Exhibit 10.2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TAILORED BRANDS 401(K) SAVINGS PLAN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



 

Nonstandardized 401(k) Plan

 

ADOPTION AGREEMENT #005

NONSTANDARDIZED 401(k) PLAN

 

The undersigned Employer, by executing this Adoption Agreement, establishes a retirement plan and trust (collectively “Plan”) under the Great-West Trust Company Defined Contribution Prototype Plan and Trust (basic plan document #11). The Employer, subject to the Employer’s Adoption Agreement elections, adopts fully the Prototype Plan and Trust provisions. This Adoption Agreement, the basic plan document and any attached Appendices or agreements permitted or referenced therein, constitute the Employer’s entire plan and trust document. All “Election” references within this Adoption Agreement are Adoption Agreement Elections. All “Article” or “Section” references are basic plan document references. Numbers in parentheses which follow election numbers are basic plan document references. Where an Adoption Agreement election calls for the Employer to supply text, the Employer (without altering the content of any existing printed text) may lengthen any space or line, or create additional tiers. When Employer-supplied text uses terms substantially similar to existing printed options, all clarifications and caveats applicable to the printed options apply to the Employer-supplied text unless the context requires otherwise. The Employer makes the following elections granted under the corresponding provisions of the basic plan document.

 

ARTICLE I

DEFINITIONS

 

1.

EMPLOYER (1.24).

 

 

 

Name:

 Tailored Shared Services, LLC

 

 

 

Address:

 6380 Rogerdale Road, Houston, Texas 77072

 

 

 

Phone number:

 (281) 776-7000

 

 

 

 

Taxpayer Identification Number (TIN):

 47-4894752

 

 

 

 

E-mail (optional):

 

 

 

 

 

Employer’s Taxable Year (optional):

 the Saturday closest to January 31

 

 

 

2.

PLAN (1.42).

 

 

 

Name:

Tailored Brands 401(k) Savings Plan

 

 

 

Plan number:

 001

(3-digit number for Form 5500 reporting)

 

 

 

Trust EIN (optional):

 

 

 

3.     PLAN/LIMITATION YEAR (1.44/1.34). Plan Year and Limitation Year mean the 12 consecutive month period (except for a short Plan/Limitation Year) ending every:

 

[Note: Complete any applicable blanks under Election 3 with a specific date, e.g., June 30 OR the last day of February OR the first Tuesday in January. In the case of a Short Plan Year or a Short Limitation Year, include the year, e.g., May 1, 2014.]

 

Plan Year (Choose one of (a) or (b). Choose (c) if applicable.):

 

(a)

[X]

December 31.

 

 

 

 

 

 

(b)

[   ]

Fiscal Plan Year: ending:

                                  .

 

 

 

 

 

 

(c)

[   ]

Short Plan Year: commencing:

                                   and ending:                                   .

 

 

Limitation Year (Choose one of (d) or (e). Choose (f) if applicable.):

 

(d)

[X]

Generally same as Plan Year. The Limitation Year is the same as the Plan Year except where the Plan Year is a short year in which event the Limitation Year is always a 12 month period, unless the short Plan Year (and short Limitation Year) result from a Plan amendment.

 

 

 

 

 

 

(e)

[   ]

Different Limitation Year: ending:

                                  .

 

 

 

 

 

 

(f)

[   ]

Short Limitation Year: commencing:

                                   and ending:                                   .

 

 

4.     EFFECTIVE DATE (1.20). The Employer’s adoption of the Plan is a (Choose one of (a) or (b). Complete (c) if new plan OR complete (c) and (d) if an amendment and restatement. Choose (e) and (f) if applicable.):

 

(a)

[   ]

New Plan.

 

 

 

 

 

 

 

(b)

[X]

Restated Plan.

 

 

 

 

 

 

 

 

PPA RESTATEMENT (leave blank if not applicable)

 

 

 

 

(1)

[   ]

This is an amendment and restatement to bring a plan into compliance with the Pension Protection Act of 2006 (“PPA”) and other legislative and regulatory changes.

 

 

 

© 2014 Great-West Trust Company, LLC or its suppliers

194530-01 (effective December 1, 2016)

1



 

Nonstandardized 401(k) Plan

 

Initial Effective Date of Plan (enter date)

 

(c)

[X]

  February 1, 1978   (hereinafter called the “Effective Date” unless 4(d) is entered below)

 

 

 

 

 

Restatement Effective Date (If this is an amendment and restatement, enter effective date of the restatement.)

 

 

 

 

 

(d)

[X]

  December 1, 2016   (enter month day, year; may enter a restatement date that is the first day of the current Plan Year. The Plan contains appropriate retroactive effective dates with respect to provisions for the appropriate laws if the Plan is a PPA Restatement.) (hereinafter called the “Effective Date”)

 

[Note: See Section 1.54 for the definition of Restated Plan. If this Plan is a PPA Restatement, the PPA restatement Effective Date may be a current date (as the basic plan document supplies the Effective Dates of various PPA and other provisions) or may be a retroactive date. If specific Plan provisions, as reflected in this Adoption Agreement and the basic plan documents, do not have the Effective Date stated in this Election 4, indicate as such in the election where called for or in Appendix A.]

 

(e)

[   ]

Restatement of surviving and merging plans. The Plan restates two (or more) plans (Complete 4(c) and (d) above for this (surviving) Plan. Complete (1) below for the merging plan. Choose (2) if applicable. Unless otherwise noted, the restated Effective Date with regard to a merging plan is the later of the date of the merger or the restated Effective Date of this Plan.):

 

 

 

 

 

 

(1)

Merging plan. The                                                                                  Plan was or will be merged into this surviving Plan as of:                                         . The merging plan’s restated Effective Date is:                                         . The merging plan’s original Effective Date was:                                         .

 

[See the Note under Election 4(d) if this document is the merging plan’s PPA restatement.]

 

 

(2)

[   ]

Additional merging plans. The following additional plans were or will be merged into this surviving Plan (Complete a. and b. as applicable.):

 

 

 

 

 

 

 

 

 

 

Name of merging plan

 

Merger date

 

Restated
Effective Date

 

Original
Effective Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b.

 

 

 

 

 

 

 

 

 

(f)

[   ]

Special Effective Date for Elective Deferral provisions:

 

 

[Note: If Elective Deferral provision is not effective as of the Initial Effective Date or the Restatement Effective Date, enter the date as of which the Elective Deferral provision is effective. The Special Effective Date may not precede the date on which the Employer adopted the Plan.]

 

5.     TRUSTEE (1.67). The Trustee executing this Adoption Agreement is (Choose one or more of (a), (b), or (c). Choose (d) or (e) if applicable.):

 

(a)

[   ]

A discretionary Trustee. See Section 8.02(A).

 

 

 

(b)

[X]

A nondiscretionary (directed) Trustee or Custodian. See Section 8.02(B).

 

 

 

(c)

[   ]

A Trustee under the:                                          (specify name of trust), a separate trust agreement the Trustee has executed and that the IRS has approved for use with this Plan. Under this Election 5(c) the Trustee is not executing the Adoption Agreement and Article VIII of the basic plan document does not apply, except as indicated otherwise in the separate trust agreement. See Section 8.11(C).

 

 

 

(d)

[X]

Permitted Trust amendments apply. Under Section 8.11(B) the Employer has made certain permitted amendments to the Trust. Such amendments do not constitute a separate trust under Election 5(c). See Election 59 in Appendix C.

 

 

 

(e)

[   ]

Use of non-approved trust. A Trustee under the:                                          (specify name of trust), a separate trust agreement the Trustee has executed for use with this Plan. Under this Election 5(e) the Trustee is not executing the Adoption Agreement and Article VIII of the basic plan document does not apply, except as indicated otherwise in the separate trust agreement. See Section 8.11(C). [Caution: Election 5(e) will result in the Plan losing reliance on its Opinion Letter and the Plan will be an individually designed plan.]

 

6.     CONTRIBUTION TYPES (1.12). The selections made below should correspond with the selections made under Article III of this Adoption Agreement. (If this is a frozen Plan (i.e., all contributions have ceased), choose (a) only.):

 

Frozen Plan. See Sections 3.01(J) and 11.04.

 

(a)

[   ]

Contributions cease. All Contributions have ceased or will cease (Plan is frozen).

 

 

 

 

(1)

[   ]

Effective date of freeze:                                          [Note: Effective date is optional unless this is the amendment or restatement to freeze the Plan.]

 

[Note: Elections 20 through 30 and Elections 36 through 38 do not apply to any Plan Year in which the Plan is frozen.]

 

 

 

© 2014 Great-West Trust Company, LLC or its suppliers

194530-01 (effective December 1, 2016)

2



 

Nonstandardized 401(k) Plan

 

Contributions. The Employer and/or Participants, in accordance with the Plan terms, make the following Contribution Types to the Plan/Trust (Choose one or more of (b) through (h).):

 

(b)

[X]

Pre-Tax Deferrals. See Section 3.02 and Elections 20-23, and 34.

 

 

 

 

(1)

[X]

Roth Deferrals. See Section 3.02(E) and Elections 20, 21, and 23. [Note: The Employer may not limit Elective Deferrals to Roth Deferrals only.]

 

 

 

 

(c)

[X]

Matching. See Sections 1.35 and 3.03 and Elections 24-26. [Note: The Employer may make an Operational QMAC without electing 6(c). See Section 3.03(C)(2). Do not elect for a safe harbor plan; use 6(e) instead.]

 

 

 

(d)

[X]

Nonelective. See Sections 1.38 and 3.04 and Elections 27-29. [Note: The Employer may make an Operational QNEC without electing 6(d). See Section 3.04(C)(2).]

 

 

 

 

(e)

[   ]

Safe Harbor/Additional Matching. The Plan is (or pursuant to a delayed election, may be) a safe harbor 401(k) Plan. The Employer will make (or under a delayed election, may make) Safe Harbor Contributions as it elects in Election 30. The Employer may or may not make Additional Matching Contributions as it elects in Election 30. See Election 26 as to matching Catch-Up Deferrals. See Section 3.05.

 

 

 

(f)

[   ]

Employee (after-tax). See Section 3.09 and Election 36.

 

 

 

 

(g)

[   ]

SIMPLE 401(k). The Plan is a SIMPLE 401(k) Plan. See Section 3.10. [Note: The Employer electing 6(g) must elect a calendar year under 3(a) and may not elect any other Contribution Types except under Elections 6(b) and 6(h).]

 

 

 

 

(h)

[   ]

Designated IRA. See Section 3.12 and Election 37.

 

7.     DISABILITY (1.16). Disability means (Choose one of (a) or (b).):

 

(a)

[X]

Basic Plan. Disability as defined in Section 1.16(A).

 

 

 

(b)

[   ]

Describe:

 

 

[Note: The Employer may elect an alternative definition of Disability for purposes of Plan distributions. However, the use of an alternative definition may result in loss of favorable tax treatment of the Disability distribution.]

 

8.     EXCLUDED EMPLOYEES (1.22(D)). The following Employees are not Eligible Employees but are Excluded Employees (Choose one of (a), (b), or (c).):

 

[Note: Regardless of the Employer’s elections under Election 8: (i) Employees of any Related Employers (excluding the Signatory Employer) are Excluded Employees unless the Related Employer becomes a Participating Employer; and (ii) Reclassified Employees and Leased Employees are Excluded Employees unless the Employer in Appendix B elects otherwise. See Sections 1.22(B), 1.22(D)(3), and 1.24(D). However, in the case of a Multiple Employer Plan, see Section 12.02(B) as to the Employees of the Lead Employer.]

