State of Maryland Participation Agreement for Pre-Tax and Roth Retirement Savings Accounts

Transcription

1 State of Maryland Partiipation Agreement for Pre-Tax and Roth Retirement Savings Aounts DC-4531 (08/2015) For help, please all

2 Things to Remember Complete all of the setions on the Partiipation Agreement that apply to your request. Complete the Authorization setion, and remember to sign and date this Partiipation Agreement. Enlose the ompleted Partiipation Agreement, and any other doumentation in the business reply envelope inluded with this booklet. All ontributions will use the same investment eletion and alloation. If you wish to have different seletions, all us at or toll-free at Earnings from designated Roth ontributions may be subjet to inome taxes and penalties upon distribution if the distribution is deemed to be Non-Qualified. A Qualified distribution is one that the ontributions are held in the Designated Roth Aount for 5 onseutive tax years and the partiipant is at least age 59 ½, has beome disabled or has died. In addition, Designated Roth Aounts whih are rolled over into this aount may be subjet to inome taxes and penalties if they are deemed Non-Qualified. Designated Roth Contributions are generally not subjet to inome taxes or penalties. Please note that, one made, ontributions and/or rollovers to a Roth aount may not be reversed. In the event you wish to make hanges, only future ontributions and/or rollovers an be redireted. 2 DC-4531 (08/2015) For help, please all

3 State of Maryland Partiipation Agreement for Pre-Tax and Roth Retirement Savings Aounts Personal Information Selet Plan Type: 457(b) Pre-Tax 401(k) Pre-Tax 403(b) Pre-Tax 457(b) Roth* 401(k) Roth* *Contributions to Roth are made on a post-tax basis. Name: Address: Date of Birth: Soial Seurity Number or Aount Number: City, State, & Zip Code: Work Phone Number: Address: Home Phone Number: Date of Hire: Ageny Code: Gender: Male Female Type of Request & Paperless Delivery Consent New Change Amount Reinstate Change Diretion of Future Contributions NOTE: All inreases, dereases and suspensions will be implemented no sooner than the first payroll of the month following the hange. Please remember to hek your pay stub to onfirm your seleted ontributions are aurately refleted and being proessed. Paperless Delivery: By providing your address you are onsenting to reeive statements, onfirmations, terms, agreements and other information provided in onnetion with your retirement plan eletronially. Unless you hoose to have statements, aount douments and other douments sent in onnetion with your retirement plan delivered via US Mail to the mailing address of reord by heking the box below, these douments will be made available to you eletronially. I wish to reeive my statements and aount douments via US Mail. Contribution Summary & Payroll Frequeny Contribution Amount - Pre-Tax Contribution Amount - Roth* Speial Amount Per Pay Total *Contributions to Roth are made on a post-tax basis. Contribution to begin on pay period ending date: Speial Pay-Period Date Range: Start Date/End Date: (Speial Amount Only) # of Pay Periods: Dollar Amount* Payroll Frequeny: Please selet your payroll frequeny to insure timely proessing. Weekly Monthly Semi-Monthly Bi-Weekly Other Benefiiary Designation Chek here if this is a hange of benefiiary. (Benefiiaries listed below replae any prior designation) PLEASE NOTE: Perentage split must total 100% for eah ategory of benefiiary. If additional spae for benefiiaries is required, attah additional sheets and mark this box: Primary Benefiiary(ies) (must total 100%): Payroll Type: Regular University Contratual Other Payroll Center Name: Central University Other Name Relationship Soial Seurity # Phone # Address Date of Birth % Split Name Relationship Soial Seurity # Phone # Address Date of Birth % Split Contingent Benefiiary(ies) (must total 100%): Name Relationship Soial Seurity # Phone # Address Date of Birth % Split Name Relationship Soial Seurity # Phone # Address Date of Birth % Split DC-4531 (08/2015) For help, please all

