Full Text
1 of 26 09/06/2019 ACCG 401(a) Defined Contribution and 457(b) Deferred Compensation Plan Plan Distributions Instructions to Participants Attached are your Election Forms and an explanation of your options upon distribution. The forms must be completed fully before you receive payment of your benefit. The description of your distribution is based on the Internal Revenue Service Regulations currently in effect. Please consult your plan representative or tax advisor prior to taking any action. You may order Publication 575 from the IRS for additional information on your distribution. A. Lump Sum Cash Payment Check Box A if you want your distribution in cash. Income Taxes at the rate of 20% will automatically be withheld if your distribution is at least $200. If you would like your money directly deposited to your bank, please attach a voided check or complete the direct deposit form. We cannot accept starter checks or direct deposit slips. Disability: If you have been deemed disabled, during employment, through Social Security please include the Social Security Award letter with your application. B. Full Rollover Check Box B if you wish a direct rollover of your entire account balance and your distribution is greater than $200. You must complete the Rollover Information Form that is included in this packet. If you do not fill in an address for your Trustee, you will receive a check made payable to the trustee of your IRA or Plan. It will then be your responsibility to deliver the check to the trustee. If you are rolling your Roth 457(b) over to an IRA please verify with your Trustee that they will accept Roth 457(b) money. C. Split Cash Payment/ Rollover Check this box if you want to do any of the following: Take part of your account balance in cash. You are not required to rollover the remaining balance. Take part of your distribution in cash, and rollover the remaining balance. Rollover a portion of your account balance. You are not required to cash out the remaining balance. Income taxes at the rate of 20% will automatically be withheld from the cash portion of your distribution if it is at least $200. Any rollover amount must be at least $200.00 and you must complete the Rollover Information Form included in this packet. If you do not fill in an address for your Trustee, you will receive a check made payable to the trustee of your IRA or Plan. It will then be your responsibility to deliver the check to the trustee. If you are rolling your Roth 457(b) over to an IRA please verify with your Trustee that they will accept Roth 457(b) money. D. Systematic Payments Check this box if you want your distribution in cash installments. The installments can be paid quarterly, semiannually or annually over a number of years. You may receive a specific dollar amount per installment. Contact you plan representative for additional information regarding Special Rules for systematic payments. The W-4P form that is attached to the packet is required to be completed to process a systematic payment. Be sure the marital status is marked at the bottom of pg. 1 of the W-4P form. ---PAGE BREAK--- 2 of 26 09/06/2019 ACCG 401(a) Defined Contribution and 457(b) Deferred Compensation Plan Plan Distributions Instructions to Participants Participants who receive a distribution under this plan may waive the 30-day notice requirement. You are not required to waive this notice. If the notice is not waived, you will receive your distribution no sooner than 30 days after the execution date of the Payment Election Form. After you elect the form of payment and indicate if you waive the 30-day notice requirement, your form should be forwarded to your former employer’s human resources department for the bottom portion of the form to be completed. You will receive a Form 1099-R attached to your check. Please keep this form since you will need it to file your taxes for the year in which you received your distribution. If you receive your payment via direct deposit or elected a Rollover, the Form 1099-R will be sent to you at the same time that your payment is deposited or sent to your Rollover Institution. A copy of the 1099-R will be available on the participant website in February the following year in which you received your payment. ---PAGE BREAK--- 3 of 26 09/06/2019 ACCG 401(a) Defined Contribution and 457(b) Deferred Compensation Plan Plan Distributions Payment Election Form Part 1 Participant Name: Social Security No.: Date of Birth: Mailing Address: E-mail: Phone No. Former Employer: BENEFIT ELECTION - Choose One of the following options: (Please select which plan you would like this distribution to come from. If you would like the distribution to apply to both the 401(a) and 457(b) please check both boxes. You can choose different options for each plan) A. LUMP SUM CASH PAYMENT (see direct deposit requirements on part 3) 401(a) 457(b) Pre-tax contributions Roth contributions (after-tax) □ Pay my distribution to me in Cash of my entire account. I realize that my distribution will be subject to 20% federal income tax withholding if my distribution exceeds $200. B. FULL ROLLOVER 401(a) 457(b) Pre-tax contributions Roth contributions (after-tax) □ Direct Rollover of my entire account balance (your distribution must be at least $200). Complete the attached Rollover Information Form. □ I am requesting Roth 457 funds to be rolled over. By checking this box, I confirm that my Trustee accepts Roth 457 funds. C. SPLIT CASH / ROLLOVER PAYMENT (see direct deposit requirements on part 3) 401(a) 457(b) Pre-tax contributions Roth contributions (after-tax) $ payable to me in Cash. I realize that this portion of my distribution will be subject to 20% federal income tax withholding if it exceeds $200. And/Or a Direct Rollover of (your Rollover must be at least $200). Complete the attached Rollover Information Form. □ I am requesting Roth 457 funds to be rolled over. By checking this box, I confirm that my Trustee accepts Roth 457 funds. ---PAGE BREAK--- 4 of 26 09/06/2019 ACCG 401(a) Defined Contribution and 457(b) Deferred Compensation Plan Plan Distributions Payment Election Form Part 2 D. SYSTEMATIC PAYMENTS (For those who select systematic payments please keep in mind that your process may take more than 15 business days to complete. Please submit the forms before the 12th day of the month in order to receive your distribution the following month) 457(b) 1. Frequency - Choose One of the following: □ □ Quarterly □ Semiannually □ Annually 2. Amount- (Please specify the dollar amount) I would like to receive $ per payment from my 457(b) ($500.00 Minimum) 401(a) 1. Frequency - Choose One of the following: □ □ Quarterly □ Semiannually □ Annually 2. Amount- (Please specify the dollar amount) I would like to receive $ per payment from my 401(a) ($500.00 Minimum) The Systematic Payment option requires that you complete the W-4P form (attached). Marital status and withholding information must be completed. If the box on line 1 of the W-4P is checked, the mandatory 20% tax withholding will still be withheld. ---PAGE BREAK--- 5 of 26 09/06/2019 ACCG 401(a) Defined Contribution and 457(b) Deferred Compensation Plan Plan Distributions Payment Election Form Part 3 You must indicate if you would like to waive the 30-day waiting period prior to receiving your distribution. You must indicate that you Waive below to receive your distribution as soon as possible. Selecting waive indicates that you are waiving the waiting period. This does not affect the processing time. I choose to: □ Waive □ Not to Waive the 30-Day Notice Requirement. I hereby certify that I have received a copy of the Instructions to Participants and the Special Tax Notice Regarding Plan Payments. Print Name: Signature: Date: IF YOU WOULD LIKE YOUR MONEY DIRECTLY DEPOSITED TO YOUR BANK, PLEASE ATTACH A VOIDED CHECK OR COMPLETE THE DIRECT DEPOSIT FORM. WE CANNOT ACCEPT STARTER CHECKS WITH YOUR NAME WRITTEN ON IT OR DEPOSIT SLIPS. PLEASE NOTE THAT IT MAY TAKE UP TO 30 DAYS TO COMPLETE YOUR DISTRIBUTION REQUEST AFTER WE HAVE RECEIVED ALL APPROPRIATE DOCUMENTS. To Be Completed By Personnel/Payroll Department of Your Prior Employer Please provide ACCG Retirement Services with the following information for this participant: (To determine vesting for the 401(a), if your plan incorporates the hours of service method, please include the hours worked for each year even part time hours. Also, please include all employment dates including initial employment dates and re-hire employment dates.) Date of Hire: Date of Termination: Last Payroll Date: Last Contribution Date: Print Name: Title: Signature: Date: Phone Number: For security purposes we prefer that these forms be submitted to our secure website by your former Employer. If you are unable to return the forms back to your former Employer, please follow the instructions below. Return completed forms to: ACCG Retirement Services, 191 Peachtree Street NE, Suite 700, Atlanta, Georgia 30303 or Fax (770) 563-9356 or e-mail: [EMAIL REDACTED] Phone (770) 952-5225 or (800) 736-7166 ---PAGE BREAK--- 6 of 26 09/06/2019 ACCG 401(a) Defined Contribution and 457(b) Deferred Compensation Plan Plan Distributions Rollover Information Form 401(a) 457(b) Pre-tax contributions Roth contributions (after-tax) □ I am requesting Roth 457 funds to be rolled over. By checking this box, I confirm that my Trustee accepts Roth 457 funds. Complete this form if you wish a direct rollover to an IRA or another Plan. Participant Name: Social Security Number: Former Employer: Rollover Election (Elect ONE of the following: ) A. □ IRA Rollover Account B. □ Plan Rollover Name of IRA Trustee/Custodian (or) Name of Plan: Account Number if Applicable: Address: Street City State Zip Code Contact Name: Phone Number: If you do not fill in an address, you will receive a check made payable to the trustee of your IRA or plan. It will then be your responsibility to deliver the check. Pursuant to the Payment Election Form, I do hereby attest that the above IRA Trustee or Plan will be the recipient of my distribution. Signature: Date: ---PAGE BREAK--- IMPORTANT NOTICE Bona Fide Termination Form At the time of your retirement or termination of employment, both you and the Jurisdiction must intend that your separation from service be permanent and there is no intent for you to return to employment with the Jurisdiction, in any capacity, in order for you to receive a distribution from your retirement plan. According to IRS rules, if you are planning to retire or terminate employment, you cannot discuss reemployment with anyone at the Jurisdiction prior to your retirement, whether it be for part time or temporary work or as an independent contractor, if you are doing so in order to facilitate a distribution from the retirement plan that would not otherwise be available to you. [Note that some plans do allow for benefit commencement and continued employment AFTER Normal Retirement Age. Please contact your plan administrator for details.] This would be considered by the IRS to be a sham retirement or termination of employment and could jeopardize the tax qualified status of the entire retirement plan. If you do return to work with the Jurisdiction after having terminated employment or retired and received or started receiving pension payments, your return to work must be caused by exigent circumstances that were not anticipated at the time you terminated employment. If you return to work with the Jurisdiction and a determination is made by the plan administrator that you retired with the intent to return and in order to facilitate a plan distribution not otherwise available to you, any ongoing pension payments will be automatically suspended and you may be required to reimburse the plan for the amounts received in violation of IRS rules. I have read this IMPORTANT NOTICE and understand and acknowledge that I am not eligible to receive any retirement plan payments if I intend to return to employment with the Jurisdiction in any capacity. Print Name Signature Date Jurisdiction approval Print name and title ---PAGE BREAK--- Have your 457(b) and your 401(a) funds direct deposited to your checking or savings acccount DIRECT DEPOSIT INFORMATION Bank Please deposit to my: Checking Account Savings Account Routing number_ Account OR: Please attach a voided check from your checking account or a deposit slip for your savings account DIRECT DEPOSIT AUTHORIZATION Signature of Spouse or Other (required for joint accounts): Routing number Account number PAYEE INFORMATION ZIP_ Phone_ Prior Employer (county name or other jurisdiction)_ Social Security Number: - - I hereby authorize the Administrator of the 457(b) and 401(a) Plans to initiate credit entries to my account indicated above for amounts due to me as a payee under the plan(s) from which I receive funds from. The above- named Depository is to credit the same to such account. If an amount is credited in error to such account, including but not limited to by reason of my death prior to the date on which any payment shall become due, I authorize the Administrator of the DC Trust to direct the Depository to make the appropriate debit adjustment. Signature: Date: ACCG Retirement Services Direct Deposit Form To: ACCG Retirement Services Attn: Client Services 191 Peachtree Street NE, Suite 700, Atlanta, GA 30303 Phone (770) 952-5225 or (800) 736-7166 ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- ---PAGE BREAK--- 7 of 26 09/06/2019 ACCG 401(a) Defined Contribution and 457(b) Deferred Compensation Plan Special Tax Notice Regarding Plan Payments This notice explains how you can continue to defer federal income tax on your retirement savings in the ACCG Defined Contribution Plan (the "Plan") and contains important information you will need before you decide how to receive your Plan benefits. This notice is provided to you by your former employer (your "Plan Administrator") because all or part of the payment that you will soon receive from the Plan may be eligible for rollover by you or your Plan Administrator to a traditional IRA, Roth IRA, or an eligible employer plan. A rollover is a payment by you or the Plan Administrator of all or part of your benefit to another plan or IRA that allows you to continue to postpone taxation of that benefit until it is paid to you. Your payment cannot be rolled over to, a SIMPLE IRA, or a Coverdell Education Savings Account (formerly known as an education IRA). An "eligible employer plan" includes a plan qualified under section 401(a) of the Internal Revenue Code, including a 401(k) plan, profit-sharing plan, defined benefit plan, stock bonus plan, and money purchase plan; a section 403(a) annuity plan; a section 403(b) tax-sheltered annuity; and an eligible section 457(b) plan maintained by a governmental employer (governmental 457 plan). An eligible employer plan is not legally required to accept a rollover. Before you decide to roll over your payment to another employer plan, you should find out whether the plan accepts rollovers and, if so, the types of distributions it accepts as a rollover. You should also find out about any documents that are required to be completed before the receiving plan will accept a rollover. Even if a plan accepts rollovers, it might not accept rollovers of certain types of distributions, such as after-tax amounts. If this is the case, and your distribution includes after-tax amounts, you may wish instead to roll your distribution over to a traditional IRA or Roth IRA split your rollover amount between the employer plan in which you will participate and a traditional or Roth IRA. If an employer plan accepts your rollover, the plan may restrict subsequent distributions of the rollover amount or may require your spouse's consent for any subsequent distribution. A subsequent distribution from the plan that accepts your rollover may also be subject to different tax treatment than distributions from this Plan. Check with the administrator of the plan that is to receive your rollover prior to making the rollover. If you have additional questions after reading this notice, you can contact your plan’s Third Party Administrator at (800) 736-7166. Your Right to Waive the 30-Day Notice Period. Generally, neither a direct rollover nor a payment can be made from the plan until at least 30 days after your receipt of this notice. Thus, after receiving this notice, you have at least 30 days to consider whether or not to have your withdrawal directly rolled over. If you do not wish to wait until this 30-day notice period ends before your election is processed, you may waive the notice period by making an affirmative election indicating whether or not you wish to make a direct rollover. Your withdrawal will then be processed in accordance with your election as soon as practical after it is received by the Plan Administrator. ---PAGE BREAK--- 8 of 26 09/06/2019 ACCG 401(a) Defined Contribution and 457(b) Deferred Compensation Plan Special Tax Notice Regarding Plan Payments Summary There are two ways you may be able to receive a Plan payment that is eligible for rollover: Certain payments can be made directly to a traditional or Roth IRA that you establish or to an eligible