 

(a)

[   ]

No Excluded Employees. There are no additional excluded Employees under the Plan as to any Contribution Type (skip to Election 9).

 

 

 

(b)

[X]

Exclusions - same for all Contribution Types. The following Employees are Excluded Employees for all Contribution Types (Choose one or more of (e) through (j). Choose column (1) for each exclusion elected at (e) through (i).):

 

 

 

 

(c)

[   ]

Exclusions - different exclusions apply. The following Employees are Excluded Employees for the designated Contribution Type (Choose one or more of (d) through (j). Choose Contribution Type as applicable.):

 

[Note: For this Election 8, unless described otherwise in Election 8(j), Elective Deferrals includes Pre-Tax Deferrals, Roth Deferrals, Employee Contributions and Safe Harbor Contributions. Matching includes all Matching Contributions except Safe Harbor Matching Contributions. Nonelective includes all Nonelective Contributions except Safe Harbor Nonelective Contributions.]

 

 

 

 

(1)

 

(2)

(3)

(4)

 

 

 

All

 

Elective

 

 

Exclusions

Contributions

 

Deferrals

Matching

Nonelective

 

 

 

 

 

 

 

 

(d)

[   ]

No exclusions. No exclusions as to the designated Contribution Type.

N/A
(See Election 8(a))

 

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(e)

[X]

Collective Bargaining (union) Employees.
As described in Code §410(b)(3)(A).

See Section 1.22(D)(1).

[X]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(f)

[X]

Non-Resident Aliens. As described in Code §410(b)(3)(C). See Section 1.22(D)(2).

[X]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(g)

[   ]

HCEs. See Section 1.22(E). See Election 30(f) as to exclusion of some or all HCEs from Safe Harbor Contributions.

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(h)

[   ]

Hourly paid Employees.

[   ]

OR

[   ]

[   ]

[   ]

 

© 2014 Great-West Trust Company, LLC or its suppliers

194530-01 (effective December 1, 2016)

3



 

Nonstandardized 401(k) Plan

 

(i)

[   ]

Part-Time/Temporary/Seasonal Employees.
See Section 1.22(D)(4). A Part-Time, Temporary or Seasonal Employee is an Employee whose regularly scheduled Service is less than            (specify a maximum of 1,000) Hours of Service in the relevant Eligibility Computation Period.

[Note: The “relevant” Eligibility Computation Period is the Initial or Subsequent Eligibility Computation Period as defined in Section 2.02(C).]

[   ]

OR

[   ]

[   ]

[   ]

 

[Note: If the Employer under Election 8(i) elects to treat Part-Time, Temporary and Seasonal Employees as Excluded Employees and any such an Employee actually completes at least 1,000 Hours of Service during the relevant Eligibility Computation Period, the Employee becomes an Eligible Employee. See Section 1.22(D)(4).]

 

(j)

[X]

Describe exclusion category and/or Contribution Type:  As to All Contributions, exclude Employees who are residents of Puerto Rico and any Employee who is expatriated to the United States from another country for so long as he continues to accrue deferred compensation or retirement benefits under any agreement or program to which a Related Employer other than an Employer or Participating Employer is a party.  An Employee who is employed outside the United States is not eligible to participate unless the Plan Administrator elects to permit the Employee to participate in the Plan.                                                                                                                

 

 

(e.g., Exclude Division B Employees OR Exclude salaried Employees from Discretionary Matching Contributions.)

 

[Note: Any exclusion under Election 8(j), except as to Part-Time/Temporary/Seasonal Employees, may not be based on age or Service or level of Compensation. See Election 14 for eligibility conditions based on age or Service. The exclusions entered under Election 8(j) cannot result in the group of Nonhighly Compensated Employees (NHCEs) participating under the plan being only those NHCEs with the lowest amount of compensation and/or the shortest periods of service and who may represent the minimum number of these employees necessary to satisfy coverage under Code §410(b).]

 

9.     COMPENSATION (1.11(B)). The following base Compensation (as adjusted under Elections 10 and 11) applies in allocating Employer Contributions (or the designated Contribution Type) (Choose one or more of (a) through (d) and choose Contribution Type as applicable. Choose (e) if applicable.):

 

[Note: For this Election 9 all definitions include Elective Deferrals unless excluded under Election 11. See Section 1.11(D). Unless described otherwise in Election 9(d), Elective Deferrals includes Pre-Tax Deferrals, Roth Deferrals and Employee Contributions, Matching includes all Matching Contributions and Nonelective includes all Nonelective Contributions. In applying any Plan definition which references Section 1.11 Compensation, where the Employer in this Election 9 elects more than one Compensation definition for allocation purposes, the Plan Administrator will use W-2 Wages for other Plan definitions of Compensation if the Employer has elected W-2 Wages for any Contribution Type or Participant group under Election 9. If the Employer has not elected W-2 Wages, the Plan Administrator for such other Plan definitions will use 415 Compensation. If the Plan is a Multiple Employer Plan, see Section 12.07. Election 9(d) below may cause allocation Compensation to fail to be nondiscriminatory under Treas. Reg. §1.414(s).]

 

 

 

 

(1)

 

(2)

(3)

(4)

 

 

 

All

 

Elective

 

 

 

Contributions

 

Deferrals

Matching

Nonelective

 

 

 

 

 

 

 

 

(a)

[   ]

W-2 Wages (plus Elective Deferrals).
See Section 1.11(B)(1).

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(b)

[X]

Code §3401 Federal Income Tax
Withholding Wages (plus Elective Deferrals).
See Section 1.11(B)(2).

[X]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(c)

[   ]

415 Compensation (simplified).
See Section 1.11(B)(3).
[Note: The Employer may elect an alternative “general 415 Compensation” definition by electing 9(c) and by electing the alternative definition in Appendix B. See Section 1.11(B)(4).]

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(d)

[   ]

Describe Compensation by Contribution Type or by Participant group:

 

 

[Note: Under Election 9(d), the Employer may: (i) elect Compensation from the elections available under Elections 9(a), (b), or (c), or a combination thereof as to a Participant group (e.g., W-2 Wages for Matching Contributions for Division A Employees and 415 Compensation in all other cases); and/or (ii) define the Contribution Type column headings in a manner which differs from the “all-inclusive” description in the Note immediately preceding Election 9(a) (e.g., Compensation for Safe Harbor Matching Contributions means W-2 Wages and for Additional Matching Contributions means 415 Compensation).]

 

(e)

[   ]

Allocate based on specified 12-month period.
The allocation of all Contribution Types (or specified Contribution Types) will be made based

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

© 2014 Great-West Trust Company, LLC or its suppliers

194530-01 (effective December 1, 2016)

4



 

Nonstandardized 401(k) Plan

 

 

 

on Compensation within a specified 12-month period ending within the Plan Year as follows:

 

 

 

 

 

 

 

 

.

 

 

 

 

 

10.   PRE-ENTRY/POST-SEVERANCE COMPENSATION (1.11(H)/(I)). Compensation under Election 9:

 

[Note: For this Election 10, unless described otherwise in Elections 10(c) or (n), Elective Deferrals includes Pre-Tax Deferrals, Roth Deferrals and Employee Contributions, Matching includes all Matching Contributions and Nonelective includes all Nonelective Contributions. Election 10(c) below may cause allocation Compensation to fail to be nondiscriminatory under Treas. Reg. §1.414(s).]

 

 

 

 

(1)

 

(2)

(3)

(4)

 

 

 

All

 

Elective

 

 

Pre-Entry Compensation (Choose one of (a) or (b).

Contributions

 

Deferrals

Matching

Nonelective

Choose Contribution Type as applicable.):

 

 

 

 

 

 

 

 

 

 

 

 

 

(a)

[X]

Plan Year. Compensation for the entire Plan Year which includes the Participant’s Entry Date. [Note: If the Employer under Election 9(e) elects to allocate some or all Contribution Types based on a specified 12-month period, Election 10(a) applies to that 12-month period in lieu of the Plan Year.]

[X]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(b)

[   ]

Participating Compensation. Only Participating Compensation. See Section 1.11(H)(1).

[   ]

OR

[   ]

[   ]

[   ]

 

[Note: Under a Participating Compensation election, in applying any Adoption Agreement elected contribution limit or formula, the Plan Administrator will count only the Participant’s Participating Compensation. See Section 1.11(H)(1) as to plan disaggregation.]

 

(c)

[   ]

Describe Pre-Entry Compensation by Contribution Type or by Participant group:

 

 

[Note: Under Election 10(c), the Employer may: (i) elect Compensation from the elections available under Pre-Entry Compensation or a combination thereof as to a Participant group (e.g., Participating Compensation for all Contribution Types as to Division A Employees, Plan Year Compensation for all Contribution Types to Division B Employees); and/or (ii) define the Contribution Type column headings in a manner which differs from the “all-inclusive” description in the Note immediately preceding Pre-Entry Compensation (e.g., Compensation for Nonelective Contributions is Participating Compensation and for Safe Harbor Nonelective Contributions is Plan Year Compensation).]

 

Post-Severance Compensation. The following adjustments apply to Post-Severance Compensation paid within any applicable time period as may be required (Choose one of (d), (e), or (f).):

 

[Note: Under the basic plan document, if the Employer does not elect any adjustments, post-severance compensation includes regular pay, leave cashouts, and deferred compensation, and excludes military and disability continuation payments.]

 

(d)

[   ]

None. The Plan includes post-severance regular pay, leave cashouts, and deferred compensation, and excludes post-severance military and disability continuation payments as to any Contribution Type except as required under the basic plan document (skip to Election 11).

 

 

 

(e)

[X]

Same for all Contribution Types. The following adjustments to Post-Severance Compensation apply to all Contribution Types (Choose one or more of (h) through (n). Choose column (1) for each option elected at (h) through (m).):

 

 

 

(f)

[   ]

Adjustments - different conditions apply. The following adjustments to Post-Severance Compensation apply to the designated Contribution Types (Choose one or more of (g) through (n). Choose Contribution Type as applicable.):

 

 

 

 

(1)

 

(2)

(3)

(4)

 

 

 

All

 

Elective

 

 

Post-Severance Compensation:

Contributions

 

Deferrals

Matching

Nonelective

 

 

 

 

 

 

 

 

(g)

[   ]

None. The Plan takes into account Post-Severance Compensation as to the designated Contribution Types as specified under the basic plan document.

N/A
(See Election 10(d))

 

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(h)

[X]

Exclude All. Exclude all Post-Severance Compensation. [Note: 415 testing Compensation (versus allocation Compensation) must include Post-Severance Compensation comprised of regular pay. See Section 4.05(F).]

[X]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(i)

[   ]

Regular Pay. Exclude Post-Severance Compensation comprised of regular pay. See Section 1.11(I)(1)(a). [Note: 415 testing Compensation (versus allocation Compensation) must include

[   ]

OR

[   ]

[   ]

[   ]

 

© 2014 Great-West Trust Company, LLC or its suppliers

194530-01 (effective December 1, 2016)

5



 

Nonstandardized 401(k) Plan

 

 

 

Post-Severance Compensation comprised of regular pay. See Section 4.05(F).]

 

 

 

 

 

 

 

 

 

 

 

 

 

(j)

[   ]

Leave cash-out. Exclude Post-Severance Compensation comprised of leave cash-out. See Section 1.11(I)(1)(b).