4 Funding Options Enroll me in asset rebalaning. I agree to omply with and be bound by the terms and onditions of the servie inluding any restritions imposed by the investment options. I understand I an obtain more information about the servie, its terms and onditions by ontating the NRS Servie Center. PLEASE NOTE: TOTAL OF ALL FUNDING OPTIONS MUST EQUAL 100% (WHOLE % ONLY) Fixed Inome Option International Investment Contrat Pool (457(b) & 401(k) only) Amerian Funds - EuroPaifi Growth Fund (R6 Shares) Vanguard Prime Money Market Fund (403(b) only) Bonds Vanguard Total International Stok Index Fund (Institutional Shares) PIMCO Total Return Fund (Institutional Shares) Vanguard Total Bond Market Index Fund (Institutional Shares) Balaned Fidelity Puritan Fund T.Rowe Prie Retirement Balaned Fund Large Cap Amerian Century Equity Growth Fund (Institutional Shares) Amerian Funds - The Growth Fund of Ameria (R6 Shares) Goldman Sahs Large Cap Value Fund (Institutional Class) Parnassus Equity Inome Fund (Institutional Shares) Vanguard Institutional Index Fund Mid Cap Janus Enterprise Fund (N Shares) T. Rowe Prie Mid Cap Value Fund Vanguard Mid Cap Index Fund (Institutional Plus Shares) Small Cap T. Rowe Prie Small Cap. Stok Fund Vanguard Small-Cap Index Fund T.Rowe Prie Target Date Retirement Funds T.Rowe Prie Retirement 2005 Fund (designed for those born in 1942 or before) T.Rowe Prie Retirement 2010 Fund (designed for those born between ) T.Rowe Prie Retirement 2015 Fund (designed for those born between ) T.Rowe Prie Retirement 2020 Fund (designed for those born between ) T.Rowe Prie Retirement 2025 Fund (designed for those born between ) T.Rowe Prie Retirement 2030 Fund (designed for those born between ) T.Rowe Prie Retirement 2035 Fund (designed for those born between ) T.Rowe Prie Retirement 2040 Fund (designed for those born between ) T.Rowe Prie Retirement 2045 Fund (designed for those born between ) T.Rowe Prie Retirement 2050 Fund (designed for those born between ) T.Rowe Prie Retirement 2055 Fund (designed for those born between ) T.Rowe Prie Retirement 2060 Fund (designed for those born in 1993 or after) Authorization Please send me a opy of the Informational Brohure/Prospetus(es). Please ontat me about my other pre-tax investments and/or roth investments that I would like to roll into this plan. I authorize my employer to redue my salary by the above amount whih will be redited to the State of Maryland 457 Plan, 401(k), and/or 403(b)Plan as appliable. The redution will ontinue until otherwise authorized in aordane with the plan. The withholding of my ontributed amount by my employer and its payment to the designated investment option(s) will be refleted in the first pay period after the proessing of this appliation by the Plan Administrator in onjuntion with the set-up time required by my payroll enter, however, in no ase prior to the beginning of the month following the month this form is signed. The redution is to be alloated to the investment options in the perentages indiated above. Current pre-tax investment eletion and alloation will be used for Roth ontributions. All hanges will be proessed when reeived by the Produt Provider. By signing below, you aknowledge reeipt of a opy of the appliable prospetus overing the options to whih your funds will be alloated. By signing below, you authorize Nationwide Retirement Solutions, as the Administrative Servies Provider, to make the hanges indiated above. I HAVE READ AND UNDERSTAND EACH OF THE STATEMENTS ON THE FRONT AND BACK OF THIS FORM, INCLUDING THE MEMORANDUM OF UNDERSTANDING WHICH HAVE BEEN DRAFTED PURSUANT TO THE APPLICABLE PROVISIONS IN THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. I ACCEPT THESE TERMS AND UNDERSTAND THAT THESE STATEMENTS DO NOT COVER ALL THE DETAILS OF THE PLAN OR PRODUCTS. Partiipant Signature: Date: Retirement Speialist Name: Agent Number: MAIL TO: 4 Nationwide Retirement Solutions MCormik Road Exeutive Plaza 1 - Suite 400 Hunt Valley, MD For assistane with ompleting this form, please all or toll-free at Fax number: DC-4531 (08/2015) For help, please all

