PRINCIPAL FINANCIAL GROUP PROTOTYPE
FOR SAVINGS PLANS
THIS IS A 401(k) PROFIT SHARING PLAN.
ADOPTION AGREEMENT NONSTANDARD
IRS SERIAL NO. K305394b ADOPTION
AGREEMENT PLAN NO. 001 TO BE USED
WITH BASIC PLAN NO. 02
APPROVED: JULY 22, 2003 103
Principal Life
Insurance Company
Des Moines, Iowa 50392-0001
DEPARTMENT OF THE TREASURY
INTERNAL REVENUE SERVICE WASHINGTON, D.C. 20224
Plan Description: Prototype Non-standardized Profit Sharing Plan with CODA
FFN: 50307440002-001 Case: ▇▇▇▇▇▇▇▇▇ EIN: ▇▇-▇▇▇▇▇▇▇
Letter Serial No: K305394b
Contact Person: ▇▇. ▇▇▇▇▇▇▇▇▇ 50-00197
PRINCIPAL LIFE INSURANCE CO Telephone Number: (▇▇▇) ▇▇▇-▇▇▇▇
▇▇▇ ▇▇▇ ▇▇▇▇▇▇ In Reference to: T:EP:RA:T2
DES MOINES, IA 50309 Date: 07/22/2003
Dear Applicant:
In our opinion, the amendment to the form of the plan identified above
does not in and of itself adversely affect the plan's acceptability under
section 401 of the Internal Revenue Code. This opinion relates only to the
amendment to the form of the plan. It is not an opinion as to the acceptability
of any other amendment or of the form of the plan as a whole, or as to the
effect of other Federal or local statutes.
You must furnish a copy of this letter to each employer who adopts this
plan. You are also required to send a copy of the approved form of the plan, any
approved amendments and related documents to Employee Plans Determinations in
Cincinnati at the address specified in section 9.11 of Rev. Proc. 2000-20,
2000-6 I.R.B. 553.
This letter considers the changes in qualifications requirements made
by the Uruguay Round Agreements Act (GATT), Pub. L. 103-465, the Small Business
Job Protection Act of 1996, Pub. L. 104-188, the Uniformed Services Employment
and Reemployment Rights Act of 1994, Pub. L. 103-353, the Taxpayer Relief Act of
1997, Pub. L. 105-34, the Job Creation and WorkersAssistance Act of 2002, Pub.
L. 105-206 and the Community Renewal Tax Relief Act of 2000, Pub. L. 106-554.
These laws are referred to collectively as GUST.
Our opinion on the acceptability of the form of the plan is not a ruling or
determination as to whether an employer's plan qualifies under Code section
401(a). However, an employer that adopts this plan may rely on this letter with
respect to the qualification of its plan under Code section 401(a), as provided
for in Announcement 2001-77, 2001-30 I.R.B. and outlined below. The terms of
the plan must be followed in operation.
Except as provided below, our opinion does not apply with respect to the
requirements of: (a) Code sections 401(a)(4), 401(a)(26), (401(1), 410(b) and
414(s). Our opinion does not apply for purposes of Code section 401(a)(10)(B)
and section 401(a)(16) if an employer ever maintained another qualified plan
for one or more employees who are covered by this plan. For this purpose, the
employer will not be considered to have maintained another plan merely because
the employer has maintained another defined contribution plan(s), provided such
other plan(s) has been terminated prior to the effective date of this plan and
no annual additions have been credited to the account of any participant under
such other plan(s) as of any date within the limitation year of this plan.
Likewise, if this plan is first effective on or after the effective date of the
repeal of Code section 415(e), the employer will not be considered to have
maintained another plan merely because the employer has maintained a defined
benefit plan(s), provided the defined benefit plan(s) has been terminated prior
to the effective date of this plan. Our opinion also does not apply for
purposes of Code section 401(a)(16) if, after December 31, 1985, the employer
maintains a welfare benefit fund defined in Code section 419(e), which provides
postretirement medical benefits allocated to separate accounts for key
employees as defined in Code section 419A(d)(3).
PRINCIPAL LIFE INSURANCE CO
FFN: 50307440002-001
Page 2
Our opinion applies with respect to the requirements of Code section 410(b) if
100 percent of all nonexcludable employees benefit under the plan. Employers
that elect a safe harbor allocation formula and a safe harbor compensation
definition can also rely on an opinion letter with respect to the
nondiscriminatory amounts requirement under section 401(a)(4) and the
requirements of sections 401 (k) and 401 (m) (except where the plan is a safe
harbor plan under section 401(k)(12) that provides for the safe harbor
contribution to be made under another plan).
An employer that elects to continue to apply the pre-GUST family aggregation
rules in years beginning after December 31,1996, or the combined plan limit of
section 415(e) in years beginning after December 31,1999, will not be able to
rely on the opinion letter without a determination letter. The employer may
request a determination letter by filing an application with Employee Plans
Determinations on Form 5307, Application for Determination for Adopters of
Master or Prototype of Volume Submitter Plans.
This letter with respect to the amendment to the form of the plan does not
affect the applicability to the plan of the remedial amendment extension period
of section 19 of Rev. Proc. 2000-20, 2000-6 I.R.B. 553. The applicability of
such provisions may be determined by reference to the initial opinion letter
issued with respect to the plan.
If you, the master or prototype sponsor, have any questions concerning the IRS
processing of this case, please call the above telephone number. This number is
only for use of the sponsor. Individual participants and/or adopting employers
with questions concerning the plan should contact the master or prototype
sponsor. The plan's adoption agreement must include the sponsor's address and
telephone number for inquiries by adopting employers.
If you write to the IRS regarding this plan, please provide your telephone
number and the most convenient time for us to call in case we need more
information. Whether you call or write, please refer to the Letter Serial
Number and File Folder Number shown in the heading of this letter.
You should keep this letter as a permanent record. Please notify us if you
modify or discontinue sponsorship of this plan.
Sincerely yours,
▇▇▇▇ ▇. ▇▇▇▇▇▇
Director
Employee Plans Rulings & Agreements
TABLE OF CONTENTS
A. ADOPTION AGREEMENT 1
B. EMPLOYER 1
C. PLAN NAME 1
D. EFFECTIVE DATE 1
E. YEARLY DATE 2
F. FISCAL YEAR 2
G. NAMED FIDUCIARY 2
H. PLAN ADMINISTRATOR 2
I. PREDECESSOR EMPLOYER AND PRIOR EMPLOYER 3
J. ELIGIBLE EMPLOYEE 4
K. HIGHLY COMPENSATED EMPLOYEE AND TESTING METHODS 6
L. ENTRY REQUIREMENTS 7
M. ENTRY DATE 9
N. PAY 10
O. ELECTIVE DEFERRAL CONTRIBUTIONS 12
P. MATCHING CONTRIBUTIONS 17
Q. OTHER EMPLOYER CONTRIBUTIONS AND FORFEITURES 19
R. NET PROFITS AND CONTRIBUTION REQUIREMENTS 26
S. CONTRIBUTION MODIFICATIONS 27
T. VOLUNTARY CONTRIBUTIONS AND ROLLOVER CONTRIBUTIONS 29
U. INVESTMENTS 30
V. VESTING PERCENTAGE 33
W. VESTING SERVICE 35
X. EQUIVALENCIES 36
Y. WITHDRAWAL BENEFITS 37
Z. RETIREMENT AND THE START OF BENEFITS 38
AA. FORMS OF DISTRIBUTION FOR RETIREMENT BENEFITS 41
AB. ADOPTING EMPLOYERS 42
ii
PRINCIPAL FINANCIAL GROUP PROTOTYPE FOR SAVINGS PLANS
ADOPTION AGREEMENT - NONSTANDARDIZED FORM
(Use black ink to complete the Adoption Agreement.)
A. This ADOPTION AGREEMENT together with the PRINCIPAL FINANCIAL GROUP
PROTOTYPE BASIC SAVINGS PLAN constitutes (Select (1), (2), or (3).)
1) [ ] a new plan.
2) [ ] a restatement of an existing plan (and trust). Such
existing plan was qualifiable under 401(a) of the Internal
Revenue Code. The provisions of this restatement are
effective on _____________________________________________.
This is the RESTATEMENT DATE. (Select if not currently on
this Plan No. 001, Basic Plan No. 02 with the approval
date shown on the cover page.)
3) [ ] Amendment No. _3_____________ to the Plan. It replaces
all prior amendments to the Plan and the first Adoption
Agreement. The provisions of this amendment are
effective on April 1. 2003______________________________.
(Select if currently on this Plan No. 001, Basic Plan No.
02 with the approval date shown on the cover page.)
B. The terms we, us, and our, as they are used in this Plan, refer to the
EMPLOYER. We,
TEMECULA VALLEY BANK
________________________________________________________________________
are the Employer. (Fill in exact legal name.)
C. The PLAN NAME is
T.V.B. 401(K) PLAN_______________________________________________________
(For example: ABC, Inc. 401(k) Savings Plan.)
D. The Plan's original effective date is August 1, 1997____________________.
This is the EFFECTIVE DATE.
Amend No. 3 Effective April 1, 2003 1 Annuity Contract No. GA 4-42423
E. The YEARLY DATE is the first day of each Plan Year. (Fill in the Effective
Date. If this is not a new plan and the Yearly Date has changed more than
once, fill in any Yearly Date that is not later than the Restatement Date
or amendment effective date.)
The Yearly Date is August 1. 1997____________________________________
and (Select one.)
1) [ ] the same day of each following year.
2) |X| each following January 1__________________________________. (The
first Plan Year is short.)
3) [ ] (a) each following
___________________________________________________ through
(b) ________________________________________________and
(c) each following _______________________________________. (A later
Plan Year is short. Complete (a) using the same month and day as
in Yearly Date above, (b) using the same month and day as in (a)
and the calendar year in which the short Plan Year begins, and
(c) using the first day of the new Plan Year.)
If the first date in Item E is after the Effective Date, Yearly Dates
before the first date in Item E above shall be determined under the
provisions of the (Prior) Plan before that date.
F. The FISCAL YEAR is our taxable year and ends on December
31__________________________________. (Month and day.)
G. We are the NAMED FIDUCIARY, unless otherwise specified in (1) below.
1)[ ]-----------------------------------------------------------------
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is the Named Fiduciary. (Principal Life Insurance Company cannot be
named.)
H. We are the PLAN ADMINISTRATOR, unless otherwise specified in (1) below.
1)[ ]
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_________is the Plan Administrator. (Principal Life Insurance Company
cannot be named.)
________If (1) is selected, complete the address, phone number, and
tax filing number of the Plan Administrator.
Address
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Phone No._______________________________ Tax Filing No. ___________
Amend No. 3 Effective April 1, 2003 2 Annuity Contract No. GA 4-42423
I. PREDECESSOR EMPLOYER AND PRIOR EMPLOYER.
1) A PREDECESSOR EMPLOYER is a firm of which we were once a part (e.g.,
due to a spin-off or a change of corporate status) or a firm
absorbed by us because of a merger or acquisition (stock or asset,
including a division or an operation of such company). No selections
are needed for a Predecessor Employer which maintained this Plan
since the Employer is defined as including such Predecessor
Employer, and service with the Employer would therefore include
service with such Predecessor Employer.
a) [ ](Select if you wish to count service or pay with a Predecessor
Employer which did not maintain this Plan.) A Predecessor
Employer which did not maintain this Plan is deemed to be the
Employer for purposes of determining: (Select at least one.)
i) [ ]Entry Service
NOTE: The Entry Date for an employee of such Predecessor
Employer shall be the earliest Entry Date on or after he has
both met the entry requirements and is an Eligible Employee.
ii) [ ] Vesting Service
iii) [ ] Hours of Service required to be eligible for an
Employer Contribution
iv) [ ]Pay
b) [ ](Select if service must be continuous.) Service with or pay
from such Predecessor Employer shall be counted only if service
continued without interruption.
c) [ ](Select if Self-employed Individual's service and pay is to be
counted.) Service with or pay from such Predecessor Employer
shall include service or pay while a sole proprietor or partner.
d) [ ] (Select if not counted for all such Predecessor Employers.)
Service with or pay from such Predecessor Employer shall be
counted only as to a Predecessor Employer which (Select (i),
(ii), or both.)
i) [ ]maintained a qualified pension or profit sharing plan
(or)
ii) [ ]is named below: (Exact legal name(s).)
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Amend No. 3 Effective April 1, 2003 3 Annuity Contract No. GA 4-42423
2) A PRIOR EMPLOYER is an Employee's last employer immediately prior
to us which is not a Predecessor Employer or a Controlled Group
member, but for which service credit is granted under the Plan.
Service with such Prior Employer shall be counted only if service
continued without interruption.
a) [ ] (Select if you wish to count service with a Prior
Employer.) The following are Prior Employers for which service
credit is granted under the Plan: (Exact legal name(s).)
