HomeMy WebLinkAbout1998 Money Purchase Plan
Augusta Richmond GA
DOCUMENT NAME: \C\S<2; m~ ~\'(dlo.~ \)\on
DOCUMENT TYPE:
YEAR: 00
BOX NUMBER: \ q
FILE NUMBER: \G~3l\
NUMBER OF PAGES: \~\
1998 AUGUSTA
MONEY PURCHASE PLAN
DOCUMENT NOTEBOOK
Pension Service Company
1100 Circle 75 Parkway
Suite 320
Atlanta, GA 30339
Phone (770) 952-5225
Fax (770) 563-9356
E-mail pensionservice@mindspring.com
.j.d. #16'1 ~ Y
AUGUSTA-RICHMOND COUNTY COMMISSION
~ --# bt1 J,k-
BOB YOUNG
Mayor
STAFF ATTORNEYS
V ANESSA FLOURNOY
HARRY B. JAMES, III
LEE BEARD
TOMMY BOYLES
ULMER BRIDGES
ANDY CHEEK
BORBY G. HANKERSON
WILLIAM B. KUHLKE, JR.
WM. "WILLIE" H. MAYS, III
STEPHEN E. SHEPARD
MARION WILLIAMS
JAMES B. WALL
CITY A TIORNEY
AUGUSTA LAW DEPARTMENT
RICHARD L. COLCLOUGH
Mayor Pro Tern
GEORGE R, KOL8
Administrator
November 4, 2003
Please Reply to:
P.O. Box 2125
Augusta, GA 30903
(706) 821-2488
Fax (706) 722-5984
j wall@augustaga.gov
Ms, Lena Bonner
Clerk, Commission
8th Floor, City-County Bldg,
Augusta, GA 30911
RE: 1998 Money Purchase Plan
Dear Lena:
Enclosed please find the 1998 Money Purchase Plan, Please include this in the
City's permanent records,
With best personal regards, I am
Yours very truly,
~
James B, Wall/~
JBW/sjp
Enclosure
V-~/s-I/J
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THE AUGUSTA-RICHAI01VD COUNTY COi\ifAIISSI01V
AGENDA
REGULAR MEETING
2:00 P,Y[
COM1VlISSION CIL.-\l\IBER
March 18. 1998
INVOCATION:
Reverend M.E. Stokes
Pastor Central African Baptist Church
PLEDGE OF ALLEGIANCE TO THE FLAG OF THE UNITED STATES OF AMERICA.
PRESENTA TION:
Proclamation Safe Communities.
DELEGATION: d
Five (5) miI1fltetil)le limit per delegation. 1I./kt IZ." 4'~q;#}#v
~' ~dtuCfJf)tLdP;ew~ag f"~~.~~ lJ!!I.~
fO~, Good~le Landing Home Owners .,-\ssoc,iation. J 5" - .5 tJ ~ ~~
1\\J~. ~i~~ {efford.s ~~'J e,l}fJUhjt? iJ;(e ~4/if -;/~~(/~~~~/3..jZ~'
~,.y-~~ ,0 ~ V .i-):J~ t(,I.C'vf"-ZT'1P'
& m fY PLANNING: !
J1. I)j Z-98-26 - Request for concurrence with the decision of the Planning
Commission to approve with the conditions: "Any entrance on wrack
? Lane shall be located no more than 100 feet from the right-of-\vay of
o Tobacco Road: and that a buffer that confonns to the side yard buffer
\ '\ provisions of the Richmond County Tree Ordinance shall be placed
~ along the remainder of the west property line adja.cent to wrack Lane"
,,~ a petition from Nleybohm Realtors, on behalf of the tvIcDonald Ga.
~ Builders, Inc. requesting a change of zoning from Zone R-3B
/ '1-- (lYlultiple-family Residential with Conditions) to Zone B-1
\ 1_ g (Neighborhood Business) on property located on the southeast
corner of the intersection of Tobacco Road and lVIack Lane.
District 6.
~2. Jl
~
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Z-98-30 - Request for concurrence with the decision of the Planning
Commission approve a petition from wlaurice fYrcKie requesting a
Special Exception for the purpose of establishing a family
personal care home as provided for in Section 26-1, Subparagraph
(h) of the Comprehensive Zoning Ordinance for Augusta-Richmond
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the annual budget. (Approved by the Commission i\'larch 3, 1998 -
Second Reading)
c~)\'v' 7~.N[otion to approve OjQinance establishing a Pension Plan for new
~';; tt employees and for employees not currently enrolled in either a City or
County Retirel.nent Plan, and to autl~orize the Mayor and Clerk to execute
documents to llnplement same, subject to final approval of Attorney and
I / Administrator. (Approved by the Commission l\tlarch 3, 1998 -
D S~cond Reading)
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wf74,N[otion to approve a~endf!len..!. of Augusta-Richmond County Code to
~q authorize License & Inspection Department License inspectors to issue
citations for violation of Augusta-Richmond Countv Code alcohol
~ -
__0 licensing and general business licensing o~~ (Approved by
to Public Services Committee "larch 9, 1998) ~
\>J~OJ f 75. Motion to a pp rove an Ordi na~ amend Section 1-7-15 (b) (2) 0 f The
'\CVV.+,5 Augusta-Richmond County Code so as to modify the powers and duties
t of the Richmond County Personnel Board; to provide an effective date:
mfJt to/J~~al ::~nf1icting qrdinances.; and for other purposes.
3'i @ ~~f ,t! itWu iVi<tptJ/UAJ / 0 --- i5
76.~ther usiness. 6 . 1---
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77.Legal me:ting.dfJ1~J PW~J
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AUGUSTA-RICHMOND COUNTY COMMISSION
BOB YOUNG
Mayor
JAMES B. WALL
CITY ATTORNEY
P. 0, Box 2125
454 GREENE STREET
AUGUSTA, GEORGIA 30903
Bus. (706) 821-2488
Fax No. (706) 722-5984
E-Mail: Jwall@co.richmoncLga.us
December 19, 2000
LEE BEARD
ULMER BRIDGES
JERRY BRIGHAM
HENRY H, BRIGHAM
ANDY CHEEK
RICHARD L. COLCLOUGH
WILLIAM B, KUHLKE, JR.
STEPHEN E, SHEPARD
MARION WILLIAMS
CHARLES R, OLIVER, P E, CPA
Administrator
WM, "WILLIE" H, MAYS, III
Mayor Pro Tem
Ms, Lena Bonner
Clerk, Commission
8th Floor, City-County Bldg.
Augusta, GA 30911
RE: Group AIIDuity Contract GA-P U806
Dear Lena:
This will acknowledge receipt of your Memo dated December 18 forwarding the
Fixed Contract Renewal Rate Endorsements from Benmark Financial Services, Inc,
No action is required by the Augusta-Richmond County Commission. I am
returning one copy of the endorsement which should be included in the 1998 Augusta Defined
Contribution Pension Plan, By carbon copy of this letter, I am forwarding a copy of same to
Brenda Byrd-Pelaez to be included in their copy of this Plan.
With best personal regards, I am
Yours very truly,
~
Jan1es B, Wall jfiJ.-fJ
JBW/sjp
Enclosure
Cc: Brenda Byrd-Pelaez
NATIONWIDE LIFE INSURANCE COMPANY
This Endorsement is attached to and made a part of
Group Annuity Contract GA-P U806
It is hereby understood and agreed that said Contract is modified by adding the following to the "Interest
Rate" section of the Contract Summary Page:
Interest Rate:
Contract Year
Rate
(January 01,2001 - December 31,2001)
(January 01,2002 - December 31,2002)
5,95%
4.95% (minimum)
Nothing herein contained shall be held to affect any of the provisions of said Contract other than as above
stated.
This endorsement shall be effective as of January 01. 2001.
NATIONWIDE LIFE INSURANCE COMPANY
Dated: November 29. 2000
BY:/~ jl~
CASE # 257-00049
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1
BOARD RESOLUTION
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2
SERVICE AGREEMENT
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3
PLAN SUMMARY
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4 ADOPTION AGREEMENT
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5 BASIC PLAN DOCUMENT
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6 ENROLLMENT FORMS
BENEFICIARY FORMS
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7 DISTRIBUTION FORMS
APPLICATION FOR BENEFITS
W AI VER FORM; TAX NOTICE
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. 8 NATIONWIDE CONTRACTS
APPOINTMENT OF AUTHORlZED REP,;
PA YOR DESIGNATION FORM
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RESOLUTION OlF THE
AUGUSTA-RICHMOND COUNTY COMMISSION
I hereby certify that the following is a true copy of a Resolution duly adopted by the
Employer on January -I!l-, 1999,
WHE.RJEAS, the Employer sponsors a Money purchase Plan;
WHE.RJEAS, the Employer desires to amend the Money Purchase Plan;
NOW THJE.RJElFO.RJE, be it resolved that the Employer hereby amends the Plan effective
as of January 1, 1999, by amending the Plan Adoption Agreement as follows:
The Contribution Formula in Exhibit 3, paragraph 1, subparagraph (a) shall be
changed to two percent (2%) of Compensation,
IN W.ITTNESS WHEREOF, I have hereunto set my hand on this K day of January,
1999,
CHMOND COUNTY
N
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ORDINANCE NO. c; 0 .2.. 1-
AN ORDINANCE ADOPTING THE ASSOCIATION OF COUNTY
COMMISSIONERS OF GEORGIA (ACCG) DEFINED
CONTRIBUTION PLAN.
it is hereby ordained by authority of same as follows:
BE IT ORDAINED BY THE AUGUSTA-RICHMOND COUNTY COMMISSION dlhi
Section 1.
Augusta, Georgia, does hereby establish a
retirement plan pursuant to the provisions of Section 401 (a) ot the
Internal Revenue Code of 1986, as amended, as set forth in that certain
"Government Retirement Plan and Trust, Basic Plan Document", attClch~d
hereto as Exhibit "A", and does further establish it~ ,.~tir~ment pLlll
Service Company as set forth in the Government Retirement Plan and TrusL
as a Money Purchase Plan and Trust in the form presented by Pensi 011
Numbered PO 2100 and the Adoption Agreement, attached hereto as Exhibit
."s" and incorporated herein by reference.
Section 2.
Pension Service Company sha 11 provi de l'eC0l"C1
keeping and administrative services for said retirement plan,
Section 3,
Said Plan shall be afforded to all illdividuals
hired on a regular basis by Augusta, Georgia, on or after MdY I, I~98,
and all current employees of Augusta, Georgia, who dr~ nuL ClHTellLly
County Retirement Plan,
enrolled in or are a member of either a City of Augusta or Richmond
terminate said Plan as provided in the Plan documents,
Section 4, Augusta, Georgia shall have the righL to amend or
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S02ctiml 5.
All laws 01' ._)nillLllll'.:~; III lloll-\:; "I I_I\'J~;
~ ; 1
Adopted this
3
ordin.:3.I:ces in conflict with this Ol-dinanc.; al-c 110l"eby l'l~P.~dj....:J,
of '11lA-ftQ, 1998,
First Reading:
3 - 3 - fg
3 -;%-9'6
Second Reading:
day of j)(P~CN' .I ~~tl, .lld l.IlJ~; .ii.... .1,1'.'
ley"
Thla cl\;(umlnl &,'I"D. a~ ..
(~YI.n~~1Jy
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FIRST AMENDMENT TO THE
1998 AUGUSTA MONEY PURCHASE PLAN
THE FIRST AMENDMENT to the 1998 Augusta Money Purchase Plan (the
"Plan") which was adopted effective May 1, 1998 in the form ofa Governmental Retirement
Plan and Trust Basic Plan Document (the "Plan Document") and accompanying Adoption
Agreement (the "Adoption Agreement"), hereby amends and modifies the Plan and Adoption
Agreement pursuant to the right reserved in Section 14,1 of the Plan Document as follows:
1. The Contribution Formula in EXHIBIT 3, paragraph 1, subparagraph (a)
shall be changed to two percent (2%) of Compensation,
2. The effective date of this Amendment to the Plan shall be January 1,
1999.
3, A copy of the amended page of the Adoption Agreement is attached
hereto,
4, All other provisions of the Plan shall remain unchanged and, as amended
herein, shall continue in full force and effect.
IN WITNESS WHEREOF, the Augusta-Richmond County Commission has
caused this Amendment to be executed by its duly authorized officer on this ~ day of
January, 1999,
By:
qtW As its Mayor
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Plan Anniversary nearest the date on which all eligibility requirements are
satisfied,
EXHIBIT 3 - CONTRIBUTION fORMULA AND ALlOCA liON fORMULA
CONTRIBUTION FORMULA (Section 6.1): The Participating Employer contribution for each
Participant who has completed the requirements specified below shall be (elect a, b, c, or
d):
1,
(a)
(b)
(c)
[Xl
[ ]
[ ]
(i)
(ii)
CD
NOTE:
(d) ~ ]
2
% of Compensation,
$_ for each Hour of Service,
Matching Employer Contributions
[ ]
Percen~age Ma~ch: The Employer shall contribute and allocate to
each eligible Participant's Matching Contribution Account an amount
equal to _ % of the amount contributed by the Participant to the _
County Commission Public Emp~oyee Deferred Compensation
Program, The Employer shall not match such Participant Deferrals as
provided above in excess of _ % of the Participant's Compensation,
[ ]
DDscl1'e~ionary Ma~clh: The Employer shall contribute and allocate to
each eligible Participant's Matching Contribution Account a percentage
of the amount contributed by the Participant to the
Deferred Compensation Program, The Employer shall set such percentage
prior to the end of the Plan Year, The Employer shall not match Participant
Elective Deferrals in excess of _% of the Participant's Compensation.
In no event may the above formula provide a Participant with more than 25%
of compensation as defined in Article VIII, Section a,5(b),
In accordance with the collective bargaining agreement between the
Participating Employer and (name of union)
2, PARTICIPATING EMPLOYEES' MANDATORY EMPLOYEE CONTRIBUTIONS (Section
6,3):
[Xl An Eligible Employee shall, subsequent to his Entry Date, contribute (please
complete) 4> % of his Compensation to the Plan,
NOTE: The Mandatory Contribution shall be considered "picked-up" by the Employer
under Section 414(h) of the Code,
o
Money Purchase P021 00-2
TRA '86 Version (Government)
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SECOND. AN[E~TIMENT TO THE
1998 AUGUSTA MONEY PURCHASE PLAJ."l
THE Employer, AugustalRichmond County, hereby amends the 1998 Augusta Money
Purchase Plan #005 (the "Plan"), which was adopted in the form of a Nationwide
Retirement Solutions, Inc, Model Governmental Defined Contribution Plan and Trust
(the "Plan Document") and Adoption Agreement (the "Adoption Agreement"), pursuant
to the right reserved in Section 8,1 of the Plan Document as follows:
415(c)(3) compensation definition:
For Limitation Years beginning on or after January 1, 1998, for purposes of applying the
limitations described in section 1.7 of the Plan Document and El. of the Adoption
Agreement. compensation paid or made available during such limitation years shall
include elective amounts that are not includible in the gross income of the employee by
re:'lson of section 132(f)(4),
IN WITNESS 'WHEREOF, the Employer has caused this Amendment to be executed
by its duly authorized officer on this --3- day of December , 2001
Aug0chilnd cou,n:y
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PLA~ SD'L\1AIW FOR THE
1998 Al'Gl:STA MO:'l'EY Pl'RCHASE PLAN
tv
FOREWORD
This Summary does not give full details of the Plan nor does it cover all points, The complete documents under which the
Plan is operated are available to you at the office of the Plan Administrator. In the case of any conflict between this Sunmlary
Information and the provisions of the Plan documents, the provisions of the Plan documents wiII prevail. In many instances.
such as where a specific interpretation of the Plan provisions is involved, or a provision of the Plan is related to a specific
situation, you should consult with the Plan Administrator.
We urge you to read this infollllation carefully, to keep it in a safe place for future reference, and to ask the Plan Administrator
any questions you may have about the Plan, or you may contact Pension Service Company at (800) 736-7166 from 9:00 - 5:00
p,m. ET, Monday through Friday,
IMPORTANT INFOI~I\IATION
Plan Name:
1998 Augusta Money Purchase Plan
Plan Sponsor:
1\ame: Augusta-Richmond County Commission
Address: 530 Greene Street, Rm, 801 Municipal Bldg., Augusta, GA 30911
Employer Identification Number: 58-2204274
Plan Number:
Type of Plan:
Effective Date:
Plan Year:
005
Money Purchase Plan
May 1, 1998
January 1st through December 31st
Plan Administrator:
Augusta-Richmond County
ID Service of legal process may be made upon either the Plan Administrator or the Trustee(s).
Funding Medium: TIle plan is funded through a trust. All contributions made to the plan wiII be deposited with the trust. The
assets of the trust are invested in group annuity contracts issued by Nationwide Life Insurance Company, All benefits due
under the plan wiII be paid by the Trustees or Nationwide to the extent of the plan funds held by the Trustees and Nationwide
or as governed by law,
Trust Name:
1998 Augusta Money Purchase Plan & Trust
Trustee(s):
Name-Larry E. Sconyers, Lee Beard. Ulmer Bridges, Jerry Brigham, Henry H, Brigham, Freddie 1.. Handy,
William B. Kuhlke Jr., Willie H. Mays III. J.B, Powell, Stephen E. Shepard. Moses Todd
Address - Same as Plan Sponsor
Entity Holding Assets of the Trust:
I'\ationwide Insurance
One Nationwide Plaza
Columbus, 01-1 43216
DEFINITIONS
Account
An account maintained for each Participant that holds the investments and investment
earnings or losses of all Plan contributions,
Compensation
The total amollnt of your gross earnings during the Plan Year. The pay on which your
contributions are based.
. Disability
The inability to engage in any substantial employment because of physical or mental
impairment that can be expected to result in death or to be of a long, continued, and
indefinite time.
Effective Date of Plan
Employer
. Fiscal Year
Forfeiture
Gain and/or Loss
INQUIRE Hotline
Investment Change Form
IRC
Normal Retirement Age
Participant
Participating Employer
Plan
Plan Administrator
. Plan Anniversary
Plan Year
Subaccount
Trust Fund
Vesting
May 1,1998
Augusta-Richmond County
January 1 st through December 31 st
The portion of your Participant Account that you are not entitled to if you leave the service
of the Employer before you meet the requirements for full vesting.
Money earned or lost through fluctuation in value of variable investments or interest
eamed on fixed investments.
The 24-hour system which gives you account balance information, and allows you to
change investments in your Account. The number is (800) 772-2182,
A form which permits you to change investments in your Account.
Internal Revenue Code. as amended.
The day a Participant attains age 65.
An employee who has completed the eligibility requirements and is still employed at an
entry date.
Your Employer and any other authorized employer who elects to adopt the Plan.
1998 Augusta Money Purchase Plan,
The Employer
January 1st.
The 12-month period beginning January 1 st and ending December 31 st of each year.
Part of the Participant's total account that relates to a specific source of contributions, e.g,;
Employer Subaccount, Employee Subaccount.
All assets of the trust.
A participant's right to all or part of his/her Participant Account.
ELIGIBILITY AND PARTICIPATION
1. When Am I Eligible To Join The Plan?
You are eligible to join the Plan on the first day of the month coinciding with or following 30 days from your date of hire,
The Plan Administrator will assist you with your enrollment and fumish all information that you may need. The Plan
Administrator also has the fOlms that you may need during your period of Plan participation,
2. If I Terminate Employment, When Willi be Eligible To Pllrticipate Again In The Plan?
You will be eligible to participate immediately after reemployment.
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CONTRI ill/nONS
1. Who Puts Money Into The Plan?
Your Employer contributes an amount equal to 2% of your compensation each Plan Year, You are required to contribute
4% of your compensation each Plan Year to participate. Your mandatory contribution will be made before taxes, thereby
saving you taxes,
2. When Will I Have To Pay Federal Income Taxes On These Contribution Amounts?
Federal income taxes will be payable in the year or years in which your account is paid to you or your beneficiary(ies).
Federal income taxes are only assessed on the amount actually withdrawn in any tax year.
3, Does This Guarantee That I will Pay Less In Taxes?
Most of us can expect to have less taxable income and to be taxed at lower rates during retirement than when we are
working, If that proves to be true in your case, you would pay less in taxes; however, it cannot be guaranteed,
4, May I Make a Rollover Contribution'?
Yes, this Plan will allow a Participant to contribute assets from another qualified plan to this plan, This procedure is called
a rollover. You are 100% Vested in your Rollover sub-account at all times, Please verify the procedures for making a
rollover contribution with your Plan Administrator.
IiWESTME~TS AND EXI'E:\'SES
1. What Happens To The Money Contributed To The Plan?
All contributions to the Plan are deposited into the trust fund. These funds are never mixed with the assets of your
Employer.
You are given the right to designate investment preferences for the contributions, to fixed or variable rate investments, or to
a combination of the two.
2. What Is My "Account"?
When you become a Participant, an Account will be established for you. Your Account will be credited with all
contributions and investment earnings, and it will be reduced by Plan expenses and investment losses. The value of your
Account is based on the combination of these credits and reductions.
For recordkeeping purposes, your Account is divided into sub-accounts.
3, What Investment Options Are Made Available Under The Plan?
A fixed fund that provides a guaranteed interest rate is available.
A selection of variable funds.
Please ask your Plan Administrator for more detailed infoI1nation.
4. How Will I Know My Account Value'?
You will receive quarterly statements showing the value of your Account. In addition, you can call the INQUIRE
Hotline which is available 24 hours a day, seven days a week (except during periodic maintenance) or the web site at
http://www.bestofamerica.com.
When Can I Change Where My .Future Contributions Are To Be Invested'?
You may change your future investment at anytime using the INQUIRE Hotline, the bestofamerica.com website or an
Investment Change Form,
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6. What Are The Limitations And Charges When I Want To Change The Investment Of My Past Contributions?
Transfers from one fund to another fund are generally available on a free and unlimited basis among the variable fund
options., There is no charge to your Account each time you make a transfer of funds between investment options, as long
as you do so through the INQUIRE line or the website, There is a $6 charge per fund for each fund out of which you
transfer assets by paper transfers,
*Some restrictions on transfers out of the fixed fund may apply und~r certain circumstances.
7. What Investment And Administration Fees Under The Plan \ViII Be Withdrllwn From My Account'?
An asset management fee of .90% or 1.10% (depending on the fund) will be charged on your variable account balance.
RETlltEM E:'/T AND DISTIUIJl:TIO:'/S
1. How Much of My Account Balance(s) WillI Be Entitled To Receive?
You will be vested in and entitled to all balances in the employer subaccounts after 5 years of service if you retire or are
terminated, or upon death or disability.
2. When May I Retire?
You may retire at your Normal Retirement Age (65) or your Early Retirement Age (50) if you have 15 years of service
with the Employer
If you choose to remain with your Employer after your Nornml Retirement Age, payment of your benefits will be
postponed until you retire.
3. How Much Will I Receive At Retirement?
You will receive your entire account balance.
4. How Do I Apply For Benefits?
If you want to make application for benefits. you should ask the Plan Administrator for an Application for Benefits.
5. How Will My Retirement Benefit Be Paid?
Your retirement benefit will be paid in the form of a one-sum cash payment, direct rollover, or purchased annuity.
6. What Happens When I Die?
If you die before distribution of your retirement benefit is scheduled to conUllence, then your beneficiary will be entitled to
receive a death benefit equal to the value of your Account.
7. How Do I Name A Beneficiary?
You name your beneficiary by completing a Beneficiary Designation Form. NornmlIy, this form will be furnished to you at
the appropriate time by the Plan Administrator.
To change a beneficiary designation, you should see or write to the Plan Administrator. He or she wilI provide you with the
proper forms to make the change.
8, What Happens If I Terminate Employment Before Normal Retirement?
At termination you are entitled to your vested account balance. Any taxable income recei\'ed prior to age 59 Y2 may result
in a 10% penalty tax being assessed by the IRS, Before you receivt: any distribution, pl~ase consult with your tax
advisor,
9. What Happens if I Become Disabled?
ffyou become disabled, you may be entitled to your Account in the fonn ofa lump sum. Whether or not you qualify for
. the distribution will be determined by the Plan Administrator.
to.Can I Assign My Benefits?
The Plan provides that to the extent permitted by law, you cannot assign, sell, transfer, or otherwise encumber your
benefits, To the same extent, your benefits are not subject to attachment or otherwise to the claims of your creditors.
Miscellaneous Questions
l. Can The Plan Be Changed'?
The Employer expects to continue the Plan indefinitely, However, the Plan Sponsor reserves the right to change,
discontinue, or terminate the Plan at any time. Any change in the Plan will not affect benefits you eamed to the date of the
change unless the change is required by govenunent regulations. You will be notified of any material change, The
Trustees may also change the investment options that are offered to you under the Plan,
2. What Happens If The Plan Terminates'?
In the event the plan is terminated, you will become 100% vested in your account. (The Plan Administrator will inform
palticipants of all available payout options,)
3. Does This Plan Affect My Social Security Benefits?
.
All benefits provided by this Plan are in addition to any benefits to which you may be entitled li'om Social Security, If you
have questions about Social Security benefits, you should contact the Social Security Administration office listed in your
telephone directory,
4. Can I Borrow Money From The Plan'?
No, loans are not permitted,
5. Are Any Other Benefit Distributions Allowed?
See your Plan Administrator if any other benefit distributions are allowed.
6. How Can I Get More Information About The Plan?
Pension Service will be happy to discuss all the advantages of enrolling in the Plan, You may call Pension Service at (800)
736-7166 to obtain information or the Nationwide website at http://bestofamerica,com,
Note that your current account balance information can be obtained, daily, through the toll-free INQUIRE Hotline at (800)
772-2182.
This Summary is imellded ollly (IS a gelleral outlille of the
Plan alld is Ilot a comprehellsive explanatioll of the Plall.
Charges, fees, and other illformatioll provided ill this
booklet may be subject to challge. For all exact statement of
your rights, YOll must refer to the Plall Documellt, a copy of
which call be obtaine(lfrom the Plan Administrator.
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April 30, 199B
MONEY PURCHASE GOVERNMENT RETIREMENT PLAN AND TRUST
WITH 414(h) PICK-UP OPTION ADOPTION AGREEMENT
Augusta, Georgia, a political subdivision of the State of Georgia, acting by and through the
Augusta-Richmond County Commission, as Employer, hereby establishes a money purchase plan
and trust for the benefit of its Eligible Employees, The plan and trust shall consist of the
Government Retirement Plan and Trust numbered PO 2100 and this Adoption Agreement.
1,
Name of Employer:
Augusta. Georgia
(a) Business Entity: [] Corporation--Date of Incorporation
[ ] Partnership [ ] Sole Proprietor [ ] S Corporation [X ] Other: County Government
(b) Type of Business or Entity (governmental; not-for-profit): Governmental
2, Employer Address: 530 Greene Street Room 801 Municipal Building. Augusta.
Georgia 3091 ~
3,
Employer Tax Year End December 31
Employer Identification No, 58-2204274
4.
Limitation Year (elect one):
[X] Calendar Year
[ ] other 12 month period ending:
5.
Plan Name: 1998 Augusta
Plan No, lQ)lOlS
Money Purchase Plan,
6, Plan Status (check a or b):
(a) [Xl Newly Adopted Plan
(b) [ ] Amendment and restatement of the (name of plan)
Effective date of amendment
This amendment shall not apply to any Employee who severed employment
before the effective date of amendment. The Accrued Benefit and vesting
percentage of each Participant who is an Employee on the effective date of
amendment shall be no less than before the amendment.
Money Purchase P02100-2
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April 30. 1998
.
EXHIBIT 1 - DEFINITIONS
1.
"Allocation Date" (Section 2,5) shall mean (elect one):
(a) [X] the last day of the month of December
in each Plan Year
(b) [ ]
other (please specify at least one day in each Plan Year)
2, "Valuation Date" (Section 2,54) shall mean (elect one):
(a) [X] the last day of the month of March. June. September & December
in each Plan Year
(b) [ ] other (please specify at least one day in each Plan Year)
3, "Reserved"
. 4,
"Compensation" (Sections 2,13 and 8,5(b)) For the purpose of determining a Participant's
allocation (Article VII) and his Annual Addition (Article VIII), Compensation shall mean
(elect a or b):
(a) [X] W-2 Earnings (as defined in Section 8,5(b)).
(b) [] Section 3401(a) Wages (as defined in Section 2.47),
(c) [ ] Other:
NOTE: If "other" is checked in 4(c) above, for the purpose of determining a
Participant's Annual Addition, Compensation shall mean W-2 Earnings Box
10,
[X] Check here if pursuant to Section 2,13, the Employer shall include in the definition
of Compensation above, for the purpose of determining a Participant's allocation
(Exhibit 3), contributions made pursuant to Section 125, 402(h), 402(a)(8), 457,
414(h), or 403(b) of the Code,
.
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April 3D, 1998
"Compensation Exclusions" (Section 2,13): For purposes of contributions and allocations
(Exhibit 3), the following Compensation shall not be considered (elect a, or one or more of
b, c, d, e, and f):
(a) [X] None, all Compensation shall be considered
(b) [ ] Bonus
(c) [ ] Overtime
(d) [ ] Commissions
(e) [ ] Compensation in excess of $
(f) [ ]
NOTE:
If (b) through (f) is selected, the definition of Compensation selected must
meet the requirements of Code Section 414(s) and regulations thereunder.
6, The compensation period shall be the (Section 2,13) (elect a, b or c):
(a) [X] Plan Year
(b) [ ] calendar year ending with or within the Plan Year
(c) [ ] Other:
NOTE:
(Such period must be permitted by Code Section 414(s) and regulations
thereunder.)
Compensation, for the purpose of any Mandatory Employee Contribution,
shall not include any Compensation earned prior to the later of the Effective
Date of the Plan, or an Eligible Employee's Entry Date,
7, "Effective Date" (Section 2,18) means May 1. 1998
NOTE:
If this is an amendment and restatement of an existing plan, insert the
original plan effective date,
8. "Plan Year" (Section 2.42) means the 12-consecutive month period beginning on the ~
day of January I and ending on the 31st day of lDecember in each year,
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If applicable, the first Plan Year will be a short Plan Year commencing on May 1.
1998 and ending on December 31.1998, Thereafter, the Plan Year shall end on the
date last specified above.
.
EXHIBIT 2 - ElIGIBiUTY REQUIREMENTS
1, CLASSIFICATION REQUIREMENTS (Section 2,21): Classifications of Employees that are not
eligible to participate in the Plan are (elect a or one or more of b through h):
(a) [ ]
(b) [ ]
(c) [ ]
.
(d) [ ]
(e) [ ]
(f) [ ]
(g) [ ]
None: all employees are eligible;
Covered by a Collective Bargaining Agreement: included in a unit of employees
where retirement benefits have been the subject of good faith bargaining
between representatives of such employee unit and the Participating Employer,
unless the resulting collective bargaining agreement provides for the inclusion of
such unit of employees under this Plan. Employee representatives shall not
include any organization more than half of whose members are Employees who
are owners, officers, or executives of the Employer,
Non-resident aliens who received no earned income from a Participating
Employer which constitutes income from sources within the United States,
Salaried: compensated on a salaried basis;
Commissioned: compensated on a commissioned basis;
Hourly Paid: compensated on an hourly basis;
Employees of an employer required to be aggregated with a Participating
Employer under Code Sections 414(b), (c), or (m) and persons deemed to be
employees under Code Section 414(n).
(h) [X] Other Classification: Employees who are already members of another City
of Augusta or Richmond County Retirement Plan. or are not Regular
Employees as defined in the Augus1ta-Richmond County Personnel Policies
and Procedures: Provided. however. it is expressly understood that the
following! are to be considered Eligible Employees. to wit: Any employee.
officeI/". appointee. or electee under any official of Augusta. Georgia. or
Richmond County. Georgia. as now constituted or hereafter constituted.
who is elected by vote of the electorate
2, SERVICE AND AGE REQUIREMENTS (Section 4,1):
.
(a) To be eligible to participate, an Eligible Employee must have completed the following
Eligibility Service requirements [check and complete appropriate box (1) and (2)]:
Money Purchase P021 00-2
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April 3D. 1998
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(1) SERVICE (2) AGE
No Service Requirement X No Age Requirement
X ~ Months from employment date _ (Specify Age)
(not to exceed 60)
_ Year(s) of Eligibility Service (not to
exceed 5)
If the service requirement elected is a stated number of months of service, each Eligible
Employee who has been employed with the Participating Employer for the number of
months elected shall be deemed to have completed the service requirement regardless of
the number of Hours Of Service actually performed, In such a situation, Hour of Service,
Break in Service, and Eligibility Service shall be determined as provided in Article III.
(b)
One year of Eligibility Service shall be credited to the Eligible Employee on the last
day of the Eligibility Computation Period in which he completes (not more than
1,000) Hours Of Service,
o
Employment with all employers listed below shall be counted as Eligibility Service on
the same basis as if such employment had been with the Participating Employer,
Not AlPlPlicable
3, ENTRY DATE (Section 4.1) The entry date shall be the (elect one):
(a) [ ] date coinciding with satisfaction of all eligibility requirements,
(b) [X] first day of the month coinciding with or next following satisfaction of all
eligibility requirements,
(c) [ ] first day of the Plan Year quarter following satisfaction of all eligibility
requirements.
(d) [ ] Plan Anniversary (elect one):
[ ] preceding [ ] coinciding with or next following-satisfaction of all eligibility
requirements,
(e)
[ ]
Plan Anniversary or the first day of the seventh month of the Plan Year
coinciding with or next following satisfaction of all eligibility requirements,
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(f)
April 30. 1998
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Plan Anniversary nearest the date on which all eligibility requirements are
satisfied.
EXHIBIT 3 - CONTRIBUTION FORMULA AND AllOCATION FORMULA
CONTRIBUTION FORMULA (Section 6,1): The Participating Employer contribution for each
Participant who has completed the requirements specified below shall be (elect a, b, c, or
d):
[Xl
[ ]
[ ]
1 % of Compensation,
Amended effective 1/1/99
See Amendment One
1.
(a)
(b)
(c)
(i)
(ii)
NOTE:
(d)
[ ]
$_ for each Hour of Service,
Matching Employer Contributions
[ ]
Percentage Match: The Employer shall contribute and allocate to
each eligible Participant's Matching Contribution Account an amount
equal to _ % of the amount contributed by the Participant to the _
County Commission Public Employee Deferred Compensation
Program, The Employer shall not match such Participant Deferrals as
provided above in excess of _ % of the Participant's Compensation,
[ ]
Discretionary Match: The Employer shall contribute and allocate to
each eligible Participant's Matching Contribution Account a percentage
of the amount contributed by the Participant to the
Deferred Compensation Program, The Employer shall set such percentage
prior to the end of the Plan Year. The Employer shall not match Participant
Elective Deferrals in excess of _% of the Participant's Compensation,
In no event may the above formula provide a Participant with more than 25%
of compensation as defined in Article VIII, Section 8,5(b),
In accordance with the collective bargaining agreement between the
Participating Employer and (name of union)
2, PARTICIPATING EMPLOYEES' MANDATORY EMPLOYEE CONTRIBUTIONS (Section
6,3):
[Xl An Eligible Employee shall, subsequent to his Entry Date, contribute (please
complete) 4 % of his Compensation to the Plan,
NOTE: The Mandatory Contribution shall be considered "picked-up" by the Employer
under Section 414(h) of the Code,
Money Purchase P021 00-2
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April 30. 1998
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All Eligible Employees are required to make a Mandatory Contribution as a condition of
employment.
[] Not applicable,
3.
ALLOCATION FORMULA (Section 7,1): The Participating Employer contribution allocated
to the Account of each Participant who has completed the requirements specified in Section
6,2 shall be determined in accordance with the contribution formula elected in Section 1
above,
4,
ELIGIBILITY FOR ALLOCATION (Section 7,2):
(a) A Participant who has completed less than 1,000 Hours of Service during a Plan Year
shall (elect 1 or 2):
(1) [ ]
share in the Participating Employer's contribution (and forfeitures) for
such Plan Year if he completes (elect i or ii):
(i)
at least 1 Hour of Service,
[ ]
[ ]
more than 500 Hours of Service,
(ii)
o
(2) [X] not share in the Participating Employer's contribution (and forfeitures)
for such Plan Year,
(b) A Participant whose employment is terminated prior to the end of the Plan Year but
after he has completed the hour(s) specified in (a) above shall (elect 1 or 2):
(1) [X] shall share in the Participating Employer's contribution (and forfeitures)
for such Plan Year.
(2) [ ] not share in the Participating Employer's contribution (and forfeitures)
for such Plan Year.
(c) The Participating Employer will allocate Employer related contributions to
Employees who terminate during the Plan Year as a result of:
[X] (i) Retirement.
[X] (ii) Disability,
[X] (iii) Death,
[ ]
(iv) Other termination of employment provided that the Participant has
completed a Year of Service as defined for Allocation Accrual
purposes,
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April 30, 1998
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(v)
Other termination of employment even though the Participant has not
completed a year of service,
[ ] (vi) Termination of employment (for any reason) provided that the
Participant has completed a Year of Service for Allocation Accrual
Purposes,
5, FORFEITURES (Section 11,2): Forfeitures shall occur (elect a or b):
(a) [X] upon distribution to a terminated Participant of his vested Accrued Benefit, or
his fifth consecutive one year Break In Service, if earlier.
(b) [ ] after the Participant has incurred his fifth consecutive one year Break In
Service,
6, FORFEITURES (Section 11,2): Forfeitures shall be (elect a or b):
(a) [ ] reallocated to the accounts of other Participants,
(b) [X] applied to reduce the next Participating Employer contribution,
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EXHIBIT 4 - INVESTMENTS
INVESTMENTS (Article IX): All assets of the Plan shall be invested by the Trustee except
that (elect a, b, c, or d):
(a) [ ] No exceptions
(b) [ ] The Employer shall direct the Trustee in selecting all investments,
(c) [X] The Participant shall direct, from eligible investments specified by the Plan
Administrator, the Trustee in selecting all investments for his Account.
(d) [ ] The Employer shall appoint an investment manager to direct the Trustee in
selecting all investments,
Name:
Address:
Telephone Number:
COMMON DUE DATE (Section 2,12) (elect a or b):
(a)
(b)
[ ]
[ ]
The day of the month of
N/A
in each year,
The following Dates:
NOTE:
Insert N/A in 2(a) above if Insurance Contracts will not be an investment
option under this Plan,
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April 30. 1998
EXHIBIT 5 - BENEFITS AND DISTRIBUTIONS
o
1.
VESTING SCHEDULE (Section 11.1): A Participant's vested interest in his employer
subaccount shall be determined by the following schedule (elect one):
(0
Vesting Of (a) (b) (c) (d) (e) (f) (g)
Vesting [] [ ] [] [X] [ ] [ ] [ ]
Service
0 100% 0% 0% 0% 0% 0%
1 0 0 0 0 0
2 0 20 0 0 0
3 100 40 0 20 0
4 60 0 40 0
5 80 100 60 0
6 100 80 0
7 100 0
8 0
9 0
10 100
2, INSURANCE POLICIES (Section 10,1) A Participant's vested interest in any Insurance
Policies purchased on his behalf shall be (elect one):
(a) [ ] 100% Vested upon purchase.
(b) [X] Subject to the vesting schedule in 1 above,
3, VESTING COMPUTATION PERIOD (Section 2,55): The 12 consecutive month period, or
such lesser period as a Participating Employer is in business, ending on the 31st day
of December in each year.
NOTE:
The Vesting Computation Period shall coincide with the Plan Year.
4,
VESTING SERVICE (Sections 2,56 and 11,1): One year of Vesting Service shall be
credited to a Participant for each Vesting Computation Period during which he completes
at least 1000 hrs (not to exceed 1,000) Hours of Service, beginning on his Employment
Date or Re-employment Date, subject to the exclusions elected in Section 5,
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April 30, 1998
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Employment with all employers listed below shall be counted as Vesting Service on the
same basis as if such employment had been with a Participating Employer. The
City Council of Augusta 08" the Richmond County Board of Commissioners
5,
EXCLUDED YEARS OF VESTING SERVICE (Section 2,56): In addition to years of Vesting
Service excluded by the Break In Service rules, the following years of Vesting Service shall
be excluded in determining a Participant's vested interest (elect a or check and complete b):
(a) [X] No Vesting Service shall be excluded,
(b) [] The following years of Vesting Service shall be excluded (elect any that are
applicable):
(1) []
years of Vesting Service before the year in which the Participant attains
age 18,
(2) [ ]
years of Vesting Service before the Effective Date of the Plan or a
predecessor plan,
6,
[ ]
ELAPSED TIME (Article III)
~
~
Check here if the elapsed time provisions of Article III are to apply, If checked,
Sections 3 and 4 above are not applicable,
7,
NORMAL RETIREMENT AGE (Section 2,33): A Participant's Normal Retirement Age will
be the day he (elect a or b):
(a) [X] attains age 65
(not more than 65).
(b) [ ]
attains age (not more than 65) or the (not more than 10)
anniversary of his participation commencement date, if later. Participation
commencement date is the first day of the Plan Year in which the Participant
began participating in the Plan,
8, EARLY RETIREMENT AGE (Section 11,4): (elect a or b):
(a) [X] A Participant who has attained age 50 and who is credited with 15
years of Vesting Service may retire on his Early Retirement Date, A
Participant's Account (elect (1) or (2)):
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(1) [x ] shall, if not previously 100% vested, be 100% vested solely upon
attainment of his Early Retirement Age,
Money Purchase P021 00-2
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(b) [ ]
April 30, 1998
(2) [ ]
shall be subject to the vesting schedule in Exhibit 5,
Early retirement is not provided,
9, COMMENCEMENT OF BENEFITS - TERMINATION OF EMPLOYMENT (Section 11,9):
A Participant who terminates his employment with his Participating Employer may receive
a distribution of his Accrued Benefit (elect a, b or c):
(a) [X] within a reasonable time after termination of employment.