5 State of Maryland Retirement Plan Memorandum of Understanding The purpose of the Memorandum of Understanding is to make you aware of the highlights, restritions and ost of your plan. It is not intended to over all speifi details of the plan. I understand that my partiipation in the Plan is governed by the terms and onditions of the Plan Doument. I understand and aknowledge the following: 1. REGARDING 457(b) PLANS: The ombined total annual pre-tax or Roth ontribution amount to all 457(b) plans is the lesser of $18,000 or 100% of inludible ompensation. Under ertain irumstanes, additional amounts above the limit may be deferred into the Plan if (1) I will attain age 50 or older during the urrent alendar year, or (2) I am within three years of Normal Retirement Age and did not defer the maximum amount in prior years. The Plan Doument provides additional details about ontribution limits. Contributions in exess of maximum amounts are not permitted and will be onsidered taxable inome when refunded. It is my responsibility to ensure my ontributions do not exeed the annual limit. It is my responsibility to adjust my ontribution amount to omply with the law. Exess ontributions will be returned to me and reported on a 1099R tax form. I aknowledge that it is my responsibility to make sure my total ontributions, inluding any 457(b), 403(b) and/or 401(k) Plan Contributions, fall within the speified limits. A Nationwide Retirement Solutions Representative an provide assistane in determining my ontribution limits. All withdrawals of funds must be in ompliane with the Internal Revenue Code and appliable regulations, some of whih are expressed in the Plan Doument. Funds may be withdrawn from the plan ONLY when one of the following events ours: Termination of State Employment Attaining age 70 1/2 even if still employed. Unforeseeable Emergeny approved by the plan Total Disability Death When taking a loan In some ases a transfer for purhase or repayment of servie redits in a Governmental Defined Benefit Plan may be permitted. Roth distributions not meeting the riteria for a qualified distribution may be subjet to inome tax and a 10% penalty. 2. REGARDING 401(k) PLANS: My ombined total annual pre-tax or Roth ontribution is subjet to ontribution limitations desribed in Setions 415() and 402(g) of the Internal Revenue Code. My maximum ontribution will be the lesser of $18,000 or 100% of my ompensation under setion 415 of the Code. Additional amounts above the limit may be deferred into the Plan if I will attain age 50 or older during the urrent alendar year. I understand that urrent or future partiipation in additional benefit plans, suh as 403(b) and/or 401(a) plans, may affet my maximum annual ontribution limit under the Maryland 401(k) Plan, in aordane with the U.S. Internal Revenue Code. It is my responsibility to adjust my ontribution amount to omply with the law. Exess ontributions will be returned to me and reported on a 1099R tax form. I aknowledge that it is my responsibility to make sure my total ontributions, and other 403(b) Plan and/or 401(k) Plan, inluding Roth, ontributions, fall within the speified limits. A Nationwide Retirement Solutions Representative an provide assistane in determining my ontribution limits. Funds may be withdrawn from the plan ONLY when one of the following events ours: Termination of State Employment (an early withdrawal penalty may apply if your separation from state servie is prior to the age of 55.) Attaining age 59 1/2 even if still employed. Finanial Hardship (a 10% early withdrawal penalty tax may apply prior to age 59 1/2) Total Disability Death When taking a loan In some ases a transfer for purhase or repayment of servie redits in a Governmental Defined Benefit Plan may be permitted. Roth distributions not meeting the riteria for a qualified distribution may be subjet to inome tax and a 10% penalty. DC-4531 (08/2015) For help, please all