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b) Service with such Prior Employer shall be counted for purposes
of determining: (If (a) above is selected, select (i), (ii), or
both.)
i) [ ]Entry Service
NOTE: The Entry Date for an employee of such Prior Employer
shall be the earliest Entry Date on or after he has both
met the entry requirements and is an Eligible Employee.
ii) [ ]Vesting Service J
..
An ELIGIBLE EMPLOYEE is (Select (1) or (2).)
1) |X|an Employee of ours or of an Adopting Employer (See Item AB.).
2) [ ]an Employee of ours or of an Adopting Employer (See Item AB.),
provided the Employee meets the requirement(s) selected below.
(Select requirement(s) in (a)-(e) that apply. Selections may
affect testing done to determine if the minimum coverage
requirement of Code Section 410(b) is met, unless otherwise
indicated.)
a) [ ] Employed in the following employment classification:
(Select at least one.)
i) [ ]Paid on a salaried basis
ii) [ ]Paid on a commission basis
iii) [ ]Paid on an hourly basis
Amend No. 3 Effective April 1, 2003 4 Annuity Contract No. GA 4-42423
iv) [ ] Represented for collective bargaining purposes by
(Select A or B.)
A. [ ]any bargaining unit
B. [ ] specific bargaining unit named below:
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v) [ ]Not represented for collective bargaining purposes by
(Select A or B.)
A. [ ]any collective bargaining agreement between us and
employee representatives, if retirement benefits
were the subject of good faith bargaining and if two
percent or less of the Employees who are covered
pursuant to that agreement are professionals defined
in section 1.410(b)-9 of the regulations. For this
purpose, the term "employee representatives" does
not include any organization more than half of whose
members are Employees who are owners, officers, or
executives of ours. (This exclusion does not affect
coverage testing.)
B. [ ]a specific bargaining unit named below:
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(This exclusion does not affect coverage testing if
requirements in (a)(v)A above are met.)
vi) |[ ]Not a nonresident alien, within the meaning of Code
Section 7701(b)(1)(B), who receives no earned income,
within the meaning of Code Section 911 (d)(2), from us
which constitutes income from sources within the United
States, within the meaning of Code Section 861(a)(3),
or who receives such earned income but it is all exempt
from income tax in the United States under the terms of
an income tax convention. (This exclusion does not
affect coverage testing.)
vii) [ ]Not a Leased Employee.
viii) [ ]Not an Employee who became an Employee as the
result of a Code Section 410(b)(6)(C) transaction.
These Employees will be excluded during the period
beginning on the date of the transaction and ending on
the last day of the first Plan Year beginning after the
date of the transaction. A Code Section 410(b)(6)(C)
transaction is an asset or stock acquisition, merger,
or similar transaction involving a change in the
employer of the employees of a trade or business. (This
exclusion does not affect coverage testing.)
Amend No. 3 Effective April 1, 2003 5 Annuity Contract No. GA 4-42423
ix) [ ]Not an Employee considered by us to be an
independent contractor, or the employee of an
independent contractor, who is later determined by the
Internal Revenue Service to be an Employee.
b) If more than one employment classification is selected in (a)
above, the Employee must meet (Select (i) or (ii).)
i) [ ]all of the employment classifications selected.
ii) [ ]any one of the employment classifications selected.
c) [ ] Not covered under any other qualified (Select (i), (ii), or
both.)
i) [ ]profit sharing plan (or)
ii) [ ]pension plan to which we contribute.
d) [ ] Employed at the following location(s) or division(s) or in
the following position(s) or classification(s): (List those to be
included.)
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e) [ ]Not employed at the following location(s) or division(s) or in
the following position(s) or classification(s): (List those to be
excluded. Cannot impose a service-based exclusion such as
part-time employees.)
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K. HIGHLY COMPENSATED EMPLOYEE AND TESTING METHODS.
1) HIGHLY COMPENSATED EMPLOYEE. The definition of Highly Compensated
Employee in Plan Section 1.02 is modified below. (Select any that
apply.)
a) [ ] TOP-PAID GROUP ELECTION. (Select if you wish to limit the
number of Highly Compensated Employees based on compensation
to the top-paid group.) In determining who is a Highly
Compensated Employee, we make a top-paid group election. The
effect of this election is that an Employee (who is not a
5-percent owner at any time during the determination year or
the look-back year) with compensation in excess of $80,000 (as
adjusted) for the look-back year is a Highly Compensated
Employee only if the Employee was in the top-paid group for
the look-back year.
Amend No. 3 Effective April 1, 2003 6 Annuity Contract No. GA 4-42423
b) [ ] CALENDAR YEAR DATA ELECTION. (Select if you wish to change
the look-back year for compensation determination. This election
has no effect if the Plan Year begins on January 1.) In
determining who is a Highly Compensated Employee (other than as a
5-percent owner), we make a calendar year data election. The
effect of this election is that the look-back year is the
calendar year beginning with or within the look-back year.
NOTE: These elections must apply consistently to the determination
years of all plans of yours except as provided in the definition of
Highly Compensated Employee in Plan Section 1.02.
2) TESTING METHODS. This Plan shall use the prior year testing method for
purposes of the ADP and ACP Tests, unless otherwise specified in (a)
below.
a) |X|(Must be selected if 401 (k) Safe Harbor Plan.) This Plan
shall use the current year testing method for purposes of the
ADP and ACP Tests.
NOTE: The Plan cannot change from the current year testing
method to the prior year testing method for a Plan Year unless
(i) the Plan has been using the current year testing method for
the preceding five Plan Years or, if less, the number of Plan
Years the Plan has been in existence or (ii) the Plan otherwise
meets one of the conditions specified in Internal Revenue
Service Notice 98-1 (or superseding guidance) for changing from
the current year testing method.
b) If this is not a successor plan and the Plan is using the prior
year testing method, for the first Plan Year this Plan permits
any Member to make Elective Deferral Contributions, the prior
year's Nonhighly Compensated Employees' ADP, as defined in Plan
Section 3.07, shall be three percent, unless otherwise
specified in (i) below.
i) LJ (Cannot be used with (a) above.) The Plan Year's ADP,
as defined in Plan Section 3.07, shall be used for the
Nonhighly Compensated Employees' ADP.
c) If this is not a successor plan and the Plan is using the
prior year testing method, for the first Plan Year this Plan
permits any Member to make Voluntary Contributions, provides
for Matching Contributions, or both, the prior year's
Nonhighly Compensated Employees' ACP, as defined in Plan
Section 3.07, shall be three percent, unless otherwise
specified in (i) below.
i) [ ](Cannot be used with (a) above.) The Plan Year's ACP,
as defined in Plan Section 3.07, shall be used for the
Nonhighly Compensated Employees' ACP.
L. ENTRY REQUIREMENTS.
1) SERVICE REQUIRED to become an Active Member: (Select (a) or
(b).)
a) [ ]Service is not required.
Amend No. 3 Effective April 1, 2003 7 Annuity Contract No. GA 4-42423
b) |X|Service requirement is (Select (i), (II), or (in). Up to one year
may be used, 6 months if Entry Date is Yearly Date.)
i) [ ] one year.
ii) |X|_3___________ months. (Up to 12. Only available
if(2)(a) below is selected.)
iii) [ ] ____________ days. (Up to 120. Only available if
(2)(a) below is selected.)
2) ENTRY SERVICE, subject to the provisions of Plan Section 1.02, shall
be determined as follows: (Select (a) or (b) if service is required
for entry.)
a) |X|ELAPSED TIME METHOD. Entry Service is the total of an
Employee's Periods of Service without regard to Hours of Service.
b) [ ]HOURS METHOD. A year of Entry Service is an Entry Service
Period in which an Employee has at least 1,000 Hours of Service,
unless otherwise specified in (i) below.
i) [ ] _________ (Up to 999.) Hours of Service.
ii) CREDITING DATE. A year of Entry Service shall be credited
at the end of the Entry Service Period, unless otherwise
specified in A below.
A. [ ]A year of Entry Service shall be credited when
the Employee has reached the specified number of
Hours of Service during the Entry Service Period.
iii) ENTRY SERVICE PERIOD is the consecutive 12-month period
beginning on an Employee's Hire Date and the consecutive
12-month period ending on the last day of each following
Plan Year, unless otherwise specified in A below.
Following Plan Years shall include all Plan Years that
begin after his Hire Date. (See Plan Section 1.02 for the
crediting of Entry Service during the first two periods.)
A. [ ]An Entry Service Period is the consecutive
12-month period beginning on an Employee's Hire
Date and each following consecutive 12-month period
beginning on an anniversary of that Hire Date.
iv) An ENTRY BREAK, when the hours method is used, is an
Entry Service Period in which an Employee is credited
with not more than one-half of the Hours of Service
required for a year of Entry Service, unless otherwise
specified in A below.
A. [ ]_____________ or fewer Hours of Service (Fill in
up to 500 hours but less than hours required for a
year of Entry Service.)
Amend No. 3 Effective April 1, 2003 8 Annuity Contract No. GA 4-42423
3) AGE REQUIRED to become an Active Member: (Select (a) or (b).)
a) |X|A minimum age is not required.
b) [ ] An Employee must be _____________________or older. (Not
overage 21, 20 1/2 if Entry Date is Yearly Date.)
4) [ ] DUAL ELIGIBILITY. (Only available if (1)(b) or (3)(b) above is
selected. Cannot be used with Item O(8) or (9).) The service and age
requirements selected in (1)(b) and (3)(b) above shall not apply for
purposes of Elective Deferral Contributions. For purposes of Elective
Deferral Contributions, an Employee shall first become an Active
Member (begin active participation in the Plan) on the earliest Entry
Date selected in Item M on which he is an Eligible Employee, unless
otherwise specified in (a) below.
a) [ ] IMMEDIATE ENTRY FOR ELECTIVE DEFERRALS. (Cannot be used
with Item M(5) or O(7).) For purposes of Elective Deferral
Contributions, an Employee shall first become an Active Member
(begin active participation in the Plan) on the earliest date
on which he is an Eligible Employee. This date is the Member's
Entry Date.
NOTE: The earliest Entry Date shall be used to determine if a Member
is an Active Member for purposes of any minimum contribution under
Plan Section 11.04.
5) [ ] WAIVING ENTRY REQUIREMENTS. The requirements selected below shall
be waived on August 1, 1997__________________________________. This
date shall be an Entry Date if the Eligible Employee has met all the
other entry requirements. (Select (a), (b), or both.)
a) [ ]Service requirement
b) [ ]Age requirement
NOTE: This waiver applies only (i) to the primary Employer in Item B
and (ii) on the date you fill in. Must be the Effective Date or
later. See Item AB for the waiver of entry requirements for an
Adopting Employer.
M. ENTRY DATE. An Eligible Employee shall enter the Plan as an Active
Member on the earliest (Select one.)
1) [ ] Monthly Date
2) [ ] Semi-yearly Date
3) [ ] Quarterly Date
Amend No. 3 Effective April 1, 2003 9 Annuity Contract No. GA 4-42423
4) [ ] Yearly Date (If selected, age and service required in Item L
cannot be over 20 112 or more than 6 months, respectively.)
5) [ ] date
on or after the date on which he meets all the entry requirements. This
date is his ENTRY DATE.
N. PAY.
NOTE: Pay is used for ADP and ACP Tests and for contribution
determinations other than for top-heavy minimum contributions and 40 (k)
SIMPLE Plan contributions. Compensation, as defined in Plan Section 3.09,
is used for 401(k) SIMPLE Plan contributions.
1) Pay is the same as Compensation defined in Item S, subject to any
modifications set forth in this Item N.
For years beginning before January 1,1998, Compensation, as defined
in Item S, does not include elective contributions, but Pay shall.
For this purpose, elective contributions are amounts excludible from
the gross income of the Employee under Code Sections 402(e)(3),
402(h)(1)(B), 125, or 403(b), and contributed by us, at the
Employee's election, to a Code Section 401(k) arrangement, a
simplified employee pension, cafeteria plan, or tax-sheltered
annuity. Elective contributions also include amounts deferred under
a Code Section 457 plan maintained by us and employee contributions
"picked up" by a governmental entity and, pursuant to Code Section
414(h)(2), treated as our contributions.
2) SAFE HARBOR FRINGE BENEFIT EXCLUSION. For the purpose of calculating
Elective Deferral Contributions and Matching Contributions only, Pay
shall not include reimbursements or other expense allowances, fringe
benefits (cash or non-cash), moving expenses, deferred compensation
(other than elective contributions), and welfare benefits, unless
otherwise specified in (a) below.
a) [ ] (Exclude fringe benefits for all purposes.) Pay for all
purposes under the Plan shall not include reimbursements or
other expense allowances, fringe benefits (cash or non-cash),
moving expenses, deferred compensation (other than elective
contributions), and welfare benefits.
3) ANNUAL PAY for a Plan Year is an Employee's Pay for the Pay Year
ending with or within the consecutive 12-month period ending on the
last day of the Plan Year. (Annual Pay is used for calculating
annual contributions and annual allocations of Qualified Nonelective
Contributions, Additional Contributions, and Discretionary
Contributions. Annual pay is not used for the Qualified Nonelective
Contributions used to satisfy the ADP Test Safe Harbor
described in Item O(8).)