employer plan that will accept it and hold it for your benefit ("Direct Rollover"); or The payment can be Paid to You. If you choose a Direct Rollover: Your payment will not be taxed in the current year and no income tax will be withheld. You choose whether your payment will be made directly to your traditional IRA, Roth IRA, or to an eligible employer plan that accepts your rollover. Your payment cannot be rolled over to a, a SIMPLE IRA, or a Coverdell Education Savings Account because these are not traditional IRAs. The taxable portion of your payment will be taxed later when you take it out of the traditional IRA, Roth IRA, or the eligible employer plan. Depending on the type of plan, the later distribution may be subject to different tax treatment than it would be if you received a taxable distribution from this Plan. If you choose to have a Plan payment that is eligible for rollover Paid To You: You will receive only 80% of the taxable amount of the payment, because the Plan Administrator is required to withhold 20% of that amount and send it to the IRS as income tax withholding to be credited against your taxes. The taxable amount of your payment will be taxed in the current year unless you roll it over. Under limited circumstances, you may be able to use special tax rules that could reduce the tax you owe. However, if you receive the payment before age 59 1/2, you may have to pay an additional 10% tax. You can roll over all or part of the payment by paying it to your traditional IRA, Roth IRA, or to an eligible employer plan that accepts your rollover within 60 days after you receive the payment. The amount rolled over will not be taxed until you take it out of the traditional IRA, Roth IRA, or the eligible employer plan. If you want to roll over 100% of the payment to a traditional IRA, Roth IRA, or an eligible employer plan, you must find other money to replace the 20% of the taxable portion 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. ---PAGE BREAK--- 9 of 26 09/06/2019 Special Tax Notice Regarding Plan Payments For Payments Not From a Designated Roth Account ---PAGE BREAK--- 10 of 26 09/06/2019 For Payments Not From a Designated Roth Account YOUR ROLLOVER OPTIONS You are receiving this notice because all or a portion of a payment you are receiving from the [INSERT NAME OF PLAN] (the “Plan”) is eligible to be rolled over to an IRA or an employer plan. This notice is intended to help you decide whether to do such a rollover. This notice describes the rollover rules that apply to payments from the Plan that are not from a designated Roth account (a type of account with special tax rules in some employer plans). If you also receive a payment from a designated Roth account in the Plan, you will be provided a different notice for that payment, and the Plan administrator or the payor will tell you the amount that is being paid from each account. Rules that apply to most payments from a plan are described in the “General Information About Rollovers” section. Special rules that only apply in certain circumstances are described in the “Special Rules and Options” section. GENERAL INFORMATION ABOUT ROLLOVERS How can a rollover affect my taxes? You will be taxed on a payment from the Plan if you do not roll it over. If you are under age 59½ and do not do a rollover, you will also have to pay a 10% additional income tax on early distributions (generally, distributions made before age 59½), unless an exception applies. However, if you do a rollover, you will not have to pay tax until you receive payments later and the 10% additional income tax will not apply if those payments are made after you are age 59½ (or if an exception applies). What types of retirement accounts and plans may accept my rollover? You may roll over the payment to either an IRA (an individual retirement account or individual retirement annuity) or an employer plan (a tax-qualified plan, section 403(b) plan, or governmental section 457(b) plan) that will accept the rollover. The rules of the IRA or employer plan that holds the rollover will determine your investment options, fees, and rights to payment from the IRA or employer plan (for example, no spousal consent rules apply to IRAs and IRAs may not provide loans). Further, the amount rolled over will become subject to the tax rules that apply to the IRA or employer plan. How do I do a rollover? There are two ways to do a rollover. You can do either a direct rollover or a 60-day rollover. If you do a direct rollover, the Plan will make the payment directly to your IRA or an employer plan. You should contact the IRA sponsor or the administrator of the employer plan for information on how to do a direct rollover. If you do not do a direct rollover, you may still do a rollover by making a deposit into an IRA or eligible employer plan that will accept it. Generally, you will have 60 days after you receive the payment to make the deposit. If you do not do a direct rollover, the Plan is required to withhold 20% of the payment for federal income taxes (up to the amount of cash and property received other than employer stock). This means that, in order to roll over the entire payment in a 60-day rollover, you must use other funds to make up for the 20% withheld. If you do not roll over the entire amount of the payment, the portion not rolled over will be taxed and will be subject to the 10% additional income tax on early distributions if you are under age 59½ (unless an exception applies). ---PAGE BREAK--- 11 of 26 09/06/2019 For Payments Not From a Designated Roth Account How much may I roll over? If you wish to do a rollover, you may roll over all or part of the amount eligible for rollover. Any payment from the Plan is eligible for rollover, except: • Certain payments spread over a period of at least 10 years or over your life or life expectancy (or the lives or joint life expectancy of you and your beneficiary); • Required minimum distributions after age 70½ (or after death); • Hardship distributions; • ESOP dividends; • Corrective distributions of contributions that exceed tax law limitations; • Loans treated as deemed distributions (for example, loans in default due to missed payments before your employment ends); • Cost of life insurance paid by the Plan; • Payments of certain automatic enrollment contributions requested to be withdrawn within 90 days of the first contribution; and • Amounts treated as distributed because of a prohibited allocation of S corporation stock under an ESOP (also, there will generally be adverse tax consequences if you roll over a distribution of S corporation stock to an IRA). The Plan administrator or the payor can tell you what portion of a payment is eligible for rollover. If I don’t do a rollover, will I have to pay the 10% additional income tax on early distributions? If you are under age 59½, you will have to pay the 10% additional income tax on early distributions for any payment from the Plan (including amounts withheld for income tax) that you do not roll over, unless one of the exceptions listed below applies. This tax applies to the part of the distribution that you must include in income and is in addition to the regular income tax on the payment not rolled over. The 10% additional income tax does not apply to the following payments from the Plan: • Payments made after you separate from service if you will be at least age 55 in the year of the separation; • Payments that start after you separate from service if paid at least annually in equal or close to equal amounts over your life or life expectancy (or the lives or joint life expectancy of you and your beneficiary); • Payments from a governmental plan made after you separate from service if you are a qualified public safety employee and you will be at least age 50 in the year of the separation; • Payments made due to disability; • Payments after your death; • Payments of ESOP dividends; • Corrective distributions of contributions that exceed tax law limitations; • Cost of life insurance paid by the Plan; • Payments made directly to the government to satisfy a federal tax levy; • Payments made under a qualified domestic relations order (QDRO); • Payments up to the amount of your deductible medical expenses (without regard to whether you itemize deductions for the taxable year); • Certain payments made while you are on active duty if you were a member of a reserve component called to duty after September 11, 2001 for more than 179 days; • Payments of certain automatic enrollment contributions requested to be withdrawn within 90 days of the first contribution; • Payments