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(k)

[   ]

Deferred Compensation. Exclude Post-Severance Compensation comprised of deferred compensation. See Section 1.11(I)(1)(c).

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(l)

[   ]

Salary continuation for military service. Include Post-Severance Compensation comprised of salary continuation for military service. See Section 1.11(I)(2).

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(m)

[   ]

Salary continuation for disabled Participants. Include Post-Severance Compensation comprised of salary continuation for disabled Participants. See Section 1.11(I)(3). (Choose one of (1) or (2).):

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

 

(1)

[   ]

For NHCEs only.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2)

[   ]

For all Participants. The salary continuation will continue for the following fixed or determinable period:                                      (specify period).

 

 

 

 

 

 

 

 

 

 

 

 

 

(n)

[   ]

Describe Post-Severance Compensation by Contribution Type or by Participant group:                                                                       

 

[Note: Under Election 10(n), the Employer may: (i) elect Compensation from the elections available under Post-Severance Compensation or a combination thereof as to a Participant group (e.g., Include regular pay Post-Severance Compensation for all Contribution Types as to Division A Employees, no Post-Severance Compensation for all Contribution Types to Division B Employees); and/or (ii) define the Contribution Type column headings in a manner which differs from the “all-inclusive” description in the Note immediately preceding Pre-Entry Compensation (e.g., Compensation for Nonelective Contributions does not include any Post-Severance Compensation and for Safe Harbor Nonelective Contributions includes regular pay Post-Severance Compensation).]

 

11.   EXCLUDED COMPENSATION (1.11(G)). Apply the following Compensation exclusions to Elections 9 and 10 (Choose one of (a), (b), or (c).):

 

(a)

[   ]

No exclusions. Compensation as to all Contribution Types means Compensation as elected in Elections 9 and 10 (skip to Election 12).

 

 

 

(b)

[X]

Exclusions - same for all Contribution Types. The following exclusions apply to all Contribution Types (Choose one or more of (e) through (l). Choose column (1) for each option elected at (e) through (k).):

 

 

 

(c)

[   ]

Exclusions - different conditions apply. The following exclusions apply for the designated Contribution Types (Choose one or more of (d) through (l) below. Choose Contribution Type as applicable.):

 

[Note: In a safe harbor 401(k) plan, allocations qualifying for the ADP or ACP test safe harbors must be based on a nondiscriminatory definition of Compensation. If the Plan applies permitted disparity, allocations also must be based on a nondiscriminatory definition of Compensation if the Plan is to avoid more complex testing. Elections 11(g) through (l) below may cause allocation Compensation to fail to be nondiscriminatory under Treas. Reg. §1.414(s). In a non-safe harbor 401(k) plan, Elections 11(g) through (l) which result in Compensation failing to be nondiscriminatory, may result in more complex nondiscrimination testing. For this Election 11, unless described otherwise in Election 11(l), Elective Deferrals includes Pre-Tax Deferrals, Roth Deferrals and Employee Contributions, Matching includes all Matching Contributions and Nonelective includes all Nonelective Contributions.]

 

 

 

 

(1)

 

(2)

(3)

(4)

 

 

 

All

 

Elective

 

 

Compensation Exclusions

Contributions

 

Deferrals

Matching

Nonelective

 

 

 

 

 

 

 

 

(d)

[   ]

No exclusions - limited. No exclusion as to the designated Contribution Type(s).

N/A
(See Election 11(a))

 

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(e)

[   ]

Elective Deferrals. See Section 1.21.

N/A

 

N/A

[   ]

[   ]

 

 

 

 

 

 

 

 

(f)

[X]

Fringe benefits. As described in Treas. Reg. §1.414(s)-1(c)(3).

[X]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(g)

[   ]

Compensation exceeding $      .

Apply this election to (Choose one of (1) or (2).):

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

 

(1)

[   ]

All Participants.

[Note: If the Employer elects Safe Harbor Contributions under Election 6(e), the Employer

 

 

 

 

 

 

© 2014 Great-West Trust Company, LLC or its suppliers

194530-01 (effective December 1, 2016)

6



 

Nonstandardized 401(k) Plan

 

 

 

may not elect 11(g)(1) to limit the Safe Harbor Contribution allocation to the NHCEs.]

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2)

[   ]

HCE Participants only.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(h)

[X]

Bonus.

[X]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(i)

[   ]

Commission.

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(j)

[   ]

Overtime.

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(k)

[X]

Related Employers. See Section 1.24(C).

(If there are Related Employers, choose one or both of (1) and (2).):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

[X]

Non-Participating. Compensation paid to Employees by a Related Employer that is not a Participating Employer.

[X]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

 

 

(2)

[   ]

Participating. As to the Employees of any Participating Employer, Compensation paid by any other Participating Employer to its Employees. See Election 28(g)(2)a.

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

 

(l)   [X]  Describe Compensation exclusion(s):  As to All Contributions, exclude amounts received as awards and tax gross-up payments and all equity compensation.                                                                                                                                                                                                         

 

[Note: Under Election 11(l), the Employer may: (i) describe Compensation from the elections available under Elections 11(d) through (k), or a combination thereof as to a Participant group (e.g., No exclusions as to Division A Employees and exclude bonus as to Division B Employees); (ii) define the Contribution Type column headings in a manner which differs from the “all-inclusive” description in the Note immediately following Election 11(c) (e.g., Elective Deferrals means §125 cafeteria deferrals only OR No exclusions as to Safe Harbor Contributions and exclude bonus as to Nonelective Contributions); and/or (iii) describe another exclusion (e.g., Exclude shift differential pay).]

 

12.   HOURS OF SERVICE (1.32). The Plan credits Hours of Service for the following purposes (and to the Employees described in Elections 12(d) or (e)) as follows (Choose one or more of (a) through (e) as applicable.):

 

 

 

 

(1)

 

(2)

(3)

(4)

 

 

 

All

 

 

 

Allocation

 

Purposes

 

Eligibility

Vesting

Conditions

 

 

 

 

 

 

 

 

(a)

[X]

Actual Method. See Section 1.32(A)(1).

[X]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(b)

[   ]

Equivalency Method:                                        

(e.g., daily, weekly, etc.). See Section 1.32(A)(2).

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(c)

[   ]

Elapsed Time Method. See Section 1.32(A)(3).

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(d)

[   ]

Actual (hourly) and Equivalency (salaried).

Actual Method for hourly paid Employees and Equivalency Method:                                          (e.g., daily, weekly, etc.) for salaried Employees.

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(e)

[   ]

Describe method:

 

 

[Note: Under Election 12(e), the Employer may describe Hours of Service from the elections available under Elections 12(a) through (d), or a combination thereof as to a Participant group and/or Contribution Type (e.g., For all purposes, Actual Method applies to office workers and Equivalency Method applies to truck drivers).]

 

13.   ELECTIVE SERVICE CREDITING (1.59(C)). The Plan must credit Related Employer Service under Section 1.24(C) and also must credit certain Predecessor Employer/Predecessor Plan Service under Section 1.59(B). If the Plan is a Multiple Employer Plan, the Plan also must credit Service as provided in Section 12.08. The Plan also elects under Section 1.59(C) to credit as Service the following Predecessor Employer service (Choose one of (a) or (b).):

 

(a)

[   ]

Not applicable. No elective Predecessor Employer Service crediting applies.

 

 

 

(b)

[X]

Applies. The Plan credits the specified service with the following designated Predecessor Employers as Service for the Employer for the purposes indicated (Choose one or both of (1) and (2) as applicable. Complete (3). Choose (4) if applicable.):

 

[Note: Any elective Service crediting under this Election 13 must be nondiscriminatory.]

 

 

(1)

[   ]

All purposes. Credit as Service for all purposes, service with Predecessor Employer(s):                                                 (insert as many names as needed).

 

 

© 2014 Great-West Trust Company, LLC or its suppliers

194530-01 (effective December 1, 2016)

7



 

Nonstandardized 401(k) Plan

 

(2)

[X]

Designated purposes. Credit as Service, service with the following Predecessor Employer(s) for the designated purpose(s):

 

(1)

Eligibility

(2)

Vesting

(3)
Contribution
Allocation

 

 

 

 

 

 

 

 

a.

Employer:

 After Hours Apparel

 

[X]

[X]

[   ]

 

 

 

 

 

 

 

 

 

b.

Employer:

 JA Apparel Corp.

 

[X]

[X]

[   ]

 

 

 

 

 

 

 

 

 

c.

Employer:

 SOURCEONE, LLC

 

[X]

[X]

[   ]

 

(3)

Time period. Subject to any exceptions noted under Election 13(b)(4), the Plan credits as Service under Elections 13(b)(1) or (2) (Choose one or more of a., b., and c. as applicable.):

 

 

 

 

a.

[X]

All. All service, regardless of when rendered.

 

 

 

 

 

b.

[   ]

Service after. All service, which is or was rendered after:                                          (specify date).

 

 

 

 

 

c.

[   ]

Service before. All service, which is or was rendered before:                                          (specify date).

 

 

 

 

(4)

[X]

Describe elective Predecessor Employer Service crediting:  Notwithstanding Election 13(b)(3), Service with After Hours Apparel will only be credited for those Participants who were employees of After Hours Apparel on April 9, 2007.  

 

[Note: Under Election 13(b)(4), the Employer may describe service crediting from the elections available under Elections 13(b)(1) through (3), or a combination thereof as to a Participant group and/or Contribution Type (e.g., For all purposes credit all service with X, but credit service with Y only on/after 1/1/05 OR Credit all service for all purposes with entities the Employer acquires after 12/31/04 OR Service crediting for X Company applies only for purposes of Nonelective Contributions and not for Matching Contributions).]

 

ARTICLE II

ELIGIBILITY REQUIREMENTS

 

14.   ELIGIBILITY (2.01). To become a Participant in the Plan, an Eligible Employee must satisfy (Choose one of (a), (b), or (c).):

 

[Note: If the Employer under a safe harbor plan elects “early” eligibility for Elective Deferrals (e.g., less than one Year of Service and age 21), but does not elect early eligibility for any Safe Harbor Contributions, also see Election 30(g).]

 

[Note: No eligibility conditions apply to Prevailing Wage Contributions. See Section 2.01(D).]

 

(a)

[   ]

No conditions. No eligibility conditions as to all Contribution Types. Entry is on the Employment Commencement Date (if that date is also an Entry Date), or if later, upon the next following Plan Entry Date (skip to Election 16).

 

 

 

(b)

[X]

Eligibility - same for all Contribution Types. To become a Participant in the Plan as to all Contribution Types, an Eligible Employee must satisfy the following eligibility conditions (Choose one or more of (e) through (k). Choose column (1) for each option elected at (e) through (j).):

 

 

 

(c)

[   ]

Eligibility - different conditions apply. To become a Participant in the Plan for the designated Contribution Types, an Eligible Employee must satisfy the following eligibility conditions (either as to all Contribution Types or as to the designated Contribution Type) (Choose one or more of (d) through (k). Choose Contribution Type as applicable.):

 

[Note: For this Election 14, unless described otherwise in Election 14(k), or the context otherwise requires, Elective Deferrals includes Pre-Tax Deferrals, Roth Elective Deferrals and Employee Contributions, Matching includes all Matching Contributions (except Safe Harbor Matching Contributions under Section 3.05(E)(3) and Operational QMACs under Section 3.03(C)(2)) and Nonelective includes all Nonelective Contributions (except Safe Harbor Nonelective Contributions under Section 3.05(E)(2) and Operational QNECs under Section 3.04(C)(2)). Safe Harbor includes Safe Harbor Nonelective and Safe Harbor Matching Contributions. If the Employer elects more than one Year of Service as to Additional Matching, the Plan will not satisfy the ACP test safe harbor. See Section 3.05(F)(3).]