Amend No. 3 Effective April 1, 2003 10 Annuity Contract No. GA 4-42423
The PAY YEAR is the consecutive 12-month period ending on the last day
of each Plan Year, unless otherwise specified in (a) below.
a) [ ] The Pay Year is the consecutive 12-month period ending on each
____________________________________________________. (Month and day.)
For an Employee whose date of hire is less than 12 months before
the end of the consecutive 12-month period designated, Pay shall
be determined over the consecutive 12-month period ending on the
last day of the Plan Year.
ANNUAL PAY MODIFICATIONS: (Select any that apply.)
b) [ ] Annual Pay shall not include Pay over $ ____
c) [ ] (Cannot use with (a) above.) Annual Pay shall only include
Pay received while an Active Member.
NOTE: Including only Pay received while an Active Member may
result in additional Contributions needed to satisfy the
top-heavy requirements, described in Plan Section 11.04, during
any Plan Year in which this Plan is a Top-heavy Plan.
4) [ ]Pay for purposes of determining the allocation or amount of:
(Select at least one.)
a) [ ] (Cannot use if 401(k) Safe Harbor Plan.) Elective Deferral
Contributions and Matching Contributions (Exclusions for Matching
Contributions only is not permitted.)
b) [ ] Qualified Nonelective Contributions (Cannot select if ADP
Test Safe Harbor is satisfied using Qualified Nonelective
Contributions, Item 0(8)(b)(ii) or (c).)
c) [ ] Additional Contributions
d) [ ] Discretionary Contributions (Exclusions are not permitted if
integrated allocation formula is used.) excludes: (Select at
least one.)
e) [ ] bonuses
f) [ ] commissions
g) [ ] overtime
h) [ ] other special pay (Specify type of pay.)
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NOTE: Exclusions for purposes of any contributions other than
Elective Deferral Contributions and Matching Contributions will
require Code Section 414(s) nondiscrimination testing.
Amend No. 3 Effective April 1, 2003 11 Annuity Contract No. GA 4-42423
5) |X| For purposes of the ADP and AGP Tests, Pay shall be limited
to Pay received while an Eligible Member, as defined in Plan
Section 3.07.
O. ELECTIVE DEFERRAL CONTRIBUTIONS for a Member are equal to a portion of Pay
as specified in the elective deferral agreement. An Employee who is
eligible to participate in the Plan may file an elective deferral agreement
with us. The Member shall modify or terminate the elective deferral
agreement by filing a new elective deferral agreement. The elective
deferral agreement may not be made retroactively and shall remain in effect
until modified or terminated.
BEGINNING OF FIRST PAY PERIOD. The elective deferral agreement to start or
modify Elective Deferral Contributions shall be effective on the first day
of the first pay period following the pay period in which the Member's
Entry Date (Reentry Date, if applicable) or any following change date
occurs, unless otherwise specified in (1) or (2) below.
1) [ ] FOLLOWING PAY DATE. (Cannot be used with (7) below.) A
Member's elective deferral agreement shall become effective on
the first day that pay is paid or made available following the
date on which the Member's Entry Date, (Reentry Date, if
applicable) or any following change date occurs.
2) [ ] BEGINNING OF SECOND PAY PERIOD. A Member's elective deferral
agreement shall become effective on the first day of the second
pay period following the pay period in which the Member's Entry
Date (Reentry Date, if applicable) or any following change date
occurs. (Consider using this option if the Plan requires
automatic deferrals.)
The elective deferral agreement to start or modify Elective Deferral
Contributions must be entered into on or before the date it is effective.
The elective deferral agreement to stop Elective Deferral Contributions
may be entered into on any date. If 0(1) is not selected above, such
elective deferral agreement shall be effective on the first day of the
first pay period following the pay period in which the elective deferral
agreement is entered into. If O(1) is selected above, such elective
deferral agreement shall be effective on the first day that pay is paid or
made available after the elective deferral agreement is entered into.
3) The change date shall be each Semi-yearly Date, unless otherwise
specified in (a), (b), (c), or (d) below. (Select one, if
applicable.)
a) |X| Monthly Date
b) [ ] Quarterly Date
c) [ ] Yearly Date
d) [ ] date
4) [ ](Cannot select if ADP Test Safe Harbor is satisfied using Qualified
Matching Contributions.) _____________% of Pay is the minimum Elective
Deferral Contribution.
Amend No. 3 Effective April 1, 2003 12 Annuity Contract No. GA 4-42423
5) [ ] Elective Deferral Contributions must be a whole percentage of Pay.
6) [ ] (Cannot select if ADP Test Safe Harbor is satisfied using
Qualified Matching
Contributions.) _____________ % of Pay is the maximum Elective Deferral
Contribution. (Consider using this option to limit Elective Deferral
Contributions to avoid 415 excesses.)
7) [ ] AUTOMATIC DEFERRAL. (Cannot be used with Item M(5).) The Plan shall
require an automatic Elective Deferral Contribution described in Plan
Section 3.01. The automatic Elective Deferral Contribution shall be 4%
of Pay, unless otherwise specified in (a) below. The Member may
affirmatively elect a different percentage or elect not to make
Elective Deferral Contributions. If the Member elects a different
percentage, such percentage must comply with any limitations selected
in (4), (5), or (6) above.
a) [ ] _____________ % (Up to 6 %.) of Pay shall be the automatic
Elective Deferral Contribution.
b) The automatic Elective Deferral Contribution shall apply to
Members only at the time they enter or reenter the Plan, unless
otherwise specified in (i) below.
i) [ ] The automatic Elective Deferral Contribution shall
also apply to all Active Members as of the effective date
of the amendment to the Plan adding this provision who
have not elected to make Elective Deferral Contributions
of at least 4% (or the percentage in (a) above, if
applicable).
8) [ ] 401 (k) SAFE HARBOR. We elect to have the 401 (k) safe harbor
provisions described in Plan Section 3.08 apply. (Select (b) or(c).
Select (d), if applicable.)
a) The Plan will satisfy the ADP Test Safe Harbor only, unless
otherwise specified in (i) below.
i) [ ] The Plan will satisfy the ADP Test Safe Harbor and
the ACP Test Safe Harbor. (Only available if (8)(b)(i) or
Item P is selected and the ACP Test Safe Harbor limits on
Matching Contributions are met.)
b) [ ] CONTRIBUTIONS FOR ALL PLAN YEARS. (Any changes under this
Item (8)(b), including electing to no longer have the
provisions apply, must be effective at the beginning of the
Plan Year, except as provided in (i)E below.) We elect to make
the 401(k) safe harbor Contributions for all Plan Years.
(Select (i) or (ii).)
i) [ ] QUALIFIED MATCHING CONTRIBUTIONS. The ADP Test Safe
Harbor shall be satisfied using Qualified Matching
Contributions. These Contributions are 100% vested and
subject to the distribution restrictions of Code Section
401(k) when made. (See Plan Section 5.04.) The amount of
our Qualified Matching Contributions shall be equal to
(Select A or B.)
Amend No. 3 Effective April 1, 2003 13 Annuity Contract No. GA 4-42423
A. [ ] BASIC MATCHING FORMULA. 100% of Elective Deferral
Contributions which are not over 3% of Pay, plus 50%
of Elective Deferral Contributions which are over 3%
but are not over 5% of Pay.
B. [ ] ENHANCED MATCHING FORMULA. 100% of Elective
Deferral Contributions which are not over 4% of Pay,
unless otherwise specified in (1) or (2) below.
1) [ ] STATED MATCH. (Complete (a) and (b). For
example: 100% of Elective Deferral
Contributions which are not over 5% of Pay.)
a) __________% of Elective Deferral
Contributions which are not over
b) __________ % of Pay.
NOTE: Must complete (a) using at least 100%.
The product of the percentages in (a) and (b)
must equal at least 4%. For example, 100% x
5% = 5% or 150% x 3% = 4.5%. If satisfying
ACP Test Safe Harbor, must complete (b) with
a percentage not more than 6%.
2) |_| STATED TIERED MATCH. (Complete (a)
through (d). For example: 100% of Elective
Deferral Contributions which are not over 4%
of Pay, plus 50% of Elective Deferral
Contributions which are over 4% but are not
over 6% of Pay.)
a) ___________% of Elective Deferral
Contributions which are not over
b) ___________% of Pay, plus (First limit
on Elective Deferral Contributions.)
c) ___________% (Must be less than (a).)
of Elective Deferral Contributions
which are over the percentage of Pay
specified in (b) but are not over
d) ___________% (Must be more than (b).)
of Pay. (Second limit on Elective
Deferral Contributions.)
NOTE: Must complete (a) using at least 100%.
The product of the percentages in (a) and (b)
must equal at least 3%. In addition, if the
product of the percentages in (a) and (b)
does not equal at least 4%, (c) must be
completed using at least 50% and the product
of the percentages in (c) and (d) when added
to the product of the percentages in (a) and
(b) must equal at least 4%. If satisfying ACP
Test Safe Harbor, must complete (b) with a
percentage less than 6% and (d) with a
percentage not more than 6%.
Amend No. 3 Effective April 1, 2003 14 Annuity Contract No. GA 4-42423
C. CALCULATION PERIOD. Qualified Matching Contributions
are calculated based on Elective Deferral
Contributions and Pay for the period specified
below. (Refers to calculation of the amount of
Qualified Matching Contributions, not when
contributed. Select (1), (2), (3), or (4).)
1) [ ] PAY PERIOD. Qualified Matching Contributions shall
be made for all persons who were Active Members at any
time during the pay period.
2) [ ] PAY PERIODS ENDING WITH OR WITHIN EACH MONTH.
Qualified Matching Contributions shall be made for all
persons who were Active Members at any time during the
month.
3) [ ] PAY PERIODS ENDING WITH OR WITHIN EACH PLAN-YEAR
QUARTER. Qualified Matching Contributions shall be made
for all persons who were Active Members at any time
during the Plan-year Quarter.
NOTE: lf (1), (2), or (3) is selected, Qualified
Matching Contributions must be contributed to the
Plan by the last day of the following Plan-year
Quarter.
4) [ ] PLAN YEAR. Qualified Matching
Contributions shall be made for all persons
who were Active Members at any time during the
Plan Year.
D. [ ] Qualified Matching Contributions shall be made
only for Nonhighly Compensated Employees.
E. [ ] The 401 (k) safe harbor election shall be revoked
as of
______________________________________________________.
Such date cannot be earlier than the later of (i) 30
days after the date Active Members are given the
supplemental notice described in Plan Section 3.08(e)
and (ii) the date the amendment revoking such
provisions is adopted. Qualified Matching Contributions
shall be made for the period prior to the revocation.
[ ] QUALIFIED NONELECTIVE CONTRIBUTIONS. The ADP Test
Safe Harbor shall be satisfied using Qualified
Nonelective Contributions. (These Contributions in excess
of the amount needed to satisfy the ADP Test Safe Harbor
may be used to satisfy the ACP Test, if applicable.)
These contributions are 100% vested and subject to the
distribution restrictions of Code Section 401(k) when
made. (See Plan Section 5.04.)
The amount of our Qualified Nonelective Contributions
shall be equal
to ___________% (Must be at least 3%.) of Pay for the
Plan Year for persons who were Active Members at any time
during the Plan Year, unless otherwise specified in A and
B below. (The Pay used for these Contributions is not
necessarily the same as Annual Pay defined in Item N.
Select any that apply.)
Amend No. 3 Effective April 1, 2003 15 Annuity Contract No. GA 4-42423
A. [ ] Pay shall only include Pay received while an Active
Member.
NOTE: Including only Pay received while an Active Member
may result in additional Contributions needed to satisfy
the top-heavy requirements, described in Plan Section
11.04, during any Plan Year in which this Plan is a
Top-heavy Plan.
B. [ ] Qualified Nonelective Contributions shall be
made only for Nonhighly Compensated Employees.
c) [ ] CONTRIBUTIONS FOR PLAN YEARS IN WHICH THE PLAN IS
AMENDED. We elect the option of amending the Plan to
provide a Qualified Nonelective Contribution to satisfy
the ADP Test Safe Harbor for a Plan Year.
d) [ ] PLAN IS AMENDED. (Only available if (c) above is
selected.) The Plan is amended to provide a Qualified
Nonelective Contribution for the Plan Year
beginning __________ _______________
________________________. (These Contributions in
excess of the amount needed to satisfy the ADP Test
Safe Harbor may be used to satisfy the ACP Test, if
applicable.) These Contributions are 100% vested and
subject to the distribution restrictions of Code
Section 401(k) when made. (See Plan Section 5.04.)
i) The amount of our Qualified Nonelective Contributions
for such Plan
Year shall be equal to ___________% (Must be at least 3%.)
of Pay for the Plan Year for persons who were Active
Members at any time during the the Plan Year, unless
otherwise specified in A and B below. (The Pay used for
these Contributions is not necessarily the same as
Annual Pay defined in Item N. Select any that apply.)