for certain distributions relating to certain federally declared disasters; and • Phased retirement payments made to federal employees. ---PAGE BREAK--- 12 of 26 09/06/2019 For Payments Not From a Designated Roth Account If I do a rollover to an IRA, will the 10% additional income tax apply to early distributions from the IRA? If you receive a payment from an IRA when you are under age 59½, you will have to pay the 10% additional income tax on early distributions on the part of the distribution that you must include in income, unless an exception applies. In general, the exceptions to the 10% additional income tax for early distributions from an IRA are the same as the exceptions listed above for early distributions from a plan. However, there are a few differences for payments from an IRA, including: • The exception for payments made after you separate from service if you will be at least age 55 in the year of the separation (or age 50 for qualified public safety employees) does not apply. • The exception for qualified domestic relations orders (QDROs) does not apply (although a special rule applies under which, as part of a divorce or separation agreement, a tax-free transfer may be made directly to an IRA of a spouse or former spouse). • The exception for payments made at least annually in equal or close to equal amounts over a specified period applies without regard to whether you have had a separation from service. • There are additional exceptions for payments for qualified higher education expenses, payments up to $10,000 used in a qualified first-time home purchase, and payments for health insurance premiums after you have received unemployment compensation for 12 consecutive weeks (or would have been eligible to receive unemployment compensation but for self-employed status). Will I owe State income taxes? This notice does not describe any State or local income tax rules (including withholding rules). SPECIAL RULES AND OPTIONS If your payment includes after-tax contributions After-tax contributions included in a payment are not taxed. If a payment is only part of your benefit, an allocable portion of your after-tax contributions is included in the payment, so you cannot take a payment of only after-tax contributions. However, if you have pre-1987 after-tax contributions maintained in a separate account, a special rule may apply to determine whether the after-tax contributions are included in a payment. In addition, special rules apply when you do a rollover, as described below. You may roll over to an IRA a payment that includes after-tax contributions through either a direct rollover or a 60-day rollover. You must keep track of the aggregate amount of the after-tax contributions in all of your IRAs (in order to determine your taxable income for later payments from the IRAs). If you do a direct rollover of only a portion of the amount paid from the Plan and at the same time the rest is paid to you, the portion directly rolled over consists first of the amount that would be taxable if not rolled over. For example, assume you are receiving a distribution of $12,000, of which $2,000 is after-tax contributions. In this case, if you directly roll over $10,000 to an IRA that is not a Roth IRA, no amount is taxable because the $2,000 amount not directly rolled over is treated as being after-tax contributions. If you do a direct rollover of the entire amount paid from the Plan to two or more destinations at the same time, you can choose which destination receives the after-tax contributions. If you do a 60-day rollover to an IRA of only a portion of a payment made to you, the after-tax contributions are treated as rolled over last. For example, assume you are receiving a distribution of $12,000, of which $2,000 is after-tax contributions, and no part of the distribution is directly rolled over. In this case, if you roll over $10,000 to an IRA that is not a Roth IRA in a 60-day rollover, no amount is taxable because the $2,000 amount not rolled over is treated as being after-tax contributions. ---PAGE BREAK--- 13 of 26 09/06/2019 For Payments Not From a Designated Roth Account If your payment includes after-tax contributions - Continued You may roll over to an employer plan all of a payment that includes after-tax contributions, but only through a direct rollover (and only if the receiving plan separately accounts for after-tax contributions and is not a governmental section 457(b) plan). You can do a 60-day rollover to an employer plan of part of a payment that includes after-tax contributions, but only up to the amount of the payment that would be taxable if not rolled over. If you miss the 60-day rollover deadline Generally, the 60-day rollover deadline cannot be extended. However, the IRS has the limited authority to waive the deadline under certain extraordinary circumstances, such as when external events prevented you from completing the rollover by the 60-day rollover deadline. Under certain circumstances, you may claim eligibility for a waiver of the 60-day rollover deadline by making a written self-certification. Otherwise, to apply for a waiver from the IRS, you must file a private letter ruling request with the IRS. Private letter ruling requests require the payment of a nonrefundable user fee. For more information, see IRS Publication 590-A, Contributions to Individual Retirement Arrangements (IRAs). If your payment includes employer stock that you do not roll over If you do not do a rollover, you can apply a special rule to payments of employer stock (or other employer securities) that are either attributable to after-tax contributions or paid in a lump sum after separation from service (or after age 59½, disability, or the participant’s death). Under the special rule, the net unrealized appreciation on the stock will not be taxed when distributed from the Plan and will be taxed at capital gain rates when you sell the stock. Net unrealized appreciation is generally the increase in the value of employer stock after it was acquired by the Plan. If you do a rollover for a payment that includes employer stock (for example, by selling the stock and rolling over the proceeds within 60 days of the payment), the special rule relating to the distributed employer stock will not apply to any subsequent payments from the IRA or employer plan. The Plan administrator can tell you the amount of any net unrealized appreciation. If you have an outstanding loan that is being offset If you have an outstanding loan from the Plan, your Plan benefit may be offset by the outstanding amount of the loan, typically when your employment ends. The offset amount is treated as a distribution to you at the time of the offset. Generally, you may roll over all or any portion of the offset amount. Any offset amount that is not rolled over will be taxed (including the 10% additional income tax on early distributions, unless an exception applies). You may roll over offset amounts to an IRA or an employer plan (if the terms of the employer plan permit the plan to receive plan loan offset rollovers). How long you have to complete the rollover depends on what kind of plan loan offset you have. If you have a qualified plan loan offset, you will have until your tax return due date (including extensions) for the tax year during which the offset occurs to complete your rollover. A qualified plan loan offset occurs when a plan loan in good standing is offset because your employer plan terminates, or because you sever from employment. If your plan loan offset occurs for any other reason, then you have 60 days from the date the offset occurs to complete your rollover. ---PAGE BREAK--- 14 of 26 09/06/2019 For Payments Not From a Designated Roth Account If you were born on or before January 1, 1936 If you were born on or before January 1, 1936 and receive a lump sum distribution that you do not roll over, special rules for calculating the amount of the tax on the payment might apply to you. For more information, see IRS Publication 575, Pension and Annuity Income. If your payment is from a governmental section 457(b) plan If the Plan is a governmental section 457(b) plan, the same rules described elsewhere in this notice generally apply, allowing you to roll over the payment to an IRA or an employer plan that accepts rollovers. One difference is that, if you do not do a rollover, you will not have to pay the 10% additional income tax on early distributions from the Plan even if you are under age 59½ (unless the payment is from a separate account holding rollover contributions that were made to the Plan from a tax-qualified