Model Order for State of Michigan 401(k Plan SAMPLE LANGUAGE NOT A LEGAL DOCUMENT Please note : in order to properly complete this form, information should be obtained from the Plan Administrator, ING, PRIOR to its execution. Please see Section 4 herein and submit a subpoena to obtain specific information regarding the sources of the participant s funds and the fund allocations. If the Participant s account was funded in part with after-tax money, you must specify an order in which to transfer the money from the various sources. STATE OF MICHIGAN IN THE COURT OF DIVISION COUNTY caption case no. QUALIFIED DOMESTIC RELATIONS ORDER This Qualified Domestic Relations Order, (hereinafter QDRO as that term is defined in section 206(d of the Employee Retirement Income Security Act of 1974 (hereinafter ERISA and section 414(p of the Internal Revenue Code of 1986, as amended (hereinafter Code, directs payment of (all or a portion of participant s State of Michigan 401(k Plan assets to the Alternate Payee, pursuantto a Judgment of Divorce dated. This QDRO is entered in accordance with Michigan Statute M.C.L. 552.101.
Section I. Identification of Plan This Order applies to benefits under the 401K Plan known as the State of Michigan 401(k Plan. Section 2. Identification of Participant, Alternate Payee and Plan Administrator a. The Participant is [name]. The Participant s social security number is [insert ssn}. The Participant s address is [insert street, city, state, and zip code]. b. The Alternate Payee is [name]. The Alternate Payee s social security number is [insert ssn]. The Alternate Payee s address is [ insert street, city, state, and zip code]. c. The Plan Administrator is ING, Attn: State of Michigan Plan Administration, P.O. Box 55497, Boston, MA 02205-5497. The Participant and the Alternate Payee shall notify the Plan Administrator of any change of address by providing notice to ING at the above address. Section 3. Amount of Account to be Paid to Alternate Payee It is the intention of the Participant and the Alternate Payee that [insert the amount or %] of the interest of the Participant, is hereby assigned to the Alternate Payee to be held in a separate account known as Account B. The [amount or percentage] is assigned as of [insert the date- date of divorce, date of this Order, or other date chosen by the parties]. A prorated share of earnings or losses shall be allocated to the Alternate Payee for the period between the date specified in this paragraph and the date the account is established for the Alternate Payee. The Account B shall be established within 60 days of receipt of the complete and lawful QDRO. Section 4. Source of Funds to be Transferred to Alternate Payee a. The Parties acknowledge that the Participant s account balance contains money invested in the following funds: [this information will be provided pursuant to a subpoena submitted to ING or its successor] The Parties agree that money will be transferred from these funds in the following order until the amount designated herein is transferred to the Alternate Payee s account: [attorneys can specify an order for the funds] The Alternate Payee s account so established shall be known as Account B. In the event that the Participant does not elect a specific order in which to transfer funds, the funds shall be transferred Pro Rata from all the funds in the Participant s account. b. The Parties acknowledge that the Participant s account balance contains money derived from the following sources: [this information will be provided pursuant to a subpoena submitted to ING] The Parties agree that the money will be transferred
from these sources in the following order until the amount designated is transferred to said Account B [attorneys must specify the order] The remaining balance after execution of the foregoing, shall remain in Participant s account free and clear of any claim by the Alternate Payee or this Court. Section 5. Establishment of Account for Alternate Payee a. Account B shall be in the name and social security number of the Alternate Payee as set forth in Section 2, however, the funds shall only be distributed as set forth in Section 6. b. Account B shall be initially established with the funds from which the Participant chose to transfer money pursuant to Section 4(a. Account B will begin accruing earnings, gains, and losses from the time Account B is established. The alternate payee may elect to transfer any or all of the Account B funds to other available investment fund options offered by the Plan. Administrative charges for Account B will be applied in the same manner as the Participant s account. c. There shall be no further principal contributions into Account B, however, the funds shall accrue interest/ investment income/ losses as provided in Sections 3 and 5(b. Section 6. Payment or Investment Options The Alternate Payee may elect to receive a payout (either a Lump Sum distribution to which a 20% Federal withholding tax will apply, or a rollover of monies to another qualified plan or IRA or to keep the funds invested with the Plan Administrator. Section 7. Death of Participant Payment of the Alternate Payee s separate interest shall not be affected by the Participant s death. Section 8. Death of Alternate Payee Prior to Distribution The Alternate Payee s interest upon his or her death shall be paid to the Alternate Payee s beneficiary, or if the beneficiary has not been so designated, to the Alternate Payee s estate. Section 9. Compliance with Applicable Laws and Plan Provisions The parties to this Order intend that it comply with the applicable provisions of ERISA and the Code.
a. The Participant and Alternate Payee shall each be responsible for his or her own Federal income taxes due as a result of the distributions made from the State of Michigan 401(k Plan as required by the Code (unless the distribution is made to a nonspouse alternate payee, in which case the distribution shall be taxable to the participant. b. No provision in this Order shall be construed to require the Plan Administrator to (1 make any payment or take any action which is inconsistent with any Federal law, rule, regulation or applicable judicial decision; (2 provide any type or form of benefit, or any option, which is not otherwise provided under the provisions of the Plan; (3 provide increased benefits; or (4 pay benefits to any Alternate Payee under another Order previously determined to be a Qualified Domestic Relations Order as defined in section 414(p of the Code. c. The undertakings and obligations of the Plan as set forth in this Order are solely those of the Plan. Neither ING, any of its subsidiary or affiliated corporations, nor any officer, employee or agent of any such corporations (other than the Plan Administrator acting as such shall be deemed to have incurred any obligations as a result of this Order. d. Notwithstanding any other provision of this Order, in the event that the Participant, Alternate Payee or any other party claiming rights under this Order shall make any claim which the Plan Administrator shall determine to be inconsistent with this Order or with the Retirement Equity Act of 1984, as amended, the Plan may cease making further payments to any person whose rights under the Plan, in the sole judgment of the Plan Administrator, may be affected by such claim, resolution of the claim or further order of this court. The Plan may also take further action or actions as may be permitted by law with respect to such claim. e. The Participant is designated as a constructive trustee for any payments that are received by the Participant, but are due to the Alternate Payee and will remit the payment to the Alternate Payee within five (5 days of receipt of such payment. Section 10. Reservation of Jurisdiction This Court reserves jurisdiction over the Participant and the Alternate Payee and the Plan until such time as the obligations of the Plan to the Alternate Payee under this Order have been fully paid and discharged. Further, this Court reserves jurisdiction to amend this Order to maintain its status as a QDRO under ERISA and the Code. IT IS SO ORDERED:
Date: JUDGE APPROVED FOR ENTRY: Plan Participant Attorney for the Participant Alternate Payee Attorney for the Alternate Payee 401kQDRO-01.10