A. [ ] Pay shall only include Pay received while an
Active Member.
NOTE: Including only Pay received while an Active Member
may result in additional Contributions needed to satisfy
the top-heavy requirements, described in Plan Section
11.04, during any Plan Year in which this Plan is a
Top-heavy Plan.
B. [ ] Qualified Nonelective Contributions shall be
made only for Nonhighly Compensated Employees.
9) [ ] 401(k) SIMPLE. (Only available if the Plan uses a calendar year
Plan Year, you are an Eligible Employer, as defined in Plan Section
3.09, and the exclusive plan requirement of (a)(1)(ii) of Plan
Section 3.09 is met. Cannot use if 401(k) Safe Harbor Plan.) We elect
to have the 401 (k) SIMPLE provisions described in Plan Section 3.09
apply to the Plan effective ____________________________________.
An amendment to have 401 (k) SIMPLE provisions no longer apply is
effective the first January 1 following the date the amendment is
adopted.
Amend No. 3 Effective April 1, 2003 16 Annuity Contract No. GA 4-42423
NOTE: See Plan Section 3.09 for 401 (k) SIMPLE provisions. If this is
a new plan, the Effective Date (Item D) and the date in (9) above
must be on or before October 1. Future Plan Years must begin on
January 1. If this is a restatement (or amendment) adding this
provision, the date in (9) above will be the same as the Restatement
Date (or effective date of the amendment) which must be on a January
1 which is the first day of a Plan Year and future Plan Years must
begin on a January 1. Such restatement (or amendment) must be adopted
before the January 1 on which the provisions become effective.
Elective Deferral Contributions and Rollover Contributions will be
the only contributions reflected in the Adoption Agreement. Other
Contributions shall only be permitted as specified in Plan Section
3.09. The Member may change the elective deferral agreement on any
date. No selections can be made in (4), (5), or (6) above. Elective
Deferral Contributions will be subject to the $6,000 (as adjusted)
annual limit of Code Section 401(k)(11).
P. |X| MATCHING CONTRIBUTIONS. (Cannot select if ADP Test Safe Harbor is
satisfied using Qualified Matching Contributions.) Any percentage
determined by us shall apply to all eligible persons for the entire Plan
Year. (Select (1), (2), or (3).)
1) [ ] STATED MATCH. We shall make Matching Contributions. The percentage
of
Elective Deferral Contributions matched is________________ %.
2) [ ] STATED TIERED MATCH. We shall make Matching Contributions in an
amount equal to (Complete (a) through (d). For example: 100% of
Elective Deferral Contributions which are not over 3% of Pay, plus
50% of Elective Deferral Contributions which are over 3% but are not
over 5% of Pay.)
a) ___________ % of Elective Deferral Contributions which are not
over
b) ___________ % of Pay, plus (First limit on Elective Deferral
Contributions.)
c) __________ % (Must be less than (a).) of Elective Deferral
Contributions which are over the percentage of Pay specified
in (b) but are not over
d) ___________ % (Must be more than (b).) of Pay. (Second limit
on Elective Deferral Contributions.)
NOTE: If satisfying ACP Test Safe Harbor, must complete (b) with a
percentage less than 6% and (d) with a percentage not more than 6%.
3) [ ] DISCRETIONARY MATCH. (If selected and Plan is satisfying ACP
Test Safe Harbor, (b) must be selected.) We may make a discretionary
Matching Contribution. The percentage of Elective Deferral
Contributions matched, if any, shall be a percentage as determined
by us. (Select any that apply.)
a) [ ] We shall make a discretionary Matching Contribution. The
percentage of Elective Deferral Contributions matched shall
be at least ___________ %.
Amend No. 3 Effective April 1, 2003 17 Annuity Contract No. GA 4-42423
b) [ ] |f we make a discretionary Matching Contribution, the percentage
of
Elective Deferral Contributions matched shall not be more than
___________%. (If satisfying ACP Test Safe Harbor, must complete
with a percentage not more than 100%.)
4) [ ] LIMIT ON ELECTIVE DEFERRALS MATCHED. (Must select if (1) or (3)
above is used and satisfying ACP Test Safe Harbor. Cannot use with (2)
above. Limit could help pass the ADP and ACP Tests for non-401 (k) Safe
Harbor Plans.) Elective Deferral Contributions which are over the
percentage of Pay below won't be matched. (Select (a) or (b).)
a) [ ] ______________% of Pay. (If satisfying ACP Test Safe Harbor,
must complete with a percentage not more than 6% (not more than
4% if (3) above is selected).)
b) [ ] A percentage determined by us. (Select any that apply. Must
select (ii) if satisfying ACP Test Safe Harbor.)
i) [ ] The percentage shall be at least _____________%.
ii) [ ] The percentage shall not be more than _______________%.
(If satisfying ACP Test Safe Harbor, must complete with a
percentage not more than 6% (not more than 4% if (3) above
is selected).)
5) CALCULATION PERIOD. Matching Contributions are calculated based on
Elective Deferral Contributions and Pay for the period specified
below. (Refers to calculation of the amount of Matching Contribution,
not when contributed. Select (a), (b), (c), or(d).)
a) [ ] PAY PERIOD. Matching Contributions shall be made for all
persons who were Active Members at any time during that pay
period.
b) [ ] PAY PERIODS ENDING WITH OR WITHIN EACH MONTH. Matching
Contributions shall be made for all persons who were Active
Members at any time during the month.
c) [ ] PAY PERIODS ENDING WITH OR WITHIN EACH PLAN-YEAR
QUARTER. Matching Contributions shall be made for all
persons who were Active Members at any time during the
Plan-year Quarter.
d) [ ] PLAN YEAR. Matching Contributions shall be made for all
persons who were Active Members at any time during the Plan
Year, unless otherwise specified in (i) below.
i). [ ] Cannot use if satisfying ACP Test Safe Harbor.)
Matching Contributions shall be made for persons meeting
the requirements in Item R.
Amend No. 3 Effective April 1, 2003 18 Annuity Contract No. GA 4-42423
6) [ ] ADDITIONAL MATCH. (Only available if (1) or (3) above is
selected. Cannot use if satisfying ACP Test Safe Harbor.) We may make
additional Matching Contributions if the total Matching Contributions
determined below are greater than the amount of Matching
Contributions determined in (1) or (3) above for the Plan Year.
Additional Matching Contributions, if any, shall be made for all
persons who were Active Members at any time during the Plan Year,
unless specified in (a) below.
a) [ ] Additional Matching Contributions shall be made for persons
meeting the requirements in Item R.
NOTE: If Item R is not active at any time during the Plan Year,
selecting (a) will require testing to determine if the
nondiscrimination requirement of Code Section 401(a)(4) is met,
unless (5)(d)(i) above is a/so selected.
Total Matching Contributions for the Plan Year shall be a percentage
of Elective Deferral Contributions and shall be calculated based on
Elective Deferral Contributions and Pay for the Plan Year. The
percentage shall be determined by us. If (1) above is selected, the
percentage determined must be equal to or greater than the percentage
specified in (1). If (3) above is selected, the percentage determined
must be equal to or greater than the percentage determined in (3).
If (4) above is selected, Elective Deferral Contributions which are
over a percentage of Pay won't be matched. The percentage is the
percentage specified in (4)(a), determined in (4)(b), or a greater
percentage as determined by us.
The amount of additional Matching Contributions, if any, shall be
calculated by subtracting the Matching Contributions determined in
(1) or (3) above for the Plan Year from total Matching Contributions
for the Plan Year.
7) [ ] Matching Contributions shall be made only for Nonhighly
Compensated Employees.
8) [ ] QUALIFIED MATCH. (Must be selected if Matching Contributions are
to be tested in the ADP Test for a non-401(k) Safe Harbor Plan.)
Matching Contributions are Qualified Matching Contributions. These
Contributions are 100% vested and subject to the distribution
restrictions of Code Section 401 (k) when made. (See Plan Section
5.04.)
9) [ ] DOLLAR LIMIT. (Cannot use if satisfying ACP Test Safe Harbor.)
Matching Contributions for a person shall not be more than $
_______________ for the Plan Year.
Q. OTHER EMPLOYER CONTRIBUTIONS AND FORFEITURES.
NOTE: If more than one Employer Contribution is selected in this Item Q,
the requirements to receive each Contribution selected should be the same.
Providing different requirements will require testing to determine if the
nondiscrimination requirement of Code Section 401(a)(4) is met. For
example, a Qualified Nonelective Contribution made to each person who is an
Active Member on the last day of the pay period and a Discretionary
Contribution allocated to each person who was an Active Member at any time
during the Plan Year will require nondiscrimination testing. If the ADP
Test Safe Harbor is satisfied using Qualified Nonelective Contributions,
Item 0(8)(b)(ii) or (c), the Additional Contributions and Discretionary
Contributions selected under this item should be made for or allocated to
each person who is an Active Member at any time during the Plan Year to
avoid nondiscrimination testing.
Amend No. 3 Effective April 1, 2003 19 Annuity Contract No. GA 4-42423
1) [ ] QUALIFIED NONELECTIVE CONTRIBUTIONS. (Cannot select ifADP Test Safe
Harbor is satisfied using Qualified Nonelective Contributions for all
Plan Years, Item O(8)(b)(ii). If this is a 401 (k) Safe Harbor Plan
using Qualified Matching Contributions to satisfy the ADP Test Safe
Harbor, these Contributions may be used to satisfy the ACP Test, if
applicable. These Contributions may be tested in the ADP orACP Test
fora non-401 (k) Safe Harbor Plan.) These Contributions are 100% vested
and subject to the distribution restrictions of Code Section 401 (k)
when made. (See Plan Section 5.04. Select at least one of (a), (b),
(c), or (e). Only one of (a), (b), or (c) may be selected. Select (d),
if applicable.)
a) [ ] SET AMOUNT. (Only available if Item 0(8)(c) is not
selected.) We shall make Qualified Nonelective Contributions
equal to the following: (Select (i) or(ii).)
i) [ ] PAY FORMULA. An amount equal to (Select one.)
A. [ ] _________________ % of Pay, for the pay period
for each person who is an Active Member on the last
day of that period.
B. [ ] _________________ % of Annual Pay for the Plan
Year for persons who meet the requirements in Item
R.
C. [ ] _________________ % of Annual Pay for the Plan
Year for persons who were Active Members at any time
during the Plan Year.
ii) [ ] SERVICE FORMULA. An amount equal to (Select one.)
A. [ ] $ _______________ for the pay period for each
person who is an Active Member on the last day of
that period.
B. [ ] $ _______________ for the Plan Year for persons
who meet the requirements in Item R.
C. [ ] $ _______________ for the Plan Year for persons
who were Active Members at any time during the Plan
Year.
b) [ ] DISCRETIONARY, PAY FORMULA. (Only available if Item O(8)(c)
is not selected.) Qualified Nonelective Contributions may be
made for each Plan Year in an amount determined by us. The
amount allocated to each eligible person shall be equal to our
Qualified Nonelective Contributions multiplied by the ratio of
such person's Annual Pay for the Plan Year to the total Annual
Pay of all such persons. The Qualified Nonelective
Contributions shall be allocated to each person meeting the
requirements in Item R, unless otherwise specified in (i) or
(ii) below.
i) [ ] The Qualified Nonelective Contributions shall be
allocated to each person who was an Active Member at any
time during the Plan Year.
ii) [ ] The Qualified Nonelective Contributions shall be
allocated to each person who is an Active Member on the
last day of the Plan Year.
Amend No. 3 Effective April 1, 2003 20 Annuity Contract No. GA 4-42423
c) [ ] DISCRETIONARY, SAME DOLLAR AMOUNT. (Only available if Item
0(8)(c) is not selected.) Qualified Nonelective Contributions
may be made for each Plan Year in an amount determined by us.
The same dollar amount shall be allocated to each eligible
person, subject to applicable limits of Plan Section 3.06. The
Qualified Nonelective Contributions shall be allocated to each
person meeting the requirements in Item R, unless otherwise
specified in (i) or (ii) below.
i) [ ] The Qualified Nonelective Contributions shall be
allocated to each person who was an Active Member at any
time during the Plan Year.
ii) [ ] The Qualified Nonelective Contributions shall be
allocated to each person who is an Active Member on the
last day of the Plan Year.
d) [ ] (Only available if (a), (b), or (c) is selected above.)