 

 

 

 

(1)

(2)

(3)

(4)

(5)

 

 

 

All

Elective

 

 

Safe

Eligibility Conditions

Contributions

Deferrals

Matching

Nonelective

Harbor

 

 

 

 

 

 

 

 

(d)

[   ]

None. Entry on the Employment Commencement Date (if that date is also an Entry Date) or if later, upon the next following Plan Entry Date.

N/A
(See Election 14(a))

[   ]

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

 

(e)

[X]

Age   21   (not to exceed age 21).

[X]

OR

[   ]

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

 

(f)

[   ]

One Year of Service. See Election 16(a).

[   ]

OR

[   ]

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

 

(g)

[   ]

Two Years of Service (without an intervening Break in Service). 100% vesting is required. [Note: Two Years of Service does not apply to Elective Deferrals, Safe Harbor Contributions or SIMPLE Contributions.]

N/A

 

N/A

[   ]

[   ]

N/A

 

 

 

© 2014 Great-West Trust Company, LLC or its suppliers

194530-01 (effective December 1, 2016)

8



 

Nonstandardized 401(k) Plan

 

(h)

[X]

  2   month(s) (not exceeding 12 months for Elective Deferrals, Safe Harbor Contributions and SIMPLE Contributions and not exceeding 24 months for other contributions). If more than 12 months, 100% vesting is required. Service need not be continuous (no minimum Hours of Service required, and is mere passage of time).

[Note: While satisfying a months of service condition without an Hours of Service requirement involves the mere passage of time, the Plan need not apply the Elapsed Time Method in Election 12(c) above, and still may elect the Actual Method in 12(a) above.]

[X]

OR

[   ]

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

 

(i)

[   ]

         month(s) with at least            Hours of Service in each month (not exceeding 12 months for Elective Deferrals, Safe Harbor Contributions and SIMPLE Contributions and not exceeding 24 months for other contributions). If more than 12 months, 100% vesting is required. If the Employee does not complete the designated Hours of Service each month during the specified monthly time period, the Employee is subject to the one Year of Service (or two Years of Service if elect more than 12 months) requirement as defined in Election 16. The months during which the Employee completes the specified Hours of Service (Choose one of (1) or (2).):

[   ]

OR

[   ]

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

 

 

(1)

[   ]

Consecutive. Must be consecutive.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2)

[   ]

Not consecutive. Need not be consecutive.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(j)

[   ]

         Hours of Service within the                                           time period following the Employee’s Employment Commencement Date (not exceeding 12 months for Elective Deferrals, Safe Harbor Contributions and SIMPLE Contributions and not exceeding 24 months for other contributions). If more than 12 months, 100% vesting is required. If the Employee does not complete the designated Hours of Service during the specified time period (if any), the Employee is subject to the one Year of Service (or two Years of Service if elect more than 12 months) requirement as defined in Election 16.

[   ]

OR

[   ]

[   ]

[   ]

[   ]

 

[Note: The Employer may leave the time period option blank in Election 14(j) if the Employer wishes to impose an Hour of Service requirement without specifying a time period within which an Employee must complete the required Hours of Service.]

 

(k)

[X]

Describe eligibility conditions:  Notwithstanding Election 14(h), One Year of Service applies to Part-Time, Temporary and Seasonal Employees.                                                                                                                                                                                                           

 

[Note: The Employer may use Election 14(k) to describe different eligibility conditions as to different Contribution Types or Employee groups (e.g., As to all Contribution Types, no eligibility requirements for Division A Employees and one Year of Service as to Division B Employees). The Employer also may elect different ages for different Contribution Types and/or to specify different months or Hours of Service requirements under Elections 14(h), (i), or (j) as to different Contribution Types. Any election must satisfy Code §410(a).]

 

 

 

© 2014 Great-West Trust Company, LLC or its suppliers

194530-01 (effective December 1, 2016)

9



 

Nonstandardized 401(k) Plan

 

15.   SPECIAL ELIGIBILITY EFFECTIVE DATE (DUAL ELIGIBILITY) (2.01(E)). The eligibility conditions of Election 14 and the entry date provisions of Election 17 apply to all Employees unless otherwise elected below (Choose (a) or (b) if applicable.):

 

[Note: Elections 15(a) or (b) may trigger a coverage failure under Code §410(b).]

 

(a)

[   ]

Waiver of eligibility conditions for certain Employees. For all Contribution Types, the eligibility conditions and entry dates apply solely to an Eligible Employee employed or reemployed by the Employer after                                      (specify date). If the Eligible Employee was employed or reemployed by the Employer by the specified date, the Employee will become a Participant on the latest of: (i) the Effective Date; (ii) the restated Effective Date; (iii) the Employee’s Employment Commencement Date or Re-Employment Commencement Date; or (iv) the date the Employee attains age            (not exceeding age 21).

 

[Note: If the Employer does not wish to impose an age condition under clause (iv) as part of the requirements for the eligibility conditions waiver, leave the age blank.]

 

(b)

[   ]

Describe special eligibility Effective Date(s):

 

 

[Note: Under Election 15(b), the Employer may describe special eligibility Effective Dates as to a Participant group and/or Contribution Type (e.g., Eligibility conditions apply only as to Nonelective Contributions and solely as to the Eligible Employees of Division B who were hired or reemployed by the Employer after January 1, 2012).]

 

16.   YEAR OF SERVICE - ELIGIBILITY (2.02(A)). (Choose (a), (b), and (c) as applicable.):

 

[Note: If the Employer under Election 14 elects a one or two Year(s) of Service condition (including any requirement which defaults to such conditions under Elections 14(i), (j), and (k)) or elects to apply a Year of Service for eligibility under any other Adoption Agreement election, the Employer should complete this Election 16. The Employer should not complete Election 16 if it elects the Elapsed Time Method for eligibility.]

 

(a)

[X]

Year of Service. An Employee must complete   1,000   Hour(s) of Service during the relevant Eligibility Computation Period to receive credit for one Year of Service under Article II. [Note: The number may not exceed 1,000. If left blank, the requirement is 1,000 Hours of Service.]

 

 

 

(b)

[X]

Subsequent Eligibility Computation Periods. After the Initial Eligibility Computation Period described in Section 2.02(C)(2), the Plan measures Subsequent Eligibility Computation Periods as (Choose one of (1), (2), or (3).):

 

 

 

 

(1)

[X]

Plan Year. The Plan Year beginning with the Plan Year which includes the first anniversary of the Employee’s Employment Commencement Date.

 

 

 

 

 

(2)

[   ]

Anniversary Year. The Anniversary Year, beginning with the Employee’s second Anniversary Year.

 

 

 

 

 

(3)

[   ]

Split. The Plan Year as described in Election 16(b)(1) as to:                                          (describe Contribution Type(s)) and the Anniversary Year as described in Election 16(b)(2) as to:                                          (describe Contribution Type(s)).

 

[Note: To maximize delayed entry under a two Years of Service condition for Nonelective Contributions or Matching Contributions, the Employer should elect to remain on the Anniversary Year for such contributions.]

 

(c)

[   ]

Describe:

 

 

 

(e.g., Anniversary Year as to Division A and Plan Year as to Division B.)

 

17.   ENTRY DATE (2.02(D)). Entry Date means the Effective Date and (Choose one or more of (a) through (g). Choose Contribution Types as applicable.):

 

[Note: For this Election 17, unless described otherwise in Election 17(g), Elective Deferrals includes Pre-Tax Deferrals, Roth Elective Deferrals and Employee Contributions, Matching includes all Matching Contributions (except Operational QMACs under Section 3.03(C)(2)) and Nonelective includes all Nonelective Contributions (except Operational QNECs under Section 3.04(C)(2)). Entry as to Prevailing Wage Contributions is on the Employment Commencement Date. See Section 2.02(D)(3).]

 

 

 

 

(1)

 

(2)

(3)

(4)

 

 

 

All

 

Elective

 

 

 

Contributions

 

Deferrals

Matching

Nonelective

 

 

 

 

 

 

 

 

(a)

[   ]

Semi-annual. The first day of the first month and of the seventh month of the Plan Year.

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(b)

[   ]

First day of Plan Year.

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(c)

[   ]

First day of each Plan Year quarter.

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(d)

[X]

The first day of each month.

[X]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(e)

[   ]

Immediate. Upon Employment Commencement Date or if later, upon satisfaction of eligibility conditions.

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(f)

[   ]

First day of each payroll period.

[   ]

OR

[   ]

[   ]

[   ]

 

 

© 2014 Great-West Trust Company, LLC or its suppliers

194530-01 (effective December 1, 2016)

10



 

Nonstandardized 401(k) Plan

 

(g)

[X]

Describe Entry Date(s):  Notwithstanding Election 17(d), the first day of each Plan Year quarter applies to Part-Time, Temporary and Seasonal Employees.                                                                                                                                                                                      

 

[Note: Under Election 17(g), the Employer may describe Entry Dates from the elections available under Elections 17(a) through (f), or a combination thereof as to a Participant group and/or Contribution Type or may elect additional Entry Dates (e.g., As to Matching Contributions excluding Additional Matching, immediate as to Division A Employees and semi-annual as to Division B Employees OR The earlier of the Plan’s semi-annual Entry Dates or the entry dates under the Employer’s medical plan).]

 

18.   PROSPECTIVE/RETROACTIVE ENTRY DATE (2.02(D)). An Employee after satisfying the eligibility conditions in Election 14 will become a Participant (unless an Excluded Employee under Election 8) on the Entry Date (if employed on that date) (Choose one or more of (a) through (f). Choose Contribution Type as applicable.):

 

[Note: Unless otherwise excluded under Election 8, an Employee who remains employed by the Employer on the relevant date must become a Participant by the earlier of: (i) the first day of the Plan Year beginning after the date the Employee completes the age and service requirements of Code §410(a); or (ii) 6 months after the date the Employee completes those requirements. For this Election 18, unless described otherwise in Election 18(f), Elective Deferrals includes Pre-Tax Deferrals, Roth Deferrals and Employee Contributions, Matching includes all Matching Contributions (except Operational QMACs under Section 3.03(C)(2)) and Nonelective includes all Nonelective Contributions, (except Operational QNECs under Section 3.04(C)(2)).]

 

 

 

 

(1)

 

(2)

(3)

(4)

 

 

 

All

 

Elective

 

 

 

Contributions

 

Deferrals

Matching

Nonelective

 

 

 

 

 

 

 

 

(a)

[X]

Immediately following or coincident with the date the Employee completes the eligibility conditions.

[X]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(b)

[   ]

Immediately following the date the Employee completes the eligibility conditions.

[   ]

OR

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

(c)

[   ]

Immediately preceding or coincident with the date the Employee completes the eligibility conditions.

N/A

 

N/A

[   ]

[   ]

 

 

 

 

 

 

 

 

(d)

[   ]

Immediately preceding the date the Employee completes the eligibility conditions.

N/A

 

N/A

[   ]

[   ]

 

 

 

 

 

 

 

 

(e)

[   ]

Nearest the date the Employee completes the eligibility conditions.