(b) [] on or after the first Anniversary Date following termination of employment.
(c) [ ] upon attainment of the Participant's Normal Retirement Date,
10, OPTIONAL FORMS OF BENEFITS (Section 11,17) In addition to the lump sum normal
form of benefit, and, if required to be provided under the Plan, a Qualified Joint and Survivor
Annuity, the following option forms of benefits shall be provided (elect any that are
applicable):
(a) [ ]
(b) [ ]
0 (c) [ ]
(d) [ ]
(e) [ ]
(f) [ ]
NOTE:
NOTE:
Straight Life Annuity
Life Annuity - Ten Years Certain
Joint and Survivor Annuity
Ten Year Certain Fixed Payments
Life Annuity - Twenty Year Certain
Other:
[X] Check here if a lump sum normal form of benefit will be the only form
of benefit offered under this Plan ((a) through (g) must not be
completed), and the Qualified Pre-Retirement Survivor Annuity and
Qualified Joint and Survivor Annuity provisions will not be applicable
(Section 11,21).
If this amendment and restatement of a prior plan, the "other" line may be
used to preserve an optional form of benefit not currently offered by
Nationwide In addition, an additional optional form of benefit may be specified
in the "other" line above only if such form of benefit does not discriminate in
favor of-any Highly Compensated Employee.
11, CASH OUT DISTRIBUTION (Section 11,18) Upon termination of service, a Participant's
vested Accrued Benefit of $5,000 or less will (elect a or b):
o
(a) [X] be immediately distributed to the Participant.
Money Purchase P02100-2
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April 30. 1998
(b) [ ]
not be distributed to the Participant without his consent.
o 12, LOANS TO PARTICIPANTS (Section 11,14) Loans to Participants are (elect a or b):
(a) [ ] permitted and (complete one of the following boxes) [ ] are considered a
general investment of the Trust Fund [ ] are considered an investment of the
Participant's Account.
(b) [X] not permitted,
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Money Purchase P02100-2
TRA 186 Version (Government)
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April 30, 1998
EXHIBIT 6 - PLAN ADMINISTRATOR
1. PLAN ADMINISTRATOR (Section 12,1): The Plan Administrator shall be (elect a, b, c, or
d):
(a) [X] the Employer,
(b) [ ] the Trustee,
(c) [ ] a committee consisting of at least three persons appointed from time to time
by the Board to serve without compensation at the pleasure of the Board, Any
person appointed a member of such committee shall signify his acceptance
of administrative responsibility by filing written acceptance with the Board and
with the committee, Any member of the committee may resign by delivering
his written resignation to the Board and the Secretary of the committee, and
such resignation shall become effective on some specified future date not less
than 30 days after receipt of such resignation by the Board,
The committee may authorize one or more of its number to execute or deliver
any instrument or make any payment in its behalf,
A majority of the members of the committee at the time in office shall
constitute a quorum for the transaction of business, All resolutions or other
matters coming before the committee may be acted upon by the members of
the committee present at any meeting or without a meeting by an instrument
in writing signed by a majority of the members of the committee, In the event
any such vote ends in a deadlock, the Board shall cast the deciding vote.
(d)
[ ]
(Specify by name, title, or other description):
Money Purchase P02100-2
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April 30. 1998
EXHIBiT 7 - LIMITATIONS ON ALLOCATIONS
1. OTHER QUALIFIED PLANS (Sections 8,3 and 8,4) If the Participating Employer maintains
or ever maintained another qualified plan in which any Participant in this Plan is (or was) a
Participant or could become a Participating Employer must also complete this Section if it
maintains a welfare benefit fund, as defined in Section 419(e) of the Code, or an individual
medical account, as defined in Section 415(1)(2) of the Code, under which amounts are
treated as annual additions with respect to any Participant in this Plan (complete a and b):
(a) If the Participant is covered under another qualified defined contribution plan
maintained by the Employer, other than a Master or Prototype Plan (complete 1, 2,
or 3):
(1 )
The provisions of Section 8,2 will apply, as if the other plan was a
Master or Prototype plan,
[ ]
(2)
(Provide the method under which the plans will limit total Annual
Additions to the Maximum Permissible Amount, and will properly
reduce any Excess Amounts, in a manner that precludes Employer
discretion,)
[ ]
(3)
[X]
not applicable,
(b) If the Participant is or ever has been a Participant in a defined benefit plan
maintained by the Employer (complete 1,2, or 3):
(1) [X] In any Limitation Year, the Annual Additions credited to the participant
under this Plan may not cause the sum of the Defined Benefit Plan
Fraction and the Defined Contribution Plan Fraction to exceed 1.0, If
the Participating Employer contributions that would otherwise be
allocated to the Participant's Account during such year would cause the
1,0 limitation to be exceeded, the allocation will be reduced so that the
sum of the fractions equals 1,0, Any contributions not allocated
because of the preceding sentence will be allocated to the remaining
Participants under the allocation formula under the plan, If the 1,0
limitation is exceeded because of an Excess Amount, such Excess
Amount will be reduced in accordance with Section 7,1(d),
(2) [ ] (Provide the method under which the plan involved will satisfy the 1,0
limitation in a manner that precludes Employer discretion,)
(3)
[ ]
not applicable,
Money Purchase P021 00-2
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EXECUTION
April 30. 1998
@ The Employer hereby adopts this Plan and Trust, subject only to acceptance by the Trustee(s) and
Nationwide Life Insurance Company, The Employer, by executing this document, acknowledges
that it has read this Plan and Trust, that it has consulted legal counsel to the extent deemed nec-
essary, and that it accepts full responsibility for its participation hereunder, and that it releases
Nationwide from any liability resulting from adoption of the Plan and Trust.
IMPORTANT NOTICE
In order to obtain reliall1lce with respect to plan qualification, the Employer must submit this
Adoption Agreement with all provisions appropriately and fully completed and the corres-
ponding l8asic Plan Document numbered PO 2100 to the appropriate IRS Key District office
with an Appiication for at Determination Letter Request.
This Adoption Agreement may be used only in conjunction with the Government Retirement Plan
and Trust Basic Plan Document numbered PO 2100.
Date:..lh o~ I/,o /t:lf
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Date:
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[SIGNATURES CONTINED
Money Purchase P021 00-2
TRA '86 Version (Government)
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EMPLOYER
By:
May
Attest:
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Money Purchase P021 00-2
TRA '86 Version (Government)
- 17 -
Moses Todd, Commissl ner
(All Trustees must sign)
INSURANCE
GOVIERi\jMIENT RIETIREMENT PLAN AND TRUST
o
lBAS~C PlA~ DOCUlMENT
PROFIT-SHARING
MONEY PURCHASE PENSION
MONEY PURCHASE 414(h) PICK-UP
o
THIS DOCUMENT IS DESIGNED SOLELY FOR USE BY GOVERNMENT EMPLOYERS, AND
MAY ONLY BE USED WITH A GOVERNMENT DEFINED CONTRIBUTION OR GOVERNMENT
PICK-UP ADOPTION AGREEMENT NUMBERED PO 2100-1 OR PO 2100-2.
THIS PLAN AND TRUST MUST BE SUBMITTED TO THE APPROPRIATE DISTRICT OFFICE
OF THE INTERNAL REVENUE SERVICE FOR APPROVAL.
@"
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TRA '86 (GOVERNMENT) Revised 12/17/97
PO 21 00
T ABllE OF CONTIENTS
o
Subiect
Article
Page
Purpose Of Plan And Trust 1
Definitions II 1
Definitions - Elapsed Time III 9
Participation IV 11
Accounts V 12
Contributions VI 13
Allocations VII 15
CD Limitations on Allocations VIII 16
Investments IX 23
Insurance Policies X 25
Benefits and Distributions XI 27
Plan Administration XII 44
Trustee XIII 45
Amendment, Merger, and Termination XIV 50
Domestic Relations Order XV 51
Miscellaneous XVI 52
CD
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GOVIERNMIENT RIETIREMIENT PLAN Ai\JD TRUST
ARTICllE ~ - PURPOSIE Of PlAi\J AND TRUST
Government Plan and Trust has been created for the exclusive benefit of Eligible Employees
and their Beneficiaries of any Participating Government Employer which adopts the Plan and
Trust, The Plan is intended to qualify under Code Section 401 (a) and the Trust is intended
to be tax-exempt under Code Section 501 (a).
ART~CllE ~I - DIEIFI~ITIO~S
Each item defined below, when used in the Plan and Trust or Adoption Agreement, with the
first letter of each word capitalized, shall have the meaning set forth in this Article.
2.1 "Account" means the value of the Annuity Contracts, Mutual Fund Shares, and other
assets held by the Trustee on behalf of the Participant. The term, II Account" does not
include the value of any Insurance Policies held by the Trustee on the life of the Participant.
2.2 "Accrued Benefit" means the sum of the value of any Insurance Policies issued on the
Participant's life plus the value of his Account and shall constitute his entire interest in the
Trust Fund.
2,3 "Adoption Agreement" means the document the Employer executes to adopt the Plan
and Trust and is made a part thereof,
2,4 "Affiliated Employer" means the Employer, and if authorized by the Employer, any
other Employer which maintains a separate plan, agrees to administer its plan in accordance
with Sections 2.20, 2.56, 4.4, and 4.5, and executes the Adoption Agreement as such.
2.5 "Allocation Date" means the date specified in Exhibit 1.
2.6 "Annuity Contract" means any annuity contract, fixed or variable, individual or group,
deferred or immediate. Any Annuity Contract distributed from this Plan shall be endorsed so
that it is nontransferable.
2.7 "Annuity Starting Date" means (i) the first day of the first period for which an amount
is paid as an annuity, or (ii) in the case of a benefit not paid in the form of an annuity, the
first day on which all events have occurred which entitle the Participant to such benefit.
- 1 -
ARTICllE II - DEfINITIONS
(Continued)
.1
"
2.8 "Beneficiary" means the Participant's Spouse unless the Participant designated
another person(s) or entity as his beneficiary. Such beneficiary designation shall be made in
a form acceptable to the Plan Administrator and must be filed with the Plan Administrator to
be effective, The Participant's most recent beneficiary designation shall supersede any
previous designation. If no such beneficiary is alive or if no designation is in effect at the
time of distribution, Beneficiary shall mean the executor or other legal representative of the
last to die of the Participant and designated beneficiary.
2.9 "Board" means the Retirement Board of the entity adopting the Plan.
2,10 "Reserved"
2.11 "Code" means the Internal Revenue Code of 1986, as amended.
2.12 "Common Due Date" means each date, if any, set forth in Exhibit 4 of the Adoption
Agreement, as of which Insurance Policies may be purchased for a Participant.
.
2.13 "Compensation" is the amount defined in Exhibit 1. Effective for the first Plan Year
beginning on or after January 1, 1993, Compensation shall be limited to the first $200,000
(or any increased amount, as permitted by the Secretary of the Treasury) of Compensation.
Such dollar increase in effect on January 1 of any calendar year is effective for years
beginning in such calendar year and the first adjustment to the $200,000 limitation is
effective on January 1, 1990. If a plan determines Compensation on a period of time that
contains fewer than 1 2 calendar months, then the annual compensation limit is an amount
equal to the annual compensation limit for the calendar year in which the compensation
period begins multiplied by the ratio obtained by dividing the number of full months in the
period by 12. In determining the compensation of a Participant for purposes of this limitation,
the rules of Section 414(q)(6) of the Code shall apply, except in applying such rules, the term
"family" shall include only the Spouse of the Participant and any lineal descendants of the
Participant who have not attained age 1 9 before the close of the year, If, as a result of the
application of such rules the adjusted $200,000 limitation is exceeded, then (except for
purposes of determining the portion of compensation up to disparity), the limitation shall be
pro-rated among the affected Participants in proportion to each such Participant Com-
pensation as determined under this Section prior to the application of this limitation. If
elected by the Employer in the Adoption Agreement, Compensation shall include any amount
which is contributed by the Participating Employer pursuant to a salary reduction agreement
and which is not includible in the gross income of an Employee under Code Section 125,
457, 414(h), 402(h), 402(a)(8), or 403(b).
.
In addition to other applicable limitations set forth in the Plan, and notwithstanding any other
provision of the Plan to the contrary, for Plan Years beginning on or after January 1, 1996,
the annual compensation of each employee taken into account under the Plan shall not
exceed the OBRA '93 annual compensation limit. The OBRA '93 annual compensation limit
is $150,000, as adjusted by the Commissioner for increases in the cost of living in
accordance with section 401 (a)(17)(B) of the Internal Revenue Code. The cost-of-living
- 2 -
ARTICllE II - DIEFH\HTIONS
(Continued)
.
adjustment in effect for a calendar year applies to any period, not exceeding 12 months, over
which compensation is determined ("determination period") beginning in such calendar year.
If a determination period consists of fewer than 12 months, the OBRA '93 annual
compensation limit will be multiplied by a fraction, the numerator of which is the number of
months in the determination period, and the denominator of which is 12.
For Plan Years beginning on or after January 1, 1996, any reference in this Plan to the
limitation under section 401 (a)(17) of the Code shall mean the OBRA '93 annual
compensation limit set forth in this provision.
If compensation for any prior determination period is taken into account in determining an
employee's benefits accruir,~ in the current Plan Year, the compensation for that prior
determination period is subject to the OBRA '93 annual compensation limit in effect for that
prior determination period. For this purpose, for determination periods beginning before the
first day of the first Plan Year beginning on or after January 1, 1996, the OBRA '93 annual
compensation limit is $150,000.
.
2.14 "Disability" means a Participant's inability to engage in any substantial gainful activity
by reason of a medically determinable physical or mental impairment which can be expected
to result in death or to be of long-continued and indefinite duration. The permanence and
degree of such disablement shall be supported by medical evidence.
2.15 "Early Retirement Age" means the age, if any, specified in Exhibit 5 of the Adoption
Agreement.
2.16 "Early Retirement Date" means the first day of any month after his Early Retirement
Age and prior to his Normal Retirement Age in which a Participant has elected to retire.
2.17 (Reserved)
2.18 "Effective Date" means the date set forth in Exhibit 1 of the Adoption Agreement.
.
2.19 "Eligibility Computation Period" means for an Employee's Initial Eligibility
Compensation period, the twelve month consecutive period beginning on an Employee's
Employment Date or if required under Section 4.1, Reemployment Date, The succeeding
twelve consecutive month periods commence with the first Plan Year which commences prior
to the first anniversary of the Employee's initial Eligibility Computation Period regardless of
whether the Employee is entitled to be credited with 1,000 Hours Of Service (or any lesser
number of hours as specified in Exhibit 2 of the Adoption Agreement) during the initial
Eligibility Computation Period. An Employee who is credited with 1,000 Hours Of Service
(or any lesser number of hours as specified in Exhibit 2 of the Adoption Agreement) in both
the initial Eligibility Computation Period and the Plan Year which commences prior to the first
anniversary of the Employee's initial Eligibility Computation Period will be credited with two
years of service for purposes of eligibility to participate.
- 3 -
o
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CD
ARTICLE II - IDEfli\!ITIOi\!S
(Continued)
2,20 "Eligibility Service" means the number of Eligibility Computation Periods during which
an Employee completes the number of Hours Of Service specified in Exhibit 2 of the Adoption
Agreement. Eligibility Service shall include service with a Participating Employer, Affiliated
Employer, and with a predecessor employer providing the Participating Employer maintains
the plan of such predecessor.
2.21 "Eligible Employee" means all Employees, excluding any classification of Employees
specified in Exhibit 2 of the Adoption Agreement, which have completed the Eligibility Service
requirements of Exhibit 2. If an Employee is excluded by classification and also excluded
based on the age and service requirements of the Plan, the Employee shall be considered
excluded based on the age and service requirements of the Plan.
2.22 "Employee" means any employee of the Participating Employer maintaining the Plan,
or of any other Employer required to be aggregated with such Participating Employer under
Sections 414(b), (c), (m), or (0) of the Code.
The term Employee shall also include any leased employee deemed to be an Employee of any
Employer described in the previous paragraph as provided in Sections 414(n) or (0) of the
Code,
2.23 "Employee Contributions" means contributions to the Plan made by the Participant
on an after tax basis.
2.24 "Employer" means the entity executing the Adoption Agreement as Employer.
2.25 "Employment Date" means the date on which an Employee first performs an Hour Of
Service.
2,26 "Hour Of Service" means
(a) each hour for which an Employee is paid, or entitled to payment, for the
performance of duties for the Participating Employer. These hours shall be credited
to the Employee for the computation period in which the duties are performed;
(b) each hour for which an Employee is paid, or entitled to payment by the
Participating Employer on account of a period of time during which no duties are
performed (irrespective of whether the employment relationship has terminated) due
to vacation, holiday, illness, incapacity (including disability), layoff, jury duty, military
duty or leave of absence;
(c) each hour for which back pay, irrespective of mitigation of damages, is either
awarded or agreed to by the Participating Employer. The same Hours Of Service shall
not be credited both under paragraph (a) or paragraph (b), as the case may be, and
under this paragraph (c). These hours shall be credited to the Employee for the
- 4 -
ART~CLE ~~ - DlEfli\HTIONS
(Continued)
1)1,.
~.. .
.'
computation period or periods to which the award or agreement pertains rather than
the computation period in which the award, agreement or payment is made;
(d) each hour for which an Employee would have been credited during a period of
time during which no duties are performed due to absence because of pregnancy of
the Employee, the birth of a child of an Employee, the placement of a child in
connection with the adoption of the child by the Employee, or for purposes of caring
for the child during the period immediately following the birth or placement for
adoption;
(e) each hour specified in (a), (b), (c), and (d) while an Employee is in an ineligible
class of Employees shall be counted for all purposes of the Plan if the Employee
becomes an Eligible Employee;
.
(f) each hour specified in (a), (b), (c), and (d) while an Employee is employed by
another Participating Employer or when employed by any employers (whether or not
incorporated) that are members of a controlled group, as defined in Section 414 (b)
of the Code or under common control, as defined in Section 414 (c) of the Code, part
of an affiliated service group, as defined in Section 414 (m) of the Code, and any
other entity required to be aggregated with the Participating Employer pursuant to
Section 414(0) and regulations thereunder, will be counted for all purposes of the
Plan; and
(g) each hour specified in (a), (b), (c), and (d) will also be counted for all purposes
of the Plan for any person considered an Employee under Code Section 414(n) or
Section 414(0) and the regulations thereunder.
2.27 "Insurance Policy" means an ordinary life insurance, term insurance, retirement
income, endowment, or any other life insurance policy which is issued by an Insurer on the
life of a Participant and acquired under the Plan.
2.28 "Insurer" means a legal reserve life insurance company from which Insurance Policies
or Annuity Contracts are purchased pursuant to the Plan.
2.29 "Mandatory Employee Contribution" means Participant after-tax contributions which
are to be made as a condition of employment with the Employer, Pursuant to Section 414(h)
of the Code, such contributions shall be picked up by the Employer and are deemed to be
Employer Contributions.
2,30 "Mutual Fund Shares" means shares of any open end investment company.
. 2.31 "Nationwide" means Nationwide Life Insurance Company, Reference to its related
and affiliated companies shall include Nationwide Financial Services, Inc., Nationwide Variable
Life Company, WAUSAU Insurance Companies, and any other company affiliated with the
Nationwide Corporation or Nationwide Life Insurance Company.
- 5 -
ARTICllE II - DEfiNITIONS
(Continued)
&
WI'
2.32
[Reserved]
2.33 "Normal Retirement Age" means the age specified In Exhibit 5 of the Adoption
Agreement.
2.34 "Normal Retirement Date" means the first day of the calendar month coinciding with
or next following a Participant's Normal Retirement Age, but not earlier than the Effective
Date.
2.35 "One Hundred Percent Vested" or "100% Vested" means the Participant's Account
is non-forfeitable.
.
2,36 "Qualified Joint and Survivor Annuity" means an immediate annuity for the life of the
Participant, or if married on the Annuity Starting Date, an immediate annuity for the life of
the Participant with a survivor annuity for the life of the Participant's Spouse which is not
less than 50% and not more than 1 00% of the amount of the annuity payable during the
joint lives of the Participant and Spouse, This form of distribution shall be the amount that
can be purchased with the Participant's Accrued Benefit, minus the value of any portion of
the Participant's Account which is used as a security interest for a loan. The normal form
of survivor annuity shall be 50%. Such an annuity shall equal the aggregate value of the
Participant's vested Account (including rollovers), whether vested before or upon death,
including the proceeds of insurance contracts, if any, on the Participant's life. "Qualified
Pre-Retirement Survivor Annuity" means an annuity for the life of the Surviving Spouse.
2,37 "Participant" means an Eligible Employee or former eligible employee who has met the
eligibility requirements specified in Exhibit 2 and who may become eligible to receive or is
receiving benefits under the Plan,
2.38 "Participating Employer" means the Employer and, if authorized by the Employer, any
other employer required to be aggregated under Code Sections 414(b), (c), (m), or (q) which
elects to participate in the Plan and executes the Adoption Agreement or executes a board
resolution specifying that it is a Participating Employer in the Plan.
2.39 "Plan" means the Plan set forth in this document, the Adoption Agreement, and
amendments thereto. The name of the Plan shall be as stated in the Adoption Agreement.
2.40 "Plan Administrator" means the person, persons, or entity specified in Exhibit 6 of the
Adoption Agreement.
2.41 "Plan Anniversary" shall mean the effective date, and subsequently, the first day of
the second and each succeeding Plan Year.
. 2.42 "Plan Year" means the period specified in Exhibit 1 of the Adoption Agreement.
2.43 "Reemployment Date" means the date on which an Employee first performs an Hour
of Service following a Break in Service.
- 6 -
.
.
.
ARTICllE n - IDlEfl~ITIONS
(Continued)
2,44 "Required Beginning Date" means the later of the first day of April of the calendar
year following the calendar year in which the Participant attains age 70 1/2 or the calendar
year in which the Participant retires.
2.45 "Rollover Contribution" means a rollover contribution defined in Section 402(a)(5),
403(a)(4), or 408(d)(3) of the Code.
2.46 [Reserved]
2.47 "Section 3401 Wages" means wages as defined in Section 3401 (a) for the purpose
of income tax withholding at the source but determined without regard to any rules which
limit the remuneration included in wages based on the nature or location of the employment
or the services performed (such as the exception for agricultural labor in Section 3401 (a)(2)).
2.48 [Reserved]
2.49 [Reserved]
2.50 "Spouse (Surviving Spouse)" means an individual who is married (or was married at
the date of the Participant's death) to a Participant, provided that a former spouse will be
treated as the Spouse or Surviving Spouse to the extent provided under a Qualified Domestic
Relations Order as described in Section 414(p) of the Code.
2.51 "Trust" means the Trust set forth in this document, the Adoption Agreement, and
amendments thereto. The Trust name shall be the Plan Name, as stated in the Adoption
Agreement, plus the word "Trust."
2.52 "Trustee(s)" means the individual(s) or entity executing the Adoption Agreement as
such,
2,53 "Trust Fund" means all assets of the Trust.
2.54 "Valuation Date" means the date(s) specified in Exhibit 1,
2.55 "Vesting Computation Period" means the period specified in Exhibit 5 of the Adoption
Agreement, If the Vesting Computation Period is changed, the two overlapping 12 month
periods beginning with the first day of the last old period and ending with the last day of the
first new period shall each be considered a Vesting Computation Period for purposes of
computing vesting under the Plan.
- 7 -
.
.
.
ARTICLE II - DlEfli\HTIONS
(Continued)
2,56 "Vesting Service" means the number of Vesting Computation Periods during which
an Employee completes the number of Hours Of Service specified in Exhibit 5, excluding any
Vesting Service specified in Exhibit 5 of the Adoption Agreement. One year of Vesting
Service shall be credited for each such Vesting Computation Period.
Vesting Service shall include service with a Participating Employer, Affiliated Employer, and
with a predecessor employer providing the Participating Employer maintains the plan of such
predecessor.
A Participant who leaves the employ of a Participating Employer to enter the military service,
or who is on an approved leave of absence shall not be considered to have terminated
employment and shall continue to accrue Vesting Service during such periods. If a Participant
fails to return or to resume employment with the Participating Employer following completion
of such periods, he shall be deemed to have terminated employment as of the date the
absence commenced.
- 8 -
.
3.1
.
.
ART~CllE m - DIEFIi\!~TIOi\!S - ElAPSIED TIME
ELAPSED TIME: If "months from employment date" is specified in Exhibit 2, or
Elapsed Time is elected for Vesting Service in Exhibit 5, the Plan Administrator shall
determine an Employee's eligibility service under the Plan under the elapsed time
method. In such case the following shall apply:
For purposes of determining an Employee's initial or continued eligibility to participate
in the Plan, or the non-forfeitable interest in the Participant's account derived from
Employer contributions, an Employee will receive credit for the aggregate of all
periods of eligibility service commencing with the Employee's Employment Date or
Re-employment Date and ending on the date a Break In Service begins. For the
purpose of this Section, Employment Date or Re-employment Date shall mean the
first day the Employer performs an Hour Of Service, as defined in this Section. An
Employee will also receive credit for any Period of Severance of less than 1 2 months.
Fractional periods of a year will be expressed in terms of days.
A Period Of Severance is a continuous period of time during which the Employee is
not employed by the Employer. Such period begins on the date the Employee retires,
quits or is discharged, or if earlier, the 12 month anniversary of the date on which the
Employee was otherwise first absent from service.
A Break In Service is a Period Of Severance of at least 12 consecutive months.
For purposes of determining an Employee's initial or continued eligibility to participate
in the Plan, an Employee will receive credit for the aggregate of all time period(s)
commencing with the Employee's first day of employment or reemployment and
ending on the date a Break In Service begins. The first day of employment or re-
employment is the first day the Employee performs an Hour Of Service. An Employee
will also receive credit for any period of severance of less than 1 2 consecutive
months. Fractional periods of a year will be expressed in terms of days.
For purposes of this Section, Hour Of Service shall mean each hour for which an
Employee is paid or entitled to payment for the performance of duties for the
Employer.
In the case of an Employee who is absent from work for maternity or paternity
reasons, the 12-consecutive month period beginning on the first anniversary of the
first date of such absence shall not constitute a Break In Service. For purposes of
this paragraph, an absence from work for maternity or paternity reasons means an
absence (1) by reason of the pregnancy of the individual, (2) by reason of the birth
of a child of the individual, (3) by reason of the placement of a child with the
individual in connection with the adoption of such child by such individual, or (4) for
purposes of caring for such child for a period beginning immediately following such
birth or placement,
- 9 -
o
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~
v
ART~CllE m - DlEf~i\!IT~Oi\!S - IELAPSED T~ME
(Continued)
3.1 ELAPSED TIME: (Continued)
If the Employer is a member of an affiliated service group (under Section 414(m), a
controlled group of corporations (under Section 414(b), a group of trades or
businesses under common control (under Section 414(c)) or any other entity required
to be aggregated with the Employer pursuant to Section 414(0) and the regulations
thereunder, service will be credited for any employment for any period of time for any
other member of such group. Service will also be credited for any individual required
under Section 414(n) or Section 414(0) and the regulations thereunder to be
considered an Employee of any Employer aggregated under Section 414(b), (c), or
(m).
- 10 -
ART!CILIE ~V - PARTIC~PA T~ON
.
4.1 ELIGIBILITY: Each Eligible Employee shall become a Participant on the Effective Date
or, if later, on the entry date specified in Exhibit 1 of the Adoption Agreement providing he
first meets the eligibility requirements specified in Exhibit 2 of the Adoption Agreement.
Following a termination of employment, a former participant, or an Eligible Employee who has
fulfilled the Plan's eligibility requirements but is no longer employed by the Participating
Employer on his entry date shall be permitted to reenter the Plan on his Reemployment Date.
In the event a Participant becomes ineligible to participate because he is no longer a member
of an eligible class of Employees specified in Exhibit 2 of the Adoption Agreement, but has
not incurred a one-year Break In Service, such Employee shall participate immediately upon
his return to an eligible class of Employees. If such Employee incurs a one year Break In
Service, his eligibility to participate shall be determined pursuant to the preceding paragraph.
In the event an Employee who is not a member of an eligible class of Employees specified in
Exhibit 2 of the Adoption Agreement becomes a member of an eligible class, such Employee
shall become a Participant immediately if such Employee has satisfied the eligibility
requirements specified in Exhibit 2,
.
4.2 WAIVER: An Employee of any Participating Employer who adopts a Plan in which
Mandatory Contributions are picked-up pursuant to Code Section 414(h) by the Participating
Employer shall not waive participation in the Plan. For any Plan Year, any Participant who
is not a Participant in a "pick-up" plan described in the previous sentence may, in writing, and
prior to the date any contribution is made on his behalf, waive all of such contribution,
including any forfeiture attributable to such contribution, providing such Participant does not
receive any amounts waived in cash.
4.3 BINDING FORCE: A Participant shall be conclusively deemed to have assented to the
Plan, to any subsequent amendments, to the terms of the Annuity Contracts or Insurance
Policies on his life, and shall be bound thereby with the same force and effect as if he had
formally executed this Plan.
4,4 TRANSFER FROM AN AFFILIATED EMPLOYER: If an Eligible Employee is transferred
from an Affiliated Employer to a Participating Employer, he shall participate immediately if he
meets the eligibility requirements specified in Exhibit 2 of the Adoption Agreement.
4.5 TRANSFER TO AN AFFILIATED EMPLOYER: If a Participant transfers to an Affiliated
Employer, he shall not be entitled to any distribution from this Plan pending his subsequent
death or severance of employment.
.
- 11 -
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CD
ARTICLE V - ACCOUNTS
5.1 PARTICIPANTS' ACCOUNTS: The Plan Administrator shall maintain an Account for
each Participant showing the current dollar value of his interest in the Plan. Subaccounts to
be known as employer, employee, mandatory, and rollover shall be kept, showing (a) the
contributions in each category (b) the earnings, losses and expenses, and (c) distributions
from each subaccount, Other subaccounts may be established as determined by the Plan
Administrator, If a Participant has five consecutive one-year Breaks In Service, the Plan
Administrator shall maintain pre-break and post-break subaccounts.
5.2 VALUATION OF ACCOUNTS: On each Valuation Date, the Plan Administrator shall
determine the net increase or decrease in the fair market value of the Trust Fund, excluding
Insurance Policies, individual annuity contracts, or allocated group annuity contracts, and
shall equitably allocate the result thereof to each Participant's Account, Such determination
shall include realized and unrealized gains and losses, investment income and losses, and
applicable expenses. To the extent a Participant fails to direct his Account, earnings and
losses of the Trust shall be allocated to each Participant's Account in the ratio that such
Account bears to all participants' accounts. Subject to Section 9.3 and 11.14, such realized
and unrealized gains and losses shall be allocated on a fair and equitable basis under a
method specified by the Plan Administrator. A Participant's interest in an individual annuity
contract or allocated group annuity contract shall be determined at the annuity contract value
and changes in such value shall be allocated to the Account of such Participant. Such deter-
mination, other than on the first Valuation Date, shall not include contribution or forfeiture
allocations.
- 12 -
ARTICLE VI - CONTRIBlIlTIO~S
.
6.1 EMPLOYER CONTRIBUTION: For each Plan Year, the Participating Employer shall
contribute the amount specified in Exhibit 3 of the Adoption Agreement.
If a Profit-Sharing Plan is adopted, the Participating Employer's contribution shall be made
from Net Profits unless otherwise elected in Exhibit 1 of the Adoption Agreement. If for any
Plan Year prior to the first Plan Year beginning in 1987, the Participating Employer contribu-
tion is less than 1 5 % of the compensation for all Participants, the Participating Employer
may, subject to Article VII, for any succeeding Plan Year, make an additional contribution to
make up the difference.
A Participating Employer shall have no right, title, or interest in contributions made to the Plan
and no part of such contributions or income derived therefrom shall revert to the Participating
Employer except as provided in Section 6.2,
6.2 RETURN OF EMPLOYER CONTRIBUTIONS: Notwithstanding any other provision of
this Plan, contributions made by a Participating Employer may be returned to such
Participating Employer if the contribution was made by reason of a mistake of fact. Such
contribution must be returned within one year of the contribution.
.
In the event that the Commissioner of Internal Revenue determines that this Plan is not
initially qualified under the Internal Revenue Code, any contribution made incident to that
initial qualification by the Participating Employer must be returned to the Participating
Employer within one year after the date the initial qualification is denied, but only if the
application for the qualification is made by the time prescribed by law for filing the
Participating Employer's return for the taxable year in which the Plan is adopted, or such later
date as the Secretary of the Treasury may prescribe. Any future contributions conditioned
upon the qualification of an ongoing plan may be returned to the Participating Employer which
are made within one year of the date the qualification of the Plan was denied.
The Participating Employer shall state by written request to the Trustee the amount of
contribution to be returned and the reason for such return. The amount returned will not
include any net earnings attributable to the contribution and will be reduced by any net losses
and expenses attributable to the contribution. The Trustee will return the specified amount
to the Participating Employer promptly upon receipt of the written request.
6,3 MANDATORY EMPLOYEE CONTRIBUTIONS: The Employer may elect in Exhibit 3 of
the Adoption Agreement that all Eligible Employees must contribute Mandatory Employee
Contributions to the Plan as a condition of employment with the Employer. The Participating
Employer shall collect such contributions and remit them to the Trustee,
.
Mandatory Employee Contributions shall be 100% Vested when made and shall be distributed
as provided by Article XI.
- 13 -
o
o
0'..
. .
ARTICllE VI - CONTRIBUTIONS
(Continued)
6.4 EMPLOYEE CONTRIBUTIONS: If this Plan is amended to permit Employee Contribu-
tions, such contributions shall solely be required to meet the requirements specified in Section
6.6, The Participating Employer shall collect such contributions and remit them to the
Trustee,
Any election, change, or revocation of Employee Contributions shall be made on a form
satisfactory to the Plan Administrator and shall be filed with the Plan Administrator within
the time period specified by the Plan Administrator prior to its effect.
6.5 ROLLOVER CONTRIBUTION: Subject to the approval of the Plan Administrator and
upon completion of such forms as the Plan Administrator may require, a Participant may
make a Rollover Contribution to this Plan.
6.6 "Reserved"
6.7 TIME AND METHOD OF PAYMENT OF CONTRIBUTIONS: Participating Employer
contributions for any Plan Year shall be paid to the Trustee in one or more installments not
later than the time prescribed by law.
Any contribution which will be invested in an Insurance Policy, Annuity Contract, or Mutual
Fund Shares, may be paid by the Participating Employer directly to the company offering such
investment. In this event such contribution shall be deemed to be received by the Trustee
as of the date of receipt by such company.
6.8 DUTY OF TRUSTEE AND PLAN ADMINISTRATOR: The Trustee and the Plan
Administrator shall neither be liable nor responsible for collecting any contribution and the
Trustee shall have only the responsibility of investing amounts received in accordance with
Article XIII.
6.9 DEDUCTIBLE VOLUNTARY CONTRIBUTIONS: This Plan will not accept deductible
Employee Contributions.
6.10 ADDITIONAL REQUIREMENTS: The Plan Administrator may specify additional
requirements governing any contributions made to the Trust Fund,
- 14 -
o
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o
ARTICllE VII - AllOCA TIOi\!S
7,1 ALLOCATION OF PARTICIPATING EMPLOYER CONTRIBUTIONS AND FORFEITURES:
If a Money Purchase Plan or Profit-Sharing Plan is adopted, the Plan Administrator, as of the
Allocation Date, shall allocate to the Account of each Participant eligible for an allocation, the
amount paid to the Trust on his behalf by his Participating Employer. Such amount shall be
determined by reference to Exhibit 3, Forfeitures from a Profit-Sharing Plan or Money
Purchase Plan shall either be used to reduce the amount of the next required Participating
Employer's contribution and allocated on the Allocation Date along with the contribution paid,
or allocated on the Allocation Date in addition to any contribution paid, as specified by Exhibit
3 of the Adoption Agreement.
7.2 ELIGIBILITY FOR ALLOCATION: Each Participant who meets the requirements of
Exhibit 3 shall share in any Employer contribution and forfeitures (if permitted by Exhibit 3)
for such Plan Year. Unless otherwise stated in Exhibit 3 of the Adoption Agreement, a
Participant who is governed by a Standardized Adoption Agreement must complete more than
500 Hours of Service (1,000 hours prior to the first Plan beginning on or after
January 1,1990) in any applicable Plan Year in order to share in an allocation for that year,
Unless otherwise stated in Exhibit 3 of the Adoption Agreement, a Participant who is
governed by a Non-Standardized Adoption Agreement must complete 1 ,000 Hours of Service
in any applicable Plan Year in order to share in an allocation for that year. Unless otherwise
specified in Exhibit 3, the Participant must be employed on the last day of the Plan Year in
order to receive an allocation.
7 .3 ALLOCATION OF OTHER CONTRIBUTIONS: Any Employee Contributions and
Rollover Contributions shall be allocated on the date received directly to the subaccount of
the Participant on whose behalf such contribution was made. Any Mandatory Employee
Contributions shall be allocated to the Participant's mandatory subaccount for the period
specified by the Plan Administrator.
- 15 -
-
~
.
.
ARl"IClLlE vm - ILIMIT A TIONS ON AllLOCA TIONS
8.1 LIMITATIONS ON PARTICIPATING EMPLOYERS THAT DO NOT MAINTAIN ANY
OTHER QUALIFIED PLAN:
(a) If the Participant does not participate in, and has never participated in another
qualified plan or a welfare benefit fund, as defined in Section 419(e) of the Code, or
an individual medical account, as defined in Section 415(1)(2) of the Code, maintained
by the Employer which provides an Annual Addition as defined in Section 8.5, the
amount of the Annual Addition which may be credited to the Participant's Account
for any Limitation Year will not exceed the lesser of the Maximum Permissible
Amount or any other limitation contained in this Plan. If the Employer contribution
that would otherwise be contributed or allocated to the Participant's Account would
cause the Annual Additions for the Limitation Year to exceed the Maximum Permis-
sible Amount, the amount contributed or allocated will be reduced so that the Annual
Additions for the Limitation Year will equal the Maximum Permissible Amount.
(b) Prior to determining the Participant's actual Compensation for the Limitation
Year, the Employer may determine the Maximum Permissible Amount for a Participant
on the basis of a reasonable estimation of the Participant's Compensation or
forfeitures for the Limitation Year, uniformly determined for all Participants similarly
situated.
(c) As soon as is administratively feasible after the end of the Limitation Year, the
Maximum Permissible Amount for the Limitation Year will be determined on the basis
of the Participant's actual Compensation for the Limitation Year.
(d) If there is an Excess Amount due to paragraph (b) above or as a result of the
allocation of forfeitures, the excess will be disposed of as follows:
(1 ) Any Employee Contributions, to the extent they would reduce the Excess
Amount, will be returned to the Participant;
(2) If after the application of (1) above an Excess Amount still exists, and the
Participant is covered by the Plan at the end of a Limitation Year, the Excess
Amount in the Participant's Account will be used to reduce Employer
contributions (including any allocation of forfeitures) for such Participant in the
next Limitation Year, and each succeeding Limitation Year, if necessary;
(3) If after the application of (2) above an Excess Amount still exists, and the
Participant is not covered by the Plan at the end of a Limitation Year, the
Excess Amount will be held unallocated in a suspense account. The suspense
account will be applied to reduce future Employer contributions (including
allocation of any forfeitures) for all remaining Participants in the next Limitation
Year, and each succeeding Limitation Year if necessary;
- 16 -
.'"
. ,
ARTICLE vm - LIMITATIONS Oi\J AllOCA TIOi\!S
(Continued)
8.1 LIMITATIONS ON PARTICIPATING EMPLOYERS THAT DO NOT MAINTAIN ANY
OTHER QUALIFIED PLAN: (Continued)
(e) If a suspense account is in existence at any time during a Limitation Year
pursuant to this Section, it will not participate in the allocation of the Trust's
investment gains and losses. If a suspense account is in existence at any time during
a particular Limitation Year, all amounts in the suspense account must be allocated
and reallocated to Participants' subaccounts before any Employer Contributions or
any Employee Contributions may be made to the Plan for that Limitation Year.
Excess amounts may not be distributed to Participants,
8.2 LIMITATIONS ON EMPLOYERS THAT MAINTAIN MORE THAN ONE QUALIFIED PLAN
ALL OF WHICH ARE QUALIFIED DEFINED CONTRIBUTION PLANS:
.
(a) This Section applies if, in addition to this Plan, the Participant is covered under
another qualified Master or Prototype defined contribution plan or a welfare fund, as
defined in Section 419(e) of the Code, maintained by the Employer, or an individual
medical account, as defined in Section 415(1)(2) of the Code, maintained by the
Employer, which provides an Annual Addition as defined in Section 8.5, during any
Limitation Year. The Annual Additions which may be credited to a Participant's
Account under this Plan for any such Limitation Year will not exceed the Maximum
Permissible Amount reduced by the Annual Additions credited to a participant's
account under the other plans and welfare benefit funds for the same Limitation Year.
If the Annual Additions with respect to the Participant under other defined contri-
bution plans maintained by the Employer are less than the Maximum Permissible
Amount and the Employer contribution that would otherwise be contributed or
allocated to the Participant's Account under this Plan would cause the Annual
Additions for the Limitation Year to exceed this limitation, the amount contributed or
allocated will be reduced so that the Annual Additions under all such plans and funds
for the Limitation Year will equal the Maximum Permissible Amount. If the Annual
Additions with respect to the Participant under such other defined contribution plans
and welfare benefit funds in the aggregate are equal to or greater than the Maximum
Permissible Amount, no amount will be contributed or allocated to the Participant's
Account under this Plan for the Limitation Year.
(b) Prior to determining the Participant's actual Compensation for the Limitation
Year, the Employer may determine the Maximum Permissible Amount for a Participant
in the manner described in Section 8.1 (b).
.