6 State of Maryland Retirement Plan Memorandum of Understanding If appliable, amounts ontributed to the 401(a) math aount, when the Math Program is in effet, do not affet employee 401(k) limits but may impat eletive ontributions or employer ontributions made on my behalf into other retirement plans. I aknowledge that I am responsible for monitoring these limits and notifying the Plan Administrator if neessary. 3. REGARDING 403(b) PLANS (available for eduation employees only): My total annual ontribution is subjet to ontribution limitations desribed in Subsetion 403(b) of the Internal Revenue Code. My maximum ontribution will be the lesser of $18,000 or inludible ompensation as defined under Setion 415 of the Code, or my basi exlusion allowane. I understand that urrent or future partiipation in additional benefit plans, suh as 401(k) plans, may affet my maximum annual ontribution limit under the Maryland 403(b) Plan, in aordane with the U.S. Internal Revenue Code. It is my responsibility to adjust my ontribution amount to omply with the law. Exess ontributions will be returned to me and reported on a 1099R tax form. I aknowledge that it is my responsibility to make sure my total ontributions and other 403(b) Plan and/or 401(k) Plan Contributions, fall within the speified limits. A Nationwide Retirement Solutions Representative an provide assistane in determining my ontribution limits. Funds may be withdrawn from the plan ONLY when one of the following events ours: Termination of State Employment (an early withdrawal penalty may apply if your separation from state servie is prior to the age of 55.) Attaining age 59 1/2 even if still employed. Finanial Hardship (a 10% early withdrawal penalty tax may apply prior to age 59 1/2) Total Disability Death When taking a loan In some ases withdrawal for purhase or repayment of servie redits in a Governmental Defined Benefit Plan may be permitted. If appliable, amounts ontributed to the 401(a) math aount, when the Math Program is in effet, do not affet employee 403(b) limits but may impat eletive ontributions or employer ontributions made on my behalf into other retirement plans. I aknowledge that I am responsible for monitoring these limits and notifying the Plan Administrator if neessary. REGARDING ALL PLANS 4. The fund prospetuses are available upon request at or by alling I must notify Nationwide Retirement Solutions of any address hanges, benefiiary hanges, ontribution amount hanges, alloation hanges or errors on my aount statement. 6. I may realloate my ontribution amount any time without limitation. 7. Contributions, in the form of salary redutions, will be made eah pay period until I notify Nationwide Retirement Solutions otherwise. A short delay may exist before my ontributions are invested due to the time required to plae the money into the investment options. 8. I will reeive a statement of my aount quarterly. 9. My distributions must begin no later than April 1st following the year I reah age 70 1/2. If I work beyond age 70 1/2, my distributions must begin no later than April 1st following the year I separate from servie or retire. All distributions are taxable as ordinary inome and subjet to inome tax in the year reeived. My distributions must be made in a manner that satisfies the minimum distribution requirements of IRC Se. 401(a)(9), whih urrently requires benefits to be paid at least annually over a period not to extend beyond my life expetany Failure to meet minimum distribution requirements may result in the payment of a 50% federal exise tax. 10. The funds in my aount may be eligible for rollover to a traditional IRA or to an eligible retirement plan. The Speial Tax Notie Regarding Plan Payments provides detailed information about my options. Due to important tax onsequenes related to distributions, I have been advised to onsult a tax advisor. I expressly assume the responsibility for tax onsequenes relating to any distribution, and I agree that neither the Plan nor the Plan Administrator shall be responsible for those tax onsequenes. 11. Eligible Rollover Distributions are subjet to 20% Federal Inome Tax withholding. 12. The share value alulated at the time of exhange depends on the investment option. Contat your Nationwide Retirement Solutions representative for speifi information for eah investment option. 13. All telephone exhange requests will be reorded for the partiipant s protetion. 14. The value of my aount in my hosen mutual funds an flutuate and result in a gain or loss depending on the market ativity. 15. An annual asset fee up to 0.14% will be assessed on my aount balane. Part of this fee, 0.05%, supports the Maryland Teahers and State Employees Supplemental Retirement Plans Board of Trustees budget. The remaining 0.09% goes toward servies provided by Nationwide Retirement Solutions. No aount will be harged a ombined board fee and Nationwide Retirement Solutions fee of more than $2, annually. A Nationwide Retirement Solutions representative an provide further details. 6 DC-4531 (08/2015) For help, please all