N/A

 

N/A

[   ]

[   ]

 

 

 

 

 

 

 

 

(f)

[   ]

Describe retroactive/prospective entry relative to Entry Date:

 

 

[Note: Under Election 18(f), the Employer may describe the timing of entry relative to an Entry Date from the elections available under Elections 18(a) through (e), or a combination thereof as to a Participant group and/or Contribution Type (e.g., As to Matching Contributions excluding Additional Matching nearest as to Division A Employees and immediately following as to Division B Employees).]

 

19.   BREAK IN SERVICE - PARTICIPATION (2.03). The one year hold-out rule described in Section 2.03(C) (Choose one of (a), (b), or (c).):

 

(a)

[X]

Does not apply.

 

 

 

(b)

[   ]

Applies. Applies to the Plan and to all Participants.

 

 

 

(c)

[   ]

Limited application. Applies to the Plan, but only to a Participant who has incurred a Severance from Employment.

 

[Note: The Plan does not apply the rule of parity under Code §410(a)(5)(D) unless the Employer in Appendix B specifies otherwise. See Section 2.03(D).]

 

ARTICLE III

PLAN CONTRIBUTIONS AND FORFEITURES

 

20.   ELECTIVE DEFERRAL LIMITATIONS (3.02(A)). The following limitations apply to Elective Deferrals under Election 6(b), which are in addition to those limitations imposed under the basic plan document (Choose (a) or choose (b) and (c) as applicable.):

 

(a)

[   ]

None. No additional Plan imposed limits (skip to Election 21).

 

[Note: The Employer under Election 20 may not impose a lower deferral limit applicable only to Catch-Up Eligible Participants and the Employer’s elections must be nondiscriminatory. The elected limits apply to Pre-Tax Deferrals and to Roth Deferrals unless described otherwise. Under a safe harbor plan: (i) NHCEs must be able to defer enough to receive the maximum Safe Harbor Matching and Additional Matching Contribution under the Plan and must be permitted to defer any lesser amount; and (ii) the Employer may limit Elective Deferrals to a whole percentage of Compensation or to a whole dollar amount. See Section 1.57(C) as to administrative limitations on Elective Deferrals.]

 

(b)

[X]

Additional Plan limit(s). (Choose (1) and (2) as applicable. Complete (3) if (1) or (2) is chosen.):

 

 

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194530-01 (effective December 1, 2016)

11



 

Nonstandardized 401(k) Plan

 

 

(1)

[X]

Maximum deferral amount. A Participant’s Elective Deferrals may not exceed:   75%   (specify dollar amount and/or percentage of Compensation).

 

 

 

 

 

(2)

[   ]

Minimum deferral amount. A Participant’s Elective Deferrals may not be less than:                                          (specify dollar amount and/or percentage of Compensation).

 

 

 

 

 

(3)

Application of limitations. The Election 20(b)(1) and (2) limitations apply based on Elective Deferral Compensation described in Elections 9 - 11. If the Employer elects Plan Year/Participating Compensation under column (1) and in Election 10 elects Participating Compensation, in the Plan Years commencing after an Employee becomes a Participant, apply the elected minimum or maximum limitations to the Plan Year. Apply the elected limitation based on such Compensation during the designated time period and only to HCEs as elected below. (Choose a. or choose b. and c. as applicable. Under each of a., b., or c. choose one of (1) or (2). Choose (3) if applicable.):

 

 

(1)

(2)

(3)

 

Plan Year/Participating
Compensation

Payroll
period

HCEs only

 

 

 

 

 

 

a.

[   ]

Both. Both limits under Elections 20(b)(1) and (2).

[   ]

[   ]

[   ]

 

 

 

 

 

 

 

 

 

 

b.

[X]

Maximum limit. The maximum amount limit under Election 20(b)(1).

[   ]

[X]

[   ]

 

 

 

 

 

 

 

 

 

 

c.

[   ]

Minimum limit. The minimum amount limit under Election 20(b)(2).

[   ]

[   ]

[   ]

 

(c)

[X]

Describe Elective Deferral limitation(s):  Notwithstanding Election 20(b)(1), HCEs may not defer in excess of 6% of Compensation each payroll period.                                                                                                                                                                                                         

 

[Note: Under Election 20(c), the Employer: (i) may describe limitations on Elective Deferrals from the elections available under Elections 20(a) and (b) or a combination thereof as to a Participant group (e.g., No limit applies to Division A Employees. Division B Employees may not defer in excess of 10% of Plan Year Compensation); (ii) may elect a different time period to which the limitations apply; and/or (iii) may apply a different limitation to Pre-Tax Deferrals and to Roth Deferrals.]

 

21.   AUTOMATIC DEFERRAL (ACA/EACA/QACA) (3.02(B)). The Automatic Deferral provisions of Section 3.02(B) (Choose one of (a) or (b). Also see Election 34 regarding Automatic Escalation of Salary Reduction Agreements.):

 

(a)

[X]

Do not apply. The Plan is not an ACA, EACA, or QACA (skip to Election 22).

 

 

 

(b)

[   ]

Apply. The Automatic Deferral Effective Date is the effective date of automatic deferrals or, as appropriate, any subsequent amendment thereto. (As to an EACA or QACA, this provision may not be effective earlier than Plan Years beginning on or after January 1, 2008). (Complete (1), (2), and (3). Complete (4) and (5) if an EACA or an EACA/QACA. Choose (6), (7), and/or (8) as applicable.):

 

 

 

 

(1)

Type of Automatic Deferral Arrangement. The Plan is an (Choose one of a., b., or c.):

 

 

 

 

 

a.

[   ]

ACA. The Plan is an Automatic Contribution Arrangement (ACA) under Section 3.02(B)(1).

 

 

 

 

 

 

 

b.

[   ]

EACA. The Plan is an Eligible Automatic Contribution Arrangement (EACA) under Section 3.02(B)(2).

 

 

 

 

 

 

 

c.

[   ]

EACA/QACA. The Plan is a combination EACA and Qualified Automatic Contribution Arrangement (QACA) under Sections 3.02(B)(3) and 3.05(J).

 

[Note: If the Employer chooses Elections 21(b)(1)c, the Employer also must choose election 6(e) and complete Election 30 as to the Safe Harbor Contributions under the QACA.]

 

 

(2)

Participants affected. The Automatic Deferral applies to (Choose one of a., b., c., or d. Choose e. if applicable.):

 

 

 

 

 

a.

[   ]

All Participants. All Participants, regardless of any prior Salary Reduction Agreement, unless and until they make a Contrary Election after the Automatic Deferral Effective Date.

 

 

 

 

 

 

 

b.

[   ]

Election of at least Automatic Deferral Percentage. All Participants, except those who have in effect a Salary Reduction Agreement on the Automatic Deferral Effective Date provided that the Elective Deferral amount under the Agreement is at least equal to the Automatic Deferral Percentage.

 

 

 

 

 

 

 

c.

[   ]

No existing Salary Reduction Agreement. All Participants, except those who have in effect a Salary Reduction Agreement on the Automatic Deferral Effective Date regardless of the Elective Deferral amount under the Agreement.

 

 

 

 

 

 

 

d.

[   ]

New Participants (not applicable to QACA). Each Employee whose Entry Date is on or following the Automatic Deferral Effective Date.

 

 

 

 

 

 

 

e.

[   ]

Describe affected Participants (not applicable to QACA):

 

 

 

 

© 2014 Great-West Trust Company, LLC or its suppliers

194530-01 (effective December 1, 2016)

12



 

Nonstandardized 401(k) Plan

 

[Note: The Employer in Election 21(b)(2)e. may further describe affected Participants, e.g., non-Collective Bargaining Employees OR Division A Employees. However, for Plan Years commencing on or after January 1, 2010, all Employees eligible to defer must be Covered Employees to apply the 6-month correction period without excise tax under Code §4979.]

 

(3)

Automatic Deferral Percentage/Scheduled increases. (Choose one of a., b., or c.):

 

 

 

 

 

a.

[   ]

Fixed percentage. The Employer, as to each Participant affected, will withhold as the Automatic Deferral Percentage,           % from the Participant’s Compensation each payroll period unless the Participant makes a Contrary Election. The Automatic Deferral Percentage will or will not increase in Plan Years following the Plan Year containing the Automatic Deferral Effective Date (or, if later, the Plan Year or partial Plan Year in which the Automatic Deferral first applies to a Participant) as follows (Choose one of d., e., or f.):

 

[Note: In order to satisfy the QACA requirements, enter an amount between 6% and 10% if no scheduled increase.]

 

 

 

b.

[   ]

QACA statutory increasing schedule. The Automatic Deferral Percentage will be:

 

 

 

 

 

 

 

 

 

Plan Year of application to a Participant

 

Automatic Deferral Percentage

 

 

 

 

 

1

 

3%

 

 

 

 

 

2

 

3%

 

 

 

 

 

3

 

4%

 

 

 

 

 

4

 

5%

 

 

 

 

 

5 and thereafter

 

6%

 

 

 

 

 

 

 

 

 

 

 

c.

[   ]

Other increasing schedule. The Automatic Deferral Percentage will be:

 

 

 

 

 

 

 

 

 

Plan Year of application to a Participant

 

Automatic Deferral Percentage

 

 

 

 

 

___

 

 

      %

 

 

 

 

 

___

 

 

      %

 

 

 

 

 

___

 

 

      %

 

 

 

 

 

___

 

 

      %

 

 

 

 

 

___

 

 

      %

 

 

 

 

 

 

 

 

 

 

 

d.

[   ]

No scheduled increase. The Automatic Deferral Percentage applies in all Plan Years.

 

 

 

 

 

 

 

e.

[   ]

Automatic increase. The Automatic Deferral Percentage will increase by           % per year up to a maximum of           % of Compensation.

 

 

 

 

 

 

 

f.

[   ]

Describe increase:

 

 

[Note: To satisfy the QACA requirements, the Automatic Deferral Percentage must be: (i) a fixed percentage which is at least 6% and not more than 10% of Compensation; (ii) an increasing Automatic Deferral Percentage in accordance with the schedule under Election 20(b)(3)b.; or (iii) an alternative schedule which must require, for each Plan Year, an Automatic Deferral Percentage that is at least equal to the Automatic Deferral Percentage under the schedule in Election 21(b)(3)b. and which does not exceed 10%. See Section 3.02(B)(3).]

 

 

(4)

EACA permissible withdrawal. The permissible withdrawal provisions of Section 3.02(B)(2)(d) (Choose one of a., b., or c.):

 

 

 

 

 

a.

[   ]

Do not apply.

 

 

 

 

 

 

 

 

b.

[   ]

90 day withdrawal. Apply within 90 days of the first Automatic Deferral.

 

 

 

 

 

 

 

 

c.

[   ]

30-90 day withdrawal. Apply, within            days of the first Automatic Deferral (may not be less than 30 nor more than 90 days).

 

 

 

 

(5)

Contrary Election/Covered Employee. For Plan Years beginning on or after January 1, 2010, any Participant who makes a Contrary Election (Choose one of a. or b.; leave blank if an ACA or a QACA not subject to the ACP test.):

 

 

 

 

 

a.

[   ]

Covered Employee. Is a Covered Employee and continues to be covered by the EACA provisions. [Note: Under this Election, the Participant’s Contrary Election will remain in effect, but the Participant must receive the EACA annual notice.]

 

 

 

 

 

 

 

 

b.