(c) As soon as is administratively feasible after the end of the Limitation Year, the
Maximum Permissible Amount for the Limitation Year will be determined on the basis
of the Participant's actual Compensation for the Limitation Year.
- 17 -
.
ARTICLE vm - UMIT A TIONS ON AllOCATIONS
(Continued)
8.2 LIMITATIONS ON EMPLOYERS THAT MAINTAIN MORE THAN ONE QUALIFIED PLAN
ALL OF WHICH ARE QUALIFIED DEFINED CONTRIBUTION PLANS: (Continued)
(d) If, pursuant to Section 8.2(c) or as a result of the allocation of forfeitures, a
Participant's Annual Additions under this Plan and such other plans would result in
an Excess Amount for a Limitation Year, the Excess Amount will be deemed to
consist of the Annual Additions last allocated except that Annual Additions
attributable to a welfare benefit fund or an individual medical account will be deemed
to have been allocated first regardless of the actual allocation date.
(e) If an Excess Amount was allocated to a Participant on the last day of the Plan
Year of this Plan which coincides with the last day of the Plan Year of another plan,
the Excess Amount attributed to this Plan will be the product of,
(1) the total Excess Amount allocated as of such date, times
.
(2) the ratio of (a) the Annual Additions allocated to the Participant for the
Limitation Year as of such date under this Plan to (b) the total Annual Additions
allocated to the Participant for the Limitation Year as of such date under this
and all the other qualified Master or Prototype defined contribution plans.
(f) Any Excess Amounts attributed to this Plan shall be disposed of in the manner
described in Section 8.1 (d),
8.3 LIMITATIONS ON PARTICIPATING EMPLOYERS THAT MAINTAIN QUALIFIED
DEFINED CONTRIBUTION PLANS OTHER THAN A MASTER OR PROTOTYPE PLAN: If the
Participant is covered under another qualified defined contribution plan maintained by the
Employer which is not a Master or Prototype plan, Annual Additions which may be credited
to the Participant's Account under this Plan for any Limitation Year will be limited as specified
in Exhibit 7 of the Adoption Agreement.
8.4 LIMITATIONS ON PARTICIPATING EMPLOYERS THAT MAINTAIN A QUALIFIED
DEFINED BENEFIT PLAN: If the Employer maintains, or at any time maintained, a qualified
defined benefit plan covering any Participant in this Plan, the sum of the Participant's Defined
Benefit Plan Fraction and Defined Contribution Plan Fraction will not exceed 1,0 in any
Limitation Year. The Annual Additions which may be credited to the Participant's Account
under this Plan for any Limitation Year will be limited in accordance with Exhibit 7 of the
Adoption Agreement.
8,5
SPECIAL DEFINITIONS:
.
(a) Annual Additions: The sum of the following amounts credited to a Participant's
Account for the Limitation Year:
(1 ) Employer contributions;
- 18 -
.
ART~CllE VIII - UM~T A TiO~S Oi\l AllOCA TIOi\lS
(Continued)
8.5
SPECIAL DEFINITIONS: (Continued)
(2) forfeitures; and
(3) the lesser of (i) one-half of the Employee Contributions or (ii) the
Employee Contributions in excess of 6% of the Participant's Compensation for
the Limitation Year. Effective the first Plan Year beginning in 1987, all
Employee Contributions shall be considered. However, the Annual Addition for
any Limitation Year beginning before January 1, 1987 shall not be recomputed
to treat all Employee Contributions as Annual Additions.
Amounts allocated after March 31, 1984 to an individual medical account, as defined in
Section 415(1)(1) of the Coce, which is part of a pension or annuity plan maintained by the
Employer, are treated as Annual Additions to a defined contribution plan, Also, amounts
derived from contributions paid or accrued in taxable years ending after December 31, 1985,
which are attributable to post-retirement medical benefits allocated to the separate account
of a Key Employee, as defined in Section 419A(d)(3), under a welfare benefit fund, as defined
in Section 419(e), maintained by the Employer, are treated as Annual Additions to a defined
contribution plan.
.
For this purpose, any Excess Amount applied under Section 8.1 (d) or 8.2(f) in the Limitation
Year to reduce Employer contributions will be considered Annual Additions for such Limitation
Year.
(b) Compensation: For the purposes of this Article and where separately
referenced as W-2 Earnings, Compensation shall mean wages within the meaning of
Section 3401 (a) of the Code and all other payments of compensation to an employee
by his employer (in the course of the employer's trade or business) for which the
employer is required to furnish the employee a written statement under Sections
6041 (d) and 6051 (a)(3) of the Code. This definition of compensation may be
modified to exclude amounts paid or reimbursed by the employer for moving
expenses incurred by an employee, but only to the extent that at the time of the
payment it is reasonable to believe that these amounts are deductible by the
employee under Section 217 of the Code.
Compensation must be determined without regard to any rules under Section 3401 (a)
of the Code that limit the remuneration included in wages based on the nature or
location of the employment or the services performed (such as the exception for
agricultural labor in Section 3401 (a)(2) of the Code).
.
For limitation years beginning after December 31, 1991, for purposes of applying the
Limitations of this Article, Compensation for a Limitation Year is the Compensation
actually paid or includible in gross income during such year.
- 19 -
ARTICLE vm - LIMIT A TIOi\!S ON ALlOCA TIOi\!S
(Continued)
ID
8.5 SPECIAL DEFINITIONS: (Continued)
(c) Defined Benefit Fraction: A fraction, the numerator of which is the sum of the
Participant's Projected Annual Benefits under all the defined benefit plans (whether
or not terminated) maintained by the Employer, and the denominator of which is the
lesser of , 25% of the dollar limitation determined for the Limitation Year under
Sections 4' 5(b) and (d) of the Code or , 40% of the Highest Average Compensation,
including any adjustments under Section 415(b) of the Code.
Notwithstanding the above if the Participant was a participant as of the first day of
the first Limitation Year beginning after December 3', , 986, in one or more defined
benefit plans maintained by the Employer which were in existence on May 6, , 986,
the denominator of this fraction will not be less than' 25% of the sum of the annual
benefits under such plans which the Participant had accrued as of the close of the
last Limitation Year beginning before January', , 987, disregarding any changes in
the terms and conditions of the Plan after May 5, , 986, The preceding sentence
applies only if the defined benefit plans individually and in the aggregate satisfied the
requirements of Code Section 4'5 for all Limitation Years beginning before January
" , 987.
tD
(d) Defined Contribution Fraction: A fraction, the numerator of which is the sum
of the Annual Additions to the Participant's Account under all the defined contribution
plans (whether or not terminated) maintained by the Employer for the current and all
prior Limitation Years, (including the Annual Additions attributable to the Participant's
non-deductible employee contributions to all defined benefit plans, whether or not
terminated, maintained by the Employer, and the Annual Addition attributable to all
welfare benefit funds, as defined in Section 4' 9(e) of the Code, and individual
medical accounts, as defined in Section 415(1)(2) of the Code, maintained by the
Employer), and the denominator of which is the sum of the Maximum Aggregate
Amounts for the current and all prior Limitation Years of service with the Employer
(regardless of whether a defined contribution plan was maintained by the Employer).
The Maximum Aggregate Amount in any Limitation Year is the lesser of , 25% of the
dollar limitation in effect under Code Section 4' 5(c)(' )(A) or 35% of the Participant's
Compensation for such year.
tv
If the Employee was a Participant as of the end of the first day of the first Limitation
Year beginning after December 3', , 986, in one or more defined contribution plans
maintained by the Employer which were in existence on May 6, , 986, the numerator
of this fraction will be adjusted if the sum of this fraction and the defined benefit
fraction would otherwise exceed '.0 under the terms of this Plan. Under the
adjustment, an amount equal to the product of (') the excess of the sum of the
fraction over '.0 times (2) the denominator of this fraction, will be permanently
subtracted from the numerator of this fraction. The adjustment is calculated using
the fractions as they would be computed as of the end of the last Limitation Year
beginning before January " , 987, and disregarding any changes in the terms and
- 20 -
.
.
.
ART~CllE vm - LIMIT A TIOi\llS ON AILLOCA TIOi\JS
(Continued)
8.5 SPECIAL DEFINITIONS: (Continued)
(d) Defined Contribution Fraction: (Continued)
conditions of the plan made after May 5, 1986, but using the Section 415 limitation
applicable to the first Limitation Year beginning on or after January 1, 1987.
The Annual Addition for any limitation year beginning before January 1, 1987, shall
not be recomputed to treat all Employee Contributions as Annual Additions.
(e) Employer: For purposes of this Article, Employer shall mean the Employer that
adopts this Plan, and all members of a controlled group of corporations (as defined
in Section 414(b) of the Code as modified by Section 415(h), all commonly controlled
trades or businesses (as defined in Section 414(c) as modified by Section 415(h)) or
affiliated service groups (as defined in Section 414(m)) of which the adopting
employer is a part, and any other entity required to be aggregated with the Employer
pursuant to regulations under Section 414(0) of the Code.
(f) Excess Amount: The excess of the Participant's Annual Additions for the
Limitation Year over the Maximum Permissible Amount.
(g) Highest Average Compensation: The Average Compensation for the three
consecutive years of service with the Participating Employer that produces the
highest average. A year of service with the Participating Employer is the 12-
consecutive month period defined in the Employer's defined benefit plan.
(h) Limitation Year: A Limitation Year shall be the period selected in Exhibit 1. If
the Employer has more than one qualified plan, this Plan or the other plan shall be
amended so that all qualified plans maintained by the Employer must use the same
Limitation Year. If the Limitation Year is amended to a different twelve-consecutive-
month period, the new Limitation Year must begin on a date within the Limitation
Year in which the amendment is made.
(i) Master or Prototype Plan: A plan the form of which is the subject of a favorable
opinion letter from the Internal Revenue Service.
(j) Maximum Permissible Amount: The maximum Annual Addition that may be
contributed or allocated to a Participant's Account under the Plan for any Limitation
Year shall not exceed the lesser of:
(i)
the defined contribution dollar limitation, or
(ii) 25% of the Participant's Compensation for the Limitation Year.
- 21 -
o
o
o
AR1IClE vm - UMil A lIONS ON AllOCA liONS
(Continued)
8,5 SPECIAL DEFINITIONS: (Continued)
(j) Maximum Permissible Amount: (Continued)
The compensation limitation referred to in (ii) shall not apply to any contribution for
medical benefits (within the meaning of Section 401 (h) or Section 419A(f)(2) of the
Code) which is otherwise treated as an Annual Addition under Section 41 5(1)( 1) or
419A(d)(2) of the Code. The defined contribution dollar limitation is the lesser of
$30,000 (or if greater, one-fourth of the limitation in Section 415(b)(1) of the Code).
If a short Limitation Year is created because of an amendment changing the
Limitation Year to a different twelve-consecutive-month period, the Maximum
Permissible Amount will not exceed the defined contribution dollar limitation
multiplied by the following fraction:
number of months in the short Limitation Year
12
(k) Projected Annual Benefit: The annual retirement benefit (adjusted to an
actuarially equivalent straight life annuity if such benefit is expressed in a form other
than a straight life annuity or Qualified Joint and Survivor Annuity) to which the
Participant would be entitled under the terms of the Plan assuming:
(1) the Participant will continue employment until Normal Retirement Age
under the Plan (or current age, if later), and
(2) the Participant's Compensation for the current Limitation Year and all
other relevant factors used to determine benefits under the Plan will remain
constant for all future Limitation Years.
- 22 -
ART~CllE IX - ~NVIESTMIENTS
.
9.1 INVESTMENT AUTHORITY: The Plan Administrator shall select suitable investments
in which Participant Accounts may be invested. Investments shall be limited to those
permitted by the law of the State of the entity establishing the Plan. Unless Nationwide
permits in writing to the contrary, a portion of the assets of the Employer's Trust is required
to be invested in Contracts, Mutual Funds or other investment products of Nationwide Life
Insurance Company, its affiliates, or subsidiaries. All Plan assets not subject to investment
direction by the Employer, Participant, or Investment Manager shall be invested by the
Trustee in accordance with Article XIII.
9.2 EMPLOYER DIRECTED INVESTMENTS: If the Employer so elects in Exhibit 4 of the
Adoption Agreement, it shall direct the Trustee in all investments of the Trust, In this event,
the Trustee shall not be liable for the directions or omissions of the Employer nor shall the
Trustee be under an obligation to invest or otherwise manage any Plan assets that are subject
to the direction of the Employer. Nothing in this Section shall relieve the Trustee of any
liability under the Trust for any act or omission of the Trustee.
.
9.3 PARTICIPANT DIRECTED INVESTMENTS: If the Employer so elects in Exhibit 4 of
the Adoption Agreement, each Participant shall direct, in writing, the investment of his
Accrued Benefit, However, a Participant shall not be permitted to direct his Accrued Benefit
if the Participant has received the entire vested portion of his Accrued Benefit. The Plan
Administrator may elect, on a non-discriminatory basis and for all Participants in the Plan, to
prohibit the Participant from directing his Account upon termination of employment or
retirement. If the Participant fails to direct in writing his investments, the Trustee shall invest
the Participant's Accrued Benefit.
If Participant directed investments are permitted, the valuation procedures specified in
Section 5.2 shall not apply. The Plan Administrator shall identify those assets being held in
each Participant's Account and shall value them at their market value in determining the value
of his Accrued Benefit, except that investments in Annuity Contracts shall be valued at the
annuity contract value,
The Plan Administrator shall not permit a Participant to direct that his Accrued Benefit, or any
portion thereof, be invested in collectibles, unless such collectibles are specified in Code
Section 408(m)(3).
The Employer, Plan Administrator, and Trustee shall be under no duty to question any
investment direction of a Participant, or to review any directed investments, or to make
suggestions to the Participant, nor shall they be held responsible in any manner for
investment loss or depreciation in asset value of any directed investment.
....
i.!
;"
- 23 -
o
o
o
AIRT~CllE ~X - ~NVIESTMlENTS
(Coll1ltinued)
9.4 INVESTMENT MANAGER: The Employer may appoint an Investment Manager in
Exhibit 4 of the Adoption Agreement to assume certain powers and responsibilities in the
investment and management of Plan assets, The Investment Manager shall assume full
liability for all duties and powers assigned to him and shall be subject to the fiduciary re-
sponsibilities of the Plan, The Trustee shall not be liable for the acts or omissions of the
Investment Manager nor shall the Trustee be under an obligation to invest or otherwise
manage any assets of the Plan that are subject to the management of an Investment
Manager. Nothing in this Section shall relieve the Trustee of any liability under the Trust for
any act or omission of the Trustee.
"Investment Manager" means any fiduciary (other than a Trustee or named fiduciary):
(a) who has the power to manage, acquire, or dispose of any assets of a plan;
(b) who is (i) registered as an investment adviser under the Investment Advisers
Act of 1940; (ii) a bank, as defined in that Act; or (iii) an insurer qualified to
perform services described in paragraph (a) under the laws of more than one
state; and
(c) who has acknowledged in writing that he is a fiduciary with respect to the Plan,
- 24-
ARTICllE )( - Ii\!SURA~CIE POLICIES
.
10.1 PURCHASE OF INSURANCE POLICIES: With the approval of the Plan Administrator,
a Participant may direct the Trustee to apply a portion of each contribution to the purchase
of an Insurance Policy, The fact that any Insurance Policy is issued on the life of a
Participant shall not vest any right, title, or interest in such Policy in the Participant except
at the time and on the terms and conditions set forth in the Plan. All Insurance Policies shall
be issued and all premiums shall be payable as of the Common Due Date.
The Plan Administrator may direct the Trustee to invest a portion of the Trust Fund in an
Insurance Policy on the life of any Employee of a Participating Employer, in which case, the
investment shall be deemed to be for the benefit of the Trust Fund as a whole.
Each Insurance Policy shall be issued by an Insurer selected by the Plan Administrator. The
Trustee shall be the applicant, owner, and beneficiary of each Insurance Policy. As applicant,
the Trustee shall execute any and all applications and other documents required by the Insurer
in connection with the issuance of any Insurance Policy. The Participating Employer, Plan
Administrator, and the Trustee shall not be liable for any loss suffered by a Participant or a
Beneficiary due to the Participant's failure to supply any information or perform any other act
required by the Insurer in connection with issuance or maintenance of an Insurance Policy.
.::
....
However, the Trustee shall be required to pay over all proceeds of any Insurance Policies to
the Participant's designated beneficiary in accordance with the distribution provisions of this
Plan. A Participant's Spouse will be the designated beneficiary of the proceeds in all
circumstances unless the Participant has designated another beneficiary. Under no
circumstances shall the Trust retain any part of the proceeds.
Insurance Policies may be held in the possession of the Trustee, Insurer, or Participating
Employer.
1 0.2 LIMITATIONS ON INSURANCE POLICIES: All Insurance Policy premiums shall be
payable from Participating Employer contributions, except as provided below.
If ordinary life insurance is purchased, aggregate premiums must be less than 50% of the
aggregate Participating Employer contributions and forfeitures allocated to the Participant.
If term or universal life insurance is purchased, aggregate premiums may not exceed 25%
of aggregate Participating Employer contributions and forfeitures allocated to the Participant.
If both ordinary and term or universal life insurance are purchased, aggregate premiums for
the term insurance plus one-half the aggregate premiums for the ordinary insurance may not
exceed 25% of the aggregate Participating Employer contributions and forfeitures allocated
to the Participant. If retirement income or endowment policies are purchased on behalf of
a Participant, the death benefit under the policy shall not be greater than 100 times the
anticipated monthly annuity provided under the policy. Ordinary life insurance is a policy that
provides both non-decreasing death benefits and non-increasing premiums.
.
If the premium payable is more than the amount of Participating Employer contribution
available for payment, the Trustee shall, unless the Participant elects otherwise, convert
- 25 -
o
o
o
ARTICLE )( - INSURANCE POLICIES
(ContinUJed)
1 0.2 LIMITATIONS ON INSURANCE POLICIES: (Continued)
other assets held on the Participant's behalf into cash in the amount of the insufficiency, to
the extent that the limitations of this section are not exceeded, and pay such amount to the
Insurer,
If a Profit-Sharing Plan or Money Purchase Plan is adopted, Insurance Policy dividends and
credits will be applied to reduce the next premium due before any Participating Employer
contributions are so applied,
10.3 DISPOSITION OF INSURANCE POLICIES: Upon the retirement, disability or other
termination of employment of a Participant, the Participant shall instruct the Trustee as to the
disposition of the Insurance Policies on his life, including the surrender, conversion, or
transfer of ownership of such policies to the Participant, or placing them on a paid-up basis.
The Trustee shall dispose of the policies in accordance with these instructions and shall, in
any event, prior to commencement of benefits under the Plan, convert Insurance Policies to
cash or an annuity contract or distribute such policies to the Participant.
10.4 MINIMUM PURCHASE: If the amount available for the purchase of an Insurance
Policy is insufficient to provide the minimum purchase amount as specified by the Insurer,
no Insurance Policy shall be purchased until the Common Due Date on which the amount
available is sufficient.
10.5 VALIDITY OF INSURANCE POLICY: Neither the Employer, the Plan Administrator, nor
the Trustee shall be responsible for the validity of any Insurance Policy, nor for the failure on
the part of the Insurer to make payments provided by such Policies, nor for the action of any
person which may render an Insurance Policy null or void or unenforceable in whole or in part.
10.6 SUBORDINATION OF INSURANCE POLICY OR ANNUITY CONTRACT: In the event
of any conflict between the terms of the Plan and the provisions of any Insurance Policy or
Annuity Contract, the terms of the Plan will control.
- 26 -
ARTICLE XI - BENIEFITS AND DISTRIBUTIONS
~
11.1 VESTING: Each Participant shall at all times be 100% Vested in his mandatory,
employee and rollover subaccounts.
Each Participant who is employed by a Participating Employer shall be 100% vested in his
Employer subaccount in the event of his Disability or death. The Participant's vested interest
in his Employer subaccount at any other time, subject to Article XII, shall be determined by
the Vesting Schedule elected in Exhibit 5 of the Adoption Agreement,
Each Participant shall be 100% vested in his Insurance Policy if (1) his premiums originated
from Employee Contributions, (2) the Participant was 100% Vested in such policy prior to
contribution to the Plan, or (3) the Participant was 100% Vested in such policy prior to
adoption or restatement of this Plan, Otherwise, the Participant's vested interest in his
Insurance Policy shall be dE;cermined according to the preceding paragraph,
~
.v
11.2 FORFEITURES: The Employer shall elect in Exhibit 3 of the Adoption Agreement
when to forfeit the nonvested portion of a terminated Participant's Accrued Benefit. If the
Participant's nonvested interest, pursuant to this Plan, is forfeited immediately, and the
Participant elects to have distributed less than the entire vested portion of the Account
derived from Employer contributions, the part of the nonvested portion that will be treated
as a forfeiture is the total nonvested portion multiplied by a fraction, the numerator of which
is the amount of the distribution attributable to Employer contributions and the denominator
of which is the total value of the vested Employer derived Account. No forfeiture shall occur
solely as a result of a Participant's withdrawal of his Mandatory Employee Contributions. If
a Participant terminates employment without a vested interest in his Accrued Benefit, the
Participant shall be deemed to have received his interest in his Accrued Benefit upon
separation of service, and a forfeiture of the Participant's Account shall occur at the time
specified in Exhibit 3 of the Adoption Agreement.
Forfeitures may be allocated to Participants' Accounts or applied to reduce the next
Participating Employer contribution, as determined by Exhibit 3 of the Adoption Agreement.
Notwithstanding anything in the Plan to the contrary, forfeitures shall not be allocated to any
Eligible Employee who, pursuant to Section 4.2, waived participation in the Plan.
If, at termination of the Plan, forfeitures remain unallocated or unapplied, such forfeitures
from a Money Purchase Plan or Profit-Sharing Plan shall be allocated to each Participant's
Account in accordance with the allocation formula specified in Exhibit 3 of the Adoption
Agreement.
11.3 NORMAL RETIREMENT BENEFIT: Each Participant who retires at his Normal Re-
tirement Age shall be entitled to his Accrued Benefit on his Normal Retirement Date.
..,.
I'
J
11.4 EARLY RETIREMENT BENEFIT: If the Employer has elected in Exhibit 5 of the
Adoption Agreement to permit early retirement, a Participant who terminates employment
after meeting the early retirement requirements specified in Exhibit 5 shall be entitled to his
vested Accrued Benefit on his Early Retirement Date,
- 27 -
..;11
~
ARTICILIE XI - BIENlEflTS A~D DISTRIBUT~Oi\lS
(Continued)
11.5 DEFERRED RETIREMENT BENEFIT: If a Participant shall continue in active
employment following his Normal Retirement Age, payment of his benefits shall be postponed
until his actual retirement,
11.6 DISABILITY BENEFIT: Notwithstanding any other provision of this Plan, a Participant
whose employment is terminated prior to his Normal Retirement Age as a result of Disability
shall be immediately entitled to his Accrued Benefit.
11. 7 DEATH BENEFIT: Notwithstanding any other provision of this Plan, if a Participant
dies before his Annuity Starting Date, the Participant's Beneficiary shall be entitled to a death
benefit equal to the Participant's Accrued Benefit, Such Accrued Benefit shall not include the
value of any security interest in the Participant's Account held by the Plan by reason of any
loan under Section 11.14. The Participant's entire interest may be distributed as soon as
administratively practical, but in any event no later than the December 31 of the calendar
year in which the fifth anniversary of the Participant's death occurs unless the designated
beneficiary or Spouse elects one of the following forms of distributions:
~
.v
(a) If any portion of the Participant's interest is payable to a designated beneficiary,
distributions may be made in substantially equal installments over the life or life
expectancy of the designated beneficiary commencing no later than the December 31
of the calendar year after the Participant's death; or
(b) If the designated beneficiary is the Participant's Surviving Spouse, the date
distributions are required to begin shall not be earlier than the later of the December
31 of the calendar year in which the Participant would have attained age 70 1/2 or
the December 31 of the calendar year immediately following the calendar year in
which the Participant died. If the Spouse dies before payments begin, such spouse
shall be treated as the Participant for the purpose of calculating future required
distributions,
If the Participant dies after distribution of his interest has begun, the remaining portion of
such interest will continue to be distributed at least as rapidly as under the method of
distribution being used prior to the Participant's death.
If the Participant dies before distribution of his interest begins, distribution of the Participant's
entire interest shall be completed by December 31 of the calendar year containing the fifth
anniversary of the Participant's death except to the extent that an election is made to receive
distributions in accordance with (a) or (b) above.
.
If the Participant has not made an election by the time of his or her death, the Participant's
Designated Beneficiary must elect the method of distribution no later than the earlier of (a)
December 31 of the calendar year in which distributions would be required to begin under this
Section, or (2) December 31 of the calendar year which contains the fifth anniversary of the
date of death of the Participant. If the Participant has no Designated Beneficiary, or if the
Designated Beneficiary does not elect a method of distribution, distribution of the
- 28 -
ARTICllE Xi - BIENlEflTS AND DiSTRiBUTIONS
(Continued)
a
u
11 . 7 DEATH BENEFIT: (Continued)
Participant's entire interest must be completed by December 31 of the calendar year
containing the fifth anniversary of the Participant's death.
For purposes of this Section, if the Surviving Spouse dies after the Participant but before
payments to such Spouse begin, the provisions of this Section, with the exception of
paragraph (b) above, shall be applied as if the Surviving Spouse were the Participant.
For purposes of this Section, any amount paid to a child of the Participant will be treated as
if it has been paid to the Surviving Spouse if the amount becomes payable to the Surviving
Spouse when the child reaches the age of majority.
For purposes of this Section, distribution of a Participant's interest is considered to begin on
the Participant's Required Beginning Date (or the date distribution is required to begin to the
Surviving Spouse pursuant to paragraph (b) above). If distribution in the form of an annuity
irrevocably commences to the Participant before the Required Beginning Date, the date the
distribution is considered to begin is the date distribution actually commences,
~
~
"Life Expectancy" and "Designated Beneficiary" shall have the meaning as defined in Section
11.16.
For purposes of the paragraphs above, payments will be calculated by use of the return
multiples specified in Tables V and VI, of Section 1.72-9 of the regulations under the Code
as of the date the distribution commences. Life expectancy of a Surviving Spouse may, at
the Spouse's election, be recalculated annually. In the absence of an election, life expectancy
of a Surviving Spouse may not be recalculated. In the case of any other designated
beneficiary, life expectancy will not be recalculated.
11.8 OTHER TERMINA liON OF EMPLOYMENT BENEFIT: Each Participant whose service
with the Participating Employer is terminated shall, if provided by Exhibit 5 of the Adoption
Agreement, be entitled to his vested Accrued Benefit at the time period specified in Exhibit
5.
11.9 COMMENCEMENT OF BENEFITS: A Participant may elect to commence distribution
of his benefit at any time on or after he meets the requirements for a distribution set forth
in this Article. However, subject to the succeeding sentence, the Plan Administrator may
elect to defer payment to a Participant until all contributions and allocations have been made
on behalf of any Participant.
tv
Notwithstanding the other requirements of this Article, distribution on behalf of any Employee
may be made in accordance with all of the following requirements (regardless of when such
distribution commences):
- 29 -
ARTICLE XI - BlEi\!IlEflTS AND DISTRIBUlT~Oi\lS
(Continued)
. 11.9
COMMENCEMENT OF BENEFITS: (Continued)
(a) The distribution by the trust is one which would not have disqualified such trust
under Section 401 (a)(9) of the Internal Revenue Code as in effect prior to amendment
by the Deficit Reduction Act of 1984;
(b) The distribution is in accordance with a method of distribution designated by
the Employee whose interest in the trust is being distributed or, if the Employee is
deceased, by a beneficiary of such Employee;
(c) Such designation was in writing, was signed by the Employee or the
beneficiary, and was made before January 1, 1983;
(d) The Employee had accrued a benefit under the Plan as of December 31, 1983;
(e) The method of distribution designated by the Employee or the beneficiary
specifies the time at which distributions will be made, and in the case of any
distribution upon the Employee's death, the beneficiaries of the Employee listed in
order of priority.
.
A distribution upon death will not be covered by this transitional rule unless the information
in the designation contains the required information described above with respect to the
distributions to be made upon the death of the Employee.
For any distribution which commences before January 1, 1984, but continues after
December 31, 1983, the Employee or the beneficiary, to whom such distribution is being
made, will be presumed to have designated the method of distribution under which the
distribution is being made if the method of distribution was specified in writing and the
distribution satisfies the requirements of this Section.
.
If a designation is revoked after December 31, 1983, any subsequent distribution must
satisfy the requirements of Section 401 (a)(9) of the Code and the proposed regulations
thereunder. If a designation is revoked subsequent to the date distributions are required to
begin, the trust must distribute by the end of the calendar year following the calendar year
in which the revocation occurs the total amount not yet distributed which would have been
required to have been distributed to satisfy Section 401 (a)(9) of the Code and the proposed
regulations thereunder, but for the Section 242(b)(2) election. For calendar years beginning
after December 31, 1988, such distributions must meet the minimum distribution incidental
benefit requirements in Section 1.401 (a)(9)-2 of the proposed regulations. Any changes in
the designation will be considered to be a revocation of the designation. However, the mere
substitution or addition of another beneficiary (one not named in the designation) under the
designation will not be considered to be a revocation of the designation, so long as such
substitution or addition does not alter the period over which distributions are to be made
under the designation, directly or indirectly (for example, by altering the relevant measuring
life). In the case in which an amount is transferred or rolled over from one plan to another
plan, the rules in O&J J-2 and O&A J-3 of such regulations shall apply.
- 30-
I)
I)
-
.
ART~CL.IE )(~ - BENlEflTS AND DlSTRIBUT~ONS
(Continued)
11.10 FORM OF DISTRIBUTION:
Participants shall elect among the forms of benefits specified in Section 11,17.
11.11 DISTRIBUTION REQUIREMENTS:
(a) The requirements of this Section shall apply to any distribution of a Participant's
interest and will take precedence over any inconsistent provisions of this Plan.
Unless otherwise specified, the provisions of this Section apply to calendar years
beginning after December 31, 1984.
(b) All distributions required under this Section shall be determined and made in
accordance with the proposed regulations under Section 401 (a)(9), including the
minimum distribution incidental benefit requirement of Section 1.401 (a)(9)-2 of the
proposed regulations.
(c) The entire interest of a Participant must be distributed or begin to be distributed
no later than the Participant's Required Beginning Date.
(d) Limits on Distribution Periods. As of the first Distribution Calendar Year,
distributions, if not made in a single-sum, may only be made over one of the following
periods (or a combination thereof):
(1 ) the life of the Participant,
(2) the life of the Participant and a Designated Beneficiary,
(3) a period certain not extending beyond the Life Expectancy of the
Participant, or
(4) a period certain not extending beyond the joint and last survivor
expectancy of the Participant and a Designated Beneficiary.
(e) If the Participant's interest is to be distributed in other than a single sum, the
following minimum distribution rules shall apply on or after the Required Beginning
Date:
(1 )
Individual Account.
(i) If a Participant's Benefit is to be distributed over (1) a period not
extending beyond the Life Expectancy of the Participant or the joint life
and last survivor expectancy of the Participant and the Participant's
Designated Beneficiary or (2) a period not extending beyond the Life
Expectancy of the Designated Beneficiary, the amount required to be
distributed for each calendar year, beginning with distributions for the
first Distribution Calendar Year must at least equal the quotient obtained
by dividing the Participant's benefit by the Applicable Life Expectancy.
- 31 -
ARTICllE XI - BIENEflTS AND DiSTRIBUTIONS
(Continued)
o
11,11 DISTRIBUTION REQUIREMENTS: (Continued)
(ii) For calendar years beginning before January 1, 1989, if the
Participant's Spouse is not the Designated Beneficiary, the method of
distribution selected must assure that at least 50% of the present value
of the amount available for distribution is paid within the Life Expectancy
of the Participant.
(iii) For calendar years beginning after December 31, 1988, the amount
to be distributed each year, beginning with distributions for the first
Distribution Calendar Year shall not be less than the quotient obtained by
dividing the Participant's benefit by the lesser of (1) the applicable Life
Expectancy or (2) if the Participant's Spouse is not the Designated
Beneficiary, the applicable divisor determined from the table set forth in
Q&A-4 of Section 1.401 (a)(9)-2 of the proposed regulations.
Distributions after the death of the Participant shall be distributed using
the Applicable Life Expectancy in (i) above as the relevant divisor without
regard to regulations Section 1,401 (a)(9)-2.
o
(iv) The minimum distribution required for the Participant's first
Distribution Calendar Year must be made on or before the Participant's
Required Beginning Date, The minimum distribution for other calendar
years, including the minimum distribution for the Distribution Calendar
Year in which the Employee's Required Beginning Date occurs, must be
made on or before December 31 of that Distribution Calendar Year.
(2)
Other Forms.
(i) If the Participant's Benefit is distributed in the form of an annuity
purchased from an insurance company, distributions thereunder shall be
made in accordance with the requirements of Section 401 (a)(9) of the
Code and the proposed regulations thereunder.
(f) Life Expectancy, Designated Beneficiary, Participant's Benefit, Distribution
Calendar Year, and Applicable Life Expectancy shall have the meanings as defined in
Section 11.16.
11.12 METHOD OF DISTRIBUTION: For any distribution under this Article, the Participant
or Beneficiary may, providing such methods of distribution are offered under the Plan, elect
payment in (a) cash, (b) Mutual Fund Shares, (c) Annuity Contracts, (d) an annuity under a
group annuity contract, or (e) Insurance Policies.
o
11.13 WITHDRAWALS OF EMPLOYEE CONTRIBUTIONS: A Participant may, upon written
notice to the Plan Administrator, withdraw from the Plan, in cash, all or a portion of the value
of his Employee Contribution subaccount,
- 32 -
ARTICllE XI - BIENEIFITS A~lO mSTIRIBUTIOi\lS
(Continued)
.
11.14 LOANS TO PARTICIPANTS: If the Employer so elects in Exhibit 5, the Trustee may
make a loan to any Participant or Beneficiary. Each loan shall be made upon the written
application of the Participant on a form acceptable to the Plan Administrator and shall be
subject to the approval of the Plan Administrator. Loans shall:
(a) be made available to Participants and Beneficiaries on a reasonably equivalent
basis;
(b) not be available to highly compensated employees (within the meaning of
414(q)) in an amount greater than the amount available to other employees;
(c) be secured by the Participant's vested Accrued Benefit and bear a reasonable
rate of interest;
(d) by its terms require that repayment (principal and interest) be amortized in level
payments, not less frequently than quarterly, over a period not extending beyond five
years from the date of the loan, unless the loan is for the sole purpose of buying the
principal residence of the Participant; and
.
(e) not exceed $50,000 (reduced by the excess, if any, of the highest outstanding
balance of loans made during the one year period ending on the day before the loan
is made, over the outstanding balance of loans from the Plan on the date the loan is
made) or 50% of the Participant's vested Accrued Benefit (without regard to a Partici-
pant's Keogh transfer subaccount), whichever is less. For these purposes, all loans
from all plans of the Participating Employer and other members of a group of
employees described in Code Sections 414(b), 414(c), and 414(m) are aggregated.
Notwithstanding the above limitations, providing collateral other than the
Participant's Account is used to secure a loan, and providing the Participant's or
Beneficiary's vested Accrued Benefit is $10,000 or less, a loan of up to the
Participant's vested Accrued Benefit may be made.
All such loans shall be considered either a general investment of the Trust Fund or an asset
of the Participant's Account, as elected in Exhibit 5.
An assignment or pledge of any portion of a Participant's interest in the Plan and a loan,
pledge, or assignment with respect to any Annuity Contract purchased under this Plan will
be treated as a loan under this Section.
.
A Participant shall not have more than one loan in effect at any time. The Plan Administrator,
in a non-discriminatory manner, may create other rules and regulations governing loans.
Effective for any loan granted or renewed on or after the first Plan Year beginning on or after
January 1, 1990, such rules and regulations must include a written document which is to be
made part of this Plan which, at a minimum, specifies:
(a) The identity of the person or positions authorized to administer the participant
loan program;
- 33 -
ART~CILIE XI - BENIEFITS AND D~STRIBUT~ONS
(Continued)
.
11.14 LOANS TO PARTICIPANTS: (Continued)
(b) A procedure for applying for loans;
(c) The basis on which loans will be approved or denied;
(d) Limitations (if any) on the types and amounts of loans offered;
(e) The procedure under the program for determining a reasonable rate of interest;
(f) The types of collateral which may secure a participant loan; and
(g) The events constituting default and the steps that will be taken to preserve plan
assets in the event of such default.
If loans are permitted in Exhibit 5, effective for any loan granted or renewed on or after the
first Plan Year beginning in 1989, the Trustee is specifically authorized to establish and the
Plan Administrator is authorized to maintain and administer a Participant loan program.
An assignment or pledge of any portion of a Participant's interest in the Plan and a loan,
pledge, or assignment with respect to any Annuity Contract purchased under this Plan will
be treated as a loan under this Section,
.
If a Participant shall default on any loan, the Plan Administrator shall deduct the unpaid
principal and any unpaid interest from the Participant's Account at the time when the
Participant's Account becomes distributable.
11.15 OTHER PROVISIONS: The Plan Administrator, on a non-discriminatory basis, may
promulgate other rules and regulations governing distributions from the Pla!l including limiting
the forms of benefits offered under this Plan.
11 . 1 6 DEFINITIONS: For the purpose of Sections 11.7 and 11.11, the following definitions
shall apply:
.."
..
,
(a) Applicable Life Expectancy. The life expectancy (or joint and last survivor
expectancy) calculated using the attained age of the Participant (or designated
beneficiary) as of the Participant's (or designated beneficiary's) birthday in the
applicable calendar year reduced by one for each calendar year which has elapsed
since the date life expectancy was first calculated. If life expectancy is being
recalculated, the applicable life expectancy shall be the life expectancy as so
recalculated, The applicable calendar year shall be the first distribution calendar year,
and if life expectancy is being recalculated such succeeding calendar year. If annuity
payments commence before the Required Beginning Date, the applicable calendar year
is the year payments commence, If distribution is in the form of an immediate
annuity purchased after the Participant's death with the Participant's remaining
interest, the applicable calendar year is the year of purchase.
- 34-
.
ARTICLE XI - BENEfiTS ANID lDiSTRIBUTIO~S
(Continuedl)
11,16 DEFINITIONS: (Continued)
(b) Designated Beneficiary, The individual who is designated as the beneficiary
under the Plan in accordance with Section 401 (a)(9) and the regulations thereunder.
(c) Distribution Calendar Year. A calendar year for which a minimum distribution
is required. For distributions beginning before the Participant's death, the first
distribution calendar year is the calendar year immediately preceding the calendar year
which contains the Participant's Required Beginning Date. For distributions beginning
after the Participant's death, the first distribution calendar year is the calendar year
in which distributions are required to begin pursuant to Section 11.9 above.
(d) Life Expectancy. Life expectancy and joint and last survivor expectancy are
computed by use of the expected return multiples in Tables V and VI of Section 1.72-
9 of the Income Tax Regulations.
Unless otherwise elected by the Participant by the time distributions are required to begin,
life expectancies shall not be recalculated annually. Such election shall be irrevocable as to
the Participant (or Spouse) and shall apply to all subsequent years. The life expectancy of
. a non-spouse beneficiary may not be recalculated.
(e) Participant's Benefit.
(1) The Participant's Account as of the last valuation date in the calendar
year immediately preceding the distribution calendar year (valuation calendar
year) increased by the amount of any contributions or forfeitures allocated to
the Account as of dates in the valuation calendar year after the valuation date
and decreased by distributions made in the valuation calendar year after the
valuation date.
(2) Exception for second distribution calendar year, For purposes of
paragraph (1) above, if any portion of the minimum distribution for the first
distribution calendar year is made in the second distribution calendar year on or
before the Required Beginning Date, the amount of the minimum distribution
made in the second distribution calendar year shall be treated as if it has been
made in the immediately preceding distribution calendar year.
11 ,1 7 FORMS OF BENEFITS: The normal form of benefit for a Profit-Sharing Plan or Money
Purchase Plan shall be a lump sum. The Plan Administrator, in its discretion, shall select
optional forms of benefits to be available to Participants. Additional optional forms of
benefits provided in this Plan shall be stated in Exhibit 5.
.
- 35 -
.
....
~
,:"
.
AfFnnClIE )(~ - BENEfiTS AND D~STRIBUTIOi\lS
(Continued)
11.17 FORMS OF BENEFITS: (Continued)
The optional forms of benefits shall be:
(a) Joint and Survivor Annuity;
(b) Straight Life Annuity;
(c) Life Annuity Ten Years Certain;
(d) Ten Year Certain Annuity;
(e) Life Annuity 20 Years Certain;
(f) Partial distribution in a single sum, and the remainder under one of (a) through
(f) above.
However, if this Plan is an amendment and restatement of a prior plan, all optional forms of
benefits provided in the prior plan, to the extent accrued, shall be provided in this Plan.
(a) If the employer selects optional forms of benefits, any Participant who is
credited with at least one Hour Of Service with the Employer after August 23, 1984,
or a Participant described in subsection (e) of this Section, shall receive a benefit at
retirement in the form of a Qualified Joint and Survivor Annuity. A Participant may
select a benefit other than a Qualified Joint and Survivor Annuity benefit during the
90 day period preceding the Annuity Starting Date provided that an appropriate
waiver, as described in subsection (c) of this Section, is executed, The Participant
may elect to have such annuity distributed upon attainment of the earliest date on
which, under the Plan, the Participant could elect to receive retirement benefits.