plan, a section 403(b) plan, or an IRA). However, if you do a rollover to an IRA or to an employer plan that is not a governmental section 457(b) plan, a later distribution made before age 59½ will be subject to the 10% additional income tax on early distributions (unless an exception applies). Other differences include that you cannot do a rollover if the payment is due to an “unforeseeable emergency” and the special rules under “If your payment includes employer stock that you do not roll over” and “If you were born on or before January 1, 1936” do not apply. If you are an eligible retired public safety officer and your payment is used to pay for health coverage or qualified long-term care insurance If the Plan is a governmental plan, you retired as a public safety officer, and your retirement was by reason of disability or was after normal retirement age, you can exclude from your taxable income Plan payments paid directly as premiums to an accident or health plan (or a qualified long-term care insurance contract) that your employer maintains for you, your spouse, or your dependents, up to a maximum of $3,000 annually. For this purpose, a public safety officer is a law enforcement officer, firefighter, chaplain, or member of a rescue squad or ambulance crew. If you roll over your payment to a Roth IRA If you roll over a payment from the Plan to a Roth IRA, a special rule applies under which the amount of the payment rolled over (reduced by any after-tax amounts) will be taxed. However, the 10% additional income tax on early distributions will not apply (unless you take the amount rolled over out of the Roth IRA within 5 years, counting from January 1 of the year of the rollover). If you roll over the payment to a Roth IRA, later payments from the Roth IRA that are qualified distributions will not be taxed (including earnings after the rollover). A qualified distribution from a Roth IRA is a payment made after you are age 59½ (or after your death or disability, or as a qualified first-time homebuyer distribution of up to $10,000) and after you have had a Roth IRA for at least 5 years. In applying this 5-year rule, you count from January 1 of the year for which your first contribution was made to a Roth IRA. Payments from the Roth IRA that are not qualified distributions will be taxed to the extent of earnings after the rollover, including the 10% additional income tax on early distributions (unless an exception applies). You do not have to take required minimum distributions from a Roth IRA during your lifetime. For more information, see IRS Publication 590-A, Contributions to Individual Retirement Arrangements (IRAs), and IRS Publication 590-B, Distributions from Individual Retirement Arrangements (IRAs). ---PAGE BREAK--- 15 of 26 09/06/2019 For Payments Not From a Designated Roth Account If you do a rollover to a designated Roth account in the Plan You cannot roll over a distribution to a designated Roth account in another employer’s plan. However, you can roll the distribution over into a designated Roth account in the distributing Plan. If you roll over a payment from the Plan to a designated Roth account in the Plan, the amount of the payment rolled over (reduced by any after-tax amounts directly rolled over) will be taxed. However, the 10% additional tax on early distributions will not apply (unless you take the amount rolled over out of the designated Roth account within the 5-year period that begins on January 1 of the year of the rollover). If you roll over the payment to a designated Roth account in the Plan, later payments from the designated Roth account that are qualified distributions will not be taxed (including earnings after the rollover). A qualified distribution from a designated Roth account is a payment made both after you are age 59½ (or after your death or disability) and after you have had a designated Roth account in the Plan for at least 5 years. In applying this 5-year rule, you count from January 1 of the year your first contribution was made to the designated Roth account. However, if you made a direct rollover to a designated Roth account in the Plan from a designated Roth account in a plan of another employer, the 5-year period begins on January 1 of the year you made the first contribution to the designated Roth account in the Plan or, if earlier, to the designated Roth account in the plan of the other employer. Payments from the designated Roth account that are not qualified distributions will be taxed to the extent of earnings after the rollover, including the 10% additional income tax on early distributions (unless an exception applies). If you are not a Plan participant Payments after death of the participant. If you receive a distribution after the participant’s death that you do not roll over, the distribution will generally be taxed in the same manner described elsewhere in this notice. However, the 10% additional income tax on early distributions and the special rules for public safety officers do not apply, and the special rule described under the section “If you were born on or before January 1, 1936” applies only if the participant was born on or before January 1, 1936. If you are a surviving spouse. If you receive a payment from the Plan as the surviving spouse of a deceased participant, you have the same rollover options that the participant would have had, as described elsewhere in this notice. In addition, if you choose to do a rollover to an IRA, you may treat the IRA as your own or as an inherited IRA. An IRA you treat as your own is treated like any other IRA of yours, so that payments made to you before you are age 59½ will be subject to the 10% additional income tax on early distributions (unless an exception applies) and required minimum distributions from your IRA do not have to start until after you are age 70½. If you treat the IRA as an inherited IRA, payments from the IRA will not be subject to the 10% additional income tax on early distributions. However, if the participant had started taking required minimum distributions, you will have to receive required minimum distributions from the inherited IRA. If the participant had not started taking required minimum distributions from the Plan, you will not have to start receiving required minimum distributions from the inherited IRA until the year the participant would have been age 70½. ---PAGE BREAK--- 16 of 26 09/06/2019 For Payments Not From a Designated Roth Account If you are a surviving beneficiary other than a spouse. If you receive a payment from the Plan because of the participant’s death and you are a designated beneficiary other than a surviving spouse, the only rollover option you have is to do a direct rollover to an inherited IRA. Payments from the inherited IRA will not be subject to the 10% additional income tax on early distributions. You will have to receive required minimum distributions from the inherited IRA. Payments under a qualified domestic relations order. If you are the spouse or former spouse of the participant who receives a payment from the Plan under a qualified domestic relations order (QDRO), you generally have the same options and the same tax treatment that the participant would have (for example, you may roll over the payment to your own IRA or an eligible employer plan that will accept it). However, payments under the QDRO will not be subject to the 10% additional income tax on early distributions. If you are a nonresident alien If you are a nonresident alien and you do not do a direct rollover to a U.S. IRA or U.S. employer plan, instead of withholding 20%, the Plan is generally required to withhold 30% of the payment for federal income taxes. If the amount withheld exceeds the amount of tax you owe (as may happen if you do a 60- day rollover), you may request an income tax refund by filing Form 1040NR and attaching your Form 1042-S. See Form W-8BEN for claiming that you are entitled to a reduced rate of withholding under an income tax treaty. For more information, see also IRS Publication 519, U.S. Tax Guide for Aliens, and IRS Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities. Other special rules If a payment is one in a series of payments for less than 10 years, your choice whether to make a direct rollover will apply to all later payments in the series (unless you make a different choice for later payments). If your payments for the year are less than $200 (not including payments from a designated Roth account in the Plan), the Plan is not required to allow you to do a direct rollover and is not required to withhold federal