Savings Contribution Rate Election Form Address street city state zip Marital Status: Married Not Married Sex: Male Female If you want to have your Statement of Account printed in Spanish, please check off this box. Savings Contribution Rate Please indicate the amount of pay that you would like to contribute. You may contribute up to 100% of your pay on a before-tax basis and/or 100% of your pay on an after-tax basis and/or 100% of pay on a Roth basis. The total amount of your savings may not exceed 100% of your pay. The amount you contribute may not exceed the IRS maximum limits each year. If you contributed to a 401(k) plan with a prior employer this year, your before-tax contributions to that plan are included in the annual dollar limit on elective deferrals. I elect to make before-tax contributions to USW Industry 401(k) Fund. A. Before Tax Contributions: B. After Tax Contributions: (check with your Employer for availability) C. Roth Contributions: (check with your Employer for availability) D. I elect not to contribute to USW Industry 401(k) Fund. Signature Send completed form to your employer. Your employer will provide a copy to the USW Industry 401(k) Fund, 1101 Kermit Dr., Ste. 800, Nashville, TN 37217 RSU4351 318 C:RS-44375-00
Complete this form for your initial enrollment by mailing to: MassMutual Retirement Services, PO Box 219062, Kansas City, MO 64121-9062. Remember, you can always make future changes to your investment election through MassMutual s participant web site www.massmutual.com/uswindustry401k, or by calling 1-800-743-5274. Marital Status: Married Not Married Sex: Male Female Investment Selection Investment Election Form Option 1 Take the Risk Profile Quiz. Then, choose the appropriate investment strategy. Important Note: Investment allocation strategies are a convenient way of allocating your account among certain of the plan s individual investment options. Any investment allocation strategies included in these materials are not intended to be investment advice or recommendations to you and may or may not be appropriate for your circumstances. In applying investment allocation strategies to your individual circumstances, you should consider your other assets, income and investments as well as your risk tolerance. If you direct your contributions or current account balance to an investment allocation strategy, your contributions or account balance will be invested in each of the individual investment alternatives in the percentages indicated for the strategy. The plan may offer other investment options not included in the strategies and the individual investment alternatives included in the strategies may also be available on a stand-alone basis. The Investment Portfolio chart lists asset classes, along with their weightings in the allocation strategy. Additional investment options may exist that are not included in the portfolio. The Cruise Control SM feature is available through www.massmutual.com/uswindustry401k to rebalance your account quarterly according to an investment strategy that you choose. 100% to Short-Term 1 Stable Value Fund...95% Select MetWest Total Return Bond Fund...5% 100% to Conservative 1 Stable Value Fund... 21% Select MetWest Total Return Bond Fund... 49% Premier Discipl Val Fd (Barings)............................. 4% MM Select Equity Opportunities Fund...5% MM S&P 500 Index Fund... 5% Fidelity Contrafund... 2% Prem Discipl Grth Fd (Barings)... 2% Oppenheimer Mn St Mid Cap Fd...7% AmerFunds EuroPacific Gr Fund...5% 100% to Moderate 1 Stable Value Fund...6% Select MetWest Total Return Bond Fund... 34% Premier Discipl Val Fd (Barings)............................. 7% MM Select Equity Opportunities Fund...9% MM S&P 500 Index Fund... 9% Fidelity Contrafund...4% Prem Discipl Grth Fd (Barings)... 4% Oppenheimer Mn St Mid Cap Fd...15% Select Mid Cap Growth Fund............................... 1% AmerFunds EuroPacific Gr Fund...11% 100% to Aggressive 1 Stable Value...2% Select MetWest Total Return Bond Fund... 14% Premier Discipl Val Fd (Barings)............................ 10% MM Select Equity Opportunities Fund...13% MM S&P 500 Index Fund... 13% Fidelity Contrafund...5% Prem Discipl Grth Fd (Barings)... 5% Oppenheimer Mn St Mid Cap Fd...19% Select Mid Cap Growth Fund............................... 2% AmerFunds EuroPacific Gr Fund...17% 100% to Ultra Aggressive 1 Premier Discipl Val Fd (Barings)............................ 12% MM Select Equity Opportunities Fund...17% MM S&P 500 Index Fund... 17% Fidelity Contrafund... 6% Prem Discipl Grth Fd (Barings)... 6% Oppenheimer Mn St Mid Cap Fd...21% Select Mid Cap Growth Fund............................... 1% AmerFunds EuroPacific Gr Fund...20% 1 These model asset allocations are based on modern portfolio theory and the historic rates of return for various asset classes (e.g. stocks, bonds, and cash). However, past performance does not guarantee future results. The model asset allocations are provided as investment education and should not be relied upon as investment advice. Consult your investment advisor. Complete reverse side.
