beginning and ending dates.. Part D. Predecessor Employer Service In addition to the service credited when an Employer maintains the plan of a predecessor employer, service with a predecessor employer will be credited for the following purposes where the Employer does not maintain the plan of a predecessor employer (select all that apply): Eligibility. Vesting. Allocation of Contributions. Name of Predecessor Employer(s):. If service with a predecessor is taken into account for one or more of the items listed above, specify any additional limitations on crediting service that apply (e.g., limitations by business classification, length of service, etc.):. #4221 (Pioneer) (4/2014) 23
SECTION SEVEN: MISCELLANEOUS Complete Parts A and B Part A. Part B. Life Insurance Will life insurance investments be permitted under the Plan (select one)? Option 2: No. NOTE: If no option is selected, Option 2 will apply. Participant Direction 1. Authorization Will a Participant be responsible for directing any or all of the investment of their Plan assets pursuant to Plan Section 7.22(B) (select one)? Option 2: No. NOTE: If no option is selected, Option 1 will apply. Complete the remainder of Part B only if Option 1 is selected. 2. ERISA 404(c) Compliance Does the Adopting Employer intend to operate this Plan in compliance with the requirements pertaining to Participant direction of investment in ERISA section 404(c) as set forth in Plan Section 7.22(B) (select one)? Option 2: No. NOTE: If no option is selected, Option 1 will apply. SECTION EIGHT: TRUSTEE AND CUSTODIAN Complete Parts A and B (as applicable) Part A. Trustee 1. Trustee Appointment a. Trustee(Select one) Option 1: Financial Organization as Trustee. Option 2: Individual Trustee. Option 3: Not applicable, a Trustee is not required to be named for this Plan (select one). Suboption (a): Plan assets are invested solely in annuity contracts or insurance policies provided by an Insurer. Name of Insurer Address Telephone Title Signature Suboption (b): This Plan is exempt from the trust requirements under ERISA section 403 (e.g., the Plan covers one or more selfemployed individuals as defined in Code section 401(c)(1)). NOTE: If Suboption (b) is selected, a Custodian must be named in Part B below. b. Type of Trustee Will the Trustee of this Plan be a Directed or Discretionary Trustee (select one)? Option 1: Option 2: Option 3: Directed Trustee. Discretionary Trustee. Not applicable, Option 3 was selected in Part 1(a) above. #4221 (Pioneer) (4/2014) 24
c. Trustee Signature NOTE: If you are an individual Trustee and no Limited Trustee is named in Part A, item 3 below you will also be deemed to be a Limited Trustee. Name of Trustee: Pioneer Investment Management USA Inc. Address: 60 State Street, Boston, MA 02109 Telephone: 1-866-622-7815 Signature Title Senior Vice President Name (type or print name if different from name of Trustee above) Tracy Connelly 2. Trust Agreement If a Trustee is designated in Part A, item 1 above, which trust agreement will apply to the Plan (select one)? Option 1: Trust provisions contained in Plan Section Eight. Option 2: Separate executed trust agreement attached hereto. NOTE: If no option is selected, Option 1 will apply. If Option 2 is selected, the attached trust agreement must be on file with the IRS for use by the Prototype Document Sponsor listed in Section Nine below. If Option 2 is selected and a Limited Trustee is named below, the separate trust agreement will not replace Plan Section 8.09. 3. Limited Trustee The Limited Trustee appointed solely for the purposes of ensuring the timely collection and deposit of Employer Contributions will be: Option 1: Option 2: The individual Trustee named above. The party named below. Name of Limited Trustee Address Telephone Name (type or print name if different from name of Trustee above) Title Signature NOTE: A Trustee, including a Limited Trustee, must be an individual or corporation. A corporate Trustee must be a bank, trust company, broker, dealer, or clearing agency as defined in Labor Regulation section 2550.403(a)-1(b). Part B. Custodian (Both a Custodian and Trustee may be appointed for the Plan. This Part B must be completed if the Plan is exempt from the Trustee requirements under ERISA section 403 and neither a Trustee nor an Insurer is appointed in Part A, item 1 above.) 1. Custodian Appointment N/A Financial Organization N/A Address N/A N/A Type Name (type or print) Title N/A Signature #4221 (Pioneer) (4/2014) 25