income taxes. However, you may do a 60-day rollover. Unless you elect otherwise, a mandatory cashout of more than $1,000 (not including payments from a designated Roth account in the Plan) will be directly rolled over to an IRA chosen by the Plan administrator or the payor. A mandatory cashout is a payment from a plan to a participant made before age 62 (or normal retirement age, if later) and without consent, where the participant’s benefit does not exceed $5,000 (not including any amounts held under the plan as a result of a prior rollover made to the plan). You may have special rollover rights if you recently served in the U.S. Armed Forces. For more information on special rollover rights related to the U.S. Armed Forces, see IRS Publication 3, Armed Forces’ Tax Guide. You also may have special rollover rights if you were affected by a federally declared disaster (or similar event), or if you received a distribution on account of a disaster. For more information on special rollover rights related to disaster relief, see the IRS website at www.irs.gov. ---PAGE BREAK--- 17 of 26 09/06/2019 For Payments Not From a Designated Roth Account FOR MORE INFORMATION You may wish to consult with the Plan administrator or payor, or a professional tax advisor, before taking a payment from the Plan. Also, you can find more detailed information on the federal tax treatment of payments from employer plans in: IRS Publication 575, Pension and Annuity Income; IRS Publication 590-A, Contributions to Individual Retirement Arrangements (IRAs); IRS Publication 590-B, Distributions from Individual Retirement Arrangements (IRAs); and IRS Publication 571, Tax-Sheltered Annuity Plans (403(b) Plans). These publications are available from a local IRS office, on the web at www.irs.gov, or by calling 1-800-TAX-FORM. ---PAGE BREAK--- 18 of 26 09/06/2019 Special Tax Notice Regarding Plan Payments For Payments From a Designated Roth Account ---PAGE BREAK--- 19 of 26 09/06/2019 For Payments From a Designated Roth Account YOUR ROLLOVER OPTIONS You are receiving this notice because all or a portion of a payment you are receiving from the [INSERT NAME OF PLAN] (the “Plan”) is eligible to be rolled over to a Roth IRA or designated Roth account in an employer plan. This notice is intended to help you decide whether to do a rollover. This notice describes the rollover rules that apply to payments from the Plan that are from a designated Roth account. If you also receive a payment from the Plan that is not from a designated Roth account, you will be provided a different notice for that payment, and the Plan administrator or the payor will tell you the amount that is being paid from each account. Rules that apply to most payments from a designated Roth account are described in the “General Information About Rollovers” section. Special rules that only apply in certain circumstances are described in the “Special Rules and Options” section. GENERAL INFORMATION ABOUT ROLLOVERS How can a rollover affect my taxes? After-tax contributions included in a payment from a designated Roth account are not taxed, but earnings might be taxed. The tax treatment of earnings included in the payment depends on whether the payment is a qualified distribution. If a payment is only part of your designated Roth account, the payment will include an allocable portion of the earnings in your designated Roth account. If the payment from the Plan is not a qualified distribution and you do not do a rollover to a Roth IRA or a designated Roth account in an employer plan, you will be taxed on the earnings in the payment. If you are under age 59½, a 10% additional income tax on early distributions (generally, distributions made before age 59½) will also apply to the earnings (unless an exception applies). However, if you do a rollover, you will not have to pay taxes currently on the earnings and you will not have to pay taxes later on payments that are qualified distributions. If the payment from the Plan is a qualified distribution, you will not be taxed on any part of the payment even if you do not do a rollover. If you do a rollover, you will not be taxed on the amount you roll over and any earnings on the amount you roll over will not be taxed if paid later in a qualified distribution. A qualified distribution from a designated Roth account in the Plan is a payment made after you are age 59½ (or after your death or disability) and after you have had a designated Roth account in the Plan for at least 5 years. In applying the 5-year rule, you count from January 1 of the year your first contribution was made to the designated Roth account. However, if you did a direct rollover to a designated Roth account in the Plan from a designated Roth account in another employer plan, your participation will count from January 1 of the year your first contribution was made to the designated Roth account in the Plan or, if earlier, to the designated Roth account in the other employer plan. ---PAGE BREAK--- 20 of 26 09/06/2019 For Payments From a Designated Roth Account What types of retirement accounts and plans may accept my rollover? You may roll over the payment to either a Roth IRA (a Roth individual retirement account or Roth individual retirement annuity) or a designated Roth account in an employer plan (a tax-qualified plan, section 403(b) plan, or governmental section 457 plan) that will accept the rollover. The rules of the Roth IRA or employer plan that holds the rollover will determine your investment options, fees, and rights to payment from the Roth IRA or employer plan (for example, no spousal consent rules apply to Roth IRAs and Roth IRAs may not provide loans). Further, the amount rolled over will become subject to the tax rules that apply to the Roth IRA or the designated Roth account in the employer plan. In general, these tax rules are similar to those described elsewhere in this notice, but differences include: • If you do a rollover to a Roth IRA, all of your Roth IRAs will be considered for purposes of determining whether you have satisfied the 5-year rule (counting from January 1 of the year for which your first contribution was made to any of your Roth IRAs). • If you do a rollover to a Roth IRA, you will not be required to take a distribution from the Roth IRA during your lifetime and you must keep track of the aggregate amount of the after-tax contributions in all of your Roth IRAs (in order to determine your taxable income for later Roth IRA payments that are not qualified distributions). • Eligible rollover distributions from a Roth IRA can only be rolled over to another Roth IRA. How do I do a rollover? There are two ways to do a rollover. You can either do a direct rollover or a 60-day rollover. If you do a direct rollover, the Plan will make the payment directly to your Roth IRA or designated Roth account in an employer plan. You should contact the Roth IRA sponsor or the administrator of the employer plan for information on how to do a direct rollover. If you do not do a direct rollover, you may still do a rollover by making a deposit (generally within 60 days) into a Roth IRA, whether the payment is a qualified or nonqualified distribution. In addition, you can do a rollover by making a deposit within 60 days into a designated Roth account in an employer plan if the payment is a nonqualified distribution and the rollover does not exceed the amount of the earnings in the payment. You cannot do a 60-day rollover to an employer plan of any part of a qualified distribution. If you receive a distribution that is a nonqualified distribution and you do not roll over an amount at least equal to the earnings allocable to the distribution, you will be taxed on the amount of those earnings not rolled over, including the 10% additional income tax on early distributions if you are under age 59½ (unless an exception applies). If you do a direct rollover of only a portion of the amount paid from the Plan and a portion is paid to you at the same time, the portion directly rolled over consists first of earnings. If you do not do a direct rollover and the payment is not a qualified distribution, the Plan is required to withhold 20% of the earnings for federal income taxes (up to the amount of cash and property received other than employer stock). This means that, in order to roll over the entire payment in a 60-day rollover to a Roth IRA, you must use other funds to make up for the 20% withheld. ---PAGE BREAK--- 21 of 26 09/06/2019 For Payments From a Designated Roth Account How much may I roll over? If you wish to do a rollover, you may roll over all or part