Model QDRO () The use of this Model is appropriate for Participants who are currently in receipt of benefit payments from one of the following plans: FCA US LLC UAW Pension Plan FCA US LLC SPFPA Pension Plan FCA US LLC IUE Pension Agreement American Motors Union Retirement Income Plan Jeep Corporation UAW Retirement Income Plan NOTE: If the Participant is receiving a benefit from more than one Plan and the intent is to award the Alternate Payee a portion of each Plan, it is strongly recommended that a separate QDRO be submitted for each Plan, as the respective Plan terms vary and the Plan benefits are administered separately The division of retirement benefits involves many complex tax and legal issues. FCA US LLC strongly recommends that individuals seek the advice of legal counsel or other qualified experts before drafting an order for the division of benefits. The following is intended as general information only. It should not be relied upon by any party as the sole method of dividing retirement benefits under this plan, nor is this model intended as legal advice. 1
ATTORNEY NAME LAW FIRM ADDRESS CITY/STATE/ZIP TELEPHONE NUMBER ATTORNEYS FOR ) [NAME OF PARTY] ) Plaintiff/Petitioner, ) ) ) CASE NO: v. ) ) [NAME OF PARTY] ) Defendant/Respondent ) QUALIFIED DOMESTIC RELATIONS ORDER WHEREAS, the parties were married to each other on and were separated on and divorced on ; and WHEREAS, this Court has personal jurisdiction over both parties and jurisdiction over the subject matter of this Order; and WHEREAS, this Order is granted in accordance with the domestic relations laws of the state of ; and WHEREAS, the parties and the Court intend that this Order shall be a qualified domestic relations order ( QDRO ), as defined in Section 414(p) of the Internal Revenue Code of 1986, as amended ( the Code )and Section 206(d) of the Employee Retirement Income Security Act of 1974, as amended ( ERISA ); and WHEREAS, the parties have stipulated that the Court shall enter this Order; NOW IT IS ORDERED AND ADJUDGED AS FOLLOWS: 2
1. DEFINITIONS As used in the Order, the following terms shall apply: a. The Participant shall mean, whose last known or current address is. The Participant is currently receiving a monthly benefit from the Plan. b. The Alternate Payee shall mean, whose last known or current address is. The Alternate Payee is the [Insert: spouse OR former spouse] of the Participant. c. The Plan shall mean the [Insert: applicable Plan name]. d. The Plan Administrator shall mean the FCA US LLC Employee Benefits Committee. 2. ALTERNATE PAYEE S AWARD The Alternate Payee is awarded [Insert: either % or $ ] from each monthly payment that the Participant receives, which includes any early retirement subsidy, supplement or separation program benefit that the Participant receives. 3. DISTRIBUTION AND FORM OF PAYMENT The Alternate Payee shall commence his or her benefits under the Plan as soon as administratively practicable following the Plan s qualification of this 3
Order as a QDRO. The Alternate Payee s payment effective date shall be the earlier of the date the Plan began segregating the Alternate Payee s portion of the benefit, if applicable, or the next administratively practicable payment date following the qualification of this Order. The Alternate Payee shall receive his or her benefits in accordance with the form of benefit received by the Participant and shall not be permitted to make an independent election related to the form of benefit or timing of commencement. 4. DEATH OF THE PARTICIPANT a. If the Participant predeceases the Alternate Payee, payments made to the Alternate Payee pursuant to this Order shall cease. The Participant s form of benefit elected, subject to Section 4.b. below, if applicable, will determine whether any further payments will be made to any party, including the Alternate Payee. b. If the Participant elected a form of benefit payment with a surviving spouse option and named the Alternate payee as the survivor, and if under the terms of the Plan the Participant is eligible to cancel the surviving spouse option upon divorce, then (select one): upon qualification of this Order, the Participant may elect to cancel the surviving spouse option and the Alternate Payee s benefit will end upon the Participant s death, or the Alternate Payee s own death, if earlier. the Participant may not elect to cancel the surviving spouse option. The Alternate Payee s benefit under the surviving spouse option will begin upon the Participant s death. 4