Qualified Nonelective Contributions in (a), (b), or (c) above
shall be made only for, or allocated only to, Nonhighly
Compensated Employees, unless otherwise specified in (i) below.
i) [ ] (Only available if (a)(i)A and (a)(ii)A above are not
selected.) The Qualified Nonelective Contributions shall
be made only for, or allocated only to, the Nonhighly
Compensated Employees whose Annual Pay for
the Plan Year is not over $ ___________.
e) [ ] DISCRETIONARY, BOTTOM UP. (Only available if Item K(2)(a) is
selected and Item 0(8)(b)(i) is not selected.) Qualified
Nonelective Contributions may be made for each Plan Year in an
amount determined by us. If Item 0(8)(c) is selected, these
Qualified Nonelective Contributions may only be made for Plan
Years in which the Plan is not so amended. If (a), (b), or (c)
above are selected, these Qualified Nonelective Contributions
are in addition to those specified in (a), (b), or (c). If the
Plan is treated as separate plans because it is mandatorily
disaggregated under the regulations of Code Section 401(k), a
separate Qualified Nonelective Contribution may be determined
for each separate plan.
These Qualified Nonelective Contributions may be used to reduce
the Excess Aggregate Contributions or Excess Contributions, as
defined in Plan Section 3.07. Such Contributions shall be
allocated first to the eligible person under the Plan (or
separate plan) with the lowest Annual Pay for the Plan Year,
then to the eligible person under the Plan (or separate plan)
with the next lowest Annual Pay, and so forth, in each case
subject to applicable limits of Plan Section 3.06. These
Qualified Nonelective Contributions shall be allocated only to
Nonhighly Compensated Employees who meet the requirements in
Item R, unless otherwise specified in (i) or (ii) below.
i) [ ] These Qualified Nonelective Contributions shall be
allocated only to Nonhighly Compensated Employees who
were Active Members at any time during the Plan Year.
ii) [ ] These Qualified Nonelective Contributions shall be
allocated only to Nonhighly Compensated Employees who are
Active Members on the last day of the Plan Year.
Amend No. 3 Effective April 1, 2003 21 Annuity Contract No. GA 4-42423
2) [ ] ADDITIONAL CONTRIBUTIONS. We shall make Additional Contributions
equal to the following: (Select (a) or (b).)
a) C] PAY FORMULA. An amount equal to (Select (i) or (ii).)
i) [ ]______________ % of Pay for the pay period for each
person who is an Active Member on the last day of that
period.
ii) [ ]___________ % of Annual Pay for the Plan Year for
persons who meet the requirements in Item R.
b) [ ] SERVICE FORMULA. An amount equal to (Select one.)
i) [ ] $ _________ for the pay period for each person who is
an Active Member on the last day of that period.
ii) [ ] $ ________ for the Plan Year for persons who meet the
requirements in Item R.
iii) [ ] $ ________ for each Hour of Service he has performed
during the pay period for each person who was an Active
Member during that d. (No contribution for paid nonworking
hours, such as vacation.)
iv) [ ] $ __________ for each Hour of Service credited during
the pay period for each person who was an Active
Member during that period. (Contribution is made for paid
nonworking hours, such as vacation.)
3) [ ] DISCRETIONARY CONTRIBUTIONS. Discretionary Contributions may be
made for each Plan Year in an amount determined by us. Discretionary
Contributions and Forfeitures, if applicable, shall be allocated as of
the last day of the Plan Year using Annual Pay for the Plan Year. The
amount allocated shall be equal to the amount determined in (a) or (b)
below. (Select (a) or (b).)
a) [ ] PAY FORMULA. Discretionary Contributions and Forfeitures, if
applicable, shall be allocated as follows:
STEP ONE: This step one shall only apply in years in which the
Plan is a Top-heavy Plan, as defined in Plan Section 11.02, and
the minimum contribution under Plan Section 11.04 is not being
provided by other contributions to this Plan or another plan of
ours.
The allocation in this step one shall be made to each person
meeting the requirements in Item R and each person who is
entitled to a minimum contribution under Plan Section 11.04.
Each such person's allocation shall be an amount equal to
Discretionary Contributions and Forfeitures, if applicable,
multiplied by the ratio of such person's Annual Pay to the
total Annual Pay of all such persons. Such amount shall not
exceed 3% of such person's Annual Pay. The allocation for any
person who does not meet the requirements in Item R shall be
limited to the amount necessary to fund the minimum
contribution.
Amend No. 3 Effective April 1, 2003 22 Annuity Contract No. GA 4-42423
STEP TWO: The allocation in this step two shall be made to each
person meeting the requirements in Item R. Each such person's
allocation shall be equal to any amount remaining after the
allocation in step one multiplied by the ratio of such person's
Annual Pay to the total Annual Pay of all such persons.
b) [ ] INTEGRATED FORMULA. Subject to the overall permitted
disparity limits, Discretionary Contributions and Forfeitures,
if applicable, shall be allocated as follows:
STEP ONE: This step one shall only apply in years in which the
Plan is a Top-heavy Plan, as defined in Plan Section 11.02, and
the minimum contribution under Plan Section 11.04 is not being
provided by other contributions to this Plan or another plan of
ours.
The allocation in this step one shall be made to each person
meeting the requirements in Item R and each person who is
entitled to a minimum contribution under Plan Section 11.04.
Each such person's allocation shall be an amount equal to
Discretionary Contributions and Forfeitures, if applicable,
multiplied by the ratio of such person's Annual Pay to the total
Annual Pay of all such persons. Such amount shall not exceed 3%
of such person's Annual Pay. The allocation for any person who
does not meet the requirements in Item R shall be limited to the
amount necessary to fund the minimum contribution.
STEP TWO: This step two shall only apply in years in which step
one applies. The allocation in this step two shall be made to
each person meeting the requirements in Item R. Each such
person's allocation shall be equal to any amount remaining after
the allocation in step one multiplied by the ratio of such
person's Annual Pay over the Integration Level to the total
Annual Pay over the Integration Level of all such persons. Such
amount shall not exceed 3% of such person's Annual Pay over the
Integration Level.
For purposes of this step two, in the case of any person who has
exceeded the cumulative permitted disparity limit described
below, such person's total Annual Pay shall be taken into
account and the applicable allocation limit for such person
shall be 3% of such person's total Annual Pay.
STEP THREE: The allocation in this step three shall be made to
each person meeting the requirements in Item R. Each such
person's allocation shall be equal to any amount remaining
after the allocation in step two multiplied by the ratio of the
sum of such person's total Annual Pay and his Annual Pay over
the Integration Level to the total of such sums for all such
persons. Such amount shall not exceed an amount equal to a
percentage (equal to the Maximum Integration Rate) of the sum
of such person's total Annual Pay and his Annual Pay over the
Integration Level.
Amend No. 3 Effective April 1, 2003 23 Annuity Contract No. GA 4-42423
If steps one and two apply, the Maximum Integration Rate minus
3% shall be substituted for the Maximum Integration Rate
wherever it appears in this step three.
For purposes of this step three, in the case of any person who
has exceeded the cumulative permitted disparity limit described
below, two times such person's total Annual Pay shall be taken
into account and the applicable allocation limit for such person
shall be a percentage (equal to the Maximum Integration Rate) of
two times such person's total Annual Pay.
STEP FOUR: The allocation in this step four shall be made to
each person meeting the requirements in Item R. Each such
person's allocation shall be equal to any amount remaining after
the allocation in step three multiplied by the ratio of such
person's Annual Pay to the total Annual Pay of all such persons.
The INTEGRATION LEVEL is the Taxable Wage Base as in effect on
the latest Yearly Date, unless otherwise specified in (i) or
(ii) below.
i) [ ] $ ________. (Must be less than such Taxable Wage
Base.)
ii) [ ]____________ % of such Taxable Wage Base. (Must be
more than 19% and less than 100%.)
The MAXIMUM INTEGRATION RATE shall be determined according to
the following schedule.
MAXIMUM
INTEGRATION LEVEL INTEGRATION RATE
100%ofTWB 5.7%
Less than 100% but more
than 80% of TWB 5.4%
More than 20% of TWB
but not more than
80% of TWB 4.3%
Not more than
20% of TWB 5.7%
"TWB" means the Taxable Wage Base as in effect on the latest
Yearly Date.
On any date the portion of the rate of tax under Code Section
3111 (a) (in effect on the latest Yearly Date) which is
attributable to old age insurance exceeds 5.7%, such rate shall
be substituted for 5.7%. 5.4% and 4.3% shall be increased
proportionately.
Amend No. 3 Effective April 1, 2003 24 Annuity Contract No. GA 4-42423
OVERALL PERMITTED DISPARITY LIMITS:
ANNUAL OVERALL PERMITTED DISPARITY LIMIT: Notwithstanding the
preceding paragraphs, for any Plan Year any person eligible for
an allocation under this formula benefits under another
qualified plan or simplified employee pension, as defined in
Code Section 408(k), maintained by us or any other employer
required to be aggregated with us under Code Sections 414(b),
(c), (m), or (o) that provides for permitted disparity (or
imputes disparity), Discretionary Contributions and Forfeitures,
if applicable, shall be allocated using only step one, if
applicable, and step four.
CUMULATIVE PERMITTED DISPARITY LIMIT: Effective for Plan Years
beginning on or after January 1, 1995, the cumulative permitted
disparity limit for a person is 35 total cumulative permitted
disparity years. Total cumulative disparity years means the
number of years credited to the person for allocation or accrual
purposes under this Plan, any other qualified plan or simplified
employee pension plan (whether or not terminated) ever
maintained by us or any other employer required to be aggregated
with us under Code Sections 414(b), (c), (m), or (o). For
purposes of determining the person's cumulative permitted
disparity limit, all years ending in the same calendar year are
treated as the same year. If the person has not benefited under
a defined benefit or target benefit plan maintained for any year
beginning on or after January 1, 1994, the person has no
cumulative permitted disparity limit.
4) FORFEITURES.
a) If (3) above is selected, Forfeitures shall be allocated with
Discretionary Contributions and shall be deemed to be
Discretionary Contributions, unless otherwise specified in (i)
below.
i) [ ] (Cannot use unless Item V(2) is completed.)
Forfeitures shall not be allocated with Discretionary
Contributions, but shall be used to offset our first
Contribution made after the Forfeiture is determined.
b) If (3) above is not selected, Forfeitures shall be used to
offset our first Contribution made after the Forfeiture is
determined, unless otherwise specified in (i) below
i) [ ] (Cannot use unless (2) above is selected and Item V(2) is
completed.) Forfeitures shall not be used to offset our
first Contribution, but shall be allocated as of the last
day of the Plan Year to those meeting the requirements in
Item R using the allocation formula in (3)(a) above, and
shall be deemed to be Additional Contributions.
Amend No. 3 Effective April 1, 2003 25 Annuity Contract No. GA 4-42423
R. NET PROFITS AND CONTRIBUTION REQUIREMENTS.
1) Our Contributions shall be made without regard to our current or
accumulated NET PROFITS, unless otherwise specified in (a) below.
a) [ ] (Cannot use if 401 (k) Safe Harbor Plan or 401 (k)
SIMPLE Plan.) Our Contributions, in excess of Elective
Deferral Contributions, shall be made out of our
current or accumulated Net Profits in excess of
Elective Deferral Contributions.
2) REQUIREMENTS FOR CONTRIBUTIONS. Our Contributions which are subject
to the requirements of this Item R and Forfeitures, if applicable,
shall be made for or allocated to each person who was an Active
Member at any time during the Plan Year, unless otherwise specified
in (a), (b), (c), or (d) below. (If annual contributions are subject
to these requirements (or if Forfeitures are allocated under Item
Q(4)(b)(i)), (a), (b), (c), or (d) may be selected.
Select (e), if applicable.)
NOTE: Selections may affect testing done to determine if the minimum
coverage requirement of Code Section 410(b) is
met, unless otherwise indicated.
a) [ ] Such amounts shall be made for or allocated to each person
who was an Active Member at any time during the Plan Year and
who either is an Active Member on the last day of the Plan
Year or has more than 500 Hours of Service during the latest
Accrual Service Period ending on or before the last day of the
Plan Year, unless a lesser number of Hours of Service is
specified in (i) below. (This selection does not affect
coverage testing if the Accrual Service Period is the Plan
Year.)
i) [ ] Has more than ________________ (Up to 499.) Hours of
Service.
b) [ ] Such amounts shall be made for or allocated to each person
who is an Active Member on the last day of the Plan Year.
c) [ ] Such amounts shall be made for or allocated to each person
who was an Active Member at any time during the Plan Year and
who has at least 1,000 Hours of Service during the latest
Accrual Service Period ending on or before the last day of the
Plan Year, unless otherwise specified in (i) below.
i) [ ] Has at least ________ (Up to 999.) Hours of Service.
d) [ ] Such amounts shall be made for or allocated to each
person who is an Active Member on the last day of the Plan
Year and who has at least 1,000 Hours of Service during the
latest Accrual Service Period ending on or before that date,
unless otherwise specified in (i) below.
i) [ ] Has at least _________ (Up to 999.) Hours of Service.
Amend No. 3 Effective April 1, 2003 26 Annuity Contract No. GA 4-42423
The requirements in (a), (b), (c), or (d) above are modified as
follows:
e) [ ] Such amounts shall also be made for or allocated to each
person who was an Active Member at any time during the Plan
Year and who has retired, become Totally Disabled, or died.