of the amount eligible for rollover. Any payment from the Plan is eligible for rollover, except: • Certain payments spread over a period of at least 10 years or over your life or life expectancy (or the lives or joint life expectancy of you and your beneficiary); • Required minimum distributions after age 70½ (or after death); • Hardship distributions; • ESOP dividends; • Corrective distributions of contributions that exceed tax law limitations; • Loans treated as deemed distributions (for example, loans in default due to missed payments before your employment ends); • Cost of life insurance paid by the Plan; • Payments of certain automatic enrollment contributions requested to be withdrawn within 90 days of the first contribution; and • Amounts treated as distributed because of a prohibited allocation of S corporation stock under an ESOP (also, there will generally be adverse tax consequences if S corporation stock is held by an IRA). The Plan administrator or the payor can tell you what portion of a payment is eligible for rollover. ---PAGE BREAK--- 22 of 26 09/06/2019 For Payments From a Designated Roth Account If I don’t do a rollover, will I have to pay the 10% additional income tax on early distributions? If a payment is not a qualified distribution and you are under age 59½, you will have to pay the 10% additional income tax on early distributions with respect to the earnings allocated to the payment that you do not roll over (including amounts withheld for income tax), unless one of the exceptions listed below applies. This tax is in addition to the regular income tax on the earnings not rolled over. The 10% additional income tax does not apply to the following payments from the Plan: • Payments made after you separate from service if you will be at least age 55 in the year of the separation; • Payments that start after you separate from service if paid at least annually in equal or close to equal amounts over your life or life expectancy (or the lives or joint life expectancy of you and your beneficiary); • Payments from a governmental plan made after you separate from service if you are a qualified public safety employee and you will be at least age 50 in the year of the separation; • Payments made due to disability; • Payments after your death; • Payments of ESOP dividends ; • Corrective distributions of contributions that exceed tax law limitations; • Cost of life insurance paid by the Plan; • Payments made directly to the government to satisfy a federal tax levy; • Payments made under a qualified domestic relations order (QDRO); • Payments up to the amount of your deductible medical expenses (without regard to whether you itemize deductions for the taxable year); • Certain payments made while you are on active duty if you were a member of a reserve component called to duty after September 11, 2001 for more than 179 days; • Payments of certain automatic enrollment contributions requested to be withdrawn within 90 days of the first contribution; and • Payments for certain distributions relating to certain federally declared disasters. ---PAGE BREAK--- 23 of 26 09/06/2019 For Payments From a Designated Roth Account If I do a rollover to a Roth IRA, will the 10% additional income tax apply to early distributions from the IRA? If you receive a payment from a Roth IRA when you are under age 59½, you will have to pay the 10% additional income tax on early distributions on the earnings paid from the Roth IRA, unless an exception applies or the payment is a qualified distribution. In general, the exceptions to the 10% additional income tax for early distributions from a Roth IRA listed above are the same as the exceptions for early distributions from a plan. However, there are a few differences for payments from a Roth IRA, including: • The exception for payments made after you separate from service if you will be at least age 55 in the year of the separation (or age 50 for qualified public safety employees) does not apply. • The exception for qualified domestic relations orders (QDROs) does not apply (although a special rule applies under which, as part of a divorce or separation agreement, a tax-free transfer may be made directly to a Roth IRA of a spouse or former spouse). • The exception for payments made at least annually in equal or close to equal amounts over a specified period applies without regard to whether you have had a separation from service. • There are additional exceptions for payments for qualified higher education expenses, payments up to $10,000 used in a qualified first-time home purchase, and payments for health insurance premiums after you have received unemployment compensation for 12 consecutive weeks (or would have been eligible to receive unemployment compensation but for self-employed status). Will I owe State income taxes? This notice does not describe any State or local income tax rules (including withholding rules). SPECIAL RULES AND OPTIONS If you miss the 60-day rollover deadline Generally, the 60-day rollover deadline cannot be extended. However, the IRS has the limited authority to waive the deadline under certain extraordinary circumstances, such as when external events prevented you from completing the rollover by the 60-day rollover deadline. Under certain circumstances, you may claim eligibility for a waiver of the 60-day rollover deadline by making a written self-certification. Otherwise, to apply for a waiver from the IRS, you must file a private letter ruling request with the IRS. Private letter ruling requests require the payment of a nonrefundable user fee. For more information, see IRS Publication 590-A, Contributions to Individual Retirement Arrangements (IRAs). ---PAGE BREAK--- 24 of 26 09/06/2019 For Payments From a Designated Roth Account If your payment includes employer stock that you do not roll over If you receive a payment that is not a qualified distribution and you do not roll it over, you can apply a special rule to payments of employer stock (or other employer securities) that are paid in a lump sum after separation from service (or after age 59½, disability, or the participant’s death). Under the special rule, the net unrealized appreciation on the stock included in the earnings in the payment will not be taxed when distributed to you from the Plan and will be taxed at capital gain rates when you sell the stock. If you do a rollover to a Roth IRA for a nonqualified distribution that includes employer stock (for example, by selling the stock and rolling over the proceeds within 60 days of the distribution), you will not have any taxable income and the special rule relating to the distributed employer stock will not apply to any subsequent payments from the Roth IRA or employer plan. Net unrealized appreciation is generally the increase in the value of the employer stock after it was acquired by the Plan. The Plan administrator can tell you the amount of any net unrealized appreciation. If you receive a payment that is a qualified distribution that includes employer stock and you do not roll it over, your basis in the stock (used to determine gain or loss when you later sell the stock) will equal the fair market value of the stock at the time of the payment from the Plan. If you have an outstanding loan that is being offset If you have an outstanding loan from the Plan, your Plan benefit may be offset by the outstanding amount of the loan, typically when your employment ends. The offset amount is treated as a distribution to you at the time of the offset. Generally, you may roll over all or any portion of the offset amount. If the distribution attributable to the offset is not a qualified distribution and you do not roll over the offset amount, you will be taxed on any earnings included in the distribution (including the 10% additional income tax on early distributions, unless an exception applies). You may roll over the earnings included in the loan offset to a Roth IRA or designated Roth account in an employer plan (if the terms of the employer plan permit the plan to receive plan loan offset rollovers). You may also roll over the full amount of the offset to a Roth IRA. How long you have to complete the rollover depends on what kind of plan loan offset you have. If you have a qualified plan loan offset, you will have until your tax return due date (including extensions) for the tax year during which the offset occurs to complete your rollover. A qualified plan loan offset occurs when a plan loan in good standing is offset because your employer plan terminates, or because you sever from employment. If your plan loan offset