Section 4.c is applicable to Jeep-UAW participants Only Who Commenced Prior to September 4, 1990 c. If the Participant is in the Jeep Corporation UAW Retirement Income Plan and commenced benefit payments prior to September 4, 1990, the Alternate Payee [Insert: will OR will not] be the Participant s designated beneficiary for the lump sum benefits under the Plan. If the Alternate Payee is the designated beneficiary the designation is made with respect to [Insert: the entire amount of the death benefit OR the same proportion as awarded to the Alternate Payee in Section 2. ] 5. DEATH OF THE ALTERNATE PAYEE If Alternate Payee predeceases Participant, the Alternate Payee s portion of Participant s benefits, as stipulated herein, shall revert to the Participant. 6. ADDITIONAL BENEFITS a. The Alternate Payee [Insert: shall OR shall not] receive a proportionate share of any cost-of-living ( COLA ) or any post retirement economic improvement or adjustment made to the Participant s benefit after commencement. 7. For purposes of Sections 402 and 72 of the Code, any Alternate Payee who is the spouse or former spouse of the Participant shall be treated as the distributee of any distribution or payments made to the Alternate Payee under the terms of the order and, as such, will be required to pay the appropriate federal, state, and local income taxes on such distributions. 8. The parties shall cause a copy of this Order to be served on the Plan Administrator for the Plan forthwith. This Order shall remain in effect until further order of this Court or its terms and/or obligations have been discharged by the distribution of benefits from the Plan. 5
9. Nothing contained in this Order shall be construed to require the Plan or Plan Administrator to: a. Provide to the Alternate Payee any type or form of benefit or any option not otherwise available to the Participant under the Plan; b. To provide to the Alternate Payee increased benefits (determined on the basis of actuarial value); and c. To pay any benefits to the Alternate Payee that are required to be paid to another alternate payee under another order previously determined by the Plan Administrator to be a QDRO. 10. In the event the Plan Administrator of the Plan does not approve the form of this Order, then each party shall cooperate and do all things reasonably necessary to devise a form of Order acceptable to the Plan Administrator. 11. To the extent that the Trustee of the Plan erroneously pays to the Participant any benefits that are payable to the Alternate Payee under this Order, the Participant shall be deemed to be a trustee holding the amount of such benefits in a constructive trust for the benefit of the Alternate Payee. The Participant is ordered to pay such amount to the Alternate Payee within five days after [he or she] receives such amount. 12. To the extent that the Trustee of the Plan erroneously pays to the Alternate Payee any benefits that are payable to the Participant under this Order, the Alternate Payee shall be deemed to be a trustee holding the amount of such benefits in a constructive trust for the benefit of the Participant. The Alternate Payee is ordered to pay such amount to the Participant within five days after [he or she] receives such amount. 6
13. The Court retains jurisdiction to enforce, revise, modify or amend this Order insofar as necessary to establish or maintain its qualification as a QDRO or to amend this Order for other reasons, provided, however, neither this Order nor any subsequent revision, modification, or amendment shall require the Plan to provide any benefit not otherwise provided by the Plan. IT IS HEREBY ORDERED: Executed on: Judge APPROVED AS TO FORM AND CONTENT: By: Participant Date: By: Attorney for Participant Date: By: Alternate Payee Date: By: Attorney for Alternate Payee Date: 7
ADDENDUM This Addendum shall not be filed with the Court, but MUST be submitted along with the QDRO to: Willis Towers Watson QDRO Service Center P.O. Box 712728 Los Angeles, CA 90071 Attn: FCA QDRO Team The complete Social Security Numbers for both the Participant and Alternate Payee MUST be provided below for identification and implementation purposes. Participant s Information Name: Address: Participant s Attorney Information Name: Law Firm: Address: Date of Birth: Phone Number: Social Security Number: Phone Number: Email Address: Alternate Payee s Information Name: Address: Alternate Payee s Attorney Information Name: Law Firm: Address: Date of Birth: Phone Number: Social Security Number: Phone Number: Email Address: 8