(b) The Spouse of any Participant who dies prior to his Annuity Starting Date will
receive a benefit in the form of a Qualified Pre-Retirement Survivor Annuity. The
Surviving Spouse may elect to have such annuity distributed within a reasonable
period after the Participant's death. A Participant may select a benefit other than a
Qualified Pre- Retirement Survivor Annuity or a beneficiary other than the
Participant's Spouse if the Participant is unmarried or if the Participant, during a
period which begins on the first day of the Plan Year in which the Participant attains
age 35 and ends on the earlier of the date of the Participant's death or his Annuity
Starting Date executes an appropriate waiver as described in subsection (c) hereof.
If a Participant terminates employment prior to the first day of the Plan Year in which
the Participant attains age 35, with respect to the Participant's Account as of the
date of termination, the election period shall begin upon termination of employment.
- 36 -
ARTICllE XI - 1B1Ei\lIEFrrS ANID IDISTRIIBUTIONS
(Continued)
. 11.17 FORMS OF BENEFITS: (Continued)
Notwithstanding the above paragraph, a Participant who will not yet attain age 35
as of the end of any current Plan Year may make a special qualified election to waive
the Qualified Pre-Retirement Survivor Annuity for the period beginning on the date of
such election and ending on the first day of the Plan Year in which the Participant will
attain age 35. Such election shall not be valid unless the Participant receives a
written explanation of the Qualified Pre-Retirement Survivor Annuity in such terms
as are comparable to the explanation required under paragraph (d) below. Qualified
Pre-Retirement Survivor Annuity coverage will be automatically reinstated as of the
first day of the Plan Year in which the Participant attains age 35. Any new waiver
on or after such date shall be subject to the full requirements of this Article.
(c) A married Participant who selects a benefit other than a Qualified Joint and
Survivor Annuity, a Qualified Pre-Retirement Survivor Annuity, or designates a
beneficiary other than his Spouse, must execute a written waiver and must obtain the
consent of his Spouse, if any, pursuant to the terms of Section 11.20 hereof. A
Participant may revoke any waiver without the consent of his Spouse at any time
before the commencement of benefits. There is no limit on the number of revo-
cations or waivers that may be made under this Article. However, after the death
-I" of the Participant, the Participant's Surviving Spouse, unless an Annuity Contract is
~ purchased or the Spouse has executed a written waiver pursuant to Section 11.20,
may elect any other form of benefit offered under the Plan.
(d) The Plan Administrator shall provide each Participant with an explanation of the
Qualified Joint and Survivor Annuity and the Qualified Pre-Retirement Survivor
Annuity which meets the requirements of the Internal Revenue Code. With respect
to the Qualified Joint and Survivor Annuity, such explanation shall be provided no less
than 30 days and no more than 90 days prior to his Annuity Start Date. Such written
explanation shall include: (i) the terms and conditions of a Qualified Joint and Survivor
Annuity; (ii) the Participant's right to make and the effect of an election to waive the
Qualified Joint and Survivor Annuity form of benefit; (iii) the rights of a Participant's
Spouse; and (iv) the right to make, and the effect of, a revocation of a previous
election to waive the Qualified Joint and Survivor Annuity.
.
With respect to the Qualified Pre-Retirement Survivor Annuity, such explanation shall
be provided within whichever of the following periods ends last: (1) the period
beginning with the first day of the Plan Year in which the Participant attains age 32
and ending on the close of the Plan Year preceding the Plan Year in which the
Participant attains age 35; (2) a reasonable period ending after the individual becomes
a Participant; (3) a reasonable period ending after Code Section 401 (a)(11) applies to
the Participant; and (4) a reasonable period ending after Section 11.21 ceases to
apply to the Participant. Notwithstanding the foregoing, notice must be provided
within a reasonable period ending after separation from service in the case of a
Participant who separates from service before attaining age 35.
- 37 -
ARTICLIE XI - BIENEFITS AND DISTRIBUTIONS
(Continued)
. 11 ,17 FORMS OF BENEFITS: (Continued)
Such written explanation of the Qualified Pre-Retirement Survivor Annuity shall be
provided in such terms and in such manner as would be comparable to the
explanation provided for meeting the requirements applicable to a Qualified Joint and
Survivor Annuity.
For purposes of applying the preceding paragraph, a reasonable period ending after
the enumerated events described above is the end of the two-year period beginning
one year prior to the date the applicable event occurs, and ending one year after that
date, In the case of a Participant who separates from service before the Plan Year
in which age 35 is attained, notice shall be provided within the two-year period
beginning one year prior to separation and ending one year after separation. If such
a Participant thereafter returns to employment with the Employer, the applicable
period for such Participant shall be redetermined.
....
='1
Notwithstanding the other requirements of this subsection (d), the respective notices
prescribed in this subsection need not be given to a Participant if (1) the Plan "fully
subsidizes" the costs of a Qualified Joint and Survivor Annuity or Qualified Pre-
Retirement Survivor Annuity, and (2) the Plan does not allow the Participant to waive
the Qualified Joint and Survivor Annuity or Qualified Pre-Retirement Survivor Annuity
and does not allow a married Participant to designate a non-spouse beneficiary. For
purposes of this subsection, a Plan fully subsidizes the costs of a benefit if no
increase in cost, or decrease in benefits to the Participant may result from the Partici-
pant's failure to e~ect another benefit.
(e) Transitional Rules:
(1) Any living Participant not receiving benefits on August 23, 1984, who
would otherwise not receive the benefits prescribed by the previous Sections
of this Article must be given the opportunity to elect to have the prior Sections
of this Article apply if such Participant is credited with at least one Hour of
Service under this Plan or a predecessor plan in a Plan Year beginning on or
after January 1, 1976, and such Participant had at least 10 years of Vesting
Service when he or she separated from service.
(2) Any living Participant not receiving benefits on August 23, 1984, who
was credited with at least one Hour of Service under this Plan or a predecessor
plan on or after September 2, 1974, and who is not otherwise credited with
any service in a Plan Year beginning on or after January 1, 1976, must be given
the opportunity to have his benefits paid in accordance with (4) below.
.
(3) The respective opportunities to elect (as described in (1) and (2) above)
must be afforded to the appropriate Participants during the period commencing
on August 23, 1984, and ending on the date benefits would otherwise
commence to said Participants.
- 38 -
ARTICllE XI - BlENlEflTS AND IDISTRIBUTIONS
(Continued)
o
11.17 FORMS OF BENEFITS: (Continued)
(4) Any Participant who has elected pursuant to section (2) above and any
Participant who does not elect under section (1) above or who meets the
requirements of (1) above except that such Participant does not have at least
10 years of Vesting Service when he or she separates from service, shall have
his or her benefits distributed in accordance with all of the following
requirements if benefits would have been payable in the form of a life annuity:
(i) Automatic joint and survivor annuity. If benefits in the form of a life
annuity become payable to married Participant who:
a. begins to receive payments under the Plan on or after Normal
Retirement Age; or
b. dies on or after Normal Retirement Age while still working for
the Employer; or
c. begins to receive payments on or after the qualified early
retirement age; or
o
d. separates from service on or after attaining Normal Retirement
Age (or the qualified early retirement age) and after satisfying the
eligibility requirements for the payment of benefits under the Plan
and thereafter dies before beginning to receive such benefits;
then such benefits will be received under this Plan in the form of
a Qualified Joint and Survivor Annuity, unless the Participant has
eJected otherwise during the election period, The election period
must begin at least 6 months before the Participant attains
qualified early retirement age and end not more than 90 days
before the commencement of benefits. Any election hereunder will
be in writing and may be changed by the Participant at any time.
o
(ii) Election of early survivor annuity. A Participant who is employed
after attaining the qualified early retirement age will be given the
opportunity to elect, during the election period, to have a survivor annuity
payable on death. If the Participant elects the survivor annuity, payments
under such annuity must not be less than the payments which would
have been made to the Spouse under the Qualified Joint and Survivor
Annuity if the Participant had retired on the day before his or her death.
Any election under this provision will be in writing and may be changed
by the Participant at any time. The election period begins on the later of
(1) the 90th day before the Participant attains the qualified early
retirement age, or (2) the date on which participation begins, and ends
on the date the Participant terminates employment.
- 39 -
ARTICllE XI - BlEi\IIlEf!TS AND DISTRIBUTIONS
(Continued)
eJ
.,,1
11.17 FORMS OF BENEFITS: (Continued)
(iii) For purposes of this subsection:
a. Qualified early retirement age is the latest of the earliest date,
under the Plan, on which the Participant may elect to receive
retirement benefits, the first day of the 1 20th month beginning
before the Participant reaches Normal Retirement Age, or the date
the Participant begins participation.
b. Qualified Joint and Survivor Annuity is defined in Section 2.36.
11.18 CASH-OUT DISTRIBUTION: If the value of the Participant's vested Accrued Benefit
on the date he terminates service does not exceed $ 5, 000, the Plan Administrator shall, as
elected in Exhibit 5, either: (1) immediately distribute to such Participant his Account in the
form of a lump sum; or (2) permit the Participant to elect to receive a distribution subject to
the provisions of this Article. The above sentence shall also apply to the value of a Qualified
Joint and Survivor Annuity or Qualified Pre-Retirement Survivor Annuity which does not
exceed $ 5,000 .However, no distribution (regardless of amount) shall be made pursuant to
the preceding sentence after the Annuity Starting Date unless the Participant waives and his
Spouse (or the Participant's Surviving Spouse) consents, pursuant to Section 11.20,
. 11,19 HARDSHIP: If the Employer has elected in Exhibit 5 to permit hardship distributions,
such distributions to a Participant shall be made if the distribution is necessary in light of
Immediate and Heavy Financial Needs of the Participant and where such Participant lacks
other available resources, A distribution based upon financial hardship cannot exceed the
amount required to meet the immediate financial need created by the hardship (or the
Participant's vested Accrued Benefit, if less) and not reasonably available from other
resources of the Participant. The determination of the existence of financial hardship and the
amount required to be distributed to meet the need created by the hardship shall be made by
the Plan Administrator in accordance with the standards set forth below,
For the purpose of this Section, Immediate and heavy Financial Need means: (1) medical
expenses described in Code Section 213(d) incurred by the Participant, the Participant's
Spouse, or dependents of the Participant (as defined in Code Section 1 52); (2) the purchase
(excluding mortgage payments) of a principal residence of the Participant; (3) payment of
tuition for the next semester or quarter of post secondary education for the Participant, his
spouse, children, or dependents; (4) the need to prevent the eviction of the Participant from
his principal residence or foreclosure on the mortgage of the Participant's principal residence;
or (5) any other even which the Commissioner of the Internal Revenue Service has deemed
to be an Immediate and Heavy Need. A Participant making an application under this Section
shall have the burden of presenting evidence of such need,
.I'i
~ :.,
- 40-
AIRT~CLlE X~ - Ii\lSIUIRAi\!ClE POUCllES
(Continued)
.
11.19 HARDSHIP: (continued)
A distribution will be considered as necessary to satisfy an immediate and heavy financial
need providing: (1) the Participant withdraws and borrows (on a nontaxable basis) all
amounts available to the Participant under this plan and all plans of the Employer (other than
the mandatory employee portion of a defined benefit plan); (2) all Plans maintained by the
Employer suspend for a period of 1 2 months from the date of such distribution, the
Participant's ability to make Salary Deferral Contributions or Employee Contributions; and (3)
al Plans maintained by the Employer limit such Participant's ability to make Salary Deferral
Contributions for the Participant's taxable year immediately following the taxable year of the
hardship in excess of the limit specified in Code Section 402(g) for such taxable year less the
amount of such Participant's Salary Deferral Contributions for the taxable year of the hardship
distribution.
Each request for a hardship distribution shall be made by written application on a form
acceptable to the Plan Administrator.
.
11.20 CONSENT: If the value of a Participant's vested Accrued Benefit derived from
Employer and Employee Contributions exceeds (or at the time of any prior distribution
exceeded) $5, 000, and his Accrued Benefit is immediately distributable, the Participant and
the Participant's Spouse (or where either the Participant or the Spouse has died, the survivor)
must consent to any distribution. The consent of the Participant and the Participant's Spouse
shall be obtained in writing within the 90-day period ending on the Annuity Starting Date,
The Plan Administrator shall notify the Participant and the Participant's Spouse of the right
to defer any distribution until the Participant's Account is no longer immediately distributable.
Such notification shall include a general description of the material features, and an
explanation of the relative values of the optional forms of benefit available under the plan in
a manner that would satisfy the notice requirements of Section 417(a)(3), and shall be
provided no less than 30 days and no more than 90 days prior to the Annuity Starting Date.
.
Notwithstanding the foregoing, only the Participant need consent to the commencement of
a distribution in the form of a Qualified Joint and Survivor Annuity while his Accrued Benefit
is immediately distributable. Furthermore, if payment in the form of a Qualified Joint and
Survivor Annuity is not required with respect to the Participant pursuant to Section 11 .21
of the Plan, only the Participant need consent to the distribution of his Accrued Benefit that
is immediately distributable. Neither the consent of the Participant nor the Participant's
Spouse shall be required to the extent that a distribution is required to satisfy Section
401 (a)(9) or Section 415 of the Code. In addition, upon termination of this Plan, if the Plan
does not offer an annuity. option (purchased from a commercial provider) and if the Employer
or any entity within the same controlled group as the Employer does not maintain another
defined contribution plan (other than an employee stock ownership plan as defined in section
4975(e)(7) of the Code), the Participant's Accrued Benefit will, without the Participant's
consent, be distributed to the Participant. However, if any entity within the same controlled
group as the Employer maintains another defined contribution plan (other than an employee
stock ownership plan as defined in section 4975(e)(7) of the Code) then the Participant's
Accrued Benefit will be transferred, without the Participant's consent, to the other Plan if the
Participant does not consent to an immediate distribution.
- 41 -
ARTICLE Xi - BIENEfiTS AND DiSTRIBUTiONS
(Continued)
o
11.20 CONSENT: (continued)
An Accrued Benefit is immediately distributable if any part of the Account could be
distributed to the Participant or Surviving Spouse before the Participant attains or would have
attained, if not deceased, the later of Normal Retirement Age or age 62. For purposes of
determining the applicability of the foregoing consent requirements to distributions made
before the first day of the first Plan Year beginning after December 31, 1988, the
Participant's vested Accrued Benefit shall not include amounts attributable to accumulated
deductible employee contributions within the meaning of Section 72(0)(5)(B) of the Code.
o
A waiver of a Qualified Pre-Retirement Survivor Annuity or Qualified Joint and Survivor
Annuity must include the consent of the Spouse of the Participant, Such consent must be
in writing and must be witnessed by either a plan representative or notary public. The
Spouse's waiver must be limited to a designation of a specific alternate beneficiary including
any class of beneficiaries or any contingent beneficiaries. Such alternate beneficiary must
not be changed without the Spouse's consent (unless the consent of the Spouse expressly
permits designations by the Participant without any requirement of further consent by the
Spouse). In addition, the Spouse's consent must acknowledge the effect of the election.
Additionally, a Participant's waiver of the Qualified Joint and Survivor Annuity shall not be
effective unless the election designates a form of benefit which may not be changed without
spousal consent (or the Spouse expressly permits designations by the Participant without any
further spousal consent). Notwithstanding the foregoing, if it is established to the
satisfaction of the plan representative that such written consent may not be obtained
because there is no Spouse or the Spouse cannot be located, no such consent will be
required.
Any consent by a Spouse obtained under this provision (or establishment that the consent
of a Spouse may not be obtained) shall be effective only with respect to such Spouse. A
consent that permits designations by the Participant without any requirement of further
consent by such Spouse must acknowledge that the Spouse has the right to limit consent
to a specific beneficiary, and a specific form of benefit where applicable, and that the Spouse
voluntarily elects to relinquish either or both of such rights. A revocation of a prior waiver
may be made by a Participant without the consent of the Spouse at any time before the
commencement of benefits. The number of revocations shall not be limited. No consent
obtained under this provision shall be valid unless the Participant has received notice as
provided in Section 11. 1 7.
o
A Participant must obtain the consent of his Spouse, if any, the use of his Account as
security for a loan. Spousal consent shall be obtained no earlier than the beginning of the 90-
day period that ends on the date on which the loan is to be so secured, The consent must
be in writing, must acknowledge the effect of the loan, and must be witnessed by a plan
representative or notary public. Such consent shall thereafter be binding with respect to the
consenting spouse or any subsequent spouse with respect to that loan, A new consent shall
be required if the Account is used for renegotiation, extension, renewal, or other revision of
the loan.
- 42 -
ARTICLE XI - BIENEflTS AND mSTRIBUTIONS
(Continued! )
e:,
...
11.20 CONSENT: (continued)
If a valid spousal consent has been obtained in accordance with the above paragraph, then,
notwithstanding any other provision of this Plan, the portion of the Participant's vested
Account used as a security interest held by the Plan by reason of a loan outstanding to the
Participant shall be taken into account for purposes of determining the amount of the
Account payable at the time of death or distribution, but only if the reduction is used as
repayment of the loan. If less than 100% of the Participant's vested Account (determined
without regard to the preceding sentence) is payable to the Surviving Spouse, then the
Account shall be adjusted by first reducing the vested Account by the amount of the security
used as repayment of the loan, and then determining the benefit payable to the Surviving
Spouse.
11.21 QUALIFIED SPECIAl.. RULE FOR PROFIT SHARING PLANS: Except as set forth in
Section 11.17(e), the above Qualified Joint and Survivor and Qualified Pre-Retirement
Survivor Annuity notice, waiver, and consent provisions shall not be applicable to this Plan
if the Plan Administrator administers a profit sharing plan according to the following
limitations:
(a) the Participant does not or cannot elect payments in the form of a life annuity;
and
. (b) on the death of the Participant, the Participant's vested Account will be paid to
the Participant's Surviving Spouse, but if there is no Surviving Spouse, or if the
Surviving Spouse has consented in a manner conforming to a qualified election, then
to the Participant's designated beneficiary. The Surviving Spouse may elect to have
distribution of the vested Account commence within the 90-day period following the
date of the Participant's death. The Account shall be adjusted for gains or losses
occurring after the Participant's death in accordance with the provisions of the Plan
governing the adjustment of Account for other types of distributions.
This Section shall not be operative with respect to a Participant in a profit sharing
plan if the plan is a direct or indirect transferee of a defined benefit plan, money
purchase plan, a target benefit plan, stock bonus, or profit sharing plan which is
subject to the survivor annuity requirements of Section 401 (a) (11) and Section 41 7
of the Code.
The Participant may waive the spousal death benefit described in this Section at any
time provided that no such waiver shall be effective unless it satisfies the conditions
of this Article (other than the notification requirement referred to therein) that would
apply to the Participant's waiver of the Qualified Pre-Retirement Survivor Annuity.
ty
In addition, this Section shall not apply unless the Participant's Spouse is the
designated beneficiary of any insurance on the Participant's life purchased by
Employer contributions or forfeitures allocated to the Participant's Account.
- 43-
ARTICllE XII - PLAN ADMINISTRATION
o
12.1 PLAN ADMINISTRATOR: The Employer shall appoint a Plan Administrator in Exhibit
6 of the Adoption Agreement. The Plan Administrator shall serve as the named fiduciary of
the Plan. If, at any time, there is no appointed Plan Administrator, the Employer shall be the
Plan Administrator.
12.2 DUTIES: The Plan Administrator shall have the general responsibility for the
administration of the Plan and carrying out its provisions, including, but not by way of
limitation, the power to interpret and construe the Plan, and to determine the validity of any
claim for benefits under the Plan, and may establish rules for the administration of the Plan
and the transaction of its business. Determinations on all questions arising out of or in
conjunction with the provisions of the Plan, not herein required to be determined by another
party, shall be made by the Plan Administrator, and any such determination shall be
conclusive and binding upon all persons having an interest in or under this Plan.
The Plan Administrator shall maintain accounts reflecting the fiscal transactions of the Plan.
The Plan Administrator shall prepare annually a report showing in reasonable detail the assets
and liabilities of the Plan and setting forth a brief account of the operation of the Plan for the
preceding year.
The Plan Administrator may employ counsel and agents and such clerical, accounting and
actuarial services as it may require in carrying out the provisions of the Plan.
o The Plan Administrator shall have the power to delegate specific fiduciary responsibilities to
Employees of the Participating Employer, or to other individuals, all of whom shall serve at
the pleasure of the Plan Administrator, and, if full time Employees of the Participating
Employer, without compensation. Any such person may resign by delivering written notice
of such resignation to the Plan Administrator. Vacancies created by resignation, death, or
other cause may be filled by the Plan Administrator or the delegated responsibilities may be
reabsorbed or redelegated by the Plan Administrator.
12.3 CLAIMS PROCEDURE: Any person who believes that he is entitled to a benefit under
the Plan shall have the right to file with the Plan Administrator a written notice of claim for
such benefit.
Within 1 20 days after its receipt of such written notice of claim, the Plan Administrator shall
either grant or deny such claim provided, however, any delay on the part of the Plan
Administrator in arriving at a decision shall not adversely affect benefits payable under a
granted claim.
12.4 ADMINISTRATION EXPENSES: All expenses incurred in establishing and maintaining
the Plan shall be paid from the Trust Fund, unless the Employer or Participating Employer, in
its discretion, elects to pay all or part of such expenses.
o
- 44-
ARTICLE xm - TRUSTIEIE
o
13.1 ESTABLISHMENT AND ACCEPTANCE OF TRUST: By executing the Adoption Agree-
ment, the Trustee accepts appointment as Trustee hereunder. The Trustee agrees to hold
in trust, manage and administer contributions to the Trust, and the income or gain or loss
therefrom, for the purposes herein set forth.
The Trust is established for the exclusive benefit of Participants and their Beneficiaries, and
no part of the Trust Fund, except such part as may be needed for expenses and taxes, shall
be used for, or diverted to, any other purpose prior to the satisfaction of all liabilities under
the Plan with respect to such person, except as provided in Section 6.2. The trust year of
the Trust Fund is the Plan Year.
13.2 CONTRIBUTIONS TO THE TRUST FUND: The Trustee shall accept such contributions
by and on behalf of Participants as it may receive from time to time from the Participating
Employer. All such contributions shall be in cash, except as otherwise approved by the
Trustee. The Trustee shall have no duty to collect any contribution or other sum from the
Participating Employer, Plan Administrator, Participants, or any other person.
13.3 CONTRIBUTION OF EXISTING QUALIFIED PLAN: If at the time the Participating
Employer adopts the Plan, it specifies in the Adoption Agreement that the Plan is to be
substituted for an existing plan that is qualified under Code Section 401 (a), the Trustee shall
accept the assets of such plan from the trustee, custodian or insurer thereof, in the form of
cash, Mutual Funds Shares, Annuity Contracts, Policies, or any other asset satisfactory to
the Trustee.
o
13.4 POWERS AND DUTIES: Subject to the limitations of Section 9.1, the Trustee shall
have all powers necessary for the performance of its duties, including the power to execute
such instruments as may be deemed necessary or proper and including the following powers,
all of which may be exercised without order of or report to any court:
(a) to invest in Annuity Contracts, Mutual Fund Shares, Insurance Policies, stocks,
bonds, securities, investment company or trust shares, mortgages, notes, accounts,
deposits, or other investments offered by a bank, chooses in action, real estate,
improvements thereon, and other property, including any such property of the
Employer;
(b) to sell, exchange, or otherwise dispose of any property at any time held or
acquired under this Trust, at public or private sale, for cash or on terms, without
advertisement, including the right to lease for any term notwithstanding the period
of this Trust;
o
(c) to transfer, at any time and from time to time, such part or all of the Trust Fund
as it shall deem advisable to any other trust which is qualified and exempt under Code
Section 401 (a) and is maintained as a medium for the collective investment of funds
of pension, profit-sharing or other employee or self-employed benefit trusts, and the
Trustee may, thereafter, withdraw any part or all of the Trust Fund so transferred to
such other trust. The provisions of any such trust shall be deemed to be a part of
this Trust;
- 45 -
o
o
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13.4
ARTICLE xm - TRUSTEIE
(Continued)
POWERS AND DUTIES: (Continued)
(d) to hold cash in such amounts as may be in its opinion reasonable for the proper
operation of this Trust, and to deposit any portion of the Trust Funds in certificates
of deposit, or in a bank account or accounts selected by the Trustee, including those
of the Trustee, or a bank or similar financial institution related to the Trustee. Any
such account deposit shall bear a reasonable rate of interest;
(e) to make such investments as the Trustee in its discretion shall deem best
without regard to any law now or hereafter in force limiting the investments for
trustees or other fiduciaries;
(f) to pay premiums, interest, or other charges due and payable to acquire or
maintain any Annuity Contract or Insurance Policy held under the Trust, provided
funds for such payments are then available in the Trust; and to exercise all ownership
rights under such Annuity Contracts or Insurance Policies in accordance with the
terms of the Plan;
(g) to vote in person or by proxy any corporate stock or other security and to agree
to take any other action in regard to any reorganization, merger, consolidation,
liquidation, bankruptcy or other procedure or proceeding affecting any stock, bond,
note or other property;
(h) to compromise, settle and/or adjust any claim or demand by or against the Trust
and to agree to any rescission or modification of any contract or agreement affecting
such Trust;
(i) to borrow money, and to secure the same by mortgaging, pledging and/or
conveying any property of the Trust;
(j) to register any stock, bond or other security in the name of a nominee, without
the addition of words indicating that such security is held in a fiduciary capacity; but
accurate records shall be maintained showing that such security is a Trust asset and
the Trustee shall be responsible for the acts of such nominee;
(k) To write covered call options on securities held in the Trust Fund, and to
engage in other transactions directly related to such covered call options outstanding
in the Trust Fund; and
(I) to delegate any administrative duties assigned to it under the Trust, with the
consent of the Plan Administrator, to any third party which shall act as the agent of
the Trustee.
- 46-
ARTICLE xm - TRUSTEIE
(Continued)
o 13.5 LIMITED TRUSTEE RESPONSIBILITIES: The Employer may appoint an investment
manager or itself to assume certain powers or responsibilities in the investment and
management of the Trust Fund. The investment manager or Employer shall assume full
liability for all duties and powers assigned to it and shall be subject to the fiduciary
responsibilities of this Plan. The Trustee shall not be liable for the acts or omissions of the
investment manager or Employer nor shall the Trustee be under an obligation to manage any
assets of the Plan that are subject to the management of an investment manager or the
Employer.
13.6 AUTHORIZED PERSONS: The Employer shall certify in writing to the Trustee the
names and signatures of the persons who are or shall act for the Plan Administrator,
investment manager, or Employer and the Trustee shall assume that such persons continue
to hold office until a new certificate is received from the Employer.
13. 7 TAXES AND FEES: The Trustee shall charge the Trust Fund for any taxes paid by it
which may be imposed upon the Trust.
o
The annual service fees (if any) of the Trustee shall be fixed in advance by agreement with
the Employer, but such agreement may be changed prospectively from time to time during
the year. However, no Trustee who receives full-time pay from the Employer shall be
compensated for his services as a Trustee except for reimbursement of expenses properly and
actually incurred. The Employer shall pay the Trustee its fees and expenses. If not so paid,
the Trustee shall withdraw its fees and expenses from the Trust Fund.
13.8 DISTRIBUTIONS: The Trustee shall make distributions from the Trust Fund in
accordance with written directions from the Plan Administrator. The Trustee may make any
payments or distributions required to be made by it hereunder by first class mail in a sealed
envelope addressed to the person to whom such payment or distribution is to be made,
according to the certification of the Plan Administrator. The Trustee shall not be required to
make any investigation to determine the identity or mailing address of any person entitled to
benefits and shall be entitled to withhold making payments or giving directions to the Insurer
with respect to the payment of benefits until the identity and mailing addresses of persons
entitled to benefits are properly certified to it including the certification as to amount, payee,
and other terms of payments. The Trustee or the Plan Administrator may direct the Insurer
to make distributions directly from Plan assets held by the Insurer.
o
- 47 -
ARTICLE xm - TRUSTEIE
(Continued)
o
13.9 TRUSTEE REPORTS: Within sixty (60) days following the close of the Plan Year or
at such other time or times as may be agreed upon, the Trustee will furnish the Plan
Administrator a written statement and report setting forth all investments, all receipts and
disbursements and all other financial transactions affecting the Trust Fund since the date of
the last such report. Upon expiration of sixty (60) days from the date of mailing the written
statement and report, the Trustee shall be forever released and discharged from any liability
or accountability to anyone as respects its transactions, except with respect to any trans-
action as to which the Plan Administrator shall, within the sixty (60) day period, file its
written disapproval, and neither the Plan Administrator nor any other person shall have the
right to demand or be entitled to any further or different accounting by the Trustee.
o
13.10 DEALING WITH THE INSURER: The Trustee is hereby authorized to execute all
necessary applications, receipts, and releases to the Insurer. The Insurer shall be fully
discharged from any and all liability for any action taken by it upon the written direction of
anyone Trustee. The Trustee shall have no responsibility for the form, genuineness, validity,
sufficiency or effect of any Insurance Policy or Annuity Contract at any time included in the
Trust, or for any action of the Participating Employer, Plan Administrator, Employee, or other
person which may render such policy or contract void, or for the failure of any Insurer to pay
the proceeds of any such policy or contract as and when the same shall become payable, or
for any delay occasioned by reason of any provisions contained in any such policy or con-
tract, or for the refusal of the Insurer to take any action requested by the Trustee, or if for
any reason whatsoever (save for the misconduct or neglect of an employee of the Trustee)
any policy or contract shall lapse or otherwise become uncollectible.
13. 11 LIMITATION OF LIABILITY: The Trustee shall use the care, skill, prudence and
diligence in the exercise of its powers and the performance of its duties hereunder that a
prudent person, who is familiar with such matters, would use in the conduct of an enterprise
of a like character and with like aims under the prevailing circumstances. The Trustee may
at any time request instruction of the Employer, the Plan Administrator, Participant or the
investment manager, if any, as to any action relating to the Trust. The Trustee shall not be
liable for any action taken or omitted on the instruction of the Employer, Participant, the Plan
Administrator, or the investment manager or in the absence of such instructions, for the
omission of any actions to which the Employer, Participant, the Plan Administrator, or the
investment manager, are required or authorized to instruct it; or for any failure of
contributions to meet pension or other liabilities under this Plan and Trust. The Trustee shall
be protected in acting upon any notice, resolution, order, certificate, opinion, telegram, or
letter or other document believed by the Trustee to be genuine and to have been signed by
the proper party or parties.
o
- 48 -
.
61,;1.
~
ID
ARTICllE xm - TRUSTEE
(Continued)
13.12 CO-TRUSTEES: A majority of Trustees shall be necessary to conduct any business
of the Trust. Anyone of the Trustees may sign any application, report, check, other
instrument or paper on behalf of all Trustees. If one or more Trustees die or resign, the
remaining Trustee or Trustees shall continue to administer this Trust until such time as the
Employer appoints an appropriate successor or successors; and the Plan Administrator shall
resolve any differences that may exist among an even number of Trustees in the interim and
its decision shall be binding on the Trustees.
13.13 TRUSTEE REMOVAL OR RESIGNATION: The Trustee may resign at any time upon
delivering to the Employer a written notice of its intention to resign. Such resignation shall
be effective not less than 30 days after the delivery thereof, unless such notice is waived by
the Employer.
Any Trustee appointed hereunder may be removed by the Employer. Such removal shall be
effective at a date specified in the written notice to the Trustee, which shall not be less than
30 days after the delivery of such notice, unless such notice is waived by the Trustee.
In case of the resignation or removal of the Trustee, the Trustee shall have the right to a
settlement of its accounts, which may be made at its option either: (1) by agreement of
settlement between the Trustee, the Employer and the Plan Administrator, or (2) by judicial
settlement in an action instituted by it in a court of competent jurisdiction.
Upon such settlement, the Trustee shall transfer to the successor trustee or to an Insurer the
Trust Fund as it may then be constituted and true copies of such of its records as relate to
the Trust; and shall execute all documents necessary for transferring the assets of the Trust;
and the Trustee shall thereupon be discharged from further accountability for all matters
embraced in its settlement.
The Employer agrees that it will, upon its receipt or giving of notice of the resignation or
removal of a Trustee, forthwith appoint a successor trustee. Any successor trustee so
appointed may qualify as such by executing, acknowledging, and delivering to the Employer
and to the resigning or removed trustee any instrument accepting such appointment; and
upon delivery of the Trust assets, such successor, without further act, shall become vested
with all the estate, right, powers, discretion and duties of its predecessor trustee with like
effect as if originally named as Trustee herein. If no Trustee is appointed, the individual
signing the most recent Adoption Agreement on behalf of the Employer shall be the Trustee.
- 49 -
o
o
o
ARTICllE XIV - AMENDMEi\lT, MERGIER, AND TlElRMli\lA TION
14.1 AMENDMENT: The Employer may amend the Adoption Agreement or basic plan
document. The Employer shall promptly submit copies of the amendment to the Trustee,
Plan Administrator, and Insurer. The Trustee, Plan Administrator or Insurer shall not be on
notice of the contents thereof until a copy is actually received.
No amendment shall increase the duties or liabilities of the Trustee or Plan Administrator
without their written consent, provide that Trust assets be used for purposes other than for
the exclusive benefit of Participants and their Beneficiaries, or provide that Trust assets ever
revert to or be used or enjoyed by any Participating Employer prior to satisfaction of all
liabilities under the Plan.
14.2 TERMINATION: The Plan Administrator will direct the Trustee to distribute all assets
to Participants upon termination of the Plan.
Upon termination or complete discontinuance of contributions under the Plan, the rights of
all Employees to benefits accrued to the date of such termination of discontinuance, to the
extent then funded, or the amounts credited to Employee Accounts are nonforfeitable. This
paragraph does not apply to amounts that may not be applied pursuant to Code Section
401 (a)(4) as in effect on September 1, 1974.
14.3 MERGER: In case of a merger or consolidation with, or transfer of assets or liabilities
to, any other plan, each participant shall (if the plan then terminated) receive a benefit
immediately after the merger, etc., which is equal to or greater than the benefit he or she
was entitled to immediately before the merger, etc., (if the plan had then terminated).
- 50 -
CD
o
o
ARTICllE X.V - !DOMIESTIC RIEILA TIO~S ORIDIER
15.1 DEFINITIONS: "Domestic Relations Order" or "DRO" means any judgment, decree,
or order (including approval of a property settlement agreement), issued by a state court
pursuant to a state domestic relations law, which provides for child support, alimony, or
marital property rights to an Alternate Payee.
"Alternate Payee" means a Spouse, former Spouse, child or other dependent of a Participant
who is recognized by a DRO as having a right to receive a benefit under the Plan.
"Qualified Domestic Relations Order" means a Domestic Relations Order which creates or
recognizes the existence of an alternate payee's right to, or assigns to an Alternate Payee the
right to, receive all or a portion of the benefits payable with respect to a Participant under this
Plan.
15.2 PROCEDURES: The Plan Administrator shall establish procedures for determining
whether a DRO is a Qualified Domestic Relations Order and in complying with its terms.
- 51 -
ARTICllE XVI - MISClEllA~IEOUlS
o
16.1 EMPLOYMENT RIGHTS: No prOVISion of this Plan shall be deemed to give any
Employee the right to be retained in the service of his Participating Employer or to interfere
with the right of the Participating Employer to discharge the Employee at any time.
16.2 NOTICES: Whenever provision is made in the Plan that a Participant may exercise any
option or election or designate any Beneficiary, the action of such Participant shall be
evidenced by a written notice signed by the Participant and delivered to the Plan
Administrator in person or by mail. If a form is furnished by the Plan Administrator for such
purpose, a Participant shall give written notice of his exercise of any option or election or of
his designation of any Beneficiary on the form provided for such purpose. Written notice
shall not be effective until received by the Plan Administrator.
16.3 COMPETENCY: If any person due a benefit hereunder is, in the judgement of the Plan
Administrator, incapable of personally receiving or receipting for any payment due hereunder,
payment may be made to the guardian or legal representative of such person, or to such
other person or institution, who, in the opinion of the Plan Administrator is then maintaining
or has custody of such person. Such payment shall constitute a full discharge of the liability
of the Plan with respect to such person.
o
16.4 MISSING PERSONS: Notwithstanding any provision in this Plan and Trust to the
contrary, if the Plan Administrator is unable to locate any former participant or Beneficiary
who is entitled to benefits under this Plan within three years of the date he first becomes
entitled to a distribution from the Trust, any amounts being held on his behalf shall be
forfeited and used to reduce the Participating Employer's current or next succeeding
contribution. The Plan Administrator shall proceed with due diligence in attempting to locate
any former participant or Beneficiary. No forfeiture shall occur until the Plan Administrator
has mailed the former participant or Beneficiary a notice advising him of his benefits and the
provisions of this Section to his last known address, via U.S. Mail Postage prepaid, return
receipt requested. If the former participant is located subsequent to such forfeiture, the
Participating Employer shall reinstate the forfeited amount to the former participant's or
Beneficiary's Account, and shall distribute the value of the Account to him in accordance
with the Plan.
16.5 CONTROLLED GROUPS AND AFFILIATED SERVICE GROUPS: Except as provided in
Article VII, all employees of all corporations which are members of a controlled group of
corporations (as defined in Code Section 414(b)) and all employees of all trades or businesses
(whether or not incorporated) which are under common control (as defined in Code Section
414(c)) will be treated as employed by a single employer. All employees of all members of
an affiliated service group (as defined in Code Section 414(m)) will be treated as employed
by a single employer.
o
- 52 -
ARTICLE XVI - MISCELlANIEOUS
(Continued!)
o 16.6 LEASED EMPLOYEES: The term "leased employee" means any person (other than
an employee of the recipient) who pursuant to an agreement between the recipient and any
other person ("leasing organization") has performed services for the recipient (or for the
recipient and related persons determined in accordance with Section 414(n)(6) of the Code)
on a substantially full time basis for a period of at least one year, and such services are of
a type historically performed by employees in the business field of the recipient employer.
Contributions or benefits provided a leased employee by the leasing organization which are
attributable to services performed for the recipient employer shall be treated as provided by
the recipient employer.
A leased employee shall not be considered an employee of the recipient if: (i) such employee
is covered by a money purchase pension plan providing: (1) a nonintegrated employer
contribution rate of at least 10% of compensation, as defined in Section 415(c)(3) of the
Code, but including amounts contributed pursuant to a salary reduction agreement which are
excludable from the employee's gross income under Section 125, Section 402(a)(8), Section
402(h) or Section 403(b) of the Code, (2) immediate participation, and (3) full and immediate
vesting; and (ii) leased employees do not constitute more than 20% of the recipient's non-
highly compensated workforce.
o
16.7 CONSTRUCTION: The Plan and Trust has been established with the intent that it
shall be a qualified plan under Code Sections 401 (a) and 401 (k) and the Trust tax-exempt
under Code Section 501 (a). All terms and provisions contained herein shall be interpreted,
wherever possible, so as to be in compliance with the requirements for such qualification and
exemption.
In case any provisions of the Plan and Trust are determined to be illegal or invalid for any
reason, such determination shall not affect the remaining provisions of the Plan and Trust,
and the Plan and Trust will be construed and enforced as if said illegal or invalid provision had
never been included herein.
16.8 GOVERNING LAW: This Plan and Trust shall be construed, administered, and
enforced according to the laws of the State of the Employer's principal place of business,
except to the extent superseded by Federal law.
16.9 GENDER AND NUMBER: The masculine gender shall include the feminine and the
singular shall include the plural.
16.10 PLAN-TO-PLAN TRANSFERS: The Trustee of this Plan may receive from or transfer
to another plan any or all assets of a Participant. Effective on and after January 1, 1993, at
such time as the Participant is eligible to receive a distribution from the Plan, the Trustee(s)
shall be required to transfer to the trustee(s) or custodian of an IRA or defined contribution
plan all or a portion of the Participant's Account providing:
o
(a) the Participant directs such Account to be transferred;
- 53 -
ARTICllE XVI - MISCELLANEOUS
(Continued)
(b) the trustee(s) of the defined contribution plan (if applicable) accept such
transfer; and
(c) the amount transferred is an "eligible rollover distribution" as defined by the
Unemployment Compensation Amendments Act of 1992.
16.11 ADDITIONAL PARTICIPATION REQUIREMENT: Effective for the first Plan Year
beginning on or after January 1, 1996, the Participating Employer's Plan must benefit the
lesser of 50 Employees of the Employer, or 40% or more of all Employees of the Participating
Employer. Such a determination shall be made in accordance with the requirements of Code
Section 401 (a)(26) and the regulations thereunder.
16.12 SPENDTHRIFT PROVISION: All benefits payable under the Plan shall be exempt from
the claims of, and shall not be subject to attachment, garnishment or other legal process by
any creditor of such Participant, his Beneficiary, or his spouse, and shall not be subject to
alienation, assignment, pledge or encumbrance, either voluntarily or involuntarily by such
person to the extent so provided by the State law governing the Plan's qualified trust.
16.13 DIRECT ROLLOVERS: This Section applies to distributions made on or after January
1, 1993. Notwithstanding any provision of the plan to the contrary that would otherwise
limit a distributee's election under this Section, a distributee may elect, at the time and in the
. manner prescribed by the plan administrator, to have any portion of an eligible rollover
distribution paid directly to an eligible retirement plan specified by the distributee in a direct
rollover.
(a) Definitions.
Eligible rollover distribution. An eligible rollover distribution is any distribution
of all or any portion of the balance to the credit of the distributee, except that an
eligible rollover distribution does not include any distribution that is one of a series of
substantially equal periodic payments (not less frequently than annually) made for the
life (or life expectancy) of the distributee or the joint lives (or joint life expectancies)
of the distributee and the distributee's designated beneficiary, or for a specified period
of ten years or more; any distribution to the extent such distribution is required under
section 401 (a)(9) of the Code; and the portion of any distribution that is not includible
in gross income (determined without regard to the exclusion for net unrealized
appreciation with respect to employer securities).
."'1
~,.