7 State of Maryland Retirement Plan Memorandum of Understanding 16. The investment options available under the plan are seleted by the Maryland Teahers and State Employees Supplemental Retirement Plans Board of Trustees and are subjet to a periodi review by the Board, its staff and its Investment Advisor to assure that the options ontinue to meet established riteria. The Board reserves the right to add additional funds to the plan and replae or remove existing funds. If existing funds are replaed, the Board reserves the right to require or diret the transfer of existing balanes and ongoing ontributions from any fund whih has been eliminated as an option within the same risk ategory that I had previously seleted. 17. I have reeived an explanation of the fixed option and understand that the rate of return produed by that option will vary over time, depending on the rates paid by the ontrats that make up the fixed option (457(b), 401(k) & 401(a) only). 18. Money alloated to eah Investment Contrat Pool, as seleted by the Board, will earn a fixed rate of interest for the ontrat term as seleted by the Board. Partiipation in the fixed option will result in a blended interest rate based upon the Investment Contrat Pools used to determine my aount value. I understand that an Investment Contrat Pool is not a mutual fund (457(b), 401(k), & 401(a) only) 19. Transfers between investment options are provided for under the Plan subjet to limitations or restritions (inluding redemption fees), if any, as imposed by the investment providers. I understand that any information regarding limitations or restritions as they apply to the Plan may be obtained from the Plan Administrator. 20. If appliable, I understand that no hanges will be effetive until they are proessed by Nationwide Retirement Solutions. 21. Distribution from the 401(a) aount may our at the time of the partiipant s death, disability, or separation of servie. Withdrawals from the 401(a) aount prior to age 59 1/2 may be subjet to a 10% federal tax penalty for early withdrawal. 22. Targeted Retirement Funds are managed by T. Rowe Prie and are omposed of other T. Rowe Prie mutual funds. There is no guarantee that the investment objetive of any fund will be ahieved. Investment return and prinipal value will flutuate, so that an investor s shares, when they are redeemed, may be worth more or less than their original ost. The Targeted Retirement Funds are designed to provide diversifiation and asset alloation aross several types of investments and asset lasses, primarily by investing in underlying funds. Therefore, you are indiretly paying a proportionate share of the appliable fees and expenses of the underlying funds. 23. Nationwide Retirement Solutions, In. and Nationwide Life Insurane Company have endorsement relationships with the National Assoiation of Counties and the International Assoiation of Firefighters-Finanial Corporation. More information about the endorsement relationships may be found online at Finanial & Realty Servies, LLC may provide eduation and marketing support servies on behalf of NRS. Its Retirement Consultants are registered representatives of FSC Seurities Corporation (FSC), member FINRA, SIPC. FSC and Finanial & Realty Servies, LLC are not affiliated with MSRP, NRS or NISC. CONSENT TO PAPERLESS DELIVERY AND ACCESS By providing your address here, you are agreeing and onsenting to reeive and view plan benefit statements, orrespondene and onfirmations, and other ommuniations eletronially. These materials will be provided through an message notifying you that eletroni douments are available online for you to view and print. This replaes all written ommuniation assoiated with your Retirement Plan(s) servied by Nationwide and you will no longer reeive these douments via U.S. Mail. By providing your onsent to paperless delivery, you are aknowledging and onfirming that you are onsenting to reeive Plan Communiations eletronially, as they are now available or as they may be required or beome available in the future and that you have aess to view and print your douments eletronially from the website and to save them from your omputer or other eletroni devie. If you would like to reeive the above referened douments in paper form via U.S. Mail you an do so by ontating Customer Servie at ( ) and requesting paper. You may opt out of paperless delivery of your plan related douments at any time. There is no additional ost to reeive douments in paper format via U.S. Mail. CHANGING YOUR ADDRESS AND YOUR PAPERLESS DELIVERY PREFERENCES You are able to update your address or hange your Paperless Delivery Preferenes anytime either on the website or via Customer Servie. YOUR RIGHT TO REVOKE CONSENT You have the right to revoke your onsent to reeive douments eletronially. Your onsent shall be effetive until you revoke it by hanging your delivery preferenes via Customer servie or on the website by seleting U.S. Mail delivery. DC-4531 (08/2015) For help, please all

8 8 DC-4531 (08/2015) For help, please all