Fillable Employee Participation Documents Form (Page 3 of 4) in pdf

Employer

For calendar Year

, your Employer will make Matching Contributions equal to 100 percent of your

Contributions

Elective Deferrals which do not exceed three percent of your Compensation unless your Employer elects to make either the

alternative Matching Contribution or the Nonelective Contribution described in Options 1 and 2 below.

Matching Contributions in an amount equal to your Elective Deferrals which do not exceed

Option 1:

% (must not be less than 1%).

Nonelective Contributions equal to two percent of Compensation on behalf of each Participant who earns at

Option 2 :

least $5,000 during the year unless a different dollar amount is specified below.

You are required to earn at least $

(may not exceed $5,000) during the year to be

eligible to receive Nonelective Contributions.

SECTION D.

DISTRIBUTIONS

The following is a summary of the rules applicable to distributions from SIMPLE IRAs. You are advised to refer to your

SIMPLE IRA documents and/or seek the assistance of a qualified tax advisor if you have additional questions.

Procedures

SIMPLE IRA assets are fully vested and may be withdrawn at any time subject to taxes and penalties as explained

below. The trustee, custodian, or issuer of your SIMPLE IRA, and not your Employer, is responsible for making

distributions to you upon your request.

Federal

Distributions from SIMPLE IRAs are taxed as ordinary income in the year in which you receive them. In addition,

Income Tax

federal income tax withholding will be applied to your distribution at a rate of 10 percent unless you specify a higher rate

or waive your right to withholding.

Penalties

A 25 percent early distribution penalty applies to SIMPLE IRA distributions taken within two years of your initial

participation in the Plan, unless you are age 59½ or older or can claim an exemption from the early distribution penalty

described in Internal Revenue Code (IRC) Sec. 72(t)(6). If you are under age 59½, have satisfied the two-year

requirement and receive a distribution, you will be subject to a 10 percent early distribution penalty.

Rollovers

SIMPLE IRA distributions may be rolled over to other SIMPLE IRAs. Rollovers from Traditional IRAs to your SIMPLE IRA

are not permitted. If a SIMPLE IRA distribution is properly rolled over, your rollover amount will be excluded when

determining the amount of your federal income tax or early distribution penalty. You may roll over SIMPLE IRA

distributions to Traditional IRAs, qualified retirement plans, tax-sheltered annuities, and 457(b) deferred compensation

plans. However, you must wait two years from the date you become a participant before doing so.

Required Minimum

You are required to begin taking minimum distributions from your SIMPLE IRA upon attainment of age 70½ in

Distributions

accordance with IRS regulations.

Procedures

If you wish to take a distribution from your SIMPLE IRA, you must complete a withdrawal statement provided by the

for Withdrawals

trustee, custodian, or issuer of your SIMPLE IRA. In addition, the following procedures apply to you upon requesting a

distribution.

Procedures

The following additional rules and procedures apply to transfers of your balance in your SIMPLE IRA.

Regarding

Transfers

11-14

Employee Participation Documents Form Page 3

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