'"I'
(b) Eligible retirement plan. An eligible retirement plan is an individual retirement
account described in section 408(a) of the Code, an individual retirement annuity
described in section 408(b) of the Code, an annuity plan described in section 403(a)
of the Code, or a qualified trust described in section 401 (a) of the Code, that accepts
the distributee's eligible rollover distribution. However, in the case of an eligible
rollover distribution to the surviving spouse, an eligible retirement plan is an individual
retirement account or individual retirement annuity.
- 54 -
CD
o
o
ARTICLIE XVi - MISCEllANEOUS
(Continued)
(c) Distributee. A distributee includes an employee or former employee. In
addition, the employee's or former employee's surviving spouse and the employee's
or former employee's spouse or former spouse who is the alternate payee under a
qualified domestic relations order, as defined in section 414(p) of the Code, are
distributees with regard to the interest of the spouse or former spouse.
(d) Direct rollover. A direct rollover is a payment by the plan to the eligible
retirement plan specified by the distributee.
16.14 EFFECTIVE DATE: If this Plan is amended and restated to comply with the Tax
Reform Act of 1986, any regulation thereunder, or any subsequent legislation or regulation,
then no such provision set forth in this document shall be effective prior to the effective date
set forth in such legislation or regulation. Notwithstanding the effective date of amendment
set forth in the Adoption Agreement, if this plan is amended and restated to comply with the
technical, clerical, and conforming amendments to the Tax Reform Act of 1984, the
Retirement Equity Act, and the Deficit Reduction Act of 1984, the effective date(s) of such
amendments shall be the date(s) set forth in such acts.
- 55 -
IE~ROLLMENT A~D Ii'iVESTME~T AUTHORIZATnON FORM
1998 Augusta Money Purchase Plan
Name of Plan
257-00049
Case Number
Please complete the following with a ball-point pen; print c1earl\'. The infomlation provided should
be current as of the date the form is completed. You must complete sections n & HI.
SECTlO:\" I - General Information
SocIal Security Number
Last :-oJ amc
First Name
MI
Employee Number
Date of Hire
Date of Birth
Age
Sex
Number and Street
Additionul V1ailing Information (PO Box)
City
State
Zip
Homc Phonc
Work Phone
SECTION II - Contribution Election:
Employer Base Contribution Q Employee Contribution Q
I recei\'e a paycheck: Weekly (52) D Hi-Wcckly (26) D Scmi-Monthly (24) D Monthly(12) D
SECTION IU - Investment Election
This investment election will be applied to all contributions made to this Plan after this date. Assets previously deposited at
Nationwide will not be changed by this election. I hereby authorize all future contributions to be invested as follows:
FUI.ds Selected VRU# Whole % FUllds Selected VRU Whole %
per fUIld* # per fillul *
Nationwide Guaranteed Interest Account 800 .0% Janus Fund 320 .0%)
Nationwide Money Market Fund 360 .Ol)./u Dreyfus Balanced Fund 219 .0%
Federated Bond Fund 235 .0% American Centurv Growth & Income 165 .0%)
Fidelitv Ad\'isors Growth Opportunities T 240 .O"'i) Nationwide hmd 385 .0%
Fidelitv Advisors High Yield Fund T 285 .0% Portfolio 2 Short-Term 450 .0U~1
Neuberger Berman Guardian Trust 565 .U";() Portfolio I Conservative Short- Term 465 .0%
Drevfus S & P 500 Index Fund 205 .OIYiI Twentieth Centurv Ultra 580 .0%
Temoleton Foreign Fund 550 .0% Warburl! Pincus Emerging Growth 600 .0%
* NOTE: Whole percentages only, no fractions or decimals.
TotallYc, of all funds chosen must equal) OO.YcI
SECTiON IV - Signature
Your Sign~ltllrc
Date
Make sure that you have completed each section fully. Please return this form to the plan administrator.
If you have any questions, call Pension Service at (770) 952-5225 or toll-free at (800) 736-7166.
IEl'lROLLMlE;\JT A:\D INVESTMENT AUTHORIZATION FORM
1998 Augusta Money Purchase Plan
"ame of Plan
257-00049
Case Number
Please complete the following with a ball-point pen; print clearly. The infomlation provided should
be current as of the date the fonn is completed. You must complete sections [ & HI.
SECTIO:\ I - General Information
Social Security Number
Last ~ amc
First Name
MI
Employee Number
Date of Hire
Date of Birth
Age
Sex
Number and Street
Additional Ylailing Information (PO Bo~)
City
State
I.lp
Home Phone
Work Phone
SECTION II - Contribution Election:
Employer Base Contribution Q Employee Contribution Q
I receive a paycheck: Weekly (52) D l3i-\\'eckly (26) D Semi-Monthly (24) D Monthly(12) D
SECTION In - Investment Election
This investment election will be applied to all contributions made to this Plan after this date. Assets previously deposited at
Nationwide will not be changed by this election. I hereby authorize all future contributions to be invested as follows:
Funds Selected VRU# Whole % F,,"ds Selected VRU Whole %
per ftmd* # per ftmd *
Nationwide Guaranteed Interest Account 800 .0% Janus Fund 320 .0%
Nationwide Money Market Fund 360 .0% Dreyfus Balanced Fund 219 .0%
Federated Bond Fund 235 .0% American Century Growth & Income 165 .0%
Fidelity Ad\'isors Growth Opportunities T 240 .O'~ U Nationwide Fund 385 .0(Yu
Fidelity Advisors HilZh Yield Fund T 285 .0% Portfolio 2 Short-Term 450 0"1.
. "
Neuberger Berman Guardian Trust 565 UU' Portfolio I ('onservati\'c Short- Term 465 .01~.U
. Yo
Dreyfus S & P 500 Index Fund 205 .0% Twentieth Century Ultra 580 .0%
Templeton Foreign Fund 550 .0% Warburg Pincus Emerging Growth 600 .0%
* NOTE: Whole percenta!!es onlv. no fractions or decimals.
Total % of all funds chosen must eauall 00%
SECTION IV - Signature
Your Slgnatun:
Date
Make sure that you have completed each section fully. Please return this form to the plan administrator.
If you have any questions, call1Pension Service at (770) 952-5225 or toll-free at (800) 736-7166.
E~ROLILME~T A~D I~VESTME~T AUTHORJ[ZA T[O~ FORtVi
1998 Augusta :Vloney Purchase Plan
!'\ame of Plan
257-00049
Case Number
Please complete the following with a ball-point pen; print c1earl\'. The infonnation provided should
be current as of the date the form is completed. You must complete sections n & un.
SECTI()~ 1- General Information
SocIal Security Number
LaSI \' amc
First Name
~I
Employee Number
Date of Hire
Dale of Birth
Age
Sex
:\lumber and Street
Additional V1ailing Information (PO 130\)
City
State
I.lp
Home Phonc
Work Phone
SECTION II - Contribution Election:
Employer Base Contribution Q Employee Contribution Q
I recei'.e a paycheck: Weekly (52) D l3i-\\'ed.ly (26) D Scmi-Monthly (24) D Monthly(12) D
SECTION liB - Investment Election
This investment election will be applied to all contributions made to this Plan after this date. Assets previously deposited at
~ationwide will not be changed by this election. I hereby authorize all future contributions to be invested as follows:
FUllds Selected VRU# Whole % FUllds Selected VRU Whole %
per /illld* # per /illul *
Nationwide Guaranteed Interest Account 800 .0% Janus Fund 320 Olll
. III
Nationwide Monev Market Fund 360 .0% Drevfus Balanced Fund 219 .0%
Federated Bond Fund 235 001 American Century Growth & Income 165 .0%
. '0
Fidelity Ad,.isor~ <'Jrowth OpportUI1lIIl:S T 240 .Ol~ n :\utlonwlde Fund 385 .0%
Fidelity Advisors High Yield Fund T 2g5 .0lJtu Portfolio 2 Short-Term 450 Olll
. II
Neuberger Berman Guardian Trust 565 un.. Portfolio 1 Conservati '.C Short- Term 465 .Ollll
. II
Dreyfus S & P 500 Index Fund 205 .O~/ll Twentieth Century Ultra 580 .0%
Templeton Foreign Fund 550 .0% Warburg Pincus Emerging Growth 600 .0%
* NOTE: \Vhole percental!es onl\'_ no fractions or decimals.
Total % of all funds chosen must eaual 100%
SECTIO~ IV - Signature
Your SIgnature
Date
Make sure that you ha\'e completed each section fully. Please return this form to the plan administrator.
[f you have any questions, call1Pension Service at (770) 952-5225 or toll-free at (800) 736-7166.
IE:\ROLLME:\T A:\D Il\VESTME:\T AUTHORIZATION FORM
1998 Augusta :\loney Purchase Plan
I\ame of Plan
257-00049
Case Number
Please complete the following with a ball-point pen; print clearly. The information provided should
be current as of the date the fOlm is completed. You must complete sections n & HI.
SECTlO:\" I - General Information
SocIal Securlly Number
Last :-'<amc
First Name
MI
Employee :-.lumber
Date of Hire
Date of Bil1h
Age
Sex
Number and Street
Additional \hliling Information (PO Bo\)
City
State
I.lp
Home Phone
Work Phone
SECTION II - Contribution Election:
Employer Base Contribution Q Employee Contribution Q
I recei,'e a paycheck: Weekly (52) D Bi-\\'cd.ly (26) D Semi-Monthly (24) D Monthly(12) D
SECTION III - Investment Election
This investment election will be applied to all contributions made to this Plan after this date. Assets previously deposited at
~ationwide will not be changed by this election. [hereby authorize all future contributions to be invested as follows:
FUllds Selected VRU# Whole % FUllds Selected VRU Whole %
oer fillld* # per fiuul *
Nationwide Guaranteed Interest Account 800 .0% Janus Fund 320 .0%
Nationwide Money Market Fund 360 .O~.;) Drevfus Balanced Fund 219 .0%
Federated Bond Fund JJ.:i .0% American Century Growth & Income 165 .0%)
, Fidelitv Ad,'isor~ (jro\\th OpportUl1ltlcs T 240 .0"'0 !\ulIon\\ide Fund 385 .0%
Fidelitv Advisors High Yield Fund T 285 .0% Portfolio 2 Short-Term 450 on.
. "
Neubefl!er Berman Guardian Trust 565 .1)"';) Portfolio 1 Conservative Short- Term 465 .O'!'u
Drevfus S & P 500 Index Fund 205 .O(~u Twentieth Century Ultra 580 .0%
Temoleton ForeilZn Fund 550 .0% WarbuTl.! Pincus Emerging Growth 600 .0%
* NOTE: Whole percenta\',:es onl\'. no fractions or decimals.
Total ul., of all funds chosen must eQual 100%
SECTlO~ IV - Signature
Y uur Signature
Date
l\-iake sure that you have completed each section fully. Please return this form to the plan administrator.
If you have any questions, call Pension Service at (770) 952-5225 or toll-free at (800) 736-7166.
ENROLLMENT A~D INVESTMENT AUTHORIZATION FORM
] 998 Augusta Money Purchase Plan
Name of Plan
257-00049
Case Number
Please complete the following with a ball-point pen; print clearly. The information provided should
be current as of the date the form is completed. You must complete sections I & HI.
SECTIOl'l1 - Gcncral Information
Social Security Numbcr
Lasl Namc
First i\ame
MI
Employee Number
Dale of Hire
Dale of Bil1h
Age
Sex
Number and Street
Additional Mailing Information (PO Box)
Cily
State
ZIp
Home Phone
Work Phonc
SECTiO~ II - Contribution Election:
Employer Base Contribution Q Employee Contribution Q
I recei\'e a paycheck: Weekly (52) D Hi-Weckly (26) D Scmi-Monthly (24) D Monthly(12) D
SECTION HI - Invcstment Election
This investment election will be applied to all contributions made to this Plan after this date. Assets previously deposited at
Nationwide wiII not be changed by this election. I hereby authorize all future contributions to be invested as follows:
Funds Selected VRU# Whole % Funds Selected VRU Whole %
pel'flllul* # perfillu[ *
Nationwide Guaranteed Interest Account 800 .0% Janus Fund 320 .0%
Nationwide Money Market Fund 360 .0% Dreyfus Balanced Fund 219 .0%
Federated Bond Fund 235 .0% Amcrican Century Growth & Income 165 .0%
Fidelity Advisors Growth Opportunities T 240 .0% NatlOnwidcFund 385 .0%
Fidelity Advisors Hi~h Yield Fund T 285 .0% Portfolio 2 Short-Term 450 .0%
Neuberger Berman Guardian Trust 565 .U% Portfolio I Conservativc Short- Term 465 .0%
Dreyfus S & P 500 Index Fund 205 .0% Twt:ntieth Century Ultra 580 .0%
Templeton Foreign Fund 550 .0% Warburg Pincus Emerging Growth 600 .0%
* NOTlE: Whole percental!es only. no fractions or decimals.
Total (XI of all funds chosen must equal 100%
SECTION IV - Signature
Your Signature
Date
Make sure that you have completed each section fully. Please return this form to the plan administrator.
If you have any questions, call Pension Service at (770) 952-5225 or toll-free at (800) 736-7166.
Plan Name:
1998 Auausta Monev Purchase Plan
Case: 257-00049
BENEFICIARY DESIGNATION FORM
(Please t) pe or print c1ea.-l~)
Social S~~unt) \umber:
Please indicate iflhls is
D Designating d Bendiclary D [jeneliclar~ t 'hange
I. Your full name:
I asl
I'II't
Il1Ilial
2. Current address:
:>;umber
Street
AptlBox #
City
3. How may we reach you by phone?
State
Zip
Work \'umbl'r
Home \'umber
4. Primary Beneficiary Name
Relationship to Participant
5. Contingent Beneficiary Name
Relationship to Participant
----------
(A Contingent Beneficiary will receive a death benefit only ifno primary beneficiary is living at the participant's death)
This beneficiary designation applies to all funding options unless otherwise noted above.
I, us a participant in thc pl:m. do hereby revoke any previous beneficiary
infomlation, and spcclfy the above named persons as bl:ndiciary(ies).
o
Signature of Participant
PLEASE ~OTE: Wilness can.!!.!!.! be a named beneficiary!
Date Signed
Signature of Witness
Street Addrcss of Witness
Please Prmt :\ame of \Vltness
City State Lip
Plan Name:
Case: 257-00049
1998 Auqusta Monev Purchase Plan
BENEFICIARY DESIGNATION FORM
(PIl.':ISl.' t~ pc or print dcarl~)
Social SecurIlY :\umber:
Please indicate if this IS
D Deslgnallng ,I Beneficiary D l3eneliclar} l'hange
I. Your full namc:
I.ast
FII.,t
Initial
2. Current addrcss:
"umber
Street
AptlBo.x 1/
City
Stale
Zip
3. How may we reach you by phone?
Work "umbL'r
Home :\lumber
4.
Primary Bcneficiary Name
Relationship to Participant
5. Contingent Beneficiary Name
Relationship to Participant
(A Contingent Bencticlary will rccci\'c a death bcnefit only ifno primary beneficiary is living at the participant's death)
This beneficiary designation applies to all funding options unless otherwise noted above.
I, as a participant in the plan, do hereby revoke any previous beneficiary
information, and spec I t~. thl: abovc named persons as bl'n.:fici:lry(ies).
o
Signature of Participant
PLEASE "OTE: Witness can 1101 he 1I 1I11111ed heneficillry!
Date Signed
Signature of Witness
Strcet Address of Witness
Please Pnnt :\'ame of Wltncss
----_. ---------- ----.-.--
City State Zip
Plan Name:
1998 Augusta Monev Purchase Plan
Case: 257-00049
BENEFICIARY DESIGNATION FORM
(Plcase t~ pl' or print dearl~ )
Social Sccunt~ \umber:
Please mdlcate iflhls IS
D Designating .1 Benelielar~ D Ileneliclar~ t 'hange
I, Your full name:
I a,1
FIN
IllItlal
2. Current address:
:\ umber
Streel
AptlBox 11
City
3. How may we reach you by phone?
Slale
lip
Work "lImb,-r
/Iome :\umber
4.
Primary Beneficiary Name
Relationship to Participant
5. Contingent Beneficiary Name
Rclationship to Participant
(A Contingent BenefiCiary will recei\'e a death benefit only ifno primary beneficiary is living at the participant's death)
This beneficiary designation applies to all funding options unless otherwise noted above.
I, as a participant in the plan. do hereby revoke any previous beneficiary
infomlation, and spccdY the above named persons as bl.'ncficiary(ies).
o
Signature of Participant
PLEASE :'iOTE: Witlless call 1101 be a lIamed belleficiary!
Date Signed
Signature of Witness
Street Address of Witness
Please Pnnt !'\ame of Wllness
Cit)'
State
Zip
Plan Name:
1998 Augusta Monev Purchase Plan
Case: 257-00049
BENEFICIARY DESIGNATION FORM
(Please t~ pc or print c1e:lrl~)
SOClil1 SeclInI) 'ulllber:
Please mdicate if this I~
D Deslgnallng d Belwficlar~ D Bcnenclar~ l'hange
I. Your tulln:lllle:
I a.1 1"1"'1 In ilia I
2. Current address:
:\ umber SII'CCI Aplll3o.x ;I
City
Slate
Zip
3. How may we reach you by phone'? _.
Work :'\umb.'r
lIomc :'\umber
4. Primary Beneficiary Name
Relationship to Participant
5. Contingent Beneficiary ~ame
Relationship to Participant
(A Contingent BeneficIary will recei,'e a death benefit only ifno primary beneficiary is living at the participant's death)
This beneficiary designation applies to all funding options unless otherwise noted above.
I, as a participant in the pltlll, do hereby revoke any previous beneficiary
infonn:ltion, and specitY the .Ibo\'e named persons as bl'ndi.:i.lry(ies).
0)
Signature of Participant
PLEASE :\'OTE: Witness can not be a named beneticiary!
Date Signed
Signature of Witness
Street Address of Witness
Please Prmt ':lme of \\'1II1e55
City
State
LIp
Case: 257-00049
Plan Name:
1998 Augusta Money Purchase Plan
BENEFICIARY DESIGNATION FORM
(Please type or print clearly)
Social Security Number:
Please indicale iflhis is
D Designating a Benellclary D Benefiemry ('hange
Initial
Apt/Box #
Stale
Zip
l'lome Number
Relationship to Participant
5. Contingent Beneficiary Name
Relationship to Participant
(A Contingent Beneficiary will receive :1 death benefit only ifno primary beneficiary is living at the paJ1ieipant's death)
This beneficiary designation applies to all funding options unless otherwise noted above.
I, as a participant in the plan, do hereby revoke any previous beneficiary
infomlation, and specify the above named persons liS bcncficiary(ics).
o
Signature of Participant
PLEASE I'iOTE: Witnes~ can not be 8 named beneficiary!
Date Signed
Signature of Witness
Street Address of Witness
Please Print Name of Witness
City
State
Zip
O(~ i 1f1a. ~
r----- -:-=.=.-:.:==- ::.:.:..::::: :-,:::,":".-=...
F
, ~~"
c ';~~;I!
tf'rf":. //;' '. ~)(i'\
.~ .1(.1.1/(-:7 ,~.) (..~/
,.'-"~
DISTRIBUTION FORMS
Enclosed is a distribution package for you to read and complete in order that your Money
Purchase Plan balance can be handled according to your wishes.
Your decision will have certain tax. consequences, so please read the material carefully
and consult your tax. advisor if you need further assistance.
You may take thirty (30) days to make your decision and then return the completed forms
to the plan administrator. You may, however, waive the 3D-day period by returning the
signed Waiver and the Application for Benefits sooner.
Please return the signed Waiver (if applicable) and the Application for Benefits to:
Pension Service Company
1100 Circle 75 Pkwy.
Suite 320
Atlanta, GA 30339
Should you have any questions, please call Pension Service Company at (770) 952-5225
or (800) 736-7166.
WAIVER OF 3<<b-JI}A Y TliME lPERliOJI} FOR
CONSENTliNG TO JI}liSTRliB1UTliON
The attached "NOTICE: Special Tax Rules On Distributions" explains, among other things, your
right to choose to have your plan benefits directly rolled over either to an IRA or another
qualified plan, or to have your benefits paid directly to you. If you choose to have your benefits
paid directly to you, 20% of the payment will automatically be withheld and sent to the IRS as
income tax withholding. You have a right to consider your decision of whether or not to elect a
direct rollover for at least 30 days from the date you receive the attached NOTICE. You can
waive the 30-day period by filling in the enclosed APPLICATION FOR BENEFITS form,
indicating on the form whether you want your benefits directly rolled over to another plan or
IRA, or paid directly to you, and submitting the signed form to the plan administrator along with
this signed Waiver Form. The submission of your completed application before the end of the
30-day waiting period will constitute a waiver of the period and your election may be
implemented in less than 30 days from the time you received this NOTICE. REMlEMlB1E:R, you
llnave tllne Il"ngM to cOllnsidlell" youll" dlecnsnon fOil" a fllln 30 days fll"om tine tnme yoan Il"eceive tllnns
NOTICE before IllIIlalldng an electnon about your benefits.
]I.. lIllllsen1 tllne date you recenved th.is FOll"m in the (IDate) space lI1ell"e.
I received the "Notice: Special Tax Rules On Distributions" on (Date)
and have made an affirmative election on the "Application for Benefits" Form to either make or
not make a direct rollover of my benefits to an IRA or another qualified plan. I hereby waive my
right to a 30-day period in which to consider the decision of whether or not to elect a direct
rollover.
2. JPrnnt your name, sign andl date. Return tll1e Form to tll1e plan administratoll".
(Date)
Printed Name of Participant or Beneficiary
Signature of Participant or Beneficiary
IRS EXPLANATION OF DIRECT ROLLOVER, WITHHOLDING AND TAX RULES
IMPORTANT WARNING: The Small Business Jo~ Protection Act, enacted on August 20, 1996, makes
numerous changes to the pension law requirements. The explanation below, which is required by the IRS, is
no longer accurate in all respects on account of these new laws. Please consult your tax advisor regarding
your distribution.
This notice contains important information you will need
before you decide how to receive your benefits from the Money
Purchase Plan (the "Plan").
SUMMARY
A payment from the Plan that is eli.&ible for "rollover" can be
taken in two ways. You can have air or any portion of your
paYl1lent either (n PAID IN A "DIRECT ROLLOVER" or (2)
PAID TO YOU. A rollover is a payment of your Plan benefits to
your individual retirement arr8!1.Eement (IRA) or to another
employer plan. This choice will affect the tax you owe.
If you choose a DIRECT ROLLOVER:
Your payment will not be taxed in the current year and
no income tax will be withheld.
Your payment will be made directly to your IRA or, if
you choose, to another employer plan that accepts your
rollover.
Your payment will be taxed later when you take it out of
the IRA or the employer plan.
If you choose to have your Plan benefits PAID TO YOU:
You will receive only 80% of the payment, because the
Plan administrator is required to withhold 20% of the
payment and send it to the IRS as income tax with-
holding to be credited against your taxes.
Your payment will be taxed in the current year unless
you roll it over. You may be able to use special tax rules
that could reduce the tax you owe. However, if you re-
ceive the payment before age 59 1/2, you also may have
to pay an additional 10% tax, with certain exceptions (see
below)
You can roll over the payment by paying it to your IRA
or to another employer plan that accepts your rollover
within 60 days of receiving the payment. The amount
rolled over will not be taxed until you take it out of the
IRA or employer plan.
If you want to roll over 100% of the payment to an IRA
or an employer plan, you must find other money to
replace the 20% that was withheld. If you roll over only
the 80% that you received, you will be taxed on the 20%
that was withheld and that is not rolled over.
I. PAYMENTS THAT CAN AND
CANNOT BE ROLLED OVER
Payments from the Plan may be "eligible rollover distri-
butions." This means that they can be rolled over to an IRA or to
another employer plan that accepts rollovers. Your Plan
administrator should be able to tell you what portion of your
payment is an eligible rollover distribution. The following types of
payments cannot be rolled over:
Non-Taxable Payments. In general, only the "taxable
portion" of your payment is an eligible rollover distribution. If you
have made "after-tax" employee contributions to the Plan, these
contributions will be non-taxable when they are paid to you, and
they cannot be rolled over. (After-tax employee contributions
generally are contributions you made from your own pay that
were already taxed.)
Payments Spread Over Long Periods. You cannot roll over a
payment if it is part of a series of equal (or almost equal) payments
that are made at least once a year and that will last for:
your lifetime (or your life expectancy) or
your lifetiJ:ne and your beneficiary's ll?etime (or life
expectancies), or
a period often years or more.
Required Minimum Payments. Beginning in the year you reach
age 70 1/2, a certain portion of your payment cannot be rolled
over because it is a "required minimum payment" that must be
paid to you.
n. DIRECT ROLLOVER
You can choose a direct rollover of all or any portion of your
payment that is an "eligible rollover distribution," as described
above. In a direct rollover, the eligible rollover distribution is paid
directly from the Plan to an IRA or another employer plan that
accepts rollovers. If you choose a direct rollover, you are not taxed
on a payment until you later take it out of the IRA or employer
plan.
Direct Rollover to an IRA. You can open an IRA to receive the
direct rollover. (The term "IRA," as used in this notice, includes
individual retirement accounts and individual retirement annu-
ities.) If you choose to have your payment made directly to an
IRA, contact an IRA sponsor (usually a fmancial institution) to
find out how to have your payment made in a direct rollover to an
IRA at that institution. If you are unsure of how to invest your
money, you can temporarily establish an IRA to receive the
payment. However, in choosing an IRA, you may wish to consider
whether the IRA you choose will allow you to move all or a part
of your payment to another IRA at a later date, without penalties
or other limitations. See IRA Publication 590, Individual
Retirement Arrangements, for more information on IRAs
(including limits on how often you can roll over between IRAs).
Direct Rollover to a Plan. If you are employed by a new
employer that has a plan, and you want a direct rollover to that
plan, ask the administrator of that plan whether it will accept your
rollover. If your new employer's plan does not accept a rollover,
you can choose a direct rollover to an IRA.
Direct Rollover of a Series of Payments. If you receive eligible
rollover distributions that are paid in a series for less than ten
years, your choice to make or not make a direct rollover for a
payment will apply to all later payments in the series until you
change your election. You are free to change your election for any
later payment in the series.
III. PAYMENT PAID TO YOU
If you have the payment made to you, it is subject to 20%
income tax withholding. The payment is taxed in the year you
receive it unless, within 60 days, you roll it over to an IRA or
another plan that accepts rollovers. If you do not roll it over,
special tax roles may apply.
Income Tax Withholding:
Mandatory Withholding. If any portion of the payment to you is
an eligible rollover distribution, the Plan is required by law to
withhold 20% of that amount. This amount is sent to the IRS as
income tax withholding. For example, if your eligible rollover
distribution is $10,000, only $8,000 will be paid to you because
the Plan must withhold $2,000 as income tax. However, when you
prepare your income tax return for the year, you will report the full
$10,000 as a payment from the Plan. You will report the $2,000 as
tax withheld, and it will be credited against any income tax you
owe for the year.
Voluntary Withholding. If any portion of your payment is not an
eligible rollover distribution but is taxable, the mandatory
withholding rules described above do not apply. In this case, you
may elect not to have withholding apply to that portion. To elect
out of withholding, ask the Plan administrator for the election
form and related information.
Sixty-Day Rol/over Option. If you have an eligible rollover
distribution paid to you, you can still decide to roll over all or part
of it to an IRA or another employer plan that accepts rollovers. If
you decide to roll over, you must make the rol/over within 60 days
after you receive the payment. The portion of your payment that is
rolled over will not be taxed until you take it out of the IRA or the
employer plan.
You can roll over up to 100% of the eligible rollover
distribution, including an amount equal to the 20% that was
withheld. If you choose to roll over 100%, you must find other
money within the 60-day period to contribute to the IRA or the
employer plan to replace the 20% that was withheld. On the other
hand, if you roll over only the 80% that you received, you will be
taxed on the 20% that was withheld.
Example: Your eligible rollover distribution is $10,000, and you
choose to have it paid to you. You will receive $8,000 and $2,000
will be sent to the IRS as income tax withholding. Within 60 days
after receiving the $8,000, you may roll over the entire $10,000 to
an IRA or employer plan. To do this, you roll over the $8,000 you
received from the Plan, and you will have to find $2,000 from
other sources (your savings, a loan, etc.). In this case, the entire
$10,000 is not taxed until you take it out of the IRA or employer
plan. If you roll over the entire $10,000, when you file your
income tax return you may get a refund of the $2,000 withheld.
If, on the other hand, you roll over only $8,000, the $2,000 you
did not roll over is taxed in the year it was withheld. When you file
your income tax return you may get a refund of part of the $2,000
withheld. (However, any refund is likely to be larger if you roll
over the entire $10,000).
Additional 10% Tax /fYou Are Under Age 59 1/2. If you receive
a payment before you reach age 59 1/2 and you do not roll it over,
then, in addition to the regular income tax, you may have to pay
an extra tax equal to 10% of the taxable portion of the payment.
The additional 10% tax does not apply to your payment if it is (l)
paid to you because you separate from service with your employer
during or after the year you reach age 55, (2) paid because you
retire due to disability, (3) paid to you as equal (or almost equal)
payments over your life or life expectancy (or your and your
beneficiary's lives or life expectancies), or (4) used to pay certain
medical expenses. See IRS Form 5329 for more information on
the additional 10% tax.
Special Tax Treatment. If your eligible rollover distribution is
not rolled over, it will be taxed in the year you receive it.
However, if it qualifies as a "lump sum distribution", it may be
eligible for special tax treatment. A lump sum distribution is a
payment, within one year, of your entire balance under the Plan
(and certain other similar plans of the employer) that is payable to
you because you have reached 59 1/2 or have separated from
service with your employer (or, in the case of a self-employed
individual, because you have reached age 59 1/2 or have become
disabled). For a payment to qualify as a lump sum distribution,
you must have been a participant in the Plan for at least 5 years.
The special tax treatment for lump sum distribution is described
below.
Five-Year Averaging. If you receive a lump sum distribution
after you are age 59 1/2, you may be able to make a one-time
election to figure the tax on the payment by using "5-year
averaging". Five-year averaging often reduces the tax you owe
because it treats the payment much as if it were paid over 5 years.
Ten-Year Averaging /fYou Were Born Before January 1, 1936.
If you receive a lump sum distribution and you were born before
January I, 1936, you can make a one-time election to figure the
tax on the payment by using "IO-year averaging" (using 1986 tax
rates) instead of 5-year averaging (using current tax rates). Like
the 5-year averaging rules, IO-year averaging often reduces the tax
you owe.
Capital Gain Treatment /f You Were Born Before January 1,
1936. In addition, if you receive a lump sum distribution and you
were born before January I, 1936, you may elect to have the part
of your payment that is attributable to your pre-I 974 participation
in the Plan (if any) taxed as long-term capital gain at a rate of
20%.
There are other limits on the special tax treatment for lump sum
distributions. For example, you can generally elect this special tax
treatment only once in your lifetime, and the election applies to all
lump sum distributions that you receive in that same year. If you
have previously rolled over a payment from the Plan (or certain
other similar plans of the employer), you cannot use this special
tax treatment for later payments from the Plan. If you roll over
your payment to an IRA, you will not be able to use this special
tax treatment for later payments from the IRA. Also, if you roll
over only a portion of your payment to an IRA, this special tax
treatment is not available for the rest of the payment. Additional
restrictions are described in IRS Form 4972, which has more
information on lump sum distributions and how you elect the
special tax treatment.
Employer Stock or Securities. There is a special rule for a
payment from the Plan that includes employer stock (or other
employer securities). To use this special rule, (I) the payment
must qualify as a lump sum distribution, as described above (or
would qualify except that you do not yet have 5 years of
participation in the Plan), or (2) the employer stock included in the
payment must be attributable to "after-tax" employee
contributions, if any. Under this special rule, you may have the
option of not paying tax on the "net unrealized appreciation" of the
stock until you sell the stock. Net unrealized appreciation
generally is the increase in the value of the employer stock while it
was held by the Plan. For example, if employer stock was
contributed to your Plan account when the stock was worth $1,000
but the stock was worth $1,200 when you received it, you would
not have to pay tax on the $200 increase in value until you later
sold the stock.
You may instead elect not to have the special rule apply to the
net unrealized appreciation. In this case, your net unrealized
appreciation will be taxed in the year you receive the stock, unless
you roll over the stock. The stock (including any net unrealized
appreciation) can be rolled over to an IRA or another employer
plan either in a direct rollover or a rollover that you make yourself.
If you receive employer stock in a payment that qualifies as a
lump sum distribution, the special tax treatment for lump sum
distributions described above (such as 5-year averaging) also may
apply. See IRS Fonn 4972 for additional infonnation on these
rules.
.nV. SURVIVING SJPOUSlESl..ALTERNATE
JPA YlElES AND 01l'HER BEl"lElFICIARIES
In general, the rules summarized above that apply to payments
to employees also apply to payments to surviving spouses of
employees and to spouses or fonner spouses who are "alternate
payees". You are an alternate payee if your interest in the Plan
results from a "qualified domestic relations order", which is an
order issued by a court, usually in connection with a divorce or
legal separation. Some of the rules summarized above also apply
to a deceased employee's beneficiary who is not a spouse.
However, there are some exceptions for payments to surviving
spouses, alternate payees and other beneficiaries that should be
mentioned.
If you are a surviving spouse, you may choose to have an
eligible rollover distribution paid in a direct rollover to an IRA or
paid to you. If you have the payment paid to you, you can keep it
or roll it over yourself to an IRA but you cannot roll it over to an
employer plan. If you are an alternate payee, you can have the
same choices as the employee. Thus, you can have the payment
paid as a direct rollover or paid to you. If you have it paid to you,
you can keep it or roll it over yourself to an IRA or to another
employer plan that accepts rollovers. If you are a beneficiary other
than the surviving spouse, you cannot choose a direct rollover, and
you cannot roll over the payment yourself.
If you are a surviving spouse, an alternate payee, or another
beneficiary, your payment is not subject to the additional 10% tax
described in section III above, even if you are younger than age 59
112.
If you are a surviving spouse, an alternate payee, or another
beneficiary, you may be able to use the special tax treatment for
lump sum distributions and the special rule for payments that
include employer stock, as described in section III above. If you
receive a payment because of the employee's death, you may be
able to treat the payment as a lump sum distribution if the
employee met the appropriate age requirements, whether or not
the employee had 5 years of participation in the Plan.
HOW 11'0 OlIn AIN ADDITIONAL INFORMATION
This notice summarizes only the federal (not state or local) tax
rules that might apply to your payment. The rules described above
are complex and contain many conditions and exceptions that are
not included in this notice. Therefore, you may want to consult
with a professional tax advisor before you take a payment of your
benefits from the Plan. Also, you can find more specific
infonnation on the tax treatment of payments from qualified retire-
ment plans in IRS Publication 575, Pension and Annuity Income,
and IRS Publication 590, Individual Retirement Arrangements.
These publications are available from your local IRS office or by
calling 1-800-TAX-FORMS.
APPLICATION FOR BENEFITS
(please print clearly or type)
Plan Name: Au~sta Richmond County Money Purchase Plan Date:
As a Participant in the above Plan, I hereby request payment of my benefit as provided below:
1. Name:
Address: (Street or PO Box)
(City, State & Zip)
2. Reason for payment
[ ] Termination of employment (including retirement) Termination Date:
[ ] Attainment of age 70-112 (required minimum distribution, unless still working).
[ ] Termination of Plan.
[ ] Death.
[ ] Disability .
Social Security No.
3. Form of payment
[ ] Normal Form under the Plan.
[ ] Lump Sum.
4. Direct Rollover or Transfer:
[ ] I choose to have my benefit paid in a direct rollover (transfer) to:
[] My IRA
Name of IRA Account:
Account Number:
Name of Bank:
Address of Bank:
Bank ABA Number:
(if wire transfer)
[] Another Plan.
Name of Plan:
Name of Employer:
Address of Employer:
Trust Account Number: (if wire transfer)
NOTE: It is your obligation to insure that the Employer Plan named above will accept the transfer of
your benefit payment. Also, only taxable monies may be rolled into another Plan or an IRA. Any non-
taxable monies (after-tax) will be distributed to you.
6. [] I choose to have my benefit paid directly to me.
Date:
Signature of Participant
DISTRIBUTION FORMS
Enclosed is a distribution package for you to read and complete in order that your Money
Purchase Plan balance can be handled according to your wishes.
Your decision will have certain tax consequences, so please read the material carefully
and consult your tax advisor if you need further assistance.
You may take thirty (30) days to make your decision and then return the completed forms
to the plan administrator. You may, however, waive the 30-day period by returning the
signed Waiver and the Application for Benefits sooner.
Please return the signed Waiver (if applicable) and the Application for Benefits to:
Pension Service Company
1100 Circle 75 Pkwy.
Suite 320
Atlanta, GA 30339
Should you have any questions, please call Pension Service Company at (770) 952-5225
or (800) 736-7166.
W AITVJElR OlF 3 <<D-l())A Y l'ITME JP>ElRITOl()) lFOlR
CONSENl'ITNG 1'0 l())ITSl'lRITlB1Ul'ITON
The attached "NOTICE: Special Tax Rules On Distributions" explains, among other things, your
right to choose to have your plan benefits directly rolled over either to an IRA or another
qualified plan, or to have your benefits paid directly to you. If you choose to have your benefits
paid directly to you, 20% of the payment will automatically be withheld and sent to the IRS as
income tax withholding. You have a right to consider your decision of whether or not to elect a
direct rollover for at least 30 days from the date you receive the attached NOTICE. You can
waive the 30-day period by filling in the enclosed APPLICATION FOR BENEFITS form,
indicating on the form whether you want your benefits directly rolled over to another plan or
IRA, or paid directly to you, and submitting the signed form to the plan administrator along with
this signed Waiver Form. The submission of your completed application before the end of the
30-day waiting period will constitute a waiver of the period and your election may be
implemented in less than 30 days from the time you received this NOTICE. REMEMBER, yoan
Rnave ttRne rightt to consider YOlllr decision for a fulD 30 days from the time YOlll receive this
NO'flICE before malking an eDection about your benefits.
:D.. lInsert tRne date yoan received this :!Form in tllne (Date) space here.
I received the "Notice: Special Tax Rules On Distributions" on (Date)
and have made an affirmative election on the "Application for Benefits" Form to either make or
not make a direct rollover of my benefits to an IRA or another qualified plan. I hereby waive my
right to a 30-day period in which to consider the decision of whether or not to elect a direct
rollover.
2. Print your name, sign amI! date. Return tine :!Form to the pDan administrator.
(Date)
Printed Name of Participant or Beneficiary
Signature of Participant or Beneficiary
IRS EXPLANATION OF DIRECT ROLLOVER, WITIDIOLDING AND TAX RULES
IMPORTANT WARNING: The Small Business Job Protection Act, enacted on August 20, 1996, makes
numerous changes to the pension law requirements. The explanation below, which is required by the IRS, is
no longer accurate in all respects on account of these new laws. Please consult your tax advisor regarding
your distribution.
This notice contains important infonnation you will need
before you decide how to receive your benefits from the Money
Purchase Plan (the "Plan").
SUMMARY
A payment from the Plan that is eHgible for "rollover" can be
taken in two ways. You can have air or a'!)l portion of your
payment either (I) PAID IN A "DIRECT ROLLOVER" or (2)
PAID TO YOU. A rollover is a payment of your Plan benefits to
your individual retirement arra.!1~ement (IRA) or to another
employer plan. This choice will affect the tax you owe.
If you choose a DIRECT ROLLOVER:
Your payment will not be taxed in the current year and
no income tax will be withheld.
Your payment will be made directly to your IRA or, if
you choose, to another employer plan that accepts your
rollover.
Your payment will be taxed later when you take it out of
the IRA or the employer plan.
If you choose to have your Plan benefits PAID TO YOU:
You will receive only 80% of the payment, because the
Plan administrator is required to withhold 20% of the
payment and send it to the IRS as income tax with-
holding to be credited against your taxes.
Your payment will be taxed in the current year unless
you roll it over. You may be able to use special tax rules
that could reduce the tax you owe. However, if you re-
ceive the payment before age 59 1/2, you also may have
to pay an additional I 0% tax, with certain exceptions (see
below)
You can roll over the payment by paying it to your IRA
or to another employer plan that accepts your rollover
within 60 days of receiving the payment. The amount
rolled over will not be taxed until you take it out of the
IRA or employer plan.
If you want to roll over 100% of the payment to an IRA
or an employer plan, you must find other money to
replace the 20% that was withheld. If you roll over only
the 80% that you received, you will be taxed on the 20%
that was withheld and that is not rolled over.
I. PAYMENTS THAT CAN AND
CANNOT BE ROLLED OVER
Payments from the Plan may be "eligible rollover distri-
butions." This means that they can be rolled over to an IRA or to
another employer plan that accepts rollovers. Your Plan
administrator should be able to tell you what portion of your
payment is an eligible rollover distribution. The following types of
payments cannot be rolled over:
Non-Taxable Payments. In general, only the "taxable
portion" of your payment is an eHgible rollover distribution. If you
have made "after-tax" employee contributions to the Plan, these
contributions will be non-taxable when they are paid to you, and
they cannot be rolled over. (After-tax employee contributions
generally are contributions you made from your own pay that
were already taxed.)
Payments Spread Over Long Periods. You cannot roll over a
payment if it is part of a series of equal (or almost equal) payments
that are made at least once a year and that will last for:
your lifetime (or your life expectancy) or
your lifetitpe and your beneficiary's lltetime (or life
expectanCIes), or
a period often years or more.
Required Minimum Payments. Beginning in the year you reach
age 70 1/2, a certain portion of your payment cannot be rolled
over because it is a "required minimum payment" that must be
paid to you.
II. DIRECT ROLLOVER
You can choose a direct rollover of all or any portion of your
payment that is an "eligible rollover distribution," as described
above. In a direct rollover, the eligible rollover distribution is paid
directly from the Plan to an IRA or another employer plan that
accepts rollovers. If you choose a direct rollover, you are not taxed
on a payment until you later take it out of the IRA or employer
plan.