[   ]

Not a Covered Employee. Is not a Covered Employee and will not continue to be covered by the EACA provisions. [Note: Under this Election, the Participant no longer must receive the EACA annual notice, but the Plan cannot use the six-month period for relief from the excise tax of Code §4979(f)(1).]

 

 

 

 

(6)

Change Date. The Elective Deferrals under Election 21(b)(3)b., c., e., or f. will increase on the following day each Plan Year:

 

 

 

 

 

a.

[   ]

First day of the Plan Year.

 

 

 

 

 

 

 

 

b.

[   ]

Other:

 

 

 

 

 

(must be a specified or definitely determinable date that occurs at least annually)

 

 

 

 

(7)

First Year of Increase. The automatic increase under Election 21(b)(3)e. or f. will apply to a Participant beginning with the first Change Date after the Participant first has automatic deferrals withheld, unless a. is selected below:

 

 

© 2014 Great-West Trust Company, LLC or its suppliers

194530-01 (effective December 1, 2016)

13



 

Nonstandardized 401(k) Plan

 

 

 

a.

[   ]

The increase will apply as of the second Change Date thereafter.

 

 

 

 

 

 

(8)

[   ]

Describe Automatic Deferral:                                                                                                                                                          

 

[Note: Under Election 21(b)(8), the Employer may describe Automatic Deferral provisions from the elections available under Election 21 and/or a combination thereof as to a Participant group (e.g., Automatic Deferrals do not apply to Division A Employees. All Division B Employee/Participants are subject to an Automatic Deferral Amount equal to 3% of Compensation effective as of January 1, 2013).]

 

22.   CODA (3.02(C)). The CODA provisions of Section 3.02(C) (Choose one of (a) or (b).):

 

(a)

[X]

Do not apply.

 

 

 

(b)

[   ]

Apply. For each Plan Year for which the Employer makes a designated CODA contribution under Section 3.02(C), a Participant may elect to receive directly in cash not more than the following portion (or, if less, the Elective Deferral Limit) of his/her proportionate share of that CODA contribution (Choose one of (1) or (2).):

 

 

 

 

(1)

[   ]

All or any portion.

 

 

 

 

 

(2)

[   ]

      %

 

23.   CATCH-UP DEFERRALS (3.02(D)). The Plan permits Catch-Up Deferrals unless the Employer elects otherwise below. (Choose (a) if applicable.)

 

(a)

[   ]

Not Permitted. May not make Catch-Up Deferrals to the Plan.

 

24.   MATCHING CONTRIBUTIONS (EXCLUDING SAFE HARBOR MATCH AND ADDITIONAL MATCH UNDER SECTION 3.05) (3.03(A)). The Employer Matching Contributions under Election 6(c) are subject to the following additional elections regarding type (discretionary/fixed), rate/amount, limitations and time period (collectively, such elections are “the matching formula”) and the allocation of Matching Contributions is subject to Section 3.06 except as otherwise provided (Choose one or more of (a) through (g) as applicable; then, for the elected match, complete (1), (2), and/or (3) as applicable. If the Employer completes (2) or (3), also complete one of (4), (5), or (6).):

 

[Note: If the Employer wishes to make any Matching Contributions that satisfy the ADP or ACP safe harbor, the Employer should make these Elections under Election 30, and not under this Election 24.]

 

 

(1)

Match
Rate/Amt
[$/% of Elective
Deferrals]

(2)
Limit on
Deferrals
Matched

[$/% of
Compensation]

(3)

Limit on
Match Amount

[$/% of
Compensation]

(4)

Apply
limit(s) per
Plan Year
[“true-up”]

(5)
Apply
limit(s) per
payroll
period [no
“true-up”]

(6)
Apply
limit(s) per
designated
time period
[no “true-up”]

 

 

 

 

 

 

 

(a)

[X]

Discretionary – see Section 1.35(B) (The Employer may, but is not required to complete (a)(1)-(6). See the “Note” following Election 24.)

–––

–––

–––

[X]

[   ]

[   ]        

 

 

 

 

 

 

 

 

 

(b)

[   ]

Fixed – uniform rate/amount

–––

–––

–––

[   ]

[   ]

[   ]        

 

 

 

 

 

 

 

 

 

(c)

[   ]

Fixed – tiered

Elective

Matching

–––

–––

[   ]

[   ]

[   ]        

 

 

 

Deferral %

Rate

 

 

 

 

 

 

 

 

      %

      %

 

 

 

 

 

 

 

 

      %

      %

 

 

 

 

 

 

 

 

      %

      %

 

 

 

 

 

 

 

 

      %

      %

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(d)

[   ]

Fixed – Years of Service

Years
of Service

Matching
Rate

–––

–––

[   ]

[   ]

[   ]        

 

 

 

___

___%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

___

___%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

___

___%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

___

___%

 

 

 

 

 

 

 

 

(1)

“Years of Service” under this Election 24(d) means (Choose one of a. or b.):

 

 

 

 

 

 

 

a.

[   ]

Eligibility. Years of Service for eligibility in Election 16.

 

 

© 2014 Great-West Trust Company, LLC or its suppliers

194530-01 (effective December 1, 2016)

14



 

Nonstandardized 401(k) Plan

 

 

 

b.

[   ]

Vesting. Years of Service for vesting in Elections 43 and 44.

 

 

 

 

 

 

 

 

 

 

(e)

[   ]

Fixed — multiple formulas

Formula 1:                     

–––

–––

[   ]

[   ]

[   ]        

 

 

 

 

 

 

 

 

 

 

 

 

Formula 2:                     

–––

–––

[   ]

[   ]

[   ]        

 

 

 

 

 

 

 

 

 

 

 

 

Formula 3:                     

–––

–––

[   ]

[   ]

[   ]        

 

 

 

 

 

 

 

 

 

(f)

[X]

Related and Participating Employers. If any Related and Participating Employers (or in the case of a Multiple Employer Plan, Participating Employers regardless of whether they are Related Employers) contribute Matching Contributions to the Plan, the following apply (Complete (1) and (2).):

 

 

 

 

(1)

Matching formula. The matching formula for the Participating Employer(s) (Choose one of a. or b.):

 

 

 

 

 

a.

[X]

All the same. Is (are) the same as for the Signatory Employer under this Election 24.

 

 

 

 

 

b.

[   ]

At least one different. Is (are) as follows:                                                                                                             .

 

 

 

 

(2)

Allocation sharing. The Plan Administrator will allocate the Matching Contributions made by the Signatory Employer and by any Participating Employer (Choose one of a. or b.):

 

 

 

 

 

a.

[   ]

Employer by Employer. Only to the Participants directly employed by the contributing Employer.

 

 

 

 

 

b.

[X]

Across Employer lines. To all Participants regardless of which Employer directly employs them and regardless of whether their direct Employer made Matching Contributions for the Plan Year.

 

[Note: Unless the Plan is a Multiple Employer Plan, the Employer should not elect 24(f) unless there are Related Employers which are also Participating Employers. See Section 1.24(D).]

 

(g)

[   ]

Describe:                                                                                                                                                                                                      

 

 

(The formula described must satisfy the definitely determinable requirement under Treas. Reg. §1.401-1(b). If the formula is non-uniform, it is not a design-based safe harbor for nondiscrimination purposes.)

 

[Note: See Section 1.35(A) as to Fixed Matching Contributions. A Participant’s Elective Deferral percentage is equal to the Participant’s Elective Deferrals divided by his/her Compensation. The matching rate/amount is the specified rate/amount of match for the corresponding Elective Deferral amount/percentage. Any Matching Contributions apply to Pre-Tax Deferrals and to Roth Deferrals unless described otherwise in Election 24(g). Matching Contributions for nondiscrimination testing purposes are subject to the targeting limitations. See Section 4.10(D). The Employer under Election 24(a) in its discretion may determine the amount of a Discretionary Matching Contribution and the matching contribution formula. Alternatively, the Employer in Election 24(a) may specify the Discretionary Matching Contribution formula.]

 

25.              QMAC (PLAN-DESIGNATED) (3.03(C)(1)). The following provisions apply regarding Plan-Designated QMACs (Choose one of (a) or (b).):

 

[Note: Regardless of its elections under this Election 25, the Employer under Section 3.03(C)(2) may elect for any Plan Year where the Plan is using Current Year Testing to make Operational QMACs which the Plan Administrator will allocate only to NHCEs for purposes of correction of an ADP or ACP test failure.]

 

(a)

[X]

Not applicable. There are no Plan-Designated QMACs.

 

 

 

(b)

[   ]

Applies. There are Plan-Designated QMACs to which the following provisions apply (Complete (1) and (2).):

 

 

 

 

(1)

Matching Contributions affected. The following Matching Contributions (as allocated to the designated allocation group under Election 25(b)(2)) are Plan-Designated QMACs (Choose one of a. or b.):

 

 

 

 

 

a.

[   ]

All. All Matching Contributions.

 

 

 

 

 

b.

[   ]

Designated. Only the following Matching Contributions under Election 24:                                      .

 

 

 

 

 

 

(2)

Allocation Group. Subject to Section 3.06, allocate the Plan-Designated QMAC (Choose one of a. or b.):

 

 

 

 

 

 

 

a.

[   ]

NHCEs only. Only to NHCEs who make Elective Deferrals subject to the Plan-Designated QMAC.

 

 

 

 

 

 

 

b.

[   ]

All Participants. To all Participants who make Elective Deferrals subject to the Plan-Designated QMAC.

 

The Plan Administrator will allocate all other Matching Contributions as Regular Matching Contributions under Section 3.03(B), except as provided in Sections 3.03(C)(2) or 3.05.

 

[Note: See Section 4.10(D) as to targeting limitations applicable to QMAC nondiscrimination testing.]

 

 

© 2014 Great-West Trust Company, LLC or its suppliers

194530-01 (effective December 1, 2016)

15



 

Nonstandardized 401(k) Plan

 

26.         MATCHING CATCH-UP DEFERRALS (3.03(D)). If a Participant makes a Catch-Up Deferral, the Employer (Choose one of (a) or (b); leave blank if Election 23(a) is selected.):

 

(a)

[   ]

Match. Will apply to the Catch-Up Deferral (Choose one of (1) or (2).):

 

 

 

 

(1)

[   ]

All. All Matching Contributions.

 

 

 

 

 

(2)

[   ]

Designated. The following Matching Contributions in Election 24:                                              .

 

 

 

 

 

(b)

[X]

No Match. Will not match any Catch-Up Deferrals.

 

[Note: Election 26 does not apply to a safe harbor 401(k) plan unless the Employer will apply the ACP test. See Elections 38(a)(2)b. In this case, Election 26 applies only to Additional Matching, if any. A safe harbor 401(k) Plan will apply the Basic Match, QACA Basic Match or Enhanced Match to Catch-Up Deferrals. If the Employer elects to apply the ACP test safe harbor under Election 38(a)(2)a., Election 26 does not apply and the Plan also will apply any Additional Match to Catch-Up Deferrals.]

 

27.         NONELECTIVE CONTRIBUTIONS (TYPE/AMOUNT) INCLUDING PREVAILING WAGE CONTRIBUTIONS (3.04(A)). The Employer Nonelective Contributions under Election 6(d) are subject to the following additional elections as to type and amount (Choose one or more of (a) through (e) as applicable.):

 

(a)

[X]

Discretionary. An amount the Employer in its sole discretion may determine.

 

 

 

(b)

[   ]

Fixed. (Choose one or more of (1) through (3) as applicable.):

 

 

 

 

 

(1)

[   ]

Uniform %.           % of each Participant’s Compensation, per                                          (e.g., Plan Year, month).