3) The ACCRUAL SERVICE PERIOD is the consecutive 12-month period ending
on the last day of each Plan Year, unless otherwise specified in (a)
below.
a) [ ] (Use only with (2) (a), (c), or (d) above.,) The Accrual
Service Period is the
consecutive 12-month period ending on each
___________________________________. (Month and day.)
NOTE: Selecting (a) above will require nondiscrimination
testing to determine if the nondiscrimination requirement
of Code Section 401(a)(4) is met.
4) [ ] (Cannot use with (1)(a) above.) We may make all or part of our
annual Contributions before the end of the Plan Year. (Select (a) or
(b).)
Such Contributions shall be
a) [ ] allocated when made. (Only available if Item Q(1)(b)(ii) and
(c)(ii) are not selected, and (2)(a), (b), (c), and (d) above are
not selected.)
b) [ ] unallocated when made.
S. CONTRIBUTION MODIFICATIONS.
CONTRIBUTION LIMITATIONS. The Annual Additions for a Member
during a Limitation Year shall not be more than the Maximum
Permissible Amount. (See Plan Sections 3.06 and 11.05.)
1) The LIMITATION YEAR is the consecutive 12-month period ending on each
December 31_________________. (Month and day. Fill in the
last day of the Limitation Year. Normally, the last day
of the Plan Year is used. You must use the same
Limitation Year in all your plans.)
2) COMPENSATION. (Compensation for the Limitation Year is used to
determine the limit on Annual Additions. Compensation for the Plan
Year is used to determine the amount of top-heavy minimum
contributions.) Compensation for purposes of Plan Section 3.06 is as
defined therein, under Information Required to be Reported Under
Code Sections 6041, 6051, and 6052 ("Wages, Tips and Other
Compensation" box on Form W-2), which is actually paid or made
available by us, unless otherwise specified in (a) or (b) below.
Amend No. 3 Effective April 1, 2003 27 Annuity Contract No. GA 4-42423
a) [ ] 415 Safe-Harbor Compensation as defined in Plan Section 3.06. b) [
] Code Section 3401 (a) Wages (wages for purposes of income tax
withholding) as defined in Plan Section 3.06.
For years beginning after December 31, 1997, Compensation shall
include elective contributions. For this purpose, elective
contributions are elective deferrals (as defined in Code Section
402(g)(3)) and amounts contributed or deferred by us at the election
of the Employee which are not includible in the gross income of the
Employee by reason of Code Section 125, 132(f)(4), or 457.
3) MULTIPLE DEFINED CONTRIBUTIONS PLANS. (This item applies if you or an
Employer, as defined in Plan Section 3.06, maintain another qualified
defined contribution plan that is not a Master or Prototype Plan in
which any Member in this Plan is or was or could become a member.) If
the Member is covered under another qualified defined contribution
plan maintained by the Employer, as defined in Plan Section 3.06, the
provisions of (f) through (k) of Plan Section 3.06 shall apply as if
the other plan were a Master or Prototype Plan, unless otherwise
specified in (a) below. (Plan Section 3.06 limits the last Annual
Additions.)
a) [ ] The method described on the attached page(s) shall be used
to limit total Annual Additions to the Maximum Permissible
Amount, and shall properly reduce the Excess Amounts, as defined
in Plan Section 3.06, in a manner which precludes Employer
discretion. (If selected, you will provide the method for
limiting Annual Additions on the attached page(s).)
4) DEFINED BENEFIT PLAN. (This item applies if you or an Employer, as
defined in Plan Section 3.06, maintain or ever maintained a qualified
defined benefit plan in which any Member in this Plan is or was or
could become a member. If this applies, you will provide the method
used to satisfy the limitation on the attached page(s). No attachment
is needed if the Effective Date (Restatement Date or amendment
effective date, if applicable) is on or after the first Limitation
Year beginning on or after January 1, 2000.) If the Member is or has
ever been a member in a qualified defined benefit plan maintained by
the Employer, as defined in Plan Section 3.06, the method described on
the attached page(s) shall be used to satisfy the 1.0 limitation of
Code Section 415, in a manner which precludes Employer discretion.
This limitation shall not apply for Limitation Years beginning on or
after January 1, 2000.
5) [ ] OTHER LIMITS. (Cannot use if 401 (k) Safe Harbor Plan or 401(k)
SIMPLE Plan.) The amount of our Contributions for any (Select (a) or
(b).)
a) [ ] Plan Year
b) [ ] Limitation Year
Amend No. 3 Effective April 1, 2003 28 Annuity Contract No. GA 4-42423
made for or allocated to a person shall not be more than
(Select at least one.)
c) [ ] $ __________ (Up to the current Defined Contribution Dollar
Limitation defined in Plan Section 3.06.)
d) [ ] ___________ % (Up to 25%.) of his Annual Pay for the Plan
Year/Compensation for the Limitation Year.
NOTE: If both (c) and (d) are selected, contributions shall be no
more than the lesser of (c) and (d).
TOP-HEAVY PLAN REQUIREMENTS. The amount and allocation of Contributions
shall be subject to the provisions of Article XI of the Basic Plan in Plan
Years when this is a Top-heavy Plan, as defined in Plan Section 11.02.
Special minimum and maximum contribution provisions will apply in such
years.
6) [ ] MULTIPLE PLANS. (Use this item to specify which plan will provide
the minimum contribution or benefit for members who are covered under
this Plan and any other plan or plans of yours. If selected, you must
provide wording on the attached page(s).) The method described on the
attached page(s) shall be used to meet the minimum contribution and
benefit requirements in Plan Years when this is a Top-heavy Plan, in
a manner which precludes Employer discretion.
7) PRESENT VALUE: (Applicable if Aggregation Group, as defined in Plan
Section 11.02, contains a defined benefit plan. The interest and
mortality in this item must match the interest and mortality used for
this purpose in such defined benefit plan.) For purposes of
establishing Present Value, as defined in Plan Section 11.02, of
benefits under a defined benefit plan to compute the Top-heavy Ratio,
as defined in Plan Section 11.02, any benefit shall be discounted
only for 7 1/2% interest and mortality according to the 1971 Group
Annuity Table (Male) without the 7% margin but with projection by
Scale E from 1971 to the later of (i) 1974, or (ii) the year
determined by adding the age to 1920, and wherein for females the
male age six years younger is used, unless otherwise specified in (a)
and (b) below.
a) [ ] Interest rate ___________________ %. b) [ ] H Mortality table:
---------------------------------------------------------------------
---------------------------------------------------------------------
T. VOLUNTARY CONTRIBUTIONS AND ROLLOVER CONTRIBUTIONS.
1) VOLUNTARY CONTRIBUTIONS are not permitted, unless otherwise specified in
(a) below.
a) [ ] (If selected, the Plan is subject to an ACP Test even if
the Plan satisfies the ACP Test Safe Harbor.) Voluntary
Contributions are permitted. (Select any that apply.)
i) [ ] _____________ % of Pay is the minimum Voluntary
Contribution.
Amend No. 3 Effective April 1, 2003 29 Annuity Contract No. GA 4-42423
ii) [ ] Voluntary Contributions must be a whole percentage of
Pay.
iii) [ ] ___________ % of Pay is the maximum Voluntary
Contribution.
2) ROLLOVER CONTRIBUTIONS are permitted, unless otherwise specified in (a)
below.
a) [ ] Rollover Contributions are not permitted.
U. INVESTMENTS.
1) The Plan does not have a Trust Agreement in effect, unless
otherwise specified in (a) below.
a) |X|TRUST AGREEMENT. The Plan has a Trust Agreement. (Select at
least one. Cannot select (ii) if (i) is selected. Cannot
select (iv) if (iii) is selected.)
i) |X| We establish the Discretionary Trust Agreement
(Attachment A of the Basic Plan).
ii) [ ] We establish the Corporate Directed Trust Agreement
(Attachment B of the Basic Plan).
iii) [ ] We establish the Corporate Custodial Trust Agreement
(Attachment C of the Basic Plan).
iv) [ ] We establish the Passive Trust Agreement (Attachment
D of the Basic Plan).
v) [ ] We establish the Trustar(R) Retirement Services
Directed Trust Agreement (Attachment E of the Basic
Plan).
2) INVESTMENT DIRECTION. Subject to the provisions of Article IV of the
Basic Plan, the Annuity Contract, and if applicable, the Trust
Agreement, the investment of a Member's Account shall be directed by
(Select one.)
a) |X| the Member for all Contributions.
b) [ ] us for all Contributions.
c) [ ] the Member for Elective Deferral Contributions,
Member Contributions, and Rollover Contributions. Us
for Employer Contributions other than Elective Deferral
Contributions.
d) [ ] the Member for Member Contributions and Rollover
Contributions. Us for Employer Contributions including
Elective Deferral Contributions.
Amend No. 3 Effective April 1, 2003 30 Annuity Contract No. GA 4-42423
3) LOANS. Loans to a Member are not permitted, unless otherwise specified
in (a) below.
a) |X| (Only available if (1)(a) above is selected and the Trustee
agrees to hold the promissory note.) Loans are available to a
Member subject to the provisions of Plan Section 5.06.
i) The Loan Administrator(s) is/are: (Fill in the person(s)
or position(s) authorized to administer the Member loan
program. Principal Life Insurance Company cannot be
named.)
▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ OR ▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇
-------------------------------------
---------------------------------------------------------
ii) [ ] The minimum amount of any loan is $ 1,000 . (
Up to $1,000.)
iii) [ ] The maximum amount of any loan is the lesser of 50% of
the Member's Vested Account, reduced by any outstanding
loan balance or
$ ____________ (Up to $50,000.), reduced by the highest
outstanding loan balance during the one-year period ending
on the day before the loan is made.
NOTE: If not selected, the maximum is the lesser of (i)
50% of the Member's Vested Account, reduced by any
outstanding loan balance or (ii) $50,000, reduced by the
highest outstanding loan balance during the one-year
period ending on the day before the loan is made.
iv) The number of outstanding loans for a Member shall be
limited to one, unless otherwise specified in A below.
A. |X| The number shall be limited to _2________. (Up to
5.)
v) The number of loans approved for a Member in any 12-month
period shall be limited to one, unless otherwise
specified in A below.
A. |X| The number shall be limited to ___ 2____. (Up to
5.)
vi) The term of the loan shall be limited to five years, unless
otherwise specified in A below.
A. [ ] The term of the loan shall not be limited to
five years for the purchase of a Member's principal
residence.
Amend No. 3 Effective April 1, 2003 31 Annuity Contract No. GA 4-42423
4) LIFE INSURANCE coverage is not provided under this Plan, unless otherwise
specified in (a) below.
a) [ ] (Only available if (1)(a)(i), (ii), or (iv) above
is selected.) Subject to the limits and provisions of
Plan Section 4.02, an Active Member may elect to have
part of his Account applied to purchase life insurance
coverage on his life.
5) QUALIFYING EMPLOYER SECURITIES. Investment in Qualifying Employer
Securities is not available, unless otherwise specified in (a) below.
a) [ ] (Only available if (1)(a)(i), (ii), (Hi), or (v) above is
selected.) Investment in Qualifying Employer Securities is
allowed.
i) The Member's Account resulting from the following
Contributions may be invested in Qualifying Employer
Securities: (Select at least one.)
A. [ ] Elective Deferral Contributions
B. [ ] Employer Contributions other than Elective
Deferral Contributions
C. [ ] Member Contributions and Rollover Contributions
ii) Voting rights for Qualifying Employer Securities will be
passed through to Members and the Members will be allowed
to direct the voting rights of Qualifying Employer
Securities for any other matter put to the vote of the
shareholders, unless otherwise specified in A, B, or C
below.
A. [ ] The Members will be allowed to direct the voting
rights for Significant Corporate Events only. The
Employer (or the Named Fiduciary or the Investment
Manager as designated by the Employer) will have the
voting rights for all other matters, unless
otherwise specified in (1) below.
1) [ ] (Only available if (1)(a)(i) or (ii)
above is selected.) The Trustee will have the
voting rights for all other matters.
B. [ ] The Employer (or the Named Fiduciary or the
Investment Manager as designated by the Employer)
will have the voting rights for any matter put to
the vote of the shareholders.
C. [ ] (Only available if (1)(a)(i) or (ii) above is
selected.) The Trustee will have the voting rights
for any matter put to the vote of the shareholders.
Amend No. 3 Effective April 1, 2003 32 Annuity Contract No. GA 4-42423
iii) Tender rights or exchange offers for Qualifying Employer
Securities will be passed through to the Members, unless
otherwise specified in A or B below.
A. [ ] Tender rights or exchange offers for Qualifying
Employer Securities will be determined by the
Employer (or the Named Fiduciary or the
Investment Manager as designated by the Employer).