occurs for any other reason, then you have 60 days from the date the offset occurs to complete your rollover. If you receive a nonqualified distribution and you were born on or before January 1, 1936 If you were born on or before January 1, 1936, and receive a lump sum distribution that is not a qualified distribution and that you do not roll over, special rules for calculating the amount of the tax on the earnings in the payment might apply to you. For more information, see IRS Publication 575, Pension and Annuity Income. ---PAGE BREAK--- 25 of 26 09/06/2019 For Payments From a Designated Roth Account If your payment is from a governmental section 457(b) plan If the Plan is a governmental section 457(b) plan, the same rules described elsewhere in this notice generally apply, allowing you to roll over the payment to an IRA or an employer plan that accepts rollovers. One difference is that, if you receive a payment that is not a qualified distribution and you do not roll it over, you will not have to pay the 10% additional income tax on early distributions with respect to the earnings allocated to the payment that you do not roll over, even if you are under age 59½ (unless the payment is from a separate account holding rollover contributions that were made to the Plan from a tax-qualified plan, a section 403(b) plan, or an IRA). However, if you do a rollover to an IRA or to an employer plan that is not a governmental section 457(b) plan, a later distribution that is not a qualified distribution made before age 59½ will be subject to the 10% additional income tax on earnings allocated to the payment (unless an exception applies). Other differences include that you cannot do a rollover if the payment is due to an “unforeseeable emergency” and the special rules under “If your payment includes employer stock that you do not roll over” and “If you were born on or before January 1, 1936” do not apply. If you receive a nonqualified distribution, are an eligible retired public safety officer, and your payment is used to pay for health coverage or qualified long-term care insurance If the Plan is a governmental plan, you retired as a public safety officer, and your retirement was by reason of disability or was after normal retirement age, you can exclude from your taxable income nonqualified distributions paid directly as premiums to an accident or health plan (or a qualified long- term care insurance contract) that your employer maintains for you, your spouse, or your dependents, up to a maximum of $3,000 annually. For this purpose, a public safety officer is a law enforcement officer, firefighter, chaplain, or member of a rescue squad or ambulance crew. If you are not a Plan participant Payments after death of the participant. If you receive a distribution after the participant’s death that you do not roll over, the distribution will generally be taxed in the same manner described elsewhere in this notice. However, whether the payment is a qualified distribution generally depends on when the participant first made a contribution to the designated Roth account in the Plan. Also, the 10% additional income tax on early distributions and the special rules for public safety officers do not apply, and the special rule described under the section “If you receive a nonqualified distribution and you were born on or before January 1, 1936” applies only if the participant was born on or before January 1, 1936. If you are a surviving spouse. If you receive a payment from the Plan as the surviving spouse of a deceased participant, you have the same rollover options that the participant would have had, as described elsewhere in this notice. In addition, if you choose to do a rollover to a Roth IRA, you may treat the Roth IRA as your own or as an inherited Roth IRA. A Roth IRA you treat as your own is treated like any other Roth IRA of yours, so that you will not have to receive any required minimum distributions during your lifetime and earnings paid to you in a nonqualified distribution before you are age 59½ will be subject to the 10% additional income tax on early distributions (unless an exception applies). If you treat the Roth IRA as an inherited Roth IRA, payments from the Roth IRA will not be subject to the 10% additional income tax on early distributions. An inherited Roth IRA is subject to required minimum distributions. If the participant had started taking required minimum distributions from the Plan, you will have to receive required minimum distributions from the inherited Roth IRA. If the participant had not started taking required minimum distributions, you will not have to start receiving required minimum distributions from the inherited Roth IRA until the year the participant would have been age 70½. ---PAGE BREAK--- 26 of 26 09/06/2019 For Payments From a Designated Roth Account If you are a surviving beneficiary other than a spouse. If you receive a payment from the Plan because of the participant’s death and you are a designated beneficiary other than a surviving spouse, the only rollover option you have is to do a direct rollover to an inherited Roth IRA. Payments from the inherited Roth IRA, even if made in a nonqualified distribution, will not be subject to the 10% additional income tax on early distributions. You will have to receive required minimum distributions from the inherited Roth IRA. Payments under a qualified domestic relations order. If you are the spouse or a former spouse of the participant who receives a payment from the Plan under a qualified domestic relations order (QDRO), you generally have the same options and the same tax treatment that the participant would have (for example, you may roll over the payment as described in this notice). If you are a nonresident alien If you are a nonresident alien and you do not do a direct rollover to a U.S. IRA or U.S. employer plan, instead of withholding 20%, the Plan is generally required to withhold 30% of the payment for federal income taxes. If the amount withheld exceeds the amount of tax you owe (as may happen if you do a 60- day rollover), you may request an income tax refund by filing Form 1040NR and attaching your Form 1042-S. See Form W-8BEN for claiming that you are entitled to a reduced rate of withholding under an income tax treaty. For more information, see also IRS Publication 519, U.S. Tax Guide for Aliens, and IRS Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities. Other special rules If a payment is one in a series of payments for less than 10 years, your choice whether to make a direct rollover will apply to all later payments in the series (unless you make a different choice for later payments). If your payments for the year (only including payments from the designated Roth account in the Plan) are less than $200, the Plan is not required to allow you to do a direct rollover and is not required to withhold federal income taxes. However, you can do a 60-day rollover. Unless you elect otherwise, a mandatory cash out from the designated Roth account in the Plan of more than $1,000 will be directly rolled over to a Roth IRA chosen by the Plan administrator or the payor. A mandatory cash out is a payment from a plan to a participant made before age 62 (or normal retirement age, if later) and without consent, where the participant’s benefit does not exceed $5,000 (not including any amounts held under the plan as a result of a prior rollover made to the plan). You may have special rollover rights if you recently served in the U.S. Armed Forces. For more information on special rollover rights related to the U.S. Armed Forces, see IRS Publication 3, Armed Forces’ Tax Guide. You also may have special rollover rights if you were affected by a federally declared disaster (or similar event), or if you received a distribution on account of a disaster. For more information on special rollover rights related to disaster relief, see the IRS website at www.irs.gov. FOR MORE INFORMATION You may wish to consult with the Plan administrator or payor, or a professional tax advisor, before taking a payment from the Plan. Also, you can find more detailed information on the federal tax treatment of payments from employer plans in: IRS Publication 575, Pension and Annuity Income; IRS Publication 590-A, Contributions to Individual Retirement Arrangements (IRAs); IRS Publication 590-B, Distributions from Individual Retirement Arrangements (IRAs); and IRS Publication 571, Tax-Sheltered Annuity Plans (403(b) Plans). These publications are available from a local IRS office, on the web at www.irs.gov, or by calling 1-800-TAX-FORM.