Direct Rollover to an IRA. You can open an IRA to receive the
direct rollover. (The tenn "IRA," as used in this notice, includes
individual retirement accounts and individual retirement annu-
ities.) If you choose to have your payment made directly to an
IRA, contact an IRA sponsor (usually a financial institution) to
find out how to have your payment made in a direct rollover to an
IRA at that institution. If you are unsure of how to invest your
money, you can temporarily establish an IRA to receive the
payment. However, in choosing an IRA, you may wish to consider
whether the IRA you choose will allow you to move all or a part
of your payment to another IRA at a later date, without penalties
or other limitations. See IRA Publication 590, Individual
Retirement Arrangements, for more infonnation on IRAs
(including limits on how often you can roll over between IRAs).
Direct Rollover to a Plan. If you are employed by a new
employer that has a plan, and you want a direct rollover to that
plan, ask the administrator of that plan whether it will accept your
rollover. If your new employer's plan does not accept a rollover,
you can choose a direct rollover to an IRA.
Direct Rollover of a Series of Payments. If you receive eligible
rollover distributions that are paid in a series for less than ten
years, your choice to make or not make a direct rollover for a
payment will apply to all later payments in the series until you
change your election. You are free to change your election for any
later payment in the series.
III. PAYMENT PAID TO YOU
If you have the payment made to you, it is subject to 20%
income tax withholding. The payment is taxed in the year you
receive it unless, within 60 days, you roll it over to an IRA or
another plan that accepts rollovers. If you do not roll it over,
special tax rules may apply.
Income Tax Withholding:
Mandatory Withholding. If any portion of the payment to you is
an eligible rollover distribution, the Plan is required by law to
withhold 20% of that amount. This amount is sent to the IRS as
income tax withholding. For example, if your eligible rollover
distribution is $10,000, only $8,000 will be paid to you because
the Plan must withhold $2,000 as income tax. However, when you
prepare your income tax return for the year, you will report the full
$10,000 as a payment from the Plan. You will report the $2,000 as
tax withheld, and it will be credited against any income tax you
owe for the year.
Voluntary Withholding. If any portion of your payment is not an
eligible rollover distribution but is taxable, the mandatory
withholding rules described above do not apply. In this case, you
may elect not to have withholding apply to that portion. To elect
out of withholding, ask the Plan administrator for the election
form and related information.
Sixty-Day Rollover Option. If you have an eligible rollover
distribution paid to you, you can still decide to roll over all or part
of it to an IRA or another employer plan that accepts rollovers. If
you decide to roll over, you must make the rollover within 60 days
after you receive the payment. The portion of your payment that is
rolled over will not be taxed until you take it out of the IRA or the
employer plan.
You can roll over up to 100% of the eligible rollover
distribution, including an amount equal to the 20% that was
withheld. If you choose to roll over 100%, you must fmd other
money within the 60-day period to contribute to the IRA or the
employer plan to replace the 20% that was withheld. On the other
hand, if you roll over only the 80% that you received, you will be
taxed on the 20% that was withheld.
Example: Your eligible rollover distribution is $10,000, and you
choose to have it paid to you. You will receive $8,000 and $2,000
will be sent to the IRS as income tax withholding. Within 60 days
after receiving the $8,000, you may roll over the entire $10,000 to
an IRA or employer plan. To do this, you roll over the $8,000 you
received from the Plan, and you will have to fmd $2,000 from
other sources (your savings, a loan, etc.). In this case, the entire
$10,000 is not taxed until you take it out of the IRA or employer
plan. If you roll over the entire $10,000, when you file your
income tax return you may get a refund of the $2,000 withheld.
If, on the other hand, you roll over only $8,000, the $2,000 you
did not roll over is taxed in the year it was withheld. When you file
your income tax return you may get a refund of part of the $2,000
withheld. (However, any refund is likely to be larger if you roll
over the entire $10,000).
Additional 10% Tax If You Are Under Age 59 1/2. If you receive
a payment before you reach age 59 1/2 and you do not roll it over,
then, in addition to the regular income tax, you may have to pay
an extra tax equal to 10% of the taxable portion of the payment.
The additional 10% tax does not apply to your payment if it is (1)
paid to you because you separate from service with your employer
during or after the year you reach age 55, (2) paid because you
retire due to disability, (3) paid to you as equal (or almost equal)
payments over your life or life expectancy (or your and your
beneficiary's lives or life expectancies), or (4) used to pay certain
medical expenses. See IRS Form 5329 for more information on
the additional 10% tax.
Special Tax Treatment. If your eligible rollover distribution is
not rolled over, it will be taxed in the year you receive it.
However, if it qualifies as a "lump sum distribution", it may be
eligible for special tax treabnent. A lump sum distribution is a
payment, within one year, of your entire balance under the Plan
(and certain other similar plans of the employer) that is payable to
you because you have reached 59 1/2 or have separated from
service with your employer (or, in the case of a self-employed
individual, because you have reached age 59 1/2 or have become
disabled). For a payment to qualify as a lump sum distribution,
you must have been a participant in the Plan for at least 5 years.
The special tax treatment for lump sum distribution is described
below.
Five-Year Averaging. If you receive a lump sum distribution
after you are age 59 1/2, you may be able to make a one-time
election to figure the tax on the payment by using "5-year
averaging". Five-year averaging often reduces the tax you owe
because it treats the payment much as if it were paid over 5 years.
Ten-Year Averaging If You Were Born Before January 1, 1936.
If you receive a lump sum distribution and you were born before
January 1, 1936, you can make a one-time election to figure the
tax on the payment by using "10-year averaging" (using 1986 tax
rates) instead of 5-year averaging (using current tax rates). Like
the 5-year averaging rules, 10-year averaging often reduces the tax
you owe.
Capital Gain Treatment If You Were Born Before January 1,
1936. In addition, if you receive a lump sum distribution and you
were born before January I, 1936, you may elect to have the part
of your payment that is attributable to your pre-1974 participation
in the Plan (if any) taxed as long-term capital gain at a rate of
20%.
There are other limits on the special tax treatment for lump sum
distributions. For example, you can generally elect this special tax
treatment only once in your lifetime, and the election applies to all
lump sum distributions that you receive in that same year. If you
have previously rolled over a payment from the Plan (or certain
other similar plans of the employer), you cannot use this special
tax treatment for later payments from the Plan. If you roll over
your payment to an IRA, you will not be able to use this special
tax treatment for later payments from the IRA. Also, if you roll
over only a portion of your payment to an IRA, this special tax
treatment is not available for the rest of the payment. Additional
restrictions are described in IRS Form 4972, which has more
information on lump sum distributions and how you elect the
special tax treabnent.
Employer Stock or Securities. There is a special rule for a
payment from the Plan that includes employer stock (or other
employer securities). To use this special rule, (1) the payment
must qualify as a lump sum distribution, as described above (or
would qualify except that you do not yet have 5 years of
participation in the Plan), or (2) the employer stock included in the
payment must be attributable to "after-tax" employee
contributions, if any. Under this special rule, you may have the
option of not paying tax on the "net unrealized appreciation" of the
stock until you sell the stock. Net unrealized appreciation
generally is the increase in the value of the employer stock while it
was held by the Plan. For example, if employer stock was
contributed to your Plan account when the stock was worth $1,000
but the stock was worth $1,200 when you received it, you would
not have to pay tax on the $200 increase in value until you later
sold the stock.
You may instead elect not to have the special rule apply to the
net unrealized appreciation. In this case, your net unrealized
appreciation will be taxed in the year you receive the stock, unless
you roll over the stock. The stock (including any net unrealized
appreciation) can be rolled over to an IRA or another employer
plan either in a direct rollover or a rollover that you make yourself.
If you receive employer stock in a payment that qualifies as a
lump sum distribution, the special tax treabnent for lump sum
distributions described above (such as 5-year averaging) also may
apply. See IRS Fonn 4972 for additional infonnation on these
rules.
IV. SURViVING SlPOUSEStALTERNATE
lP A YIEIES AND OTHER BE~EFICIARIES
In general, the rules summarized above that apply to payments
to employees also apply to payments to surviving spouses of
employees and to spouses or fonner spouses who are "alternate
payees". You are an alternate payee if your interest in the Plan
results from a "qualified domestic relations order", which is an
order issued by a court, usually in connection with a divorce or
legal separation. Some of the rules summarized above also apply
to a deceased employee's beneficiary who is not a spouse.
However, there are some exceptions for payments to surviving
spouses, alternate payees and other beneficiaries that should be
mentioned.
If you are a surviving spouse, you may choose to have an
eligible rollover distribution paid in a direct rollover to an IRA or
paid to you. If you have the payment paid to you, you can keep it
or roll it over yourself to an IRA but you cannot roll it over to an
employer plan. If you are an alternate payee, you can have the
same choices as the employee. Thus, you can have the payment
paid as a direct rollover or paid to you. If you have it paid to you,
you can keep it or roll it over yourself to an IRA or to another
employer plan that accepts rollovers. If you are a beneficiary other
than the surviving spouse, you cannot choose a direct rollover, and
you cannot roll over the payment yourself.
If you are a surviving spouse, an alternate payee, or another
beneficiary, your payment is not subject to the additional 10% tax
described in section III above, even if you are younger than age 59
1/2.
If you are a surviving spouse, an alternate payee, or another
beneficiary, you may be able to use the special tax treatment for
lump sum distributions and the special rule for payments that
include employer stock, as described in section III above. If you
receive a payment because of the employee's death, you may be
able to treat the payment as a lump sum distribution if the
employee met the appropriate age requirements, whether or not
the employee had 5 years of participation in the Plan.
HOW TO OBTAiN ADDITIONAL INlFORMA nON
This notice summarizes only the federal (not state or local) tax
rules that might apply to your payment. The rules described above
are complex and contain many conditions and exceptions that are
not included in this notice. Therefore, you may want to consult
with a professional tax advisor before you take a payment of your
benefits from the Plan. Also, you can fmd more specific
infonnation on the tax treatment of payments from qualified retire-
ment plans in IRS Publication 575, Pension and Annuity Income,
and IRS Publication 590, Individual Retirement Arrangements.
These publications are available from your local IRS office or by
calling 1-800- TAX-FORMS.
APPLICATION FOR BENElFITS
(please print clearly or type)
Plan Name: Augusta Richmond County Money Purchase Plan Date:
As a Participant in the above Plan, I hereby request payment of my benefit as provided below:
1. Name:
Address: (Street or PO Box)
(City, State & Zip)
2. Reason for payment
[ ] Termination of employment (including retirement) Termination Date:
[ ] Attainment of age 70-1/2 (required minimum distribution, unless still working).
[ ] Termination of Plan.
[ ] Death.
[ ] Disability .
Social Security No.
3. Form of payment
[ ] Normal Form under the Plan.
[ ] Lump Sum.
4. Direct Rollover or Transfer:
[ ] I choose to have my benefit paid in a direct rollover (transfer) to:
[] My IRA
Name of IRA Account:
Account Number:
Name of Bank:
Address of Bank:
Bank ABA Number:
(if wire transfer)
[] Another Plan.
Name of Plan:
Name of Employer:
Address of Employer:
Trust Account Number: (if wire transfer)
NOTE: It is your obligation to insure that the Employer Plan named above will accept the transfer of
your benefit payment. Also, only taxable monies may be rolled into another Plan or an IRA. Any non-
taxable monies (after-tax) will be distributed to you.
6. [] I choose to have my benefit paid directly to me.
Date:
Signature of Participant
DISTRIBUTION FORMS
Enclosed is a distribution package for you to read and complete in order that your Money
Purchase Plan balance can be handled according to your wishes.
Your decision will have certain tax consequences, so please read the material carefully
and consult your tax advisor if you need further assistance.
You may take thirty (30) days to make your decision and then return the completed forms
to the plan administrator. You may, however, waive the 30-day period by returning the
signed Waiver and the Application for Benefits sooner.
Please return the signed Waiver (if applicable) and the Application for Benefits to:
Pension Service Company
1100 Circle 75 Pkwy.
Suite 320
Atlanta, GA 30339
Should you have any questions, please call Pension Service Company at (770) 952-5225
or (800) 736-7166.
W AJIVlElR OF 30-JDA Y 1LJIMJE lPJElRJIOJD FOlR
CONSJEN1LJING 1LO JDJIS1LlRm1U1LJION
The attached "NOTICE: Special Tax Rules On Distributions" explains, among other things, your
right to choose to have your plan benefits directly rolled over either to an IRA or another
qualified plan, or to have your benefits paid directly to you. If you choose to have your benefits
paid directly to you, 20% of the payment will automatically be withheld and sent to the IRS as
income tax withholding. You have a right to consider your decision of whether or not to elect a
direct rollover for at least 30 days from the date you receive the attached NOTICE. You can
waive the 3D-day period by filling in the enclosed APPLICATION FOR BENEFITS form,
indicating on the form whether you want your benefits directly rolled over to another plan or
IRA, or paid directly to you, and submitting the signed form to the plan administrator along with
this signed Waiver Form. The submission of your completed application before the end of the
3D-day waiting period will constitute a waiver of the period and your election may be
implemented in less than 30 days from the time you received this NOTICE. REMEMBER, you
lI1ave tllne rigllnt to cOllRsidlell" YOlllr decisiollll for a full 30 days from tll1e time YOlllll"cceive tlh1is
NOT][CE before malking aDD. electiolll ab01llt Y01llr bellRefits.
1. ][llRseri the date you receivedl tll1is Form in the (Date) space h.ere.
I received the "Notice: Special Tax Rules On Distributions" on (Date)
and have made an affirmative election on the "Application for Benefits" Form to either make or
not make a direct rollover of my benefits to an IRA or another qualified plan. I hereby waive my
right to a 3D-day period in which to consider the decision of whether or not to elect a direct
rollover.
2. :!Print your DD.ame, sign and date. Return the Form to tine plan admillllistrator.
(Date)
Printed Name of Participant or Beneficiary
Signature of Participant or Beneficiary
IRS EXPLANATION OF DIRECT ROLLOVER, WITHHOLDING AND TAX RULES
IMPORTANT WARNING: The Small Business Job Protection Act, enacted on August 20, 1996, makes
numerous changes to the pension law requirements. The explanation below, which is required by the IRS, is
no longer accurate in all respects on account of these new laws. Please consult your tax advisor regarding
your distribution.
This notice contains important information you will need
before you decide how to receive your benefits from the Money
Purchase Plan (the "Plan").
SUMMARY
A payment from the Plan that is eligible for "rollover" can be
taken in two ways. You can have all or any portion of your
paYl!lent either (1) PAID IN A "DIRECT ROLLOVER" or (2)
PAID TO YOU. A rollover is a payment of your Plan benefits to
your individual retirement aITa!l~ement (IRA) or to another
employer plan. This choice will affect the tax you owe.
If you choose a DIRECT ROLLOVER:
Your payment will not be taxed in the current year and
no income tax will be withheld.
Your payment will be made directly to your IRA or, if
you choose, to another employer plan that accepts your
rollover.
Your payment will be taxed later when you take it out of
the IRA or the employer plan.
If you choose to have your Plan benefits PAID TO YOU:
You will receive only 80% of the payment, because the
Plan administrator is required to withhold 20% of the
payment and send it to the IRS as income tax with-
holding to be credited against your taxes.
Your payment will be taxed in the current year unless
you roll it over. You may be able to use special tax rules
that could reduce the tax you owe. However, if you re-
ceive the payment before age 59 1/2, you also may have
to pay an additional 10% tax, with certain exceptions (see
below)
You can roll over the payment by paying it to your IRA
or to another employer plan that accepts your rollover
within 60 days of receiving the payment. The amount
rolled over will not be taxed until you take it out of the
IRA or employer plan.
If you want to roll over 100% of the payment to an IRA
or an employer plan, you must find other money to
replace the 20% that was withheld. If you roll over only
the 80% that you received, you will be taxed on the 20%
that was withheld and that is not rolled over.
i. PAYMENTS THAT CAN AND
CANNOT BE ROLLED OVER
Payments from the Plan may be "eligible rollover distri-
butions." This means that they can be rolled over to an IRA or to
another employer plan that accepts rollovers. Your Plan
administrator should be able to tell you what portion of your
payment is an eligible rollover distribution. The following types of
payments cannot be rolled over:
Non-Taxable Payments. In general, only the "taxable
portion" of your payment is an eligible rollover distribution. If you
have made "after-tax" employee contributions to the Plan, these
contributions will be non-taxable when they are paid to you, and
they cannot be rolled over. (After-tax employee contributions
generally are contributions you made from your own pay that
were already taxed.)
Payments Spread Over Long Periods. You cannot roll over a
payment if it is part of a series of equal (or almost equal) payments
that are made at least once a year and that will last for:
your lifetime (or your life expectancy) or
your IifetiIpe and your beneficiary's lifetime (or life
expectancies), or
a period of ten years or more.
Required Minimum Payments. Beginning in the year you reach
age 70 1/2, a certain portion of your payment cannot be rolled
over because it is a "required minimum payment" that must be
paid to you.
II. ][)IRECT ROLLOVER
You can choose a direct rollover of all or any portion of your
payment that is an "eligible rollover distribution," as described
above. In a direct rollover, the eligible rollover distribution is paid
directly from the Plan to an IRA or another employer plan that
accepts rollovers. If you choose a direct rollover, you are not taxed
on a payment until you later take it out of the IRA or employer
plan.
Direct Rollover to an IRA. You can open an IRA to receive the
direct rollover. (The term "IRA," as used in this notice, includes
individual retirement accounts and individual retirement annu-
ities.) If you choose to have your payment made directly to an
IRA, contact an IRA sponsor (usually a [mancial institution) to
find out how to have your payment made in a direct rollover to an
IRA at that institution. If you are unsure of how to invest your
money, you can temporarily establish an IRA to receive the
payment. However, in choosing an IRA, you may wish to consider
whether the IRA you choose will allow you to move all or a part
of your payment to another IRA at a later date, without penalties
or other limitations. See IRA Publication 590, Individual
Retirement Arrangements, for more information on IRAs
(including limits on how often you can roll over between IRAs).
Direct Rollover to a Plan. If you are employed by a new
employer that has a plan, and you want a direct rollover to that
plan, ask the administrator of that plan whether it will accept your
rollover. If your new employer's plan does not accept a rollover,
you can choose a direct rollover to an IRA.
Direct Rollover of a Series of Payments. If you receive eJjgible
rollover distributions that are paid in a series for less than ten
years, your choice to make or not make a direct rollover for a
payment will apply to all later payments in the series until you
change your election. You are free to change your election for any
later payment in the series.
III. PAYMENT PAID TO YOU
If you have the payment made to you, it is subject to 20%
income tax withholding. The payment is taxed in the year you
receive it unless, within 60 days, you roll it over to an IRA or
,.
,
another plan that accepts rollovers. If you do not roll it over,
special tax rules may apply.
Income Tax Withholding:
Mandatory Withholding. If any portion of the payment to you is
an eligible rollover distribution, the Plan is required by law to
withhold 20% of that amount. This amount is sent to the IRS as
income tax withholding. For example, if your eligible rollover
distribution is $10,000, only $8,000 will be paid to you because
the Plan must withhold $2,000 as income tax. However, when you
prepare your income tax return for the year, you will report the full
$10,000 as a payment from the Plan. You will report the $2,000 as
tax withheld, and it will be credited against any income tax you
owe for the year.
Voluntary Withholding. If any portion of your payment is not an
eligible rollover distribution but is taxable, the mandatory
withholding rules described above do not apply. In this case, you
may elect not to have withholding apply to that portion. To elect
out of withholding, ask the Plan administrator for the election
fonn and related infonnation.
Sixty-Day Rollover Option. If you have an eligible rollover
distribution paid to you, you can still decide to roll over all or part
of it to an IRA or another employer plan that accepts rollovers. If
you decide to roll over, you must make the rollover within 60 days
after you receive the payment. The portion of your payment that is
rolled over will not be taxed until you take it out of the IRA or the
employer plan.
You can roll over up to 100% of the eligible rollover
distribution, including an amount equal to the 20% that was
withheld. If you choose to roll over 100%, you must find other
money within the 60-day period to contribute to the IRA or the
employer plan to replace the 20% that was withheld. On the other
hand, if you roll over only the 80% that you received, you will be
taxed on the 20% that was withheld.
Example: Your eligible rollover distribution is $10,000, and you
choose to have it paid to you. You will receive $8,000 and $2,000
will be sent to the IRS as income tax withholding. Within 60 days
after receiving the $8,000, you may roll over the entire $10,000 to
an IRA or employer plan. To do this, you roll over the $8,000 you
received from the Plan, and you will have to fmd $2,000 from
other sources (your savings, a loan, etc.). In this case, the entire
$10,000 is not taxed until you take it out of the IRA or employer
plan. If you roll over the entire $10,000, when you file your
income tax return you may get a refund of the $2,000 withheld.
If, on the other hand, you roll over only $8,000, the $2,000 you
did not roll over is taxed in the year it was withheld. When you file
your income tax return you may get a refund of part of the $2,000
withheld. (However, any refund is likely to be larger if you roll
over the entire $10,000).
Additional 10% Tax /fYou Are Under Age 59 1/2. If you receive
a payment before you reach age 59 1/2 and you do not roll it over,
then, in addition to the regular income tax, you may have to pay
an extra tax equal to 10% of the taxable portion of the payment.
The additional10% tax does not apply to your payment if it is (I)
paid to you because you separate from service with your employer
during or after the year you reach age 55, (2) paid because you
retire due to disability, (3) paid to you as equal (or almost equal)
payments over your life or life expectancy (or your and your
beneficiary's lives or life expectancies), or (4) used to pay certain
medical expenses. See IRS Fonn 5329 for more infonnation on
the additional 10% tax.
Special Tax Treatment. If your eligible rollover distribution is
not rolled over, it will be taxed in the year you receive it.
However, if it qualifies as a "lump sum distribution", it may be
eligible for special tax treatment. A lump sum distribution is a
payment, within one year, of your entire balance under the Plan
(and certain other similar plans of the employer) that is payable to
you because you have reached 59 1/2 or have separated from
service with your employer (or, in the case of a self-employed
individual, because you have reached age 59 1/2 or have become
disabled). For a payment to qualify as a lump sum distribution,
you must have been a participant in the Plan for at least 5 years.
The special tax treatment for lump sum distribution is described
below.
Five-Year Averaging. If you receive a lump sum distribution
after you are age 59 1/2, you may be able to make a one-time
election to figure the tax on the payment by using "5-year
averaging". Five-year averaging often reduces the tax you owe
because it treats the payment much as if it were paid over 5 years.
Ten- Year Averaging /f You Were Born Before January I, 1936.
If you receive a lump sum distribution and you were born before
January I, 1936, you can make a one-time election to figure the
tax on the payment by using "IO-year averaging" (using 1986 tax
rates) instead of 5-year averaging (using current tax rates). Like
the 5-year averaging rules, I O-year averaging often reduces the tax
you owe.
Capital Gain Treatment /f You Were Born Before January J,
J936. In addition, if you receive a lump sum distribution and you
were born before January 1, 1936, you may elect to have the part
of your payment that is attributable to your pre-1974 participation
in the Plan (if any) taxed as long-tenn capital gain at a rate of
20%.
There are other limits on the special tax treatment for lump sum
distributions. For example, you can generally elect this special tax
treatment only once in your lifetime, and the election applies to all
lump sum distributions that you receive in that same year. If you
have previously rolled over a payment from the Plan (or certain
other similar plans of the employer), you cannot use this special
tax treatment for later payments from the Plan. If you roll over
your payment to an IRA, you will not be able to use this special
tax treatment for later payments from the IRA. Also, if you roll
over only a portion of your payment to an IRA, this special tax
treatment is not available for the rest of the payment. Additional
restrictions are described in IRS Fonn 4972, which has more
infonnation on lump sum distributions and how you elect the
special tax treatment.
Employer Stock or Securities. There is a special rule for a
payment from the Plan that includes employer stock (or other
employer securities). To use this special rule, (1) the payment
must qualify as a lump sum distribution, as described above (or
would qualify except that you do not yet have 5 years of
participation in the Plan), or (2) the employer stock included in the
payment must be attributable to "after-tax" employee
contributions, if any. Under this special rule, you may have the
option of not paying tax on the "net unrealized appreciation" of the
stock until you sell the stock. Net unrealized appreciation
generally is the increase in the value of the employer stock while it
was held by the Plan. For example, if employer stock was
contributed to your Plan account when the stock was worth $1,000
but the stock was worth $1,200 when you received it, you would
not have to pay tax on the $200 increase in value until you later
sold the stock.
You may instead elect not to have the special rule apply to the
net unrealized appreciation. In this case, your net unrealized
appreciation will be taxed in the year you receive the stock, unless
you roll over the stock. The stock (including any net unrealized
appreciation) can be rolled over to an IRA or another employer
plan either in a direct rollover or a rollover that you make yourself.
If you receive employer stock in a payment that qualifies as a
lump sum distribution, the special tax treatment for lump sum
distributions described above (such as 5-year averaging) also may
apply. See IRS Fonn 4972 for additional infonnation on these
rules.
:O:V. SUlRViVING SPOUSESI..ALTERNATE
P A YElES AND OTHER BE~EFICIARIES
In general, the rules summarized above that apply to payments
to employees also apply to payments to surviving spouses of
employees and to spouses or fonner spouses who are "alternate
payees". You are an alternate payee if your interest in the Plan
results from a "qualified domestic relations order", which is an
order issued by a court, usually in connection with a divorce or
legal separation. Some of the rules summarized above also apply
to a deceased employee's beneficiary who is not a spouse.
However, there are some exceptions for payments to surviving
spouses, alternate payees and other beneficiaries that should be
mentioned.
If you are a surviving spouse, you may choose to have an
eligible rollover distribution paid in a direct rollover to an IRA or
paid to you. If you have the payment paid to you, you can keep it
or roll it over yourself to an IRA but you cannot roll it over to an
employer plan. If you are an alternate payee, you can have the
same choices as the employee. Thus, you can have the payment
paid as a direct rollover or paid to you. If you have it paid to you,
you can keep it or roll it over yourself to an IRA or to another
employer plan that accepts rollovers. If you are a beneficiary other
than the surviving spouse, you cannot choose a direct rollover, and
you cannot roll over the payment yourself.
If you are a surviving spouse, an alternate payee, or another
beneficiary, your payment is not subject to the additional 10% tax
described in section III above, even if you are younger than age 59
112.
If you are a surviving spouse, an alternate payee, or another
beneficiary, you may be able to use the special tax treatment for
lump sum distributions and the special rule for payments that
include employer stock, as described in section III above. If you
receive a payment because of the employee's death, you may be
able to treat the payment as a lump sum distribution if the
employee met the appropriate age requirements, whether or not
the employee had 5 years of participation in the Plan.
HOW TO 081' AIIN ADD!TllONAL INlFORMA TlON
This notice summarizes only the federal (not state or local) tax
rules that might apply to your payment. The rules described above
are complex and contain many conditions and exceptions that are
not included in this notice. Therefore, you may want to consult
with a professional tax advisor before you take a payment of your
benefits from the Plan. Also, you can fmd more specific
infonnation on the tax treatment of payments from qualified retire-
ment plans in IRS Publication 575, Pension and Annuity income,
and IRS Publication 590, Individual Retirement Arrangements.
These publications are available from your local IRS office or by
calling 1-800- TAX-FORMS.
APPlLICATION lFOR BENElFITS
(please print clearly or type)
Plan Name: Augusta Richmond County Money Purchase Plan Date:
As a Participant in the above Plan, I hereby request payment of my benefit as provided below:
1. Name:
Address: (Street or PO Box)
(City, State & Zip)
2. Reason for payment
[ ] Termination of employment (including retirement) Tennination Date:
[ ] Attainment of age 70-1/2 (required minimum distribution, unless still working).
[ ] Termination of Plan.
[ ] Death.
[ ] Disability.
Social Security No.
3. Form of payment
[ ] Normal Form under the Plan.
[ ] Lump Sum.
4. Direct Rollover or Transfer:
[ ] I choose to have my benefit paid in a direct rollover (transfer) to:
[] My IRA
Name of IRA Account:
Account Number:
Name of Bank:
Address of Bank:
Bank ABA Number:
(if wire transfer)
[] Another Plan.
Name of Plan:
Name of Employer:
Address of Employer:
Trust Account Number: (if wire transfer)
NOTE: It is your obligation to insure that the Employer Plan named above will accept the transfer of
your benefit payment. Also, only taxable monies may be rolled into another Plan or an IRA. Any non-
taxable monies (after-tax) will be distributed to you.
6. [] I choose to have my benefit paid directly to me.
Date:
Signature of Participant
o
:11: ~ N~ !t}/.~ ('~ frO.~ ~~\\ (",VI r fi J' f!~:
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. ! '.~'I ~,. , : '< u\ ~" ,.,
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C!l
NATIONWIDE LIFE INSURANCE COMPANY
Home Ollice . Columbus, Ohio
(Hereinafter Called the Company)
, ".7',r--. T;"'\'" "( 1-'\ D-
.\ ,,1""..1 ),1_..
I
I
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.~. '0_..- _
J!JL. 0 6 1998
c: III . . . . a II . . . 0 . . . . e I . . . . . . . (l . . . . . . . . . III C . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . I . . . . . . . . III . . . . . . . . . . . . . . . . . . . . . . . . . . .
In consideration of the Application for this Contract made by
lIrusfte19(s) COl~ fch19 ,
~ ~~8 Al!.ngl!.n$~ MOIl'll(9)f [pll!.nIi'(CIhl~S19 fl~~1l'll 1I1i'l!.nS~
(The Contractholder)
and of the payment of Deposits as provided, the Company agrees to pay, in
accordance with and subject to the terms and conditions of this Contract, the benefits
set forth with respect to each Participant.
Effective Date of Contract:
July 01, 1998
Issue Date of Contract:
June 22, 1998
Jurisdiction:
Georgia
o In witness whereof the Company has caused this Contract to be executed and duly
attested on the Issue Date shown above.
/~fl~
President
~uat
Attest~ ~
Secretary
All COlNlll~CTlUlAl VALUES BASED ONlllIHlE ~INIVIE~lI~EINIT RIESlUJlll~ Of /A
~IEIP'/ARA 11 IE /ACCOUlNIlI ~INIClUDIE[Q) ~lNIl1IHUS COlNlll~CT ARE V /AR~AIBl[E (~/A Y
~NCRlEASIE OR IOlIECRIE/ASlE) /AlNlfDl /ARE 1NI01l GlUJARANlIlElED AS 110 IDOllAR
/AMOU~lI. -
GROUI?' ~IEI?'ARA lIfE ACCOU~lr ANINIUnrV COlNllrfRAC1l' NOl. GAal?' lUJ8<<>>1
. 0 IF~XIED DOLLAR AN~U~lI~lES O~L y
1NI0INlaI?'ARlI~e~PA l~INIG
A~INIUJ/Al /AIfilIPUC/A lI~Ob\!l Of [EXI?IER~IENCfE IRA lI~NG fPllAlNI
APO-2243
VARIABLE
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CD
TABLE OF CONTENTS
ARTICLE
PAGE
CONTRACT SUMMARY PAGE....... ..... ...................... ..... .................... ......... 1
I. DEFINITIONS. ................................ ..... ....... .......... ...... .......... ........... ..............4
~1. VARiABLE FUND
2.1 Variable Fund .................................................................................. 6
2.2 Amount Of Variable Fund................................................................. 6
2.3 Units.... .......... ................... ................... .......... ....................... ............6
2.4 Unit Value. ........ ................. .... ............. .......... ....... ....... ......................6
2.5 Valuation Factor.. ..... ..... ........ ....... .............. ................ .... ..... .............6
m. DlEI?OS~TS
3.1 Deposits... ...... ............. ...... .................. ..... ..... ............... ........ ............ 8
3.2 Crediting Of Deposits.... .................... ....... ...................... ..... .............8
IV. EXCHANGES
4.1 Exchange To A Companion Contract Or A Fund ............................. 9
4.2 Exchanges From A Companion Contract......................................... 9
V. PAYMENT OF BENEFITS
5.1 Benefit Payments .............................................................................10
5.2 Purchase And Amount Of Annuity.................................................... 11
5.3 'Small Annuities .......................................:........................................11
5.4 Facility Of Payment.......................................................................... 12
5.5 Misstatements And Adjustments ...................................................... 12
5.6 Cash Payments Or Loans ..................................................................:.12
VI.
CHARGES
6.1 Administration Charge........ ................................ .............................. 14
6.2 Contract Charge.. ......... .............. ...... .... ................ ........ ........ ............ 14
6.3 Asset Management Charge.............................................. .......... ...... 14
6.4 Contingent Deferred Sales Charge .................................................. 14
6.5 Other Expense Charges......................... ........................... .......... ..... 15
6.6 Other Expense Withdrawals............................................................. 15
6.7 Payment Of Charges...... .......................... ........................ .......... ...... 15
6.8 Premium Tax .............. ............ ..... ..... ........ ....... .................. ............... 15
VARIABLE
o
o
o
TABLE OF CONTENTS
(Continued)
ARTiCLE
PAGE
VU. PAYMENTS UPON TERMINATION OF PLAN - CONTRACT OR REDIUCTION IN
NUMBER OF PARTICIPANTS
7.1 Payments Upon Termination Of Plan Or Reduction
In Number Of Participants ............... ..... ......... ................ ........ ........... 16
7 .2 Termination Of Contract................................................................ ... 16
VIID. TRANSFERS
8.1 Notice Of Transfer And Transfer Payments.......... ....... .................... 17
8.2 Variable Fund Unit Cancellations And Transfer Payments .............. 17
IX. GENERAL PROVISIONS
9.1 Guarantees And Change Of Contract.............................................. 18
9.2 Contractholder................................. ................................ ................. 19
9.3 Communication And Notification...................................................... 19
9.4 Place Of Payment-Currency ........................................................... 20
9.5 Certifi cates. .. . .. .. . .. . .. .. . .. . . . .. .. .. . .. . . . .. .. . .. .. . . . .. .. .. .. . . . . . . . .. . .. .. .. .. . .. .. .. .. . . . ... 20
9.6 Beneficiary-Settlement Options ...................................................... 20
9.7 Experience Rate Credits.................................................................. 21
9.8 Assignment.................. ..................................................................... 21
9.9 Information--Records ....................................................................... 21
9.10 Entire Contract-Construction.. .... .... .... ....... ... ......... .......... ... ..... ........21
APPLICATION FOR AND ACCEPTANCE OF GROUP ANNUITY CONTRACT
VARIABLE
CO~lRAC1SUMMA~Y~AGE
Administration Charge:
None.
Asset Management Charge:
"GAalP lIJl80i'
1.10% for Funds selected by the Contractholder from
Primary Funds on the Application. This represents a
0.40% reduction in the standard Asset Management
Charge of 1.50%.
1.20% for Funds selected by the Contractholder from
Optional Funds on the Application. This represents a
0.30% reduction in the standard Asset Management
Charge of 1.50%.
The Asset Management Charge will be reviewed,
and changed if appropriate, on the first Contract
Anniversary occurring no earlier than six months from
the Effective Date, and on each subsequent Contract
Anniversary. The sum of amounts in this Contract and
the Companion Contract(s), calculated by averaging
the beginning balances for such contracts for the two
month period prior to the month of the Contract
Anniversary Date, will determine whether or not a
change in the Asset Management Charge applies, per
the following schedule:
.'i
"
.
Sum of Amounts in
this Contract and the
Companion Contract(s)
$ 750,000 - $ 999,999
$ 1,000,000 - $ 1,499,999
$ 1,500,000 - $ 1,999,999
$ 2,000,000 - $ 2,249,999
$ 2,250,000 - $ 2,499,999
$ 2,500,000 - $ 2,749,999
$ 2,750,000 $ 3,124,999
$ 3,125,000 - $ 3,499,999
$ 3,500,000 - $ 4,124,999
$ 4,125,000 - $ 4,874,999
$ 4,875,000 - $ 5,749,999
$ 5,750,000 - $ 6,999,999
$ 7,000,000 - $ 8,499,999
Reduction in the
Standard Asset
Management
Charge for Primary
0.35%
0.40%
0.45%
0.51%
0.53%
0.55%
0.57%
0.59%
0.61%
0.63%
0.65%
0.67%
0.69%
-1-
Reduction in the
Standard Asset
Management
Charge for Optional
0.30%
0.30%
0.30%
0.31%
0.33%
0.35%
0.37%
0.39%
0.41%
0.43%
0.45%
0.47%
0.49%
VARIABLE
~.I''i'i~i
t l:';t=-=
....;....1
.':1-'
h
r"
.
COlNllrRACT $lUJlliiI~A~V I?AGIE
GAA~ l!.B801
Sum of Amounts in
this Contract and the
Companion Contract(s)
$ 8,500,000 - $ 9,999,999
$ 10,000,000 - $ 11,499,999
$ 11,500,000 - $ 12,999,999
$ 13,000,000 - $ 14,999,999
$ 15,000,000 - $ 16,999,999
$ 17,000,000 - $ 18,999,999
$ 19,000,000 - $ 21,999,999
$ 22,000,000 - $ 24,999,999
$ 25,000,000 - $ 29,999,999
Reduction in the
Standard Asset
Management
Charge for Primary
0.71%
0.73%
0.75%
0.77%
0.79%
0.80%
0.81%
0.82%
0.83%
Reduction in the
Standard Asset
Management
Charge for Optional
0.51%
0.53%
0.55%
0.57%
0.59%
0.60%
0.61%
0.62%
0.63%
If the sum of the amounts in this Contract an~ the Companion Contract(s)
decreases to less than $750,000 during any Contract Year, the Asset
Management Charge will be determined in accordance with uniform
procedures applicable to all contracts of this class. Any change in the Asset
Management Charge will be effective on the next Contract Anniversary.
Companion Contract(s):
GA-P U806.
Contingent Deferred
Sales Charge:
Contract Year
1
2
3
4
5
6
7
8
9
Thereafter
Deferred Sales
Charge Percentage
3.25%
3.25%
3.25%
3.00%
2.50%
2.00%
1.75%
1.25%
0.75%
0.00%
The Contingent Deferred Sales Charge Percentage shall be applied to the
dollar value of units canceled as provided in this Contract.
Contract Anniversary:
January 01, 2000, and each January 01 thereafter.
Contract Charge:
None.
-2-
VARIABLE
o
o
o
Creditable Percentage:
Crediting Deposits:
Plan:
Processing Exchanges:
COli\!llMC1r SlUJM~AIRV f?AGIE
GA-!? lUJ801
100%
Each Deposit, as described in Article III, will be
credited to the applicable Fund or Funds no later than
the third !Business Day following its receipt.
1998 Augusta Money Purchase Plan.
Exchanges, as described in Article IV, will be
made within three Business Days following receipt
of the Contractholder's written request.
Processing Annuity Purchases: Annuity Purchases, as described in Article V, will be
made within 15 Business Days following receipt of the
the Contractholder's written request.
Processing Cash Payments:
Processing Payments Upon
Plan Termination or Reduction
in Number of Participants:
Processing Transfers:
Purchase Rate Basis:
Percentage Reduction in
Number of Participants as
defined in Section 1.13:
Cash Payments, as described in Article V, will be made
within five Business Days following receipt of the
Contractholder's written request.
Benefit Payments to each affected Participant, as
described in Article VII, will be made within 30
calendar days following receipt of the Contractholder's
written req uest.
Transfers, as described in Article VIII, will be made
within 12 Business Days following receipt of the
Contractholder's written request.
1983 Table A (Male), with Annuitant ages set back 10
years and survivor Annuitant ages set back 5 years;
3.0% interest; and 4.0% loading.
15%
-3-
VARIABLE
o
o
o
ARTICLE I - DEFIN~TIONS
1.1 ANNUITANT - a person receiving an Annuity.
1.2 . ANNUITY - any benefit in the form of a series of payments due in accordance with the
Plan, payable under this Contract.
1.3 BENEFIT PAYMENT - a distribution that is permitted by the Plan on behalf of a
Participant.
1.4 BUSINESS DAY - each day that the Company's Home Office and the applicable
financial institutions for purposes of processing financial transactions are open for
business. All requests for transactions that are received after 1 :00 p.m. Columbus,
Ohio time will be considered to be received on the next Business Day.
1.5 CASH PAYMENT - a form of Benefit Payment other than an Annuity purchased under
this Contract.
1.6 CONTRACT YEAR - a period beginning on the Effective Date or any Contract
Anniversary and ending on the day immediately preceding the next following Contract
Anniversary.
1.7 EMPLOYER - any organization reported to the Company by the Contractholder for
inclusion under this Contract, some or all of whose employees are covered under the
Plan.
1.8 FUND - a registered investment management company (mutual fund), specified in the
Application, in which assets of a Series will be invested.
1.9 FUNDING SUCCESSOIR - the Plan's and successor plan's trustee and any financial
institution providing an investment option to the Plan.
1.10 OFfiCERS ~ as defined in Section 416 of the Internal Revenue Code and
Regulations. If an individual is considered to be an Officer at any time during the
term of this Contract, the individual will always be considered as such for purposes of
this Contract.
1.11 OWNERS - as defined in Section 416 of the Internal Revenue Code and Regulations.
For purposes of this Contract, an Owner is defined as a 10% Owner. If an individual
is considered to be an Owner at any time during the term of this Contract, the
individual will always be considered as such for purposes of this Contract.
1.12 PARTICIPANT - a person for whom benefits are to be provided under this Contract,
in accordance with the Plan, as reported by the Contractholder.
-4-
VARIABLE
o
o
o
ARTICLE I - DEFINITIONS
(Continued)
1.13
RIEDUCT~ON IN NUMBER OF PARTICIPANTS - any reduction of more than the
percentage, as set forth on the Contract Summary Page, of the number of Partici-
pants under the Plan since the Effective Date of the Contract which is the result of
any change in the Plan or action taken by the Employer.