B. [ ] (Only available if (1)(a)(i) or (ii) above is
selected.) Tender rights or exchange offers for
Qualifying Employer Securities will be determined
by the Trustee.
iv) The optional forms of distribution provided in Plan
Section 6.01 or 6A.01, whichever applies, shall include
both a single sum payment and a distribution in kind for
that portion of a Member's Vested Account which is held
in the Qualifying Employer Securities Fund, unless
otherwise specified in A or B below.
A. [ ] No distribution in kind is permitted.
B. [ ] No single sum payment is permitted.
V. VESTING PERCENTAGE is used to determine the nonforfeitable percentage of a
Member's Account resulting from our Contributions.
The Vesting Percentage for a Member who is an Employee on or after the
date he reaches Normal Retirement Age or Early Retirement Age shall be
100%. The Vesting Percentage for a Member who is an Employee on the date
he becomes Totally Disabled or dies shall be 100%.
1) FULLY VESTED CONTRIBUTIONS. Elective Deferral Contributions, Qualified
Matching Contributions, and Qualified Nonelective Contributions are
100% vested. The following Employer Contribution(s) are also 100%
vested at all times. (Select any that apply.)
a) [ ] Matching Contributions
b) [ ] Additional Contributions
c) [ ] Discretionary Contributions
Amend No. 3 Effective April 1, 2003 33 Annuity Contract No. GA 4-42423
2) A Member's Account resulting from our Contributions which are not 100%
vested when made is subject to the vesting schedule selected below.
(Select (a), (b), (c), (d), or (e) if some Employer Contributions are
not 100% vested. If (e) is selected, fill in percentages.)
VESTING SERVICE VESTING PERCENTAGE
(a) (b) (c) (d) (e)
[ ] [ ] [ ] [ ] [ ]
Less than 1 0 0 0 0
----------
1 0 0 0 0
----------
2 0 20 0 0
----------
3 100 40 0 20
----------
4 60 0 40
----------
5 80 100 60
----------
6 100 80
----------
7 100
----------
NOTE: The schedule in (e) must provide full (100%) vesting after 5 years of
Vesting Service or must at all times be as great as the Vesting Percentage which
the schedule in (d) would provide.
A Member's Vesting Percentage determined above shall never be reduced
in later years. If this Plan is or ever has been a Top-heavy Plan, the
minimum vesting provisions of Plan Section 11.03 shall apply.
3) TOP-HEAVY VESTING. A Member's Account resulting from additional
Employer Contributions made to satisfy the minimum contribution
requirements of Plan Section 11.04 shall be subject to the vesting
schedule selected below. (Select (a), (b), or (c) if the Plan is not
a 401 (k) SIMPLE Plan and does not allow any Employer Contributions
other than Elective Deferral Contributions, Qualified Matching
Contributions, and Qualified Nonelective Contributions.)
VESTING SERVICE VESTING PERCENTAGE
(a) (b) (c)
[ ] [ ] [ ]
Less than 1 0 0 100
1 0 0
2 20 0
3 40 100
4 60
5 80
6 100
Amend No. 3 Effective April 1, 2003 34 Annuity Contract No. GA 4-42423
W. VESTING SERVICE, subject to the provisions of Plan Section
1.02, shall be determined as follows: (Select (1) or (2) if
some Employer Contributions are not 100% vested, if Item
V(3)(a) or (b) is completed, or if Early Retirement Age is
based on Vesting Service.)
1) [ ] ELAPSED TIME METHOD. Vesting Service is the total
of an Employee's countable Periods of Service without
regard to Hours of Service.
2) [ ] HOURS METHOD. A year of Vesting Service is a
Vesting Service Period in which an Employee has at
least 1,000 Hours of Service, unless otherwise
specified in (a) below.
a) [ ] (Up to 999.) Hours of Service.
b) A VESTING SERVICE PERIOD is the consecutive 12-month
period ending on the last day of each Plan Year, unless
otherwise specified in (i) or (ii) below. i) [ ] The
consecutive 12-month period ending on each
______________________________________________________.
(Month and day.)
ii) [ ] (Vesting Service Period changes.) The consecutive
12-month period ending on
A. each _____________________________________ through
B. _______________________________________________ and
C. each following ____________________________________.
(Complete A using month and day, B using the same month
and day as in A and the calendar year in which the last
day of the last period ending on this date falls, and C
using the month and day on which the new period ends.)
c) A VESTING BREAK, when the hours method is used, is a Vesting
Service Period in which an Employee is credited with not more
than one-half of the Hours of Service required for a year of
Vesting Service, unless otherwise specified in (i) below.
i) [ ] ________ or fewer Hours of Service. (Fill in up to
500 hours but less than hours required for a year of
Vesting Service.)
NOTE: If the hours method is used, any date completed in (3), (4), or (5)
below should be the first day of a Vesting Service Period. If the first
day of such period is not used, service during the period in which the
date occurs shall not be excluded because of these modifications. If both
(3) and (5) are selected, the date in (5) must be before the date in (3).
(3) and (5) cannot be used with (4). If the hours method is used and (6)
is selected, service during the period in which the Employee attains the
age completed in (6) shall not be excluded because of that modification.
Amend No. 3 Effective April 1, 2003 35 Annuity Contract No. GA 4-42423
VESTING MODIFICATIONS:
3) [ ] Service before __________________________________________________
is the total of an Employee's countable service with us, expressed in
whole years and fractional parts of a year (counting a partial month
as a complete month).
NOTE: If selected, fill in a date on or before the date the Plan
became subject to ERISA, A new plan becomes subject to ERISA on its
Effective Date.
4) [ ] Service before
___________________________________________________ shall be
determined under the provisions of the (Prior) Plan in effect on the
day before that date.
NOTE: If selected, fill in a date after the Effective Date.
5) [ ] Service before __________________________________________________
shall not be counted.
NOTE: If selected, fill in a date on or before the date the Plan
became subject to ERISA. A new plan becomes subject to ERISA on its
Effective Date.
6) [ ] Service before an Employee attains age _______________ (Up to 18.)
shall not be counted.
X. EQUIVALENCIES. Hours of Service shall be determined on the basis of actual
Hours of Service for which an Employee is paid or entitled to payment,
unless otherwise specified in (1), (2), or (3) below.
1) [ ] DAYS. On the basis of days worked. An Employee shall be credited
with 10 Hours of Service for each day in which he would otherwise be
credited with at least one Hour of Service.
2) [ ] WEEKS. On the basis of weeks worked. An Employee shall be credited
with 45 Hours of Service for each week in which he would otherwise be
credited with at least one Hour of Service.
3) [ ] MONTHS. On the basis of months worked. An Employee shall be
credited with 190 Hours of Service for each month in which he would
otherwise be credited with at least one Hour of Service.
NOTE: If selected, the equivalency shall be used for all Employees.
Amend No. 3 Effective April 1, 2003 36 Annuity Contract No. GA 4-42423
Y. WITHDRAWAL BENEFITS.
1) VOLUNTARY. A Member may withdraw any part of his Vested Account
resulting from Voluntary Contributions.
A Member may make only two such withdrawals in any 12-month
period, unless otherwise specified in (a) or (b) below.
a) [ ] A Member may make such a withdrawal at any time.
b) [ ] A Member may make only _________________________ such
withdrawal(s) in any 12-month period.
2) ROLLOVER. A Member may withdraw any part of his Vested Account
resulting from Rollover Contributions.
A Member may make only two such withdrawals in any 12-month
period, unless otherwise specified in (a) or (b) below.
a) [ ] A Member may make such a withdrawal at any time.
b) [ ] A Member may make only _________________________ such
withdrawal(s) in any 12-month period.
3) [xl 401 (k) HARDSHIP. Unless otherwise specified in (a) below, a
Member may withdraw any part of his Vested Account resulting from
Elective Deferral Contributions, Matching Contributions (other than
Qualified Matching Contributions), Additional Contributions, and
Discretionary Contributions in the event of undue financial hardship.
Withdrawals from the Member's Account resulting from Elective Deferral
Contributions shall be limited to the amount of the Member's Elective
Deferral Contributions (and earnings thereon accrued as of December
31, 1988). The withdrawal is subject to the provisions of Plan Section
5.05.
a) [ ] Such withdrawal shall be limited to the amount of the
Member's Elective Deferral Contributions (and earnings thereon
accrued as of December 31, 1988).
4) |X| AGE 59 1/2. A Member may withdraw any part of his Vested Account
resulting from Elective Deferral Contributions, Matching
Contributions, Qualified Nonelective Contributions, Additional
Contributions, and Discretionary Contributions any time after he
attains age 59 1/2.
A Member may make only two such withdrawals in any 12-month period,
unless otherwise specified in (a) or (b) below.
a) |X| A Member may make such a withdrawal at any time.
b) [ ] A Member may make only __________________________ such
withdrawal(s) in any 12-month period.
Amend No. 3 Effective April 1, 2003 37 Annuity Contract No. GA 4-42423
5) [ ] FIVE YEARS AS AN ACTIVE MEMBER. A Member may withdraw any part of
his Vested Account resulting from Matching Contributions (other than
Qualified Matching Contributions), Additional Contributions, and
Discretionary Contributions at any time after he has been an Active
Member for at least five years.
NOTE: A Member's earliest Entry Date shall be used to determine his
eligibility for such a withdrawal.
A Member may make only two such withdrawals in any 12-month period,
unless otherwise specified in (a) or (b) below.
a) [ ] A Member may make such a withdrawal at any time.
b) [ ] A Member may make only _________________________ such
withdrawal(s) in any 12-month period.
NOTE: Withdrawals are subject to the distribution of benefits provisions of
Article VI or VIA of the Basic Plan, whichever applies.
Z. RETIREMENT AND THE START OF BENEFITS.
1) NORMAL RETIREMENT AGE is the age at which the Member's Account shall
become nonforfeitable if he is an Employee. A Member's Normal
Retirement Age is age 65, unless otherwise specified in (a) or (b)
below.
a) [ ] Age _____________________. (Less than 65.)
b) [ ] The older of age _____________________(Up to 65.) or his age
on the (Select (i) or(ii).)
i) [ ] date __________ (Up to 5.) years after the first day
of the Plan Year in which his earliest Entry Date
occurred.
ii) [ ] earlier of the date _______ (Up to 5.) years after
his Hire Date or the date 5 years after the first day
of the Plan Year in which his earliest Entry Date
occurred.
The provisions of (b) are modified as follows:
c) [ ] A Member's Normal Retirement Age shall not be older than age
_______________________________. (Up to 70.)
2) START OF RETIREMENT BENEFITS. A Member may choose to have retirement
benefits begin on or after his Normal Retirement Date and before he
ceases to be an Employee, unless otherwise specified in (a) below.
a) [ ] A Member may not choose to have retirement benefits begin
before he ceases to be an Employee.
Amend No. 3 Effective April 1, 2003 38 Annuity Contract No. GA 4-42423
3) EARLY RETIREMENT DATE. (Select (a) or (b).)
a) |X| Early Retirement Date is the first day of the month before a
Member's Normal Retirement Date which he selects for the start
of retirement benefits. This day shall be on or after the date
the Member ceases to be an Employee and reaches Early Retirement
Age. A Member reaches Early Retirement Age on the date the
following requirement(s) are met: (Select at least one. A
Member's Account is 100% vested if he is an Employee on or after
he reaches this age.)
i) |X| He is age 55_____.
ii) [ ] He has _________years of Vesting Service.
iii) [ ] He is within _______years of Normal Retirement Date.
iv) [ ] He has been an Active Member _____________years based on
his earliest Entry Date.
b) [ ] Early retirement is not permitted.
4) VESTED BENEFIT MODIFICATIONS. Plan Section 5.03 permits an Inactive
Member to elect to start benefits after he ceases to be an Employee.
The start of benefits is modified as follows: (Select (a) or (b), if
applicable.)
a) [ ] An Inactive Member cannot elect to receive benefit payments
from that part of his Vested Account resulting from Elective
Deferral Contributions, Matching Contributions, Qualified
Nonelective Contributions, Additional Contributions, and
Discretionary Contributions before he becomes Totally Disabled
(Retirement Date or death, if earlier). A small Vested Account,
as defined in Plan Section 10.11, shall be paid earlier in
a single sum. (Select (i), if applicable.)
i) [ ] Such restriction shall not apply to that part of an
Inactive Member's Vested Account resulting from Elective
Deferral Contributions.
b) [ ] An Inactive Member cannot elect to receive benefit payments
from that part of his Vested Account resulting from Elective
Deferral Contributions, Matching Contributions, Qualified
Nonelective Contributions, Additional Contributions, and
Discretionary Contributions before he has ceased to be an
Employee for a period of time (Retirement Date or death, if
earlier). Payment of a small Vested Account, as defined in Plan
Section 10.11, shall also be delayed. (Select (i), if
applicable.)
i) [ ] Such restriction shall not apply to that part of an
Inactive Member's Vested Account resulting from Elective
Deferral Contributions.
The period of time is (Select (ii) or (Hi).)
ii) [ ] ______months. (Up to 60.)
iii) [ ] _____years. (Up to 5.)
