Model QDRO (Separate Interest) The use of this Model is appropriate for Participants who are not yet receiving benefits from the following plan: FCA US LLC Pension Plan The former Chrysler Group LLC Pension Plan ( CPP ) which includes benefits accrued under the following merged Plans: The Chrysler Group LLC Subsidiaries Pension Plan ( Subs Plan ) The Chrysler Group LLC Salaried Employees Retirement Plan ( SERP ) The Chrysler Group LLC Executive Salaried Employees Retirement Plan ( ESERP ) NOTE: A QDRO naming the FCA US LLC Pension Plan (former CPP ) will be applicable to the Participant s entire benefit from the Plan, including all applicable merged Plan s, unless specifically excluded in the QDRO. This Model is drafted to apply a single award formula to all of a Participant s benefits under the merged Plans. If the intent is to apply different award formulas to the respective merged Plan benefits, separate QDROs should be drafted for each merged plan benefit. If the Participant participates in 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. 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 FCA US LLC Pension Plan (formerly the CPP ), which includes the Participant s benefits under all plans previously merged into the Plan, unless specifically excluded below: i. Excluding the former Chrysler Group LLC Salaried Employees Retirement Plan ( SERP ) Chrysler Group LLC Executive Salaried Employees Retirement Plan ( ESERP ) benefit(s) under the Plan, if applicable. ii. Excluding the former Chrysler Group LLC Subsidiaries Pension Plan (the Subs Plan ) benefit under the Plan, if applicable. d. The Plan Administrator shall mean the FCA US LLC Employee Benefits Committee. 2. ALTERNATE PAYEE S AWARD [OPTION 1] The Alternate Payee is awarded % of the Participant's Accrued Benefit in the Plan as of. [OPTION 2] The Alternate Payee is awarded % of the Marital Portion of the Participant s Accrued Benefit in the Plan. The Marital Portion of the Participant s Accrued Benefit shall be determined by multiplying the Participant s Accrued Benefit in the Plan as of the Alternate Payee s benefit commencement date by a fraction, the numerator of which is the number of months of Participant's service used for determining benefit accruals in the Plan from the 3
date of marriage ( ) [Insert: Date], up to and including the date of [Insert: separation OR divorce] ( ) [Insert: Date], and the denominator of which is the total number of months of Participant's service used for determining benefit accruals in the Plan as of the earliest of the Participant s retirement, termination or death, or the Alternate Payee s benefit commencement date. 3. DISTRIBUTION AND FORM OF PAYMENT a. Distribution to the Alternate Payee of the portion of the benefit awarded to him or to her pursuant to this Order may commence at the request of the Alternate Payee on or after the Participant's attainment of the earliest retirement age as that term is defined in Section 414(p)(4)(B) of the Code and shall commence no later than the Participant s benefit commencement date or the Participant s Normal Retirement Date, if earlier. If the Alternate Payee elects to receive his or her benefit prior to the Participant's Normal Retirement Date, the benefit shall be reduced for early commencement, as applicable. b. The Plan is hereby ordered to pay directly to Alternate Payee the benefit in the Plan as set forth in the form of a single life annuity, which shall be actuarially adjusted for payment over the lifetime of the Alternate Payee. c. If the Participant and the Alternate Payee commence benefit payments concurrently, the Alternate Payee shall receive a proportionate share of any early retirement subsidy, supplement or separation program received by the Participant. If the Participant has not commenced benefit payments on the Alternate Payee s benefit commencement date, payments to the Alternate Payee shall not include an early retirement subsidy, supplement or separation program. However, if the Participant subsequently retires and receives an early retirement subsidy, supplement or separation program, the Alternate Payee s benefit [Insert: shall OR shall not] be recalculated to include a proportionate share of such subsidy, supplement or separation program, if any. 4
4. DEATH OF THE PARTICIPANT a. The Participant s death shall not affect the Alternate Payee s entitlement to the benefit awarded in Section 2, above. [Include 4.b) only if the Order provides an award from the SERP or ESERP portion(s) of the benefit] [Option 1] b. In the event of the Participant's death prior to the Participant s benefit commencement the Alternate Payee shall be the Participant s designated beneficiary for the contributory and noncontributory lump sum death benefits available under the Plan. Such designation is made to the extent of the [Insert: entire amount of the available death benefit OR same proportion of the accrued benefit awarded to the Alternate Payee in Section 2, above ]. [Option 2] b. In the event of the Participant's death prior to the Participant s benefit commencement the Alternate Payee shall not be the Participant s designated beneficiary for the contributory and noncontributory lump sum death benefits available under the Plan. 5. DEATH OF THE ALTERNATE PAYEE a. If the Alternate Payee s death should occur prior to his or her benefit commencement date, no benefits are payable from the Plan on the Alternate Payee s behalf, and the portion of the benefit awarded to the Alternate Payee shall revert to the Participant. b. If the Alternate Payee s death occurs after his or her benefit commencement, any further benefit payable shall be dictated solely by the form of benefit elected by the Alternate Payee. 5
6. ADDITIONAL BENEFITS The Alternate Payee [Insert: shall OR shall not] receive a proportionate share of any cost-of-living ( COLA ) increase or post-retirement benefit increase made to the Participant s benefit. 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. 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. 6
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. 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 Plans 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: 7
By: Attorney for Participant Date: By: Alternate Payee Date: By: Attorney for Alternate Payee Date: 8
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: 9