1. ~4 SERIES - sub-accounts of the Separate Account to which specific Fund shares are
allocated and for which units are separately maintained.
1.15 SEPARATE ACCOUNT - the "Nationwide Qualified Plans Variable Account" is a
segregated investment account maintained by the Company with respect to a portion
of its assets in connection with this Contract and certain other Group Annuity
Contracts.
Assets of the Separate Account equivalent to the reserve for this Contract will be
invested in shares of the specific Funds elected in the Contract Application.
The assets of the Separate Account will be held for the sole benefit of all contracts
which provide for the dollar amount of the contract values to vary to reflect investment
results of the Account.
All income, gains, losses, and expenses, whether or not realized from assets held in
the Separate Account for each Series, shall be credited to or charged against the
Separate Account Series without regard to the other income, gains, or losses of the
Company. Assets of the Separate Account may not be used by the Company to
satisfy the liabilities of the general account.
- 5-
VARIABLE
o
o
o
ARTICLE II - VARIABLE FUND
2. ~ VARIABLE FUND
The Company shall establish and maintain a Variable Fund. The Company shall
provide to the Contractholder an annual accounting of all financial transactions
occurring with respect to this Contract.
2.2 AMOUNT OIF VARBABLE FUND
The amount of the Variable Fund in Units, as of any date, is equal to the aggregate of
the units credited to each Series in accordance with Section 2.3, less any Units
cancelled in accordance with Articles IV, V, VI, VII, and VIII. The amount of the
Variable Fund, in dollars, as of any date, is equal to the aggregate of the product of
the number of units in the Series and corresponding unit value, as of such date. The
dollar value of the Variable Fund is not guaranteed as to either principal or rate of
investment return.
2.3
UNITS
All deposits made to a Fund, exchanges from a Fund, and exchanges from a
Companion Contract will be applied to credit units. The number of units credited is
equal to the quotient of the amount applied divided by the applicable Series unit
value on the applicable Business Day.
2.4
UNIT VALUE
The unit value of any Business Day is equal to the dollar value of one unit for the
Business Day.
The unit value for any Business Day is determined as of the end of the Business Day
by multiplying the Fund's Valuation Factor for the Business Day by the Series' unit
value for the immediately preceding Business Day.
2.5 VALUATION FACTOR
The Valuation Factor represents a means of reflecting, in the unit value, the effective
investment return of a Series in the Separate Account. In determining the effective
investment return, the Company will take into account the investment income and
market value changes after provision for taxes applicable to contracts of this class
arising from the operation of such Series.
-6-
VARIABLE
o
o
o
ARTICLE II - VARIABLE FUND
(Continued)
2.5
VALUATION FACTOR (CoB1ltonued)
The Valuation Factor for any Business Day is equal to the quotient of (a) divided by
(b), where:
(a) is the dollar amount at the end of the Business Day resulting, after provision for
the taxes described in the preceding paragraph and the Asset Management
Charge, as set forth on the Contract Summary Page, from $1,000 in the Series
at the end of the immediately preceding Business Day, and
(b) is $1,000.
The aggregate of the amounts by which the Series is reduced each year for taxes
shall be deducted to the extent possible from the Series investment income, and any
balance will be deducted from the principal of the Account.
-7-
VARIABLE
o
o
o
ARTICLE III - DEPOSITS
3.1 DEPOSITS
The Contractholder may make Deposits to the Company in such amount as may be
determined by the Contractholder.
3.2 CREDITING OF DEPOSITS
The Contractholder shall advise the Company in writing of a Fund or Funds to which
each Deposit is to be credited. The Company reserves the right to limit the number of
Funds selected by the Contractholder. With Company approval, the Contractholder
may add or delete Funds by submitting written request to the Company.
Each Deposit, multiplied by the Creditable Percentage set forth on the Contract
Summary Page, will be credited to the applicable Fund or Funds as described in the
Crediting Deposits provision set forth on the Contract Summary Page.
-8-
VARIABLE
o
o
o
ARTICLE IV - EXCHANGES
4.1 EXCHANGE TO A COMPANION CONTRACT OR A FUND
The Contractholder may make an unlimited number of exchanges from a Fund to a
Companio!1 Contract or to another Fund. Exchanges may be subject to limitations
imposed by a Fund or a Companion Contract, if applicable.
Exchanges shall be made by cancelling a number of Units equal to the quotient of the
amount to be exchanged divided by the Unit Value on the exchange date and
crediting the amount to the Companion Contract or to a Fund, in accordance with
Section 2.3. Exchanges shall be completed as described in the Processing
Exchanges provision set forth on the Contract Summary Page.
4.2 EXCHANGES FROM A COMPAN!ON CONTRACT
The Contractholder may exchange amounts into this Contract from a Companion
Contract. Limitations may be imposed by the Companion Contract.
Any Exchange to be made in accordance with this section shall be made by applying
the amount received to credit units, in accordance with Section 2.3, in the designated
Fund. Exchanges shall be completed as described in the Processing Exchanges
provision set forth on the Contract Summary Page.
-9-
VARIABLE
o
o
CD
ARTICLE V - PAYMENT OF BENEFITS
5.1 BENEFIT PAYMENTS
Subject to the other provisions of this Contract, upon written notice from the
Contractholder, the Company shall purchase Annuities or make Cash Payments in
such manner and amounts specified by the Contractholder. The Contractholder may
request anyone of the fallowing Annuity forms on behalf of a Participant:
(a) Straight Life Form - This form of Annuity provides payments during the lifetime
of the Annuitant. Payments will end with the last payment made on or
preceding the Annuitant's date of death.
(b) Joint and Survivor Form - This form of Annuity provides periodic payments dur-
ing the joint lifetime of the Annuitant and the survivor Annuitant. Periodic pay-
ments to the Annuitant will end with the last periodic payment made preceding
the Annuitant's death. Upon the Annuitant's death, periodic payments in the
amount of 50%, 66-2/3%, 75%, or 100% (as elected by the Annuitant) of the
periodic payments payable to the Annuitant, will be continued to the survivor
Annuitant, if living. Periodic payments will terminate with the last periodic
payment made preceding the later of the date of death of the Annuitant and the
survivor Annuitant.
(c) Life With Period Certain Form - This form of Annuity provides payments during
the lifetime of the Annuitant. If the death of the Annuitant occurs before the
Annuitant has received the specified number of payments (as elected by the
Annuitant), the payments remaining will be paid to a Beneficiary designated by
the Annuitant. If no Beneficiary has been designated or if the death of the
designated Beneficiary occurs before the Annuitant and Beneficiary have
received the total number of payments due, the commuted value of the
payments remaining will be paid in a single sum. Such payment will be paid to
the estate of the last to die of the Annuitant and the designated Beneficiary.
Annuity purchases and Cash Payments may be made on any form mutually agreeable
between the Company and the Contractholder, in accordance with the provisions of
the Plan. The Company will purchase the Annuity or provide the Cash Payment as
described in the Processing Annuity Purchases and Processing Cash Payments
provisions set forth on the Contract Summary Page.
-10 -
VARIABLE
o
o
(})
5.3
ARTICLE V - PAYMENT OF BENEFITS
(Continued)
5.2
PURCHASE AND AMOUNT OF ANNUITY
The Company will purchase an Annuity by cancelling a number of units in the
designated Fund or Funds equal to the quotient of the amount to be applied to
purchase the Annuity divided by the applicable unit value on the date of cancellation.
The amount of the Annuity will be determined by dividing the dollar value of the units
cancelled, less the amount of state premium tax, if any, by the appropriate purchase
rate, which may not be less favorable than the purchase rate determined in
accordance with the Purchase Rate Basis set forth on the Contract Summary Page.
If the number of units requested to be cancelled plus any applicable expense charges
and taxes exceed the number therein, the amount of the Annuity will be limited to that
which can be purchased by the amount of the Variable Fund remaining after
withdrawal of any tax or charges specified in Article VI.
SMALL ANNUITIES
If the amount to be applied to purchase an Annuity is less than $3,500, the Company
may, instead of purchasing an Annuity, make a Cash Payment to the Participant,
Beneficiary, or Contractholder. The Cash Payment will be equal to the amount to be
applied, less any tax or charges specified in Article VI.
DC
- 11 -
VARIABLE
.
.
.
5.6
ARTICLE V - PAYMENT OF BENEFITS
(Continued)
5.4
FACILITY OF PAYMENT
If any Annuitant is, in the judgment of the Company, legally, physically, or mentally
incapable of personally receiving any payment due under this Contract, the Company
may make payment or any part thereof to another person, persons, or institutions
who, in the opinion of the Company, are then maintaining or have custody of the
Annuitant, until claim is made by the duly appointed guardian or other legal
representative of the Annuitant. The payment shall constitute a full discharge of the
liability of the Company to the extent thereof. Upon notice to the Company of the
appointment of a legal guardian or other legal representative, the Company will pay
amounts only to the guardian or other legal representative.
5.5
MISSTATEMIENTS AND ADJUSTMENTS
If the age or any other relevant fact relating to any Annuitant is found to have been
misstated, the amount of Annuity payments payable by the Company will be adjusted,
unless some other adjustment, satisfactory to the Contractholder and the Company is
made. The amount of the adjustment will be made on the basis of the corrected
information. The adjustment will be made without changing the date of the first
payment. Any adjustment made shall be conclusive on any person affected by the
adjustment. The dollar amount of any underpayment made by the Company will be
paid in full with the next payment due. The dollar amount of any overpayment by the
Company will be deducted to the extent possible from the next payment or payments.
CASH PAYMENTS OIR lOANS
The Contractholder may notify the Company in writing that a Cash Payment or loan
has become payable in accordance with the Plan. The Contractholder must specify
the amount payable by the Company from a Fund or Funds. The Company shall
cancel the number of units equal to the quotient of the amount divided by the
applicable unit value on the date of cancellation, and shall pay the amount withdrawn
to the Participant, Beneficiary, or Contractholder (if a trust), less taxes and applicable
charges, in accordance with Article VI. If the Cash Payment results from a termina-
tion of Plan or Reduction in Number of Participants, the amount payable to each
affected Participant or to the Contractholder shall be made in accordance with
Section 7.1. This Section shall not apply to any payment made for the purpose of
reinvestment in accordance with the Plan without the approval of the Company.
- 12-
VARIABLE
o
o
o
ARTICLE V - PAYMENT OF BENEFITS
(Continued)
5.6
CASH PAYMENTS OR LOANS (Continued)
If, at any time, the Contractholder has Plan investment authority, Cash Payments or
loans made from this Contract shall be limited to an amount equal to the amount of
the Cash Payment or loan times the quotient of the value of this Contract and the
amount of total Plan assets. Any Cash Payments or loan amounts made from this
Contract which exceed this limit shall be subject to the Contingent Deferred Sales
Charge, in accordance with Section 6.4.
If the number of units to be cancelled for the payment of a Cash Payment or loan
exceeds the number of units in the Fund or Funds, the payment will be limited to the
dollar amount in the Fund or Funds less taxes and applicable charges.
-13 -
VARIABLE
.
.
.
ARTICLE VI - CHARGES
5.1 ADMIi\HSTIRA TION CHARGE
In the event that an Administration Charge is due, as set forth on the Contract
Summary Page, the Company shall cancel units in the Fund or Funds specified by
the Contractholder equal in number to the quotient of the amount of the charge,
divided by the unit value on the date of cancellation.
6.2 CONTRACT CHARGE
In the event that a Contract Charge is due, as set forth on the Contract Summary
Page, the Company shall cancel the number of units in the Fund or Funds specified
by the Contractholder equal to the quotient of the Contract Charge amount divided by
the unit value on the date of cancellation.
6.3 ASSET MANAGEMENT CHARGE
The Company shall assess the Asset Management Charge, as set forth on the
Contract Summary Page, in accordance with Section 2.5.
6.4
CONTUNGIENT DEFIERRED SALleS CHARGE
The Contingent Deferred Sales Charge Percentage, set forth on the Contract
Summary Page, will be applied to reduce the following:
dollar amount of a transfer to a Funding Successor;
Cash Payments to Officers and Owners for in-service withdrawals
(except loans, financial hardships of $50,000 or less taken at least
12 months prior to separation of service, and amounts required to
be distributed as a result of compliance with Section 401 (a)(9) of the
Internal Revenue Code), disability payments if such disability does
not meet the Social Security definition, or upon severance of
employment or retirement;
outstanding loan balances of Officers and Owners upon payment of
a Cash Payment on or after severance of employment;
Cash Payments resulting from a termination of a Plan or Reduction
in Number of Participants; and
Cash Payments or loan amounts which exceed the limit specified in
Section 5.6.
- 14-
VARIABLE
o
r:\
U
o
6.7
6.8
ARTICLE VI - CHARGES
(Continued)
6.5 OTHER EXPENSE CHARGES
For services rendered at the written request of the Contractholder, the Company shall
withdraw from a Fund or Funds amounts sufficient to reimburse itself for expenses.
The amounts shall be determined by the Company in a manner consistent with its
general practices for contracts of this class for services it renders with respect to the
Plan or Contract.
6.6 OTHER EXPENSE WITHDRAWALS
The Contractholder may notify the Company in writing that the Plan has incurred an
expense and may direct that the amount be paid from a Fund or Funds. The
Company shall cancel Units equal to the dollar value of the amount and shall pay the
amount to the person or entity specified in the notice.
PAYMENT OIF CHARGES
With the agreement of the Company, the Contractholder may elect to pay any charge
in accordance with Sections 6.1, 6.2, or 6.5 directly to the Company. In this event,
the Company shall notify the Contractholder of the amount of such charge, as of the
date such charge would otherwise have been withdrawn from a Fund or Funds. If
payment of such charge is not received by the Company within thirty-one (31) days
after the date of the notice, the number of Units equal to the amount of such charge
will be cancelled.
/PREMIUM TAX
The Company shall cancel Units in the Fund or Funds equal to the amount of any
premium tax levied by a state or other government entity in addition to the taxes
referred to in Section 5.2.
- 15-
VARIABLE
o
o
CD
ARTICLE ViI - PAYMENTS UPON TERMINATION OF PLAN -
CONTRACT OR REDUCTION IN NUMBER OF PARTICIPANTS
7.1 PAYMENTS UPON TERMINATION OF PLAN OR REDUCTION IN NUMBER OF
PARTICIPANTS
In the event that the Contractholder requests a payment from the Contract due to
Plan termination, merger of the Plan, or Reduction in Number of Participants, the
Contractholder shall give written direction to the Company, in accordance with
Section 9.3, to make payments in one of the following manners:
(a) purchase an Annuity for each affected Participant;
(b) use all or a portion of the Variable Fund to make Cash Payments to each
affected Participant in accordance with Section 5.6. In this event, the Company
will pay the amounts in accordance with Article VIII, less taxes and applicable
charges in accordance with Article VI;
(c) use all or a portion of the Variable Fund to make payment to a Funding
Successor, in accordance with Section 8.2.
Payments will be made as described in the Processing Payments Upon Plan
Termination or Reduction in Number of Participants provision set forth on the
Contract Summary Page.
If any amount remains in the Variable Fund after all liabilities of the Plan have been
satisfied, the Company will pay the amount to the Contractholder in accordance with
Section 8.2. Experience Rate Credits which would otherwise be credited after the
Plan is terminated and after the Variable Fund has been exhausted, will be paid to
the Contractholder in cash.
7.2 TERMU\lATION OF CONTRACT
This Contract shall terminate on the date coinciding with:
(a) the day each Fund is exhausted by cancellation of Units, or
(b) the day no further Annuity payments are payable hereunder,
whichever occurs later.
- 16-
VARIABLE
o
()
G)
ARTICLE VIII . TRANSFERS
8.1 NOTICE OF TRANSFER AND TRANSFER PAYMENTS
The Contractholder may, at any time, give written direction to the Company to cancel
all or part of the units in a Fund to provide transfer payments to a Funding Successor.
The unit cancellation will be made as described in the Processing Transfers provision
set forth on the Contract Summary Page.
8.2 VAIRDABLE FUJI\lD UNIT CANCELLATIONS AND TRANSfER PAYMENTS
The Company shall make a Transfer payment to the Funding Successor equal to the
product .of the number of units cancelled and the unit value on the date of
cancellation less taxes and applicable charges in accordance with Article VI.
The Transfer payment will be made as described in the Processing Transfers
provision set forth on the Contract Summary Page.
-17 -
VARIABLE
o
o
o
ARTICLE IX - GENERAL PROVBSIONS
9.1 GUARANTEES AND CHANGE OF CONTRACT
. The Company guarantees that the Contingent Deferred Sales Charge Percentage set
forth on the Contract Summary Page will not be changed.
The Company guarantees that no provision of the Contract will be changed before
the second Contract Anniversary. The Company reserves the right to change the
provisions of this Contract at any time thereafter, by giving written notice to the
Contractholder not less than ninety (90) days before the effective date of the change.
Any portion of this Contract added or changed will be guaranteed by the Company for
one year against subsequent change.
Notwithstanding the other provisions of this Section, the Company may amend the
Contract when, in the opinion of the Company, an amendment is necessary to protect
the Company from adverse financial impact due to any amendment to or modification
of the Plan, changes in the administrative practices adhered to by the Plan, changes
in investment options offered by the Plan, or the action of any legislative, judiciary, or
regulatory body, which impact the Contract.
If the shares of a Fund should no longer be available for investment by the Separate
Account or if, in the judgment of the Company, further investment in the shares of a
Fund should become inappropriate in view of the purposes of the Contract, the
Company may substitute shares of another Fund for Fund shares already purchased
or to be purchased in the future.
This Contract may also be changed in any respect, at any time, by written agreement
between the Contractholder and the Company.
No change will adversely affect the rights of any Participant with respect to an
Annuity purchased before the effective date of the change unless:
(a) the change is required by a governmental agency, or
(b) the consent of each Participant in interest is obtained.
- 18 -
VARIABLE
o
ARTICLE IX - GENERAL PROVISIONS
(Continued)
9.1
GUARANTEES AND CHANGE OF CONTRACT (Continued)
No agent or other person except an officer of the Company or other Home Office
official to whom authority has been delegated has authority to change this Contract,
to extend the times for payment of Deposits, to waive any charges, or to bind the
Company by making any promise, representation or by giving any information. Any
change, extension, waiver, promise, or representation shall not be construed as
authority, or act as a precedent, for the same or similar act performed by the
Company on another occasion.
9.2 CON1"RACTHOlDEIR
The Contractholder shall be the representative under this Contract of each Employer.
The Contractholder may appoint an authorized representative. The authorized
representative must be mutually agreeable to both the Company and the Contract-
holder. The Company will deal only with the Contractholder or its authorized
representative. The Company shall be entitled to rely on any action taken or omitted
by the Contractholder or its authorized representative pursuant to the terms of this
Contract. For purposes of this Article, Contractholder shall mean the Contractholder
o or its authorized representative.
. 9.3 COMMlUJNICATION AND NOT~FICATION
All communications to the Contractholder or to the Company, as required under this
Contract, shall be in writing. The written communication shall be addressed to the
Contractholder at its principal office or to the Company at its Home Office. The
Contractholder shall notify the Company of the following events thirty (30) days prior
to the effective date of the event:
(a) amendment or modification of the Plan;
(b) change in the administrative practices adhered to by the Plan;
(c) change in the Investment Options offered by the Plan;
(d) Reduction in Number of Participants;
(e) Plan termination; or
(f) merger with another Plan for all or a class of Participants.
The Contractholder shall notify the Company of a merger, consolidation, or
reorganization by the Employer within thirty (30) days after the effective date of the
event.
f?'.
V
- 19-
VARIABLE
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9.6
ARTICLE IX - GEI\lERAL PROVISIOI\lS
(Continued)
9.4
PLACE OF PAYiVlEI\lT--CURRENCY
All Deposits and other amounts payable by the Contractholder shall be payable to the
Company at its Home Office. All payments by the Company under this Contract shall
be payable at its Home Office, except where payment at any other place is required
by an applicable law.
All monies payable under this Contract, whether to or by the Company, shall be in
lawful money of the United States of America.
9.5 CEIRT~FICA TES
The Company will issue an Annuity certificate to each person for whom an Annuity is
purchased under this Contract, as of the date the first payment is made. In addition,
if any applicable law requires, the Company will issue a descriptive certificate to the
Contractholder for delivery to each Participant. Each descriptive certificate will
describe the benefits to which the person or Participant is entitled under this Contract.
BIEN lEfICIAIRYa-SETTLEMENT OPTIONS
If this Contract provides for payment of any amount or amounts after the death of an
Annuitant to a person other than a survivor Annuitant, payment shall be made to a
Beneficiary designated by such Annuitant. An Annuitant may change a Beneficiary
previously designated.
Any designation or change shall be made by filing a request with the Company on a
form satisfactory to it, and shall become effective when entert:!d upon the records of
the Company. After any such designation or change is entered, it shall relate back
and take effect as of the date of the request, but without prejudice to the Company on
account of any payments made by it before receipt of such request.
The interest of any Beneficiary shall cease upon death, unless the Annuitant has
directed otherwise. If there is no designated Beneficiary to receive any amount which
becomes payable to a Beneficiary, the amount shall be payable to the estate of the
last to die of the Annuitant and the Beneficiary.
The Company, in determining the existence, ages, or any other facts relating to any
persons designated as Beneficiaries, either as a class or otherwise, may rely solely
on any affidavit or other evidence deemed satisfactory by it, and each and every
payment made by it in reliance thereon will, to the extent of such payment, be a valid
discharge of its obligation under this Contract.
- 20-
VARIABLE
.
.
.
9.7
9.8
ARTICLE IX - GENERAL PROVISIONS
(CoD1ltinued)
9.6
BENEFIC~ARY--SETTLEMENT OPTIONS (ContinUled)
If any payments other than a single sum become payable to one or more Benefici-
aries, and if the monthly amount of the payments payable to any Beneficiary is less
than $20, or if the Beneficiary is other than a natural person receiving payments in its
own right, the Company may, instead of making the payments, pay the commuted
value thereof in full settlement of its liability for such payments.
If at any time the amount that would be payable in a single sum to the Beneficiary, if
such Annuitant were to die at that time, exceeds $3,500, the Annuitant and the
Company may arrange, by mutual agreement, a mode of settlement other than
payment in a single sum. If no mode of settlement has been arranged before the
death of an Annuitant, the Beneficiary and the Company may then mutually agree
upon a mode of settlement for the benefit of the Beneficiary other than payment in a
single sum.
EXPERIENCE IRATE CREDITS
This Contract will be experience rated each calendar year by application of the
Company's experience rating plan in force during such year. Any experience rate
credits which may arise through such application will be credited to the Fund
specified by the Contractholder, except as provided in Section 7.1.
ASSIGNMENT
Except insofar as may be contrary to any applicable laws. all Benefit Payments under
this Contract ::ire not assignable and are not subject to the claims of any creditor.
9.9 IN FORMATIOI\!--RECORDS
The Contractholder shall furnish all information which the Company may reasonably
require for the administration of this Contract. If the Contractholder cannot furnish
this information, the Company may request the person concerned to furnish such
information. The Company will not be liable for the fulfillment of any obligations until
it receives all requested information in a form satisfactory to it.
9.10 ENTIRE CONTRACT --CONSTRUCTION
This document, together with the attached Application, constitute the entire Contract.
This Contract will be construed according to the laws of the jurisdiction set forth on
the cover page of this document.
- 21 -
VARIABLE
o
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APPLICATION FOR GROUP ANNUITY CONTRACT
MADE TO
NATIONWIDE LIFE INSURANCE COMPANY
(called Nationwide)
ONE NATIONWIDE PlAZA
COLUMBUS, OHIO 43216
TRUSTEE(S) OF THE 1998 Augusta Money Purchase Plan TRUST
(ElCact Name or Applicant, e.g., ABC Company, Inc. or Trustees or XYZ. Company, Inc. Retirement Trust)
The Applicant applies for Group Annuity Contract Form No. APO-2243. The Applicant approves and
accepts the terms of the Contract. The Applicant certifies that to the best of its knowledge:
The Applicant has the authority to enter into the Contract. The Applicant's plan qualifies under Section
401 of the Internal Revenue Code. If not so qualified, describe type of plan:
The Applicant, if a sole proprietorship or partnership: is a financially sophisticated
law, accounting, investment banking, pension consulting, or investment advisory firm with
financial/business knowledge and experience, capable of adequately representing its interests and those
of its employees; or has obtained the advice of an independent, expert financial or business adviser
having no affiliation or material business relationship with Nationwide Life, and capable of adequately
representing the interest of the Applicant and its employees; and the plan covers only employees of a
single employer or employees of interrelated partnerships. This Contract is a permissible investment
under the Applicant's plan.
If Nationwide fails to accept this Application, the value of each Fund will be refunded.
( ,'1
....,
,.
MCM Financial Corpo dba Pension Service Coo
to receive any commissions payable under this Contract.
'-. i~ delliignated
'.- .
Applicant Signature
Signature of Licensed Agent
License Number
Typed or Printed Name
See Trustees' Signatures
~tti!!ched
Title (Trustee, If Applicable) .. J
~ fl. If'fli! ~~
Date ' r ._
~~~~
Signect A City
(9A
State
- 1
on
r ,...,
. ;
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-..,
.. I
All CONlrRACT VAllDES BASED ON THE ~NVESTMENT RESULTS elF A-
VARIABLE flDND ARE VARIABLE (MAY INCREASE OR DECREASE) AND":~~RE~
NOT G~ARANTEIED AS TO DOLLAR AMOUNT. 0"\ r.:i
-..,
...~
APO-3322
FUND SELECTION ON OTHER SIDE (9/97)
.
.
;".)
(All Trustees must sign)- ., ~
c"..... r. ~
- "
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..
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,
I R':-i".c'~7"'.l"'VE[);
. J U L {} 6 1998 I
I
ENDORSEMENT
", .
Group Separate Account Annuity Contract
(APO-2243, APO-2243-NM, APO-2243-NY, APO-2243-0R,
APO-2243-WI, APO-2243-MO, APO-2243-WA, APO-2954, AND APO-1472)
Attached to and made a part of this Contrapt by
NATIONWIDE LIFE INSURANCE COMPANY
ONE NATIONWIDE PlAZA
COLUMBUS, OH 43215
WHEREAS, the above referenced group annuity contract was issued to Trustee(s) of
the 1998 Augusta Money Purchase Plan Trust (the "Contractholder") by NATIONWIDE
LIFE INSURANCE COMPANY (the "Company"); and
WHEREAS, the Company and the Contractholder wish to modify this contract pursuant
to Section 9.1.
NOW, THEREfORE, ~he Company hereby endorses the Contract as follows:
1. The Asset Management Charge on the Contract Summary page is hereby revised to
read as follows:
Asset Management Charge: 0.90% for Funds selected by the Contractholder
from Primary Plus on the Application. This represents
a 0.60% reduction in the standard Asset Management
Charge of 1.50%.
1.10% for Funds selected by the Contractholder
from Primary on the Application. This represents a
0.40% reduction in the standard Asset Management
Charge of 1.50%.
1.20% for Funds selected by the Contractholder
from Optional on the Application. This represents a
0.30% reduction in the standard Asset Management
Charge of 1.50%.
APO-3220
1
GA-P U807
o
The Asset Management' Charge .will be
reviewed. and changed if a'ppropriate, on
the first Contract Anniversary occurring no
earlier than six months from the Effective
Date of this endorsement and on each
Contract Anniversary thereafter. The sum
of amounts in this Contract and the
Companion Contract(s). calculated by
averaging the beginning balances for such
contracts for the two month period prior to
the month of the Contract Anniversary
Date, will determine whether or not a
change in the Asset Management Charge
applies, per the following schedule: "
Sum of Amounts in this Contract
and the Companion Contract{s)
Reduction in the Reduction in the Reduction in the
Standard Asset Standard Asset Standard Asset
Management Management Management
Charge for. Primary Charge for Charge for
Pius Primary Optional
0.55% 0.35% 0.:;0%
0.60% 0.40% 0.30%
0.65% 0.45% 0.30%
0.71% 0.51% 0.31%
0.73% 0.53% 0.33%
0.75% 0.55% 0.35%
o.n% 0.57% 0.37%
. 0.79% 0.59% 0.39%
0.81% 0.61% 0.41%
0.83% 0.63% 0.43%
0.85% 0.65% 0.45%
0.87% 0.67% 0.47%
0.89% 0.69% 0.49%
0.91% 0.71% 0.51%
0.93% 0.73% 0.53%
0.95% 0.75% 0.55%
0.97% o.n% 0.57%
0.99% 0.79% 0.59%
1.00%, 0.80% 0.60%
1.01% 0.81% 0.61%
1.02% 0.82% 0.62%
1.03% 0.83% 0.63%
2
o
$ 750,000 - . $999.999
$1,000,000 - $1,499,999
$1,500.000 - $1,999.999
$2,000,000 - $2,249.999
$2,250.000 - $2,499,999
$2,500,000 - $2.749.999
$2,750,000 - $3,124.999
$3,125,000 --$3,499,999
$3,500,000 - $4,124.999
$4,125.000 - $4,874.999
$4,875.000 - 55.749.999
$5.750,000 - $6.999.999
$7.000,000 - $8,499,999
$8,500.000 - $9.999,999
$10.000,000 - $11.499,999
$11.500,000 - $12,999,999
$13.000,000 - $14.999.999
$15.000,000 - $16.9~9,999
$17.000,000 - $18,999',999
$19.000,000 -$21.999.999
$22.000,000 - $24,999,999
$2?000,000 - $29,999.999
0"
. .
lID
If the sum of amounts in this Contract and
the Companion Contract(s) decreases to
less than $750,000 during any Contract
Year, the Asset Management Charge will
be determined in accordance with uniform
procedures applicable to all contracts of
this class. Any change in the Asset .
Management Charge will be effective on.
the next Contract Anniversary.
2.
The Contract Summary Page is hereby modified to include the following:
Managed Segregated Asset Account Investment Management and
Administrative Charges:
Personal Portfolio Series 6
Personal Portfolio Series 5
Personal Portfolio Series 4
Personal Portfolio Series 3
Personal Portfolio Series 2
Personal Portfolio Series 1
1.25%
1.25%
1.15%
1.10%
1.00%
1.00%
.
3. Article 1, DEFINITIONS is hereby modified by deleting Section 1.8 (which
is Section 1.5 in APO-1472) and its respective definition and replacing it in
its entirety. Sections 1.16 and 1.17 (which are Sections 1.12 and '1.13 in
APO-1472) are being added as follows: '
-
(1.5) 1.8 .
'. ,. ~
IFllBNIOl - a Mutual Fund or a sub-account of the 'Managed
Segregated Asset Account specified in the Application, in
which assets of a Series will be invested.
(1.12) 1.16
MANAGED SEGREGATED ASSET ACCOUNT (Or
(UMANAGED ACCOlJ)N~') - the Nationwiqe Pensions
Managed Variable Account which is a segregated account
maintained by the Company with respect to a portion of its
assets in connection with this Contract and certain other
group annuity contracts.
.
The Managed Account will be divided into sub-accounts each
of which is composed .of a portfolio of investments with
distinct. risk and reward characteristics which reflect the
investment preferences of Participants. Each portfolio may
consist of domestic and foreign
3
.
.
.' .
4.
. 5.
(1.12) 1.16 MANAGED SEGREGATED ASSET ACCOUNT or
. (UMANAGEr;> ACCOUlNT") continued
company common and preferred stocks; domestic and foreign
debt securities; cash equivalent securities; cash; and any
other investment suitable for a retirement plan qualified under
Section 401 of the Internal Revenue Code.
The assets of the Managed Account will be held for the sole
benefit of all contracts which provide for the dollar amount of
contract values to vary to reflect investment results of the
Managed Account.
All income, gains, and losses, whether or not realized from
assets allocated to the Managed Account shall be credited to
or charged against the' Managed Account without regard to
the other income, gains or losses of the Company. There
shall also be charged against the Managed Account. the
amounts that are detennined by the Company to be allocable
to the Managed Account as investment expense and as
contributions to ~ny statutory special contingent reserve fund
established for the Managed Account.
The dollar value of the Managed Account in any Business
Day is equal to the sum of the dollar values of the sub- .
accounts in each Business Day.
.. .
(1.13) 1.1? MUTUAL FUND - a registered investment management
company.
Article II, Section 2.1, Variable Fund is hereby modified as follows:
SECTION 2.1 VARIABLE FUND.
The Company shall establish and maintain one or more Variable Funds
reflecting the Contracts' experience in the Separate Account and the ..' -
Managed Segregated Asset Account. The Company shall provide to the
ContracthoJder an annual accounting of all financial transactions occurring
with respect to this Contract.
Article II, Section 2.5, Valuation Factor is hereby deleted in its entirety and
replaced as follows:
4
'.
liD SECTION 2.5 V ALUA T!ON FACTOR
The Valuation Factor for the Separate Account represents a means of
reflecting, in the unit value, the effective.investment return of a Series in the
Separate Account In determining the effective investment return, the
Company will take into account the investment income and market value
changes after provision for taxes applicable to contracts of this class arising
from the operation of such Series and after provision for the Asset
Management Charge set forth in the Contract Summary Page. The
Valuation Factor for a Series for any Business Day is equal to the quotient
of (a) divided by (b), where:
(a) is the dollar amount at the end of the Business Day resulting, after
provision for the taxes described in the preceding paragraph and the
Asset Management Charge, from $1.000 in the Series at the end of
the immediately preceding Business Day, and
(b) is $1.000.
.
The aggregate of the amounts by which the Series is reduced each year for
taxes, if any. shall be deducted to the extent possible from the Series
investment income, and any balance will be deducted from the principal of
the Separate Account.
The Valuation Factor for the sub-accounts of Managed Segregated Asset
Account represents a means of reflecting, in the unit value, the effective
investment return of a sub-account. In determining the effective investment
return, ,the, Company will take. into account the investment income and
..- 'marKet value changes after provision for the Managed Segregate~ Asset
Account Investment Management and Ac;lministrative Charges set forth on
the Contract Summary Page. If there is no readily available market as to
any portion of the Managed Segregated Asset Account's assets. the
Company will value that portion at fair market value in accordance with
accepted accounting practices and applicable laws and regulations.
The Valuation Factor for a sub-account for any Business Day is equal to
the quotient of (a) divided by (b), where:,
.
5
o
SECTION 2.5 VALUATION FACTOR continued
(a) is the dollar amount at the end of the Business Day resulting, after
provision for the Managed Segregated Asset Account Investment
Management and Administrative Charges, from $1,000 in the sub-
account at the end of the immediately preceding Business Day, and
(b) is $1,000.
The aggregate of the amounts by which the sub-account is reduced each
year for taxes. if any. shall be deducted to the extent possible from the sub-
account investment income, and any balance will be deducted from the
principal of the Managed Account.
6. Article IX - General Provisions. Section 9.1. Guarantees and. change .of
Contract is modified as follows: .
9. 'i GUARANTEES AND CHANGE OF CONTRACT
o
. .
The second paragraph (the first paragraph in APO-1472) is deleted in its
entirety and replaced with the fo'lowing:
The Company guarantees that no provision of the Contract except the
Managed Segregated Asset Account investment policy will be changed
before the second Contract Anniversary. The Company reserves the right
to change the provisions of this Contract at any time thereafter, by giving
written notice to the Contractholder not less than ninety (90) days before
the effective date of the change.
.,-
;7?~?~
~ [?o~~~
PRESIDENT
SECRETARY
o
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.
.
.~.. '\ n /,;\ c:, :~n if'" ,). nl\' r;;..l' [i ri)-~ .' .,
: i ~~t~~ ~ U~~~~ m1 U ~.dJ\~::~
. I ~ :~ ~ 8; 1 "f')) /iJ... ~r r0> :;:~
~__.J ! I.:~:: ;~, ~ ..'...,' :.'- ~\. ;,...:..~ L '\: \.~ 'l ~ ..;
(!)
NATIONWIDE LIFE INSURANCE COMPANY
.~~~:.-;-~~ ~"'-:;-;\.?T~ ,
JUL'06 19-98
Home Ollice 0 Columbus. Ohio
(Hereinafter CaUed the Company)
. 0 0 0 . . . . . . . . . . . 0 ~ G . . . . 0 . . . . . 0 I: r. I . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . I . . . . . . , , . . . . . . . . . . . . , . . . . . . . . . .
In consideration of the Application for this Contract made by
Tli'lYsfts~($) @~ ttIhle
~ 998 AlUJ~lUJS~ MOlnlelf 1?1UJIi'lCIh1aJse I?laJlnl Tli'lUJsft
(The Contractholder)
and of the payment of Deposits as provided, the Company agrees to pay, in accordance with
and subject to the terms and conditions of this Contract, the benefits set forth with respect to
each Participant.
Effective Date of Contract
July 1,1998
Issue Date of Contract
June 22, 1998
Jurisdiction:
Georgia
In witness whereof the Company has caused this Contract to be executed and duly attested
on the Issue Date shown above.
/~f?~
President
~uP:L
Attest: ~ ~
Secretary
.
GROIUJI? AINIINlIUJ~TY CONTRACT 1NI0. GA.-I? 1UJ806
GIUJAMINITfElEfO flUJINID
1F~){lElDJ IDOlLAIR AINIINIUl~T~IES ONll Y
NOINl-I?ARTIC~I?A TIINIG
AIi\!INIUJAl AflPUCA T~OINl OF IE){P~R~IEINICIE IRA l~N1G PLAN
APO-2242
FIXED
.
.
.
TABLE OF CONTENTS
ARTICLE
PAGE
CONTRACT SUMMARY PAGE.............. ........ .............................................1
I. DEFI NITIONS. .. .. ........ . . .. . .. ... .. .. ... . ... . .. ... ..... . .. .... . ..... ... . . .. . . . . . . ... ..... .. . . .. . . . . . . .. 4
II. G~AIRANTEED FUND
2.1 Guaranteed Fund ..............................................................................6
2.2 Amount Of Guaranteed Fund............................................................ 6
2.3 Interest C red its.. . . .. .. . .. .. . .. . .. . . . .. . . .. .. . .. . .. . . . . .. .. .. . . .. . . . .. . . . . . .. .. . .. . . . . . .. . . .. . .. .6
m. DEPOSITS
3.1 Deposits................................................................ ............................7
3.2 Crediting Of Deposits ........................................................................ 7
IV. IE}(CHANGIES
4.1 Exchange To A Companion Contract................................................ 8
4.2 Exchange From A Companion Contract.... ..................................... ...8
V. PAYMENT OF BENEF~TS
5.1 Benefit Payments.............................................................................. 9
5.2 Purchase And Amount Of Annuity................................................... 1 0
5.3 Small Annuities.......... ...................................................................... 1 0
5.4 Facility Of Payment .........................................................................11
5.5 Misstatements And Adjustments...................................................... 11
5.6 Cash Payments Or Loans ...............................................................11
VI. CHARGES
6.1 Administration Charge................. .................. ................................. .13
6.2 Contract Charge.. ......... ................ ...................... ..... ...... .......... ........13
6.3 Contingent Deferred Sales Charge................................................. 13
6.4 Other Expense Charges ... .................... ... ..... ................ ...... ............ .13
6.5 Other Expense Withdrawals............................................................ 14
6.6 Payment Of Charges....................................................................... 14
6.7 Premium Tax......................................... ......................... .................14
FIXED
o
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11" ABLE OF CONTENTS
(Cofl'lltomnedl)
ARTICLE
PAGE
VII. PAYMENTS UPON TERMINATION OF PLAN - CONTRACT OR REDIUCTION IN
NUMBIER OfF PARTiCIPANTS
7.1 Payments Upon Termination Of Plan Or Reduction
In Number Of Participants ................................................................15
7.2 Termination Of Contract .... ................ ... ... ..... ............. ..... ... .... ......... .16
VIII. TRANSFIERS
8.1 Notice Of Transfer And Transfer Payments ....................................17
8.2 Guaranteed Fund Withdrawals And Transfer Payments.................17
8.3 Alternative Guaranteed Fund Withdrawal AndTransfer Payment ...17
8.4 Interest After Transfer Date............................................................. 18
I}{. GENERAL fPlROVISIONS
9.1 Guarantees And Change Of Contract............................................. 19
9.2 Contractholder................................................................................. 20
9.3 Communication And Notification.................................................... .20
9.4 Place Of Payment-Currency...................................................... ....21
9.5 Certificates..................................................................................... .21
9.6 Beneficiary--Settlement Options..................................................... .21
9.7 Experience Rate Credits................................................................ .22
9.8 Assignment..................................................................................... .22
9.9 Information--Records....................................................................... 22
9.10 Entire Contract-Construction......................................................... .23
APPLICATION FOR AND ACCEPTANCE OF GROUP ANNUITY CONTRACT
FIXED
o
o
o
Administration Charge:
Book Value Exchange Limit:
Book Value Transfer Limit
Companion Contract(s):
Contingent Deferred
Sales Charge:
Contract Year
1
2
3
<4
5
6
7
8
9
Thereafter
CO~lrRAClr SlUllilRMAIRY PAGE
GAA~) lUJ80S
None.
20% of the Guaranteed Fund.
20% of the Guaranteed Fund on the Transfer
Date.
GA-P U807.
Deferred Sales
Charge Percentage
3.25%
3.25%
3.25%
3.00%
2.50%
2.00%
1.75%
1.25%
0.75%
0.00%
The Contingent Deferred Sales Charge Percentage shall be applied to
withdrawals from the Guaranteed Fund as provided in this Contract.
Contract Anniversary:
Contract Charge:
Creditable Percentage:
January 01, 2000, and each January 01 thereafter.
None.
100%
-1-
FIXED
.
.
.
Crediting Deposits:
~nterest Rate:
COINl1!"RAC1!"$lIlMMARYf?AGIE
GAof? lIlS0S
Each Deposit, as described in Article III, will be credited
to the Guaranteed Fund no later than the third Business
Day following receipt.