Amend No. 3 Effective April 1, 2003 39 Annuity Contract No. GA 4-42423
5) The REQUIRED BEGINNING DATE for a Member who is a 5-percent Owner, as
defined in Plan Section 7.02, is the April 1 of the calendar year
following the calendar year in which he attains age 70 1/2.
The Required Beginning Date for any Member who is not a 5-percent
Owner, as defined in Plan Section 7.02, is the April 1 of the calendar
year following the later of the calendar year in which he attains age
70 1/2 or the calendar year in which he retires, unless otherwise
specified in (a) below.
a) [ ] LATER OF AGE 70 1/2 OR RETIRE FOR BENEFITS ACCRUED AFTER DATE. The
Required Beginning Date is the April 1 of the calendar year following
the calendar year in which he attains age 70 1/2, except that the
Required Beginning Date for benefits accrued after the later of the
adoption or effective date of the amendment to the Plan changing the
Required Beginning Date is the April 1 of the calendar year following
the later of the calendar year in which he attains age 70 1/2 or the
calendar year in which he retires.
If (5)(a) is not selected and the Plan previously provided for a
Required Beginning Date based on age 70 1/2 for all Members, the
following shall apply to any Member who is not a 5-percent Owner, as
defined in Plan Section 7.02.
b) Any such Member attaining age 70 1/2 in years after 1995 may
elect by April 1 of the calendar year following the calendar
year in which he attained age
70 1/2 (or by December 31, 1997 in the case of a Member
attaining age 70 1/2 in 1996) to defer distributions until the
calendar year following the calendar year in which he retires,
unless otherwise specified in (i) below.
i) [ ] NO DEFERRAL. (Only available if (5)(a) above is not
selected.) The Member shall begin receiving distributions
by the April 1 of the calendar year following the year in
which he attained age 70 1/2 (or by December 31, 1997 in
the case of a Member attaining age 70 1/2 in 1996).
c) Any such Member attaining age 70 1/2 in years prior to 1997 may
elect to stop distributions which are not purchased annuities
and recommence by the April 1 of the calendar year following
the year in which he retires, unless otherwise specified in (i)
below.
i) [ ] NO STOPPING. (Only available if (5)(a) above is not
selected.) The Member may not elect to stop distributions.
If the Member is permitted to stop distributions, there shall
be a new Annuity Starting Date upon recommencement, unless
otherwise specified in (ii) below.
ii) [ ] NO NEW ANNUITY STARTING DATE. (Only available if (5)(a)
and (5)(c)(i) above are not selected.) There shall be no new
Annuity Starting Date.
Amend No. 3 Effective April 1, 2003 40 Annuity Contract No. GA 4-42423
6) AUTOMATIC ROLLOVER OF SMALL AMOUNTS PAYMENT. If any part of a
distribution made under Plan Section 10.11 is an Eligible Rollover
Distribution which is equal to or more than $1,000 and for which
the Distributee has not elected otherwise, such Eligible Rollover
Distribution shall be rolled over to an Individual Retirement
Account (IRA) with an affiliate of Principal Life Insurance
Company, unless otherwise specified in (a) below. (See Plan Section
10.02.)
a) [ ] Such Eligible Rollover Distribution shall be paid to the
Distributee.
AA. FORMS OF DISTRIBUTION FOR RETIREMENT BENEFITS.
1) OPTIONS. The options available under the Plan shall be those
specified in Plan Section 6.02 (includes life annuities) unless
otherwise specified in (a) below.
NOTE: If this Plan is a direct or indirect transferee after
December 31, 1984, of a defined benefit plan, money purchase plan,
target benefit plan, stock bonus plan, or profit sharing plan which
is subject to the survivor annuity requirements of Code Sections
401(a)(11) and 417, (a) below cannot be selected.
a) [ ] The options available under the Plan shall be those
specified in subparagraph (a)(2) of Plan Section 6A.02 (does
not include life annuities or full flexibility option),
unless otherwise specified in (i) below.
i) [ ] The only options available under the Plan shall be
the options specified in subparagraph (a)(1) of Plan
Section 6A.02 (single sum payment and distribution in
kind).
NOTE: If the Plan later becomes a direct or indirect transferee of
a defined benefit plan, money purchase plan, target benefit plan,
stock bonus plan, or profit sharing plan which is subject to the
survivor annuity requirements of Code Sections 401(a)(11) and 417,
then the options available under the Plan shall be those specified
in Plan Section 6.02 and the selections in (1) above shall be void.
2) The options specified in Plan Section 6.02 (includes life
annuities) may be modified as provided below. (Select any that
apply.)
a) [ ] NO FULL FLEXIBILITY OPTION. (Only available if (1)(a)
above is not selected.) The full flexibility option shall
not be available.
b) [ ] SINGLE SUM LIMITED. (Only available if (1)(a) above is
not selected; Item U(1)(a)(v) is not selected; Item U(5)(a)
is not selected; and Items Y(3), (4), and (5) are not
selected.) A Member may not receive a single sum payment of
that part of his Vested Account resulting from Elective
Deferral Contributions, Matching Contributions, Qualified
Nonelective Contributions, Additional Contributions, and
Discretionary Contributions (Select (i) or (ii).)
i) [ ] at any time.
Amend No. 3 Effective April 1, 2003 41 Annuity Contract No. GA 4-42423
ii) [ ] before his Retirement Date or the date he becomes
Totally Disabled, if earlier.
If (2)(a) is not selected, the full flexibility option shall
not be available for that part of a Member's Vested Account
which he cannot receive in a single sum.
NOTE: A small Vested Account, as defined in Plan Section
10.11, shall be paid in a single sum.
3) If the Plan is being amended to eliminate or restrict an optional
form of distribution and the Plan provides a single sum distribution
form that is otherwise identical to the optional form of
distribution eliminated or restricted, the amendment shall not apply
to any distribution with an Annuity Starting Date earlier than the
first day of the second Plan Year following the Plan Year in which
the amendment is, adopted, unless otherwise specified in (a) below.
a) [ ] 90 DAYS AFTER SUMMARY. The amendment shall not apply to
any distribution with an Annuity Starting Date earlier than
the earlier of (i) the 90th day after the date the Member
receiving the distribution has been furnished a summary that
reflects the amendment and satisfies the ERISA requirements at
29 CFR 2520.104b-3 relating to a summary of material
modifications or (ii) the first day of the second Plan Year
following the Plan Year in which the amendment is adopted.
AB. ADOPTING EMPLOYERS. (Identify Adopting Employers below.)
NOTE: The Plan must meet the minimum coverage requirement of Code Section
410(b) taking into account all employees of Controlled Groups and
Affiliated Service Groups. If you are a member of such a group, other
employers in the group may need to adopt this Plan in order for your Plan
to meet this requirement. Some employers of the group may also choose to
adopt this Plan even though not required. Use this item to identify the
other employers in the group whose employees may become Members.
1) There are no Adopting Employers, unless otherwise specified in (a)
below.
a) [ ] The Adopting Employers listed in (3) below establish a
separate plan for the benefit of their Employees or
participate with us in a single plan, as specified.
2) Separate Plans or Single Plan.
a) SEPARATE PLANS. Adopting Employers may establish a separate
plan for the exclusive benefit of their Employees. The
establishment of an Adopting Employer's separate plan shall
be evidenced in writing according to the provisions of Plan
Section 2.04.
Amend No. 3 Effective April 1, 2003 42 Annuity Contract No. GA 4-42423
NOTE: A separate plan should not be established unless (i) each
plan can meet the minimum coverage requirement of Code Section
410(b) separately or (ii) the combined plans can meet the
minimum coverage requirement of Code Section 410(b) and the
nondiscrimination requirement of Code Section 401 (a) (4). The
combined plans may not meet the requirement of Code Section
401(a)(4) if the plans provide fora discretionary Matching
Contribution or Discretionary Contribution which is determined
separately for each Adopting Employer.
b) SINGLE PLAN. Adopting Employers may participate with us in a
single plan. An Adopting Employer's agreement to participate in
this Plan shall be evidenced in writing according to the
provisions of Plan Section 2.05.
NOTE: The provisions of Plan Section 10.03 shall apply in the
case of the merger of this Plan with any Prior Plan of an
Adopting Employer participating with us in a single plan.
Amend No. 3 Effective April 1, 2003 43 Annuity Contract No. GA 4-42423
Amend No. 3 Effective April 1, 2003 44 Annuity Contract No. GA 4-42423
By executing this Adoption Agreement, we, the Employer, adopt the "Principal
Financial Group Prototype for Savings Plans" for the exclusive benefit of our
Employees. Our selections and specifications contained in this Adoption
Agreement and the terms, provisions, and conditions provided in the Principal
Financial Group Prototype Basic Savings Plan constitute our PLAN. No other basic
plan may be used with this Adoption Agreement.
It is understood that Principal Life Insurance Company is not a party to our
Plan and shall not be responsible for any tax or legal aspects of our Plan. We
assume responsibility for these matters. We acknowledge that we have counseled,
to the extent necessary, with selected legal and tax advisors. The obligations
of Principal Life Insurance Company shall be governed solely by the provisions
of its contracts and policies. Principal Life Insurance Company shall not be
required to look into any action taken by the Plan Administrator, Named
Fiduciary, Trustee, Investment Manager, or us and shall be fully protected in
taking, permitting, or omitting any action on the basis of our actions.
Principal Life Insurance Company shall incur no liability or responsibility for
carrying out actions as directed by the Plan Administrator, Named Fiduciary,
Trustee, Investment Manager, or us.
(Complete in black ink.)
This Adoption Agreement is executed ______________________________________.
FOR THE EMPLOYER
By my signature, I certify that I have reviewed the terms of and the Items
selected within this Adoption Agreement. If the Plan has a Trust Agreement in
effect, I hereby certify that a copy of this Plan document shall be provided to
each Trustee and proper signatures will be obtained on the appropriate
attachment to the Basic Plan.
[ ] (Only available if Item U(1)(a)(i) is selected.) By my signature, I hereby
direct the Trustee under the Discretionary Trust Agreement to enter into the
Principal Financial Group Electronic Linkage5" Group Custodial Agreement.
[ ] (Only available if Item U(1)(a)(v) is selected.) By my signature, I hereby
direct Delaware Charter Guarantee & Trust Company, conducting business under
the trade name of Trustar(R) Retirement Services, to enter into the Principal
Financial Group Electronic LinkageSM Group Custodial Agreement.
[ ] (Only available if Item U(1)(a)(v) is selected.) By my signature, I hereby
direct Delaware Charter Guarantee & Trust Company, conducting business under
the trade name of Trustar(R) Retirement Services, to enter into the Principal
Self-directed Brokerage ▇▇▇▇▇▇▇.▇▇
By _________________________________________________________________________
(Signature)
Business Title _____________________________________________________________
I I By my signature above, I hereby execute this Adoption Agreement on behalf
of each Adopting Employer identified in Item AB.
ACKNOWLEDGMENT BY THE NAMED FIDUCIARY (Complete if other than the Employer.)
By ___________________________________________________________________________
(Signature)
Amend No. 3 Effective April 1, 2003 45 Annuity Contract No. GA 4-42423
This Plan is an important legal document. It may not fit your
situation. You will want to consult with your lawyer on whether it does fit your
situation and on its tax and legal implications, for which neither Principal
Life Insurance Company, nor its agents, can assume responsibility.
Failure to properly fill out this Adoption Agreement may result in
disqualification of this Plan. Principal Life Insurance Company will inform you
of any amendments made to the Plan or of the abandonment of the Plan. The
address of Principal Life Insurance Company is ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇ ▇▇▇▇▇▇,
▇▇▇▇ ▇▇▇▇▇-▇▇▇▇. When you first adopt the prototype, Principal Life will assign
a contact person and give you a toll-free number. If you have not been assigned
a contact person, call ▇-▇▇▇-▇▇▇-▇▇▇▇, extension 88126, for assistance.
You may rely on an opinion letter issued by the Internal Revenue Service as
evidence that this Plan is qualified under Code Section 401 only to the extent
provided in Announcement 2001-77, 2001-30 I.R.B.
You may not rely on the opinion letter in certain other circumstances or with
respect to certain qualification requirements, which are specified in the
opinion letter issued with respect to the Plan and in Announcement 2001-77.
In order to have reliance in such circumstances or with respect to such
qualification requirements, application for a determination letter must be made
to Employee Plans Determinations of the Internal Revenue Service.
Amend No. 3 Effective April 1, 2003 46 Annuity Contract No. GA 4-42423
Item S(3)(a): The method used to limit Annual Additions to the Maximum
Permissible Amount:
Item S(4): For Limitation Years beginning before January 1, 2000, the method
used to satisfy the 1.0 limitation of Code Section 415:
Item S(6): The method used to meet the minimum contribution and benefit
requirements in Plan Years when this is a Top-heavy Plan:
Amend No. 3 Effective April 1, 2003 Annuity Contract No. GA 4-42423