Investment Election Form (continued) Option 2 Target Asset Allocation Investment Options: Please pick one option from the list below based on your target retirement date. Option 3 Create your own investment strategy: The minimum investment selection for any investment option is 1% and may be increased in increments of 1%. The sum of your elections must equal 100%. Wells Fargo Adv Dow Jones Target Today Fund... %% Wells Fargo Adv Dow Jones 2015 Fund... %% Wells Fargo Adv Dow Jones 2025 Fund... %% Wells Fargo Adv Dow Jones 2035 Fund... %% Wells Fargo Adv Dow Jones 2045 Fund... %% Higher Risk/Return Potential Lower Stable Value Fund... % Select MetWest Total Return Bond Fund... % Wells Fargo Adv Dow Jones Target Today Fund... % MM RetireSMART Conservative... % Wells Fargo Adv Dow Jones 2015 Fund... % Wells Fargo Adv Dow Jones 2025 Fund.... % MFS Total Return Fund... % MM RetireSMART Moderate... % Wells Fargo Adv Dow Jones 2035 Fund... % Premier Discipl Val Fd (Barings)... % MM S&P 500 Index Fund... % Fidelity Contrafund... % Prem Discipl Grth Fd (Barings)... % Wells Fargo Adv Dow Jones 2045 Fund... % MM RetireSMART Moderate Growth... % Oppenheimer Mn St Mid Cap Fd... % Select Mid Cap Growth Fund... % MM Select Equity Opportunities Fund... % AmerFunds EuroPacific Gr Fund... % You will receive an Investment Selection Confirmation report from MassMutual for your records. You may change your investment selection by calling 1-800-743-5274 or accessing the Internet (www.massmutual.com/uswindustry401k): each available 24 hours a day, 7 days a week. You may change your investment selection daily for future contributions and transfer existing balances between investments daily at no charge. MassMutual Retirement Services cannot guarantee availability during periods of high demand. Important Note: If MassMutual Retirement Services receives this form and you have already made changes to your elections through phone or the Internet, the most recently dated activity will prevail. For more complete information about each investment, including charges and expenses, we recommend that you read each investment s prospectus and investment profile carefully before investing. Asset allocation doesn t protect against loss or ensure a profit, but can be a sound investment strategy. You can read and print copies for all of your plan s investment options through the web site at www.massmutual.com/uswindustry401k. You also may contact our Information Center at 1-800-743-5274 between 8:00 a.m. and 8:00 p.m. ET, Monday through Friday to request a prospectus. Signature RSU4350 318 C:RS-44374-00
Beneficiary Designation Marital Status: Married Not Married Sex: Male Female IMPORTANT: If no valid beneficiary designation is on file or if designation cannot otherwise be determined, a beneficiary will be determined by the plan fiduciary according to plan documents and applicable law. This designation supersedes any prior designation. Primary Beneficiary: (Check either box 1 or 2) 1. Spouse Primary Beneficiary: I designate my spouse to receive my entire account balance upon my death. Spouse s Name: Spouse s Social Security No.: Spouse s of Birth: 2. Non-Spouse or Multiple Primary Beneficiaries: I designate the following person(s) to receive my account balance upon my death: (Must be in whole percentages totaling 100%.). If applicable, Spouse s of Birth: If you are married and you have not elected your spouse as primary beneficiary, please have your spouse provide consent on the reverse side of this form. Complete reverse side.
Beneficiary Designation (continued) Spousal Consent: I understand I have a legal right to a death benefit equal to the participant s entire account balance. I consent to waive that legal right in accordance with the beneficiary designation set forth above. I acknowledge that I have a right to limit my consent only to a specific beneficiary and that I voluntarily elect to relinquish such right. I further understand and acknowledge that if I sign this form, no death benefit will be payable to me except as provided above. Spouse s Signature Notary Public s Signature Commission Expires Secondary Beneficiary (optional): If no Primary Beneficiary listed above is alive upon my death, I designate the following person(s) to receive my account balance upon my death: (Must be in whole percentages totaling 100%.) Signatures I understand that this beneficiary designation supersedes any previous designation. RSU4352 318 C: RS-44376-00