1 -
2-
Contract Year
(July 1,1998 - December 31,1999)
(January 1, 2000 - December 31, 2000)
Rate
4.80%
3.30% (minimum)
Maximum Annual Deposit:
Plan:
Processing Exchanges:
$1,000,000
1998 Augusta Money Purchase Plan.
Exchanges as described in Article IV, will be made
within three Business Days following receipt of the
Contractholder's written request.
Processing Annuity Purchases: Annuity Purchases, as described in Article V, will
be made within 15 Business Days following receipt
of the Contractholder's written request.
Processing Cash Payments:
Processing payments Upon
Plan Termination or Reduction
in Number of Participants:
Cash Payments, as described in Article V ,will be
made within five Business Days following receipt of
the Contractholder's written request.
Benefit Payments to each affected Participant, as
described in Article VII, will be made within 30
calendar days following receipt of the Contractholder's
written request.
-2-
FIXED
o
o
o
Processing Transfers:
Purchase Rate Basis:
Percentage Reduction in
Number of Participants as
defined in Section 1.15:
CON1MCl SlUJlliilMARV I?AGIE
GA-fllJl806
The Transfer Date, as described in Article VIII, will not
be more than 120 calendar days following receipt of
the Contractholder's written request.
1983 Table A (Male), with Annuitant ages set back 10
years and survivor Annuitant ages set back 5 years;
3.0% interest; and 4.0% loading.
15%
-3-
FIXED
o
o
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ARTICLE I - DEFINITIONS
1.1
ANNUlTANT- a person receiving an Annuity.
1.2 ANNUITY - any benefit in the form of a series of payments due in accordance with
the Plan, payable under this Contract.
1.3 BENEFIT PAYMENT - a distribution that is permitted by the Plan on behalf of a
Participant.
i.~ BIUSINESS DAY - each day that the Company's Home Office and the applicable
financial institutions for purposes of processing financial transactions are open for
business. All requests for transactions that are received after 1 :00 p.m. Columbus,
Ohio time will be considered to be received on the next Business Day.
~.5 CASH PAYMENT - a form of Benefit Payment other than an Annuity purchased
under this Contract.
i.6 CONTRACT YIEAR - a period beginning on the Effective Date or on any Contract
Anniversary and ending on the day immediately preceding the next following
Contract Anniversary.
1." IEMfPlLOYlE1R - any organization reported to the Company by the Contractholder for
inclusion under this Contract, some or all of whose employees are covered under the
Plan.
1.8 FmlElD INVESTMENT - an investment which guarantees principal and/or interest, a
money market fund, or any other investment which could contain more than 50%
short term debt securities. An investment which could contain more than 50% short
term debt securities available under a Companion Contract will not be considered a
Fixed Investment, excluding a money market fund. Instruments which provide for a
guarantee of principal upon withdrawal include but are not limited to group annuities
and individual annuities which are invested in an insurer's general account,
guaranteed investment contracts, bank certificates of deposit, and any other
investment determined to be a Fixed Investment by the Company on the Effective
Date or the date on which Investment Options are added to the Plan.
1.S FUNDING SIUCCESSOR - the Plan's and successor plan's trustee and any financial
institution providing an Investment Option to the Plan.
1.10 INVESTMENT OPTION - a fund offered by the Plan, composed of one or more
investments and which is available for independent selection by the participant.
-4-
FIXED
@)
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(f\
,'2/
ARTICLE I - DEF~NITIONS
(Continued)
1. ~ i OFFICERS - as defined in Section 416 of the Internal Revenue Code and Regula-
tions. If an individual is considered to be an Officer at any time during the term of
this Contract, the individual will always be considered as such for purposes of this
Contract.
1.12 OWNERS - as defined in Section 416 of the Internal Revenue Code and Regula-
tions. For purposes of this Contract, an Owner is defined as a 10% owner. If an
individual is considered to be an Owner at any time during the term of this Contract,
the individual will always be considered as such for purposes of this Contract.
1.13 PARTiCIPANT - a person for whom benefits are to be provided under this Contract,
in accordance with the Plan, as reported by the Contractholder.
1.14
PRO RATA W~THlDRAWAlS - withdrawals from this Contract will be made from
each Sub-Fund of the Guaranteed Fund in proportion to the amount of each Sub-
Fund to the amount of the Guaranteed Fund. Withdrawals from this Contract will be
made from the Guaranteed Fund in proportion to the amount of the Guaranteed
Fund to the amount of the Guaranteed Fund plus all other Fixed Investments which
are a part of the same Investment Option.
If the Contractholder has Plan investment authority, withdrawals from this Contract
will be made from each Sub-Fund of the Guaranteed Fund in proportion to the
amount of each Sub-Fund to the amount of the Guaranteed Fund. Withdrawals from
this Contract will be made from the Guaranteed Fund in proportion to the amount of
the Guaranteed Fund to the amount of the Guaranteed Fund plus the amount of total
Plan assets.
1.i5
IREDUCT~ON IN NIUJMBER OfF PARTICIPANTS - any reduction of more than the
percentage, as set forth on the Contract Summary Page, of the number of
Participants under the Plan since the Effective Date of the Contract which is the
result of any change in the Plan or action taken by the Employer.
1.1S SIUB-FUNID - a portion of the Guaranteed Fund to which separate guarantees or
other contractual provisions apply.
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ARTICLE ~I - GUARANTEED FUND
2.1 GUARANTEED FUND
The Company shall establish and maintain a Guaranteed Fund. The Company shall
provide to the Contractholder an annual accounting of all financial transactions
occurring with respect to this Contract.
2.2 AMOIUNT OF GUARANTEED FUND
The amount of the Guaranteed Fund at any time will be equal to the total of the
Deposits credited in accordance with Article III, plus any amounts exchanged in
accordance with Section 4.2, plus interest as provided in Section 2.3, less any
withdrawals made from the Guaranteed Fund in accordance with Articles IV, V, VI,
VII, and VIII.
2.3 INTEREST CREDITS
Subject to the provisions of Sections 8.4 and 9.1, during each Contract Year, the
Guaranteed Fund will be credited with daily interest at an effective annual rate of
interest equal to the Interest Rate set forth on the Contract Summary Page.
In computing the amount of interest to be credited to the Guaranteed Fund, the
Company will use the first day following the date amounts are credited to the
Guaranteed Fund through the actual date on which withdrawals are made from the
Guaranteed Fund.
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ARTICLE III - DIEPOS~TS
3.11
DEPOSITS
The Contractholder may make Deposits to the Company in such amount as may be
determined by the Contractholder. Unless otherwise agreed to in writing by the
Company, the Maximum Annual Deposit which may be paid during a Contract Year
shall not exceed the amount set forth on the Contract Summary Page.
3.2 CRIEDlTING OIF DEPOSITS
Each Deposit, multiplied by the Creditable Percentage set forth on the Contract
Summary Page, will be credited to the Guaranteed Fund as described in the
Crediting Deposits provision set forth on the Contract Summary Page.
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~.2
ARTICLE IV - EXCIHANGES
4.1
EXCHANGE TO A COMPAi\HON CONTRACT
The Contractholder may exchange amounts from the Guaranteed Fund to a
Companion Contract subject to the following limitations. Exchanges may not exceed
the Book Value Exchange Limit, set forth on the Contract Summary Page, on the
exchange date less any amounts exchanged during the one~year period ending on
the exchange date.
Exchanges shall be made on a Pro Rata Withdrawal basis from all Sub-Funds under
this Contract. Exchanges shall be completed as described in the Processing
Exchanges provision set forth on the Contract Summary Page.
Exchanges shall be made by withdrawing 100% of the amount to be exchanged from
the Guaranteed Fund and crediting the amount to the Companion Contract.
This Section 4.1 will become inoperative on and after the Company's receipt of the
Contractholder's direction to make a transfer payment in accordance with Article VIII.
IEXCIHIANGE FROM A COMPANION CONTRACT
The Contractholder may exchange amounts into this Contract from a Companion
Contract. Limitations may be imposed by the Companion Contract.
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~
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AIRTIClE V - PAYMENT OF BIENEFITS
5.1
BENEFIT I?AYI\IlENTS
Subject to the other provisions of this Contract, upon written notice from the
Contractholder, the Company shall purchase Annuities or make Cash Payments in
such manner and amounts specified by the Contractholder. The Contractholder may
request anyone of the following Annuity forms on behalf of a Participant:
(a) Straight Life Form - This form of Annuity provides payments during the lifetime
of the Annuitant. Payments will end with the last payment made on or
preceding the Annuitant's date of death.
(b) Joint and Survivor Form - This form of Annuity provides periodic payments
during the joint lifetime of the Annuitant and the survivor Annuitant. Periodic
payments to the Annuitant will end with the last periodic payment made pre-
ceding the Annuitant's death. Upon the Annuitant's death, periodic payments
in the amount of 50%, 66-2/3%, 75%, or 100% (as elected by the Annuitant) of
the periodic payments payable to the Annuitant, will be continued to the
survivor Annuitant, if living. Periodic payments will terminate with the last
periodic payment made preceding the later of the date of death of the
Annuitant and the survivor Annuitant.
(c) Life With Period Certain Form - This form of Annuity provides payments during
the lifetime of the Annuitant. If the death of the Annuitant occurs before the
Annuitant has received the specified number of payments (as elected by the
Annuitant), the payments remaining will be paid to a Beneficiary designated by
the Annuitant. If no Beneficiary has been designated or if the death of the
designated Beneficiary occurs before the Annuitant and Beneficiary have
received the total number of payments due, the commuted value of the
payments remaining will be paid in a single sum. Such payment will be paid to
the estate of the last to die of the Annuitant and the designated Beneficiary.
Annuity purchases and Cash Payments may be made on any form mutually agree-
able between the Company and the Contractholder, in accordance with the provi-
sions of the Plan. The Company will purchase the Annuity or provide the Cash
Payment as described in the Processing Annuity Purchases and Processing Cash
Payments provisions set forth on the Contract Summary Page.
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(tj"I!..i
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;;11' .
ICi\I
V
.Q)
5.3
AIRTICLE V - PAYMENT OF BENEFITS
(Colnl~iru.!lleo1)
5.2 PURCHASE AND AMOUNT OF ANNUITY
The Company will purchase an Annuity by withdrawing the amount to be applied to
purchase the Annuity from the Guaranteed Fund.
The amount of the Annuity will be determined by dividing the amount withdrawn, less
the amount of state premium tax, if any, by the appropriate purchase rate, which may
not be less favorable than the purchase rate determined in accordance with the
Purchase Rate Basis set forth on the Contract Summary Page.
If the withdrawal requested plus any applicable expense charges and taxes exceed
the amount of the Guaranteed Fund, the amount of the Annuity will be limited to that
which can be purchased by the amount of the Guaranteed Fund remaining after with-
drawal of any tax or charges specified in Article VI.
SMALL ANNUITIES
If the amount to be applied to purchase an Annuity is less than $3,500, the Company
may, instead of purchasing an Annuity, make a Cash Payment to the Participant,
Beneficiary, or Contractholder. The Cash Payment will be equal to the amount to be
applied, less any tax or charges specified in Article VI.
DC
-10 -
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.
5.5
I)
5.6
.
ARTICLE V - PAYMENT OF BENEFITS
(Con~imJJed)
5.4 FACILITY OIF PAYMENT
If any Annuitant is, in the judgment of the Company, legally, physically, or mentally
incapable of personally receiving any payment due under this Contract, the Com-
pany may make payment or any part thereof to another person, persons, or institu-
tions who, in the opinion of the Company, are then maintaining or have custody of
the Annuitant, until claim is made by the duly appointed guardian or other legal
representative of the Annuitant. The payment shall constitute a full discharge of the
liability of the Company to the extent thereof. Upon notice to the Company of the
appointment of a legal guardian or other legal representative, the Company will pay
amounts only to the guardian or other legal representative.
iYHSSTATEMIENTS AND ADJIUJSTMENTS
If the age or any other relevant fact relating to any Annuitant is found to have been
misstated, the amount of Annuity payments payable by the Company will be
adjusted, unless some other adjustment, satisfactory to the Contractholder and the
Company is made. The amount of the adjustment will be made on the basis of the
corrected information. The adjustment will be made without changing the date of the
first payment. Any adjustment made shall be conclusive on any person affected by
the adjustment. The dollar amount of any underpayment made by the Company will
be paid in full with the next payment due. The dollar amount of any overpayment by
the Company will be deducted to the extent possible from the next payment or
payments.
CAS~ I?AYMENTS OR LOANS
The Contractholder may notify the Company in writing that a Cash Payment or loan
has become payable, in accordance with the Plan. The Company shall withdraw on
a Pro Rata Withdrawal basis the amount payable from the Guaranteed Fund, and
shall pay the amount withdrawn to the Participant, Beneficiary, or Contractholder (if a
trust), less taxes and applicable charges, in accordance with Article VI. If the Plan
provides for employee-directed investments and this Contract is the only investment
of the Investment Option, the Pro Rata Withdrawal provision will apply only to Sub-
Funds under this Contract. If the Cash Payment results from a termination of the
Plan or Reduction in Number of Participants, the amount payable to each affected
Participant or to the Contractholder shall be made in accordance with Section 7.1.
No loans shall be made after the Transfer Date specified in Article VIII. This Section
shall not apply to any payment made for the purpose of reinvestment in accordance
with the Plan without the approval of the Company.
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.
.
.
ARTICLE V - FA YMENT OF BENEFITS
(Co&1ltinuad)
5.6 CASH PAYMENTS OR LOANS (Continued)
If the amount to be withdrawn for the payment of a Cash Payment or loan exceeds
the value of the Guaranteed Fund, the payment will be limited to the dollar amount in
the Guaranteed Fund less taxes and applicable charges.
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AR"f~ClE VI - CIHIAIRGES
5. ~ AIDM~NISTIRA TION CHARGlE
In the event that an Administration Charge is due, as set forth on the Contract
Summary Page, the Company shall withdraw the amount of the charge from the
Guaranteed Fund.
5.2 CONTIAAC"f CIHIARGIE
In the event that a Contract Charge is due, as set forth on the Contract Summary
Page, the Company shall withdraw the amount of the charge from the Guaranteed
Fund.
5.3 CO~rnNGIENT DEFERRED SALES CIHIARGE
The Contingent Deferred Sales Charge Percentage, set forth on the Contract
Summary Page, will be applied to reduce the following:
dollar amount of a transfer to a Funding Successor;
Cash Payments to Officers and Owners for in-service with-
drawals (except loans, financial hardships of $50,000 or less
taken at least 12 months prior to separation of service, and
amounts required to be distributed as a result of compliance with
Section 401 (a)(9) of the Internal Revenue Code), disability
payments if such disability does not meet the Social Security
definition, or upon severance of employment or retirement;
outstanding loan balances of Officers and Owners upon payment
of a Cash Payment on or after severance of employment;
Cash Payments resulting from a termination of a Plan or
Reduction in Number of Participants.
6.4 OTHER [E)(flEi\!SIE CHARGIES
For services rendered at the written request of the Contractholder, the Company
shall withdraw from the Guaranteed Fund amounts sufficient to reimburse itself for
expenses. The amounts shall be determined by the Company in a manner consis-
tent with its general practices for contracts of this class for services it renders with
respect to the Plan or Contract.
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ART~CLE V~ - CHARGES
(Coll1l~DD1IUJJed)
6.5 OTHER EXPENSE WITHDRAWALS
The Contractholder may notify the Company in writing that the Plan has incurred an
expense and may direct that the amount be paid from the Guaranteed Fund. The
Company shall withdraw the amount from the Fund and shall. pay the amount to the
person or entity specified in the notice.
6.6 ~AYi\liIENT OF CHARGES
With the agreement of the Company, the Contractholder may elect to pay any charge
in accordance with Sections 6.1, 6.2, or 6.4 directly to the Company. In this event,
the Company shall notify the Contractholder of the amount of such charge, as of the
date such charge would otherwise have been withdrawn from the Guaranteed Fund.
If payment of such charge is not received by the Company within thirty-one (31) days
after the date of the notice, the amount thereof shall be withdrawn from the Guaran-
teed Fund.
6.7
~REi\li~lIIM TAX
The Company shall withdraw from the Guaranteed Fund the amount of any premium
tax levied by a state or other government entity in addition to the taxes referred to in
Section 5.2.
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AIRT~CllE Vii - PAYMENTS UPON TERMINATION OF PLAN -
CONTRACT OIR REDIJCT~ONINNlUMBER OF PARTICIPANTS
7.1 PAYMENTS UPON TERMINATION OF PLAN OIR REDUCTION IN NUMBER OF
PARTICIPANTS
In the event that the Contractholder requests a payment from the Contract due to
Plan termination, merger of the Plan, or Reduction in Number of Participants, the
Contractholder shall give written direction to the Company, in accordance with
Section 9.3, to make payments in one of the following manners:
(a) purchase an Annuity for each affected Participant;
(b) use all or a portion of the Guaranteed Fund to make Cash Payments to each
affected Participant in accordance with Section 5.6. In this event, the
Company will pay the market value of the amount withdrawn, less taxes and
applicable charges in accordance with Article VI. The market value of the
amount withdrawn is equal to the amount withdrawn, increased or decreased
by the Market Value Adjustment. The Market Value Adjustment is determined
by the Company in accordance with uniform procedures applicable to all
contracts of this class;
(c) use all or a portion of the Guaranteed Fund to make payment to a Funding
Successor, in accordance with Section 8.3.
Payments will be made as described in the Processing Payments Upon Plan
Termination or Reduction in Number of Participants provision set forth on the
Contract Summary Page.
If any amount remains in the Guaranteed Fund after all liabilities of the Plan have
been satisfied, the Company will pay the amount to the Contractholder in
accordance with Section 8.3. Experience Rate Credits which would otherwise be
credited after the Plan is terminated and after the Guaranteed Fund has been
exhausted, will be paid to the Contractholder in cash.
- 15-
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ARTICLE VII - PA YMIENTS UPON TIERIYHNA TION OF PLAN -
CONTRACT OR REDUCTION IN NUMBER OF PARTICIPANTS
o (ContimJled)
1.2 TERMINATION OF CONTRACT
This Contract shall terminate on the date coinciding with:
(a) the day the Guaranteed Fund is exhausted by withdrawals, or
(b) the day no further Annuity payments are payable hereunder,
whichever occurs later.
o
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8.2
ARTICLE vm - TRANSFERS
8.1
NOTICE OF TRANSFER AND TRANSFER PAYMENTS
The Contractholder may, at any time, give written direction to the Company to make
one or more withdrawals from the Guaranteed Fund to provide transfer payments to
a Funding Successor.
The first Guaranteed Fund withdrawal will be made on a Transfer Date as described
in the Processing Transfers provision set forth on the Contract Summary Page.
GUARANTEED FUND WITHlDRAWAlS AND TRANSFER I?AYI\IiENTS
The Company will make annual withdrawals from the Guaranteed Fund beginning on
the Transfer Date and continuing on each anniversary thereof until the Fund is
exhausted. The first withdrawal will be equal to the Book Value Transfer Limit
reduced by the sum of (a) any amounts exchanged from the Guaranteed Fund to a
Companion Contract during the twelve-month period immediately preceding the
withdrawal and (b) any amounts withdrawn from the Guaranteed Fund to make Cash
Payments during the twelve-month period immediately preceding the withdrawal.
Subsequent withdrawals will be equal to the Book Value Transfer Limit reduced by
any amounts withdrawn from the Guaranteed Fund to make Cash Payments during
the twelve-month period immediately preceding the withdrawal.
Instead of annual withdrawals, the Company may, at its option, make monthly
withdrawals in an amount equal to one-twelfth of the annual amounts as described in
the paragraph above. The Company may, at any time after the Transfer Date.
withdraw the balance of the Guaranteed Fund. In this event, the Contingent
Deferred Sales Charge, if any, shall be waived.
Each time a withdrawal is made from the Guaranteed Fund. in accordance with this
Section, the Company shall make a transfer payment to the Funding Successor in
the amount of the withdrawal less taxes and applicable charges in accordance with
Article VI.
8.3 Al TERNATIVlE GUARANTEED FUND WITHlIDRAWAL AND TRANSFER PAYMENT
Instead of the withdrawals and transfer payments provided in Section 8.2, the
Contractholder may direct the Company to withdraw all of the Guaranteed Fund on
the Transfer Date.
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ARTICLE vm - TRANSFERS
(Cofl"lltil1llUJedl)
8.3 AlTERNAT~VE GUARANTEED !FUND WITHDRAWAL AND TRANSFER PAYMENT
(CoD1ftimJledl)
In this event, the Company shall make a transfer payment to the Funding Successor
equal to the market value of such amount. The market value of the withdrawal is
equal to the amount withdrawn, increased or decreased by the Market Value
Adjustment. The Market Value Adjustment is determined by the Company in
accordance with uniform procedures applicable to all contracts of this class. The
transfer payment shall be reduced by taxes and applicable charges in accordance
with Article VI.
Upon receipt of written request, the Company shall furnish the Market Value
Adjustment formula to the Contractholder.
8.4 ~NTIERlEST AFTER TRANSFER lOA TIE
On the Transfer Date, Section 2.3 will become inoperative. During each Contract
Year thereafter, the Guaranteed Fund will be credited daily with an effective annual
rate of interest equal to (a) minus (b) where:
(a) is three times the Interest Rate last in effect; and
(b) is two times the market interest rate available to the Company on investments
for this class of contracts on the date that notice of transfer is received by the
Company.
For purposes of this Section, the Interest Rate will be the current rate or the rate in
effect thirty (30) days prior to the date that notice of transfer is received, whichever is
greater.
In the event there are multiple Sub-Funds, an average Interest Rate will be
determined by multiplying the amount of each Sub-Fund as of the Transfer Date by
the Interest Rate, summing these amounts, and dividing this sum by the amount of
the Guaranteed Fund as of the Transfer Date.
Upon receipt of written request, the Company shall furnish an explanation of the
formula described in (a) and (b) and of the bond index used to forecast the interest
rate described in (b).
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ARTiCLE IX - GENERAL PROVISIONS
9.~
GUARANTEES AND CHANGE OF CONTRACT
The Company guarantees that the Contingent Deferred Sales Charge Percentage
set forth on the Contract Summary Page will not be changed during the term of this
Contract.
The Company guarantees that the Interest Rate will not be changed before the end
of the period for which the Interest Rate is set forth on the Contract Summary Page.
Prior to the expiration of the guarantee, the Company shall provide written notice to
the Contractholder of the new interest rate.
The Company guarantees to credit interest to the Guaranteed Fund in accordance
with the formula described in Section 8.4 during the transfer payment period.
The Company reserves the right to change all other provisions of this Contract as of
the second Contract Anniversary, and at any time thereafter, by giving notice to the
Contractholder not less than ninety (90) days before the effective date of the change.
Any portion of this Contract added or changed will be guaranteed by the Company
for one year against subsequent change.
Notwithstanding the other provisions of this Section, the Company may amend the
Contract when, in the opinion of the Company. an amendment is necessary to
protect the Company from adverse financial impact due to any amendment to or
modification of the Plan, changes in the administrative practices adhered to by the
Plan, changes in Investment Options offered by the Plan, or the action of any
legislative, judiciary, or regulatory body, which impact the Contract.
This Contract may also be changed in any respect, at any time, by written agreement
between the Contractholder and the Company.
No change will adversely affect the rights of any Participant with respect to an
Annuity purchased before the effective date of the change unless:
(a) the change is required by a governmental agency, or
(b) the consent of each Participant in interest is obtained.
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ARTICLE IX - GENERAL PROVISIONS
CColl1~iuuJled)
9. ~ GUARANTEES AND CIHIANGE OF CONTRACT (Continued)
No agent or other person except an officer of the Company or other Home Office
official to whom authority has been delegated has authority to change this Contract,
to extend the times for payment of Deposits, to waive any charges, or to bind the
Company by making any promise, representation or by giving any information. Any
change, extension, waiver, promise, or representation shall not be construed as
authority, or act as a precedent, for the same or similar act performed by the
Company on another occasion.
9.2 CONTRACTIHIOlDER
The Contractholder shall be the representative under this Contract of each
Employer. The Contractholder may appoint an authorized representative. The
authorized representative must be mutually agreeable to both the Company and the
Contractholder. The Company will deal only with the Contractholder or its
authorized representative. The Company shall be entitled to rely on any action
taken or omitted by the Contractholder or its authorized representative pursuant to
the terms of this Contract. For purposes of this Article, Contractholder shall mean
the Contractholder or its authorized representative.
9.3 COMiYlUlNICA TION AND NOT~IFICA T!ON
All communications to the Contractholder or to the Company, as required under this
Contract, shall be in writing. The written communication shall be addressed to the
Contractholder at its principal office or to the Company at its Home Office. The
Contractholder shall notify the Company of the following events thirty (30) days prior
to the effective date of the event:
(a) amendment or modification of the Plan;
(b) change in the administrative practices adhered to by the Plan;
(c) change in the Investment Options offered by the Plan;
(d) Reduction in Number of Participants;
(e) Plan termination; or
(f) merger with another Plan for all or a class of Participants.
The Contractholder shall notify the Company of a merger, consolidation, or
reorganization by the Employer within thirty (30) days after the effective date of the
event.
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ARTICLE IX - GENERAll?ROVISIONS
(ColnJ~ilnJlUled)
9.~ I?LACE OF PAYMENT--CURRIENCY
All Deposits and other amounts payable by the Contractholder shall be payable to
the Company at its Home Office. All payments by the Company under this Contract
shall be payable at its Home Office, except where payment at any other place is
required by an applicable law.
All monies payable under this Contract, whether to or by the Company, shall be in
lawful money of the United States of America.
9.5 CIERTIFICA TIES
The Company will issue an Annuity certificate to each person for whom an Annuity is
purchased under this Contract as of the date the first payment is made. In addition,
if any applicable law requires, the Company will issue a descriptive certificate to the
Contractholder for delivery to each Participant. Each descriptive certificate will
describe the benefits to which the person or Participant is entitled under this
Contract.
9.S
~lENIEFICIARY --SETTLEMENT OPTIONS
If this Contract provides for payment of any amount or amounts after the death of an
Annuitant to a person other than a survivor Annuitant, payment shall be made to a
Beneficiary designated by such Annuitant. An Annuitant may change a Beneficiary
previously designated.
Any designation or change shall be made by filing a request with the Company on a
form satisfactory to it, and shall become effective when entered upon the records of
the Company. After any such designation or change is entered, it shall relate back
and take effect as of the date of the request, but without prejudice to the Company
on account of any payments made by it before receipt of such request.
The interest of any Beneficiary shall cease upon death, unless the Annuitant has
directed otherwise. If there is no designated Beneficiary to receive any amount
which becomes payable to a Beneficiary, the amount shall be payable to the estate
of the last to die of the Annuitant and the Beneficiary.
The Company, in determining the existence, ages, or any other facts relating to any
persons designated as Beneficiaries, either as a class or otherwise, may rely solely
on any affidavit or other evidence deemed satisfactory by it, and each and every
payment made by it in reliance thereon will, to the extent of such payment, be a valid
discharge of its obligation under this Contract.
- 21 -
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9.7
9.8
ARTICLE m: - GIENERAL /PROVISIONS
(ConlthlllUJedl)
9.6 I8IENEFICIARY--SETl"lEMENT OIPTIONS (Continued)
If any payments other than a single sum become payable to one or more
Beneficiaries, and if the monthly amount of the payments payable to any Beneficiary
is less than $20, or if the Beneficiary is other than a natural person receiving
payments in its own right, the Company may, instead of making the payments, pay
the commuted value thereof in full settlement of its liability for such payments.
If at any time the amount that would be payable in a single sum to the Beneficiary, if
such Annuitant were to die at that time, exceeds $3,500, the Annuitant and the
Company may arrange, by mutual agreement, a mode of settlement other than
payment in a single sum. If no mode of settlement has been arranged before the
death of an Annuitant, the Beneficiary and the Company may then mutually agree
upon a mode of settlement for the benefit of the Beneficiary other than payment in a
single sum.
IE~PERIENCE IRATE CREDITS
This Contract will be experience rated each calendar year by application of the
Company's experience rating plan in force during such year. Any experience rate
credit which may arise through such application will be credited to the Guaranteed
Fund, except as provided in Section 7.1.
ASSIGNMENT
Except insofar as may be contrary to any applicable laws, all Benefit Payments
under this Contract are not assignable and are not subject to the claims of any
creditor.
9.9 ~NfORMA1~ONDDRECORIDS
The Contractholder shall furnish all information which the Company may reasonably
require for the administration of this Contract. If the Contractholder cannot furnish
this information, the Company may request the person concerned to furnish such
information. The Company will not be liable for the fulfillment of any obligations until
it receives all requested information in a form satisfactory to it.
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ARTICLE IX - GENERAll?ROVISIONS
(CorntiB1lLlledl)
9. ~ 0 ENTIRE CONTRACT --CONSTRUCTION
This document, together with the attached Application, constitute the entire Contract.
This Contract will be construed according to the laws of the jurisdiction set forth on
the cover page of this document.
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o
AIPIPIUCATRONIFOIA GIAOUI? ANN/URTY CONTRACT
MAIDE TO
NATBONWIIOE UIFE INSURANCE COMPANY
(called Naiionwide)
ONE NATUONWBOIE I?ILAZA
COlUJMBlUIS, OIHlUO 43216
Trustee(s) of the 1998 Auqusta Money PllrC'!h.::l!C:~ 'Pl an b Trust
(Exact Name of Applicant, e.g., ABC Company, Inc. or Trustees of XVZ Company, Inc. Retirement Trust)
The Applicant applies for Group Annuity Contract Form No.
o APO-2241 (V1)
}[! APO-2242 (V2)
o APO-1538 (V3)
The Applicant approves and accepts the terms of the Contract.
The Applicant cenifies that to the best of its knowledge:
1.
The Applicant has the authority to enter into the Contract.
2.
The Applicant's plan qualifies under Section 401 of the Internal Revenue Code. If not so
qualified, describe type of plan:
3.
The Applicant, if a sole proprietorship or partnership: : . ~
a. is a financially sophisticated law, accounting, investment banking, pension.Gpnsulting,
or investment advisory firm with financial/business knowledge' 'and experience,
capable of adequately representing its interests and those of its e.nJploy~es; or
o
b. has obtained the advice of an independent, expert financial or busir;~ss ad\tisor hav-
ing no affiliation or material business relationship with Nationwide life, ar.,d capable
of adequately representing the interest of the Applicant and its emp-Ioyees; and
c. the plan covers only employees of a single employer or employees of interrelated
partnerships.
4. This Contract is a permissible investment under the Applicant's plan.
FOR USE WBTIHI VDIRTlUJOSO 3 CONTRACTS ONLY
AmolL8U1t of !Deposit Commitment $ to be made within
":;
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If Nationwide fails to accept this Application, the amount of Deposit will be refunded..withqut
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interest.
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MCM Financial Corp. dba Pension Service d.%Qesignatedtoreceiveanycomr;tlJssi8~s
payable under this Contract. _-I
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See Trustees' Signatures Attached
Title (Trustee. If Applicable)
APO-2251
VIRTUOSO
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Lee Beard, Mayor Pro Tern
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(All Trustees must sign)
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AIPPO~~l'MIE~1r Of CON1rIFU\C1rIHlOl[D)lEIRD~ AlUJl'IHlOIR~ZIEIQ) IRIEIP'RIESIE~l' A l'~VIE
VIER~f~CA l'~ON Of RECEHPl Of SIP'EC~MEINI GROUP ANlNllUJ~1V CONTRAC1r(S)
o AND COMPllETED PROPOSAL PAG!E~
Trustees of the 1998 AUGUSTA MONEY I?IURCIHIASE PLAN Trus~ ("Contractholder") hereby delegate
to I?IENSION SlElRV~CIE COMPANY ("Authorized Representative"), the authority and responsibilty to act
on behalf of the Contractholder in performing the following acts under one or more Nationwide Life
Insurance Company ("Nationwide@") group annuity contracts ("Contract(s)") issued in connection with a
retirement plan ("Plan"):
1.
2.
3.
4.
Q
To receive all communications from Nationwide@ as they pertain to a Contract, and to forward all
communications to Nationwide@) from the Contractholder.
To receive information relating to Contract fund performance, updated interest guarantees, and all
other funding information which is provided by Nationwide@).
To receive issued Contracts, Contract amendments, Contract endorsements, and all other
correspondence from Nationwide@) and to deliver such items to the Contractholder.
To receive Contract deposits from the Contractholder, but only in the form of notes made payable to
Nationwide@), and to submit such deposits, along with all information required by Nationwide@ for
the proper and prompt investment of such deposits, to Nationwide@).
To access Contract values and Contract fund balances, as frequently as necessary for the benefit
of the Contractholder, including, but not limited to, receiving periodic accountings of all transactions
under a Contract and delivering such accounting to the Contractholder.
The Authorized Representative may be authorized to access account balances through the
Nationwide@ voice response system (1INQUIRE") and the Internet. This election will also authorize
Nationwide@) to allow participants to access their account balances through INQUIRE and the
Internet. In the event the Authorized Representative and participants are authorized to access
account balances through INQUIRE and the Internet, the Authorized Representative shall provide
copies of the brochures and other written materials describing these services to the Contractholders
and participants. The authority to access account balances is contingent upon the election below:
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5.a. The Authorized Representative and participants are hereby 00 authO}iled'.D not
authorized to access account balances through the Nationwide@ voice response system
(1INQUIRE") and the Internet in accordance with Section 5. 0', .
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6. To instruct Nationwide@ to exchange amounts within and among Contract(s) an~o provide all
information required by Nationwide@ for the proper and prompt exchange of these arriliunts":
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APO-2704-C (10/96)
6/4198 3:02:48 PM
257.1998 AUGUSTA MONEY PURCHASE PLAN
.
7.
8.
.
9.
The Authorized Representative may be authorized to make exchanges and change participants'
fund elections of future contributions through the Nationwide@) full-service voice response system
("INQUIRE") and the Internet. This election will also authorize Nationwide@) to take direction from
participants for exchanges and changes in their fund elections of future contributions through the
Nationwide@) full-service voice response system (1INQUIRE") and the Internet. In the event the
Authorized Representative and participants are authorized access to the full-service version of
INQUIRE and the Internet, the Authorized Respresentative shall provide copies of the brochures
and other written materials describing these services to the Contractholders and participants. The
authority to access this version of INQUIRE and the Internet is contingent upon the election below:
6.a. The Authorized Representative and participants are hereby 00 authorized 0 not
authorized to make exchanges and change participants' fund elections of future
contributions through the Nationwide@ full-service voice response system (1INQUIRE")
and the Internet in accordance with Section 6.
To instruct Nationwide@) to purchase annuities or make cash payments to participants pursuant to a
Contract and to provide all information required by Nationwide@ to make such annuity purchases or
cash payments.
To notify Nationwide@) of expenses incurred by a Plan which are to be paid from the amounts held
under a Contract. Such notification will include all information required by Nationwide@) to make
such a payment.
To receive checks from Nationwide@) made payable to the Authorized Representative, withdrawn
from funds held under any and all Nationwide@ group annuity contracts issued to the
Contractholder. Such checks will be for the sole purpose of providing payment of plan
administration service fees for services rendered by the Authorized Representative to the Plan(s)
which are funded by the Contract(s). . Nationwide@ shall accept the Authorized Representative's
direction as to the fees to be withdrawn, in accordance with the authority granted in Section 8 of this
form. The authority to accept such payment is contingent upon the election below:
9.a. The Authorized Representative is hereby 00 authorized D not authorized to J;eceive
checks from Nationwide@ in accordance with Section 9. ~ -;..-!.
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10. To request that services be performed by Nationwide@ for which Nationwide@ may::feimbi:Jrse itself
from a Contract for the cost of such services. The Authorized Representative agreesnot "to request
such services without prior written agreement between the Authorized Represeillati~~ and the
Contractholder. N :' . :
11.
.
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To perform any other act specifically authorized by the Contractholder in writing. SuCh written
authorization must be received and accepted by Nationwide@). Upon acceptance by Nationwide@,
such additional written authorization will be attached to and be made part of this Appointment and
be subject to all provisions set forth herein.
APO-2704-C (10/96)
6/4198 3:02:48 PM
257.1998 AUGUSTA MONEY PURCHASE PLAN
'.. ".
The Contractholder and Authorized Representative agree to hold Nationwide@ harmless for any
~pre.sentations or any action.s taken by the A~th~rized. Representative, its employees, its ~gents, or .its
C)>polntees, when the Authonzed Representative IS acting on behalf of the Contractholder In performing
Cfelegated tasks related to the operation of the Contract. The Contractholder and Authorized
Representative further agree that Nationwide@ will reserve the right to communicate directly with the
Contractholder without notification to the Authorized Representative whenever Nationwide@ deems it
necessary .
This Appointment shall be effective from the date of execution until ten (10) days after the
Contractholder delivers a notice, in writing, to Nationwide@ of its canceUation.
VERIFICA TION OF RECEIPT OF SPECIMEN GROUP ANNUITY CONTRACT(S)
AND COMPLETED PROPOSAL PAGES
The trustee acknowledges that helshe has received and read the Nationwide@ group annuity specimen
contract(s) , , and the completed proposal pages for each applicable contract form, indicated below prior
to signing any Nationwide@) group annuity contract application(s). The trustee understands that the
appropriate interest rates (where applicable) and contract charges are disclosed in these documents.
[g] Nationwide@) Variable Product - Specimen Contract Form APO-2243
[g] Nationwide@) Fixed Product - Specimen Contract Form APO-2242
()J Nationwide@ Indexed Fixed Product - Specimen Contract Form APO-2241
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We hereby agree with the provisions set forth herein and the verification indicated above: . '::
Attached
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Date
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Date
ationwide@ Life I
(p!J()(Cfrt
DC<te I
Authorized Representative
APO-2704-C (10/96)
6/4198 3:02:48 PM
257 -1998 AUGUSTA MONEY PURCHASE PLAN
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Lee Be~rd, Mayor Pro Tem
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Stephen E. Shepar ,
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Moses Todd, Commlssionerc: :",
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(All Trustees must sign)
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APO-2706
614/98 3:02:49 PM
NATIONWIDE LIFE INSURANCE COMPANY
PAYOR DESIGNATION FORM EXPLANATION
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The Unemployment Compensation Amendments of 1992 affects plan participants receiving
distributions from a qualified plan. The Act impacts qualified retirement plan rOllovers,
withholding and transfer rules.
The Act provides that the "Plan Administrator" (as defined in your plan document) must
withhold a mandatory 20% on any distribution from a qualified plan which is eligible to be
rolled over unless the distribution is transferred directly to an IRA or another qualified plan.
Existing withholding rules apply to distributions which are not eligible for rollover treatment.
The "Plan Administrator" must withhold and be liable for payment of any Federal income tax
from plan benefit paid to participants. If Administrator is not defined in the plan, the
Employer, as plan sponsor, is usually deemed to be the Administrator. The responsibility to
withhold can be designated to Nationwide Life Insurance Company ("Nationwide@") for
payments made from contracts funding a qualified retirement plan.
".
As designated Payor, Nationwide@ will provide the following services:
1. Make benefit check or wire payable to the plan participant less 20% withheld for
Federal Income Tax, or other applicable Federal Income Tax; or
2. Make benefit check or wire payable directly to an IRA for the benefit of the plan
participant; or
3. Make benefit check or wire payable directly to another qualified employer plan
for the benefit of the plan participant.
4. Provide tax reporting information to all participants who have received benefit
payment(s) during a calendar year on a Form 1099-R.
5. Withhold and remit to the Federal goverment, all withholding amounts. This
service eliminates the need for the Plan Administrator to remit these amounts
and prepare necessary quarterly and annual reporting forms to document
withholding to the IRS.
257.1998 AUGUSTA MONEY PURCHASE PLAN
.
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APO-2706
6/4/98 3:02:49 PM
Nationwide@ must receive the following information in order to accept liability for Federal
Income Tax withholding:
..
The name, address, and social security number of the payee,
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the amount of "after-tax" employee contributions (not eligible for rollover),
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amount of any premiums for life insurance paid for the current cost of life
insurance that were previously included as income (not eligible for rollover),
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reason for distribution (e.g. death, disability, retirement),
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any other information required by 1099R.
If Nationwide@) IS NOT designated Payor, services will be limited to a check or wire
payable to the Trustees. IT WILL BE THE RESPONSIBILITY OF THE TRUSTEE TO
APPLY THE APPROPRIATE WITHHOLDING RULES AND REPORTING RULES.
This designation will remain in effect until it is revoked in writing by the plan trustees.
The above information is not intended to provide plan or legal advice. Please contact
your tax advisor if there are questions regarding the Plan Administrator responsibilities
under the Act.
If you would like to designate Payor responsibilities to Nationwide Life Insurance Company,
please check Box A on the attached form. If you do not wish for Nationwide@ to perform the
services outlined above, please check Box B. Please return this form at your earliest
convenience as distributions cannot be processed without it.
257.1998 AUGUSTA MONEY PURCHASE PLAN
o
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APO-2706
6/4/98 3:02:49 PM
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NATIONWIDE LIFE INSURANCE COMPANY
PAYOR DESIGNATION FORM
Please check 80x A or 8, and sign and date this form.
[KJ A. As Plan Administrator, I hereby direct Nationwide Life Insurance Company to
process participant distributions as prescribed by the Unemployment
Compensation Amendments. Provisions of the Act will be followed for qualified
plan rollovers, transfers, and withholding. I agree to provide Nationwide@ with
the necessary information.
D
8. As Plan Administrator, I do not direct Nationwide Life Insurance Company to
process participant distributions. I will take responsibility for:
1. Initiating benefit payments,
2. provide tax reporting forms to participants, and
3. remit withholding to the IRS.
Name of Plan: 1998 AUGUSTA MONEY PURCHASE PLAN Trust
Case No.
Dated:
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TIllo documonl oppIOVod &s
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nome, ~ .
257 - 1998 AUGUSTA MONEY PURCHASE PLAN