 

 

 

 

 

(2)

[   ]

Fixed dollar amount. $          , per                                          (e.g., Plan Year, month, HOS, per Participant per month).

 

 

 

 

 

(3)

[   ]

Describe:                                                                                                                                                                                           

 

 

 

(The formula described must satisfy the definitely determinable requirement under Treas. Reg. §1.401-1(b). If the formula is non-uniform, it is not a design-based safe harbor for nondiscrimination purposes.)

 

[Note: The Employer under Election 27(b)(3) may specify any Fixed Nonelective Contribution formula not described under Elections 27(b)(1) or (2) (e.g., For each Plan Year, 2% of net profits exceeding $50,000, or The cash value of unused paid time off, as described in Section 3.04(A)(2)(a) and the Employer’s Paid Time Off Plan) and/or the Employer may describe different Fixed Nonelective Contributions as applicable to different Participant groups (e.g., A Fixed Nonelective Contribution equal to 5% of Plan Year Compensation applies to Division A Participants and a Fixed Nonelective Contribution equal to $500 per Participant each Plan Year applies to Division B Participants).]

 

(c)

[   ]

Prevailing Wage Contribution. The Prevailing Wage Contribution amount(s) specified for the Plan Year or other applicable period in the Employer’s Prevailing Wage Contract(s). The Employer will make a Prevailing Wage Contribution only to Participants covered by the Contract and only as to Compensation paid under the Contract. The Employer must specify the Prevailing Wage Contribution by attaching an appendix to the Adoption Agreement that indicates the contribution rate(s) applicable to the prevailing wage employment/job classification(s). If the Participant accrues an allocation of Employer Contributions (including forfeitures) under the Plan or any other Employer plan in addition to the Prevailing Wage Contribution, the Plan Administrator will (Choose one of (1) or (2).):

 

 

 

 

 

(1)

[   ]

No offset. Not reduce the Participant’s Employer Contribution allocation by the amount of the Prevailing Wage Contribution.

 

 

 

 

 

(2)

[   ]

Offset. Reduce the Participant’s Employer Contribution allocation by the amount of the Prevailing Wage Contribution.

 

 

 

 

(d)

[X]

Related and Participating Employers. If any Related and Participating Employers (or in the case of a Multiple Employer Plan, Participating Employers regardless of whether they are Related Employers) contribute Nonelective Contributions to the Plan, the contribution formula(s) (Choose one of (1) or (2).):

 

 

 

 

 

(1)

[X]

All the same. Is (are) the same as for the Signatory Employer under this Election 27.

 

 

 

 

 

(2)

[   ]

At least one different. Is (are) as follows:                                                                                                                                         .

 

[Note: Unless the Plan is a Multiple Employer Plan, the Employer should not elect 27(d) unless there are Related Employers which are also Participating Employers. See Section 1.24(D). The Employer electing 27(d) also must complete Election 28(g) as to the allocation methods which apply to the Participating Employers.]

 

(e)

[   ]

Describe:                                                                                                                                                                                           

(The formula described must satisfy the definitely determinable requirement under Treas. Reg. §1.401-1(b). If the formula is non-uniform, it is not a design-based safe harbor for nondiscrimination purposes.)

 

[Note: Under Election 27(e), the Employer may describe the amount and type of Nonelective Contributions from the elections available under Election 27 and/or a combination thereof as to a Participant group (e.g., A Discretionary Nonelective Contribution applies to Division A Employees. A Fixed Nonelective Contribution equal to 5% of Plan Year Compensation applies to Division B Employees).]

 

 

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194530-01 (effective December 1, 2016)

16



 

Nonstandardized 401(k) Plan

 

28.         NONELECTIVE CONTRIBUTION ALLOCATION (3.04(B)). The Plan Administrator, subject to Section 3.06, will allocate to each Participant any Nonelective Contribution (excluding QNECs) under the following contribution allocation formula (Choose one or more of (a) through (h) as applicable.):

 

(a)

[X]

Pro rata. As a uniform percentage of Participant Compensation.

 

 

 

 

(b)

[   ]

Permitted disparity. In accordance with the permitted disparity allocation provisions of Section 3.04(B)(2), under which the following permitted disparity formula and definition of “Excess Compensation” apply (Complete (1) and (2).):

 

 

 

 

 

(1)

Formula (Choose one of a., b., or c.):

 

 

 

 

 

 

a.

[   ]

Two-tiered.

 

 

 

 

 

 

 

b.

[   ]

Four-tiered.

 

 

 

 

 

 

 

c.

[   ]

Two-tiered, except that the four-tiered formula will apply in any Plan Year for which the Plan is top-heavy.

 

 

 

 

(2)

Excess Compensation. For purposes of Section 3.04(B)(2), “Excess Compensation” means Compensation in excess of the integration level provided below (Choose one of a. or b.):

 

 

 

 

 

 

a.

[   ]

Percentage amount.      % (not exceeding 100%) of the Taxable Wage Base in effect on the first day of the Plan Year, rounded to the next highest $      (not exceeding the Taxable Wage Base).

 

 

 

 

 

 

b.

[   ]

Dollar amount. The following amount: $      (not exceeding the Taxable Wage Base in effect on the first day of the Plan Year).

 

 

 

 

(c)

[   ]

Incorporation of contribution formula. The Plan Administrator will allocate any Fixed Nonelective Contribution under Elections 27(b), 27(d), or 27(e), or any Prevailing Wage Contribution under Election 27(c), in accordance with the contribution formula the Employer adopts under those Elections.

 

 

 

 

(d)

[   ]

Classifications of Participants. [This is a nondesigned based safe harbor allocation method.] In accordance with the classifications allocation provisions of Section 3.04(B)(3). (Complete (1) and (2).):

 

 

 

 

 

(1)

Description of the classifications. [This is a nondesigned based safe harbor allocation method.] The classifications are (Choose one of a., b., or c.):

 

 

 

 

[Note: Typically, the Employer would elect 28(d) where it intends to satisfy nondiscrimination requirements using “cross-testing” under Treas. Reg. §1.401(a)(4)-8. However, choosing this election does not necessarily require application of cross-testing and the Plan may be able to satisfy nondiscrimination as to its classification-based allocations by testing allocation rates.]

 

 

 

 

 

 

a.

[   ]

Each in own classification. Each Participant constitutes a separate classification.

 

 

 

 

 

 

 

b.

[   ]

NHCEs/HCEs. Nonhighly Compensated Employee/Participants and Highly Compensated Employee/Participants.

 

 

 

 

 

 

 

c.

[   ]

Describe the classifications:                                                                                                                                                     

 

[Note: Any classifications under Election 28(d) must result in a definitely determinable allocation under Treas. Reg. §1.401-1(b)(1)(ii). The classifications cannot limit the NHCEs benefiting under the Plan only to those NHCE/Participants with the lowest Compensation and/or the shortest periods of Service and who may represent the minimum number of benefiting NHCEs necessary to pass coverage under Code §410(b). In the case of a self-employed Participant (i.e., sole proprietorships or partnerships), the requirements of Treas. Reg. §1.401(k)-1(a)(6) apply and the allocation method should not result in a cash or deferred election for the self-employed Participant. The Employer by the due date of its tax return (including extensions) must advise the Plan Administrator or Trustee in writing as to the allocation rate applicable to each Participant under Election 28(d)(1)a. or applicable to each classification under Elections 28(d)(1)b. or c. for the allocation Plan Year.]

 

 

 

 

 

(2)

Allocation method within each classification. Allocate the Nonelective Contribution within each classification as follows (Choose one of a., b., or c.):

 

 

 

 

 

 

a.

[   ]

Pro rata. As a uniform percentage of Compensation of each Participant within the classification.

 

 

 

 

 

 

 

b.

[   ]

Flat dollar. The same dollar amount to each Participant within the classification.

 

 

 

 

 

 

 

c.

[   ]

Describe:                                                                                                                                                                  

(e.g., Allocate pro rata to NHCEs and flat dollar to HCEs.)

 

 

 

 

(e)

[   ]

Age-based. [This is a nondesigned based safe harbor allocation method.] In accordance with the age-based allocation provisions of Section 3.04(B)(5). The Plan Administrator will use the Actuarial Factors based on the following assumptions (Complete both (1) and (2).):

 

 

 

 

 

(1)

Interest rate. (Choose one of a., b., or c.):

 

 

 

 

 

a.

[   ]

7.5%

b.

[   ]

8.0%

c.

[   ]

8.5%

 

 

© 2014 Great-West Trust Company, LLC or its suppliers

194530-01 (effective December 1, 2016)

17



 

Nonstandardized 401(k) Plan

 

 

(2)

Mortality table. (Choose one of a. or b.):

 

 

 

 

 

 

 

a.

[   ]

UP-1984. See Appendix D.

 

 

 

 

 

 

 

b.

[   ]

Alternative:                                (Specify 1983 GAM, 1983 IAM, 1971 GAM or 1971 IAM and attach applicable tables using such mortality table and the specified interest rate as replacement Appendix D.)

 

 

 

 

 

(f)

[   ]

Uniform points. In accordance with the uniform points allocation provisions of Section 3.04(B)(6). Under the uniform points allocation formula, a Participant receives (Choose one or both of (1) and (2). Choose (3) if applicable.):

 

 

 

 

 

 

(1)

[   ]

Years of Service.                                point(s) for each Year of Service. The maximum number of Years of Service counted for points is                               .

 

 

 

 

 

 

 

“Year of Service” under this Election 28(f) means (Choose one of a. or b.):

 

 

 

 

 

 

 

a.

[   ]

Eligibility. Years of Service for eligibility in Election 16.

 

 

 

 

 

 

 

b.

[   ]

Vesting. Years of Service for vesting in Elections 43 and 44.

 

 

 

 

 

 

 

[Note: A Year of Service must satisfy Treas. Reg. §1.401(a)(4)-11(d)(3) for the uniform points allocation to qualify as a safe harbor allocation under Treas. Reg. §1.401(a)(4)-2(b)(3).]

 

 

 

 

 

 

(2)

[   ]

Age.                                point(s) for each year of age attained during the Plan Year.

 

 

 

 

 

 

(3)

[   ]

Compensation.                                point(s) for each $       (not to exceed $200) increment of Plan Year Compensation.

 

 

 

 

 

(g)

[X]

Related and Participating Employers. If any Related and Participating Employers (or in the case of a Multiple Employer Plan, Participating Employers regardless of whether they are Related Employers) contribute Nonelective Contributions to the Plan, the Plan Administrator will allocate the Nonelective Contributions made by the Participating Employer(s) under Election 27(d) (Complete (1) and (2).):

 

 

 

 

 

 

(1)

Allocation Method. (Choose one of a. or b.):

 

 

 

 

 

 

 

a.

[X]

All the same. Using the same allocation method as applies to the Signatory Employer under this Election 28.

 

 

 

 

 

 

 

b.

[   ]

At least one different. Under the following allocation method(s):                                                                                         .

 

 

 

 

 

 

(2)

Allocation sharing. The Plan Administrator will allocate the Nonelective Contributions made by the Signatory Employer and by any Participating Employer (Choose one of a. or b.):

 

 

 

 

 

 

 

a.

[   ]

Employer by Employer. Only to the Participants directly employed by the contributing Employer.

 

 

 

 

 

 

 

b.

[X]

Across Employer lines. To all Participants regardless of which Employer directly employs them and regardless of whether their direct Employer made Nonelective Contributions for the Plan Year.

 

 

 

 

 

[Note: Unless the Plan is a Multiple Employer Plan, the Employer should not elect 28(g) unless there are Related Employers which are also Participating Employers. See Section 1.24(D) and Election 27(d). If the Employer elects 28(g)(2)a., the Employer should also elect 11(k)(2), to disregard the Compensation paid by “Y” Participating Employer in determining the allocation of the “X” Participating Employer contribution to a Participant (and vice versa) who receives Compensation from both X and Y. If the Employer elects 28(g)(2)b., the Employer should not elect 11(k)(2). Election 28(g)(2)a. does not apply to Safe Harbor Nonelective Contributions.]

 

 

 

 

 

(h)

[   ]

Describe:                                                                                                                                                                                                                   

(The formula described must satisfy the definitely determinable requirement under Treas. Reg. §1.401-1(b).  If the formula is non-uniform, it is not a design-based safe harbor for nondiscrimination purposes.)

 

29.           QNEC (PLAN-DESIGNATED) (3.04(C)(1)). The following provisions apply regarding Plan-Designated QNECs (Choose one of (a) or (b).):

 

[Note: Regardless of its elections under this Election 29, the Employer under Section 3.04(C)(2) may elect for any Plan Year where the Plan is using Current Year Testing to make Operational QNECs which the Plan Administrator will allocate only to NHCEs for purposes of correction of an ADP or ACP test failure.]

 

(a)

[X]

Not applicable. There are no Plan-Designated QNECs.

 

 

 

 

 

(b)

[   ]

Applies. There are Plan-Designated QNECs to which the following provisions apply (Complete (1), (2), and (3).):

 

 

 

 

 

 

(1)

Nonelective Contributions affected. The following Nonelective Contributions (as allocated to the designated allocation group under Election 29(b)(2)) are Plan-Designated QNECs (Choose one of a. or b.):

 

 

 

 

 

 

 

a.

[   ]

All. All Nonelective Contributions.

 

 

 

 

 

 

 

b.

[   ]

Designated. Only the following Nonelective Contributions under Election 27:                                                                      .

 

 

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194530-01 (effective December 1, 2016)

18



 

 

(2)

Allocation Group. Subject to Section 3.06, allocate the Plan-Designated QNEC (Choose one of a. or b.):

 

 

 

 

 

 

 

a.

[   ]

NHCEs only. Only to NHCEs under the method elected in Election 29(b)(3).

 

 

 

 

 

 

 

b.

[   ]

All Participants. To all Participants under the method elected in Election 29(b)(3).

 

 

 

 

 

 

(3)

Allocation Method. The Plan Administrator will allocate a Plan-Designated QNEC using the following method (Choose one of a., b., c., or d.):

 

 

 

 

 

 

 

a.

[   ]

Pro rata.

 

 

 

 

 

 

 

b.

[   ]

Flat dollar.

 

 

 

 

 

 

 

c.

[   ]

Reverse. See Section 3.04(C)(3).

 

 

 

 

 

 

 

d.

[   ]

Describe:                                                                                                                                                                                             

(The formula described must satisfy the definitely determinable requirement under Treas. Reg. §1.401-1(b).  If the formula is non-uniform, it is not a design-based safe harbor for nondiscrimination purposes.)

 

 

 

 

 

[Note: See Section 4.10(D) as to targeting limitations applicable to QNEC nondiscrimination testing.]

 

30.           SAFE HARBOR 401(k) PLAN (SAFE HARBOR CONTRIBUTIONS/ADDITIONAL MATCHING CONTRIBUTIONS) (3.05). The Employer under Election 6(e) will (or in the case of the Safe Harbor Nonelective Contribution may) contribute the following Safe Harbor Contributions described in Section 3.05(E) and will or may contribute Additional Matching Contributions described in Section 3.05(F) (Choose one of (a) through (e) when and as applicable. Complete (f) and (i). Choose (g), (h), and (j) as applicable.):

 

(a)

[   ]

Safe Harbor Nonelective Contribution (including QACA). The Safe Harbor Nonelective Contribution equals      % of a Participant’s Compensation [Note: The amount in the blank must be at least 3%. The Safe Harbor Nonelective Contribution applies toward (offsets) most other Employer Nonelective Contributions. See Section 3.05(E)(12).]

 

 

 

(b)

[   ]

Safe Harbor Nonelective Contribution (including QACA)/delayed year-by-year election (maybe and supplemental notices). In connection with the Employer’s provision of the maybe notice under Section 3.05(I)(1), the Employer elects into safe harbor status by giving the supplemental notice and by making this Election 30(b) to provide for a Safe Harbor Nonelective Contribution equal to      % (specify amount at least equal to 3%) of a Participant’s Compensation. This Election 30(b) and safe harbor status applies for the Plan Year ending:                                (specify Plan Year end), which is the Plan Year to which the Employer’s maybe and supplemental notices apply.

 

 

 

 

 

[Note: An Employer distributing the maybe notice can use election 30(b) without completing the year. Doing so requires the Plan to perform Current Year Testing unless the Employer decides to elect safe harbor status. If the Employer wishes to elect safe harbor status for a single year, the Employer must amend the Plan to enter the Plan Year end above.]

 

 

 

 

 

(c)

[   ]

Basic Matching Contribution. A Matching Contribution equal to 100% of each Participant’s Elective Deferrals not exceeding 3% of the Participant’s Compensation, plus 50% of each Participant’s Elective Deferrals in excess of 3% but not in excess of 5% of the Participant’s Compensation. See Sections 1.35(E) and 3.05(E)(4). (Complete (1).):

 

 

 

 

 

 

(1)

Time period. For purposes of this Election 30(c), “Compensation” and “Elective Deferrals” mean Compensation and Elective Deferrals for:                               . [Note: The Employer must complete the blank line with the applicable time period for computing the Basic Match, such as “each payroll period,” “each calendar month,” “each Plan Year quarter” or “the Plan Year.”]

 

 

 

 

 

(d)

[   ]

QACA Basic Matching Contribution. A Matching Contribution equal to 100% of a Participant’s Elective Deferrals not exceeding 1% of the Participant’s Compensation, plus 50% of each Participant’s Elective Deferrals in excess of 1% but not in excess of 6% of the Participant’s Compensation. (Complete (1).): [Note: This election is available only if the Employer has elected the QACA automatic deferrals provisions under Election 21.]

 

 

 

 

 

 

(1)

Time period. For purposes of this Election 30(d), “Compensation” and “Elective Deferrals” mean Compensation and Elective Deferrals for:                               . [Note: The Employer must complete the blank line with the applicable time period for computing the QACA Basic Match, such as “each payroll period,” “each calendar month,” “each Plan Year quarter” or “the Plan Year.”]

 

 

 

 

 

(e)

[   ]

Enhanced Matching Contribution (including QACA). See Sections 1.35(F) and 3.05(E)(6). (Choose one of (1) or (2) and complete (3) for any election.):

 

 

 

 

 

 

(1)

[   ]

Uniform percentage. A Matching Contribution equal to      % of each Participant’s Elective Deferrals but not as to Elective Deferrals exceeding      % of the Participant’s Compensation.

 

 

 

 

 

 

(2)

[   ]

Tiered formula. A Matching Contribution equal to the specified matching rate for the corresponding level of each Participant’s Elective Deferral percentage. A Participant’s Elective Deferral percentage is equal to the Participant’s Elective Deferrals divided by his/her Compensation.

 

 

© 2014 Great-West Trust Company, LLC or its suppliers

194530-01 (effective December 1, 2016)

19



 

Nonstandardized 401(k) Plan

 

Elective Deferral Percentage

Matching Rate

         %

         %

         %

         %

         %

         %

 

 

(3)

Time period. For purposes of this Election 30(e), “Compensation” and “Elective Deferrals” mean Compensation and Elective Deferrals for:                                      . [Note: The Employer must complete the blank line with the applicable time period for computing the Enhanced Match, such as “each payroll period,” “each calendar month,” “each Plan Year quarter” or “the Plan Year.”]

 

 

 

 

[Note: The matching rate may not increase as the Elective Deferral percentage increases and the Enhanced Matching formula otherwise must satisfy the requirements of Code §§401(k)(12)(B)(ii) and (iii) (taking into account Code §401(k)(13)(D)(ii) in the case of a QACA). If the Employer elects to satisfy the ACP safe harbor under Election 38(a)(2)a., the Employer also must limit Elective Deferrals taken into account for the Enhanced Matching Contribution to a maximum of 6% of Plan Year Compensation.]

 

 

 

 

(f)

Participants who will receive Safe Harbor Contributions. The allocation of Safe Harbor Contributions (Choose one of (1), (2), or (3). Choose (4) if applicable.):

 

 

 

 

 

(1)

[   ]

Applies to all Participants. Applies to all Participants except as may be limited under Election 30(g).

 

 

 

 

 

(2)

[   ]

NHCEs only. Is limited to NHCE Participants only and may be limited further under Election 30(g). No HCE will receive a Safe Harbor Contribution allocation.

 

 

 

 

 

(3)

[   ]

NHCEs and designated HCEs. Is limited to NHCE Participants and to the following HCE Participants and may be limited further under Election 30(g):                                                                                                                                                                         .

 

 

 

 

[Note: Any HCE allocation group the Employer describes under Election 30(f)(3) must be definitely determinable. (e.g., Division “A” HCEs OR HCEs who own more than 5% of the Employer without regard to attribution rules).]

 

 

 

 

 

(4)

[   ]

Applies to all Participants except Collective Bargaining Employees. Notwithstanding Elections 30(f)(1), (2) or (3), the Safe Harbor Contributions are not allocated to Collective Bargaining (union) Employees and may be further limited under Election 30(g).

 

 

 

 

(g)

[   ]

Early Elective Deferrals/delay of Safe Harbor Contribution. The Employer may elect this Election 30(g) only if the Employer in Election 14 elects eligibility requirements for Elective Deferrals of less than age 21 and/or one Year of Service but elects age 21 and one Year of Service for Safe Harbor Matching or for Safe Harbor Nonelective Contributions. The Employer under this Election 30(g) applies the rules of Section 3.05(D) to limit the allocation of any Safe Harbor Contribution under Election 30 for a Plan Year to those Participants who the Plan Administrator in applying the OEE rule described in Section 4.06(C), treats as benefiting in the disaggregated plan covering the Includible Employees.

 

 

 

 

(h)

[   ]

Another plan. The Employer will make the Safe Harbor Contribution to the following plan:                                                       .

 

 

 

 

(i)

Additional Matching Contributions. See Sections 1.35(G) and 3.05(F). (Choose one of (1) or (2).):

 

 

 

 

 

(1)

[   ]

No Additional Matching Contributions. The Employer will not make any Additional Matching Contributions to its safe harbor Plan.

 

 

 

 

 

(2)

[   ]

Additional Matching Contributions. The Employer will or may make the following Additional Matching Contributions to its safe harbor Plan. (Choose a., b., and c. as applicable.):

 

 

 

 

 

 

a.

[   ]

Fixed Additional Matching Contribution. The following Fixed Additional Matching Contribution (Choose (i) and (ii) as applicable and complete (iii) for any election.):

 

 

 

 

 

 

 

(i)

[   ]

Uniform percentage. A Matching Contribution equal to      % of each Participant’s Elective Deferrals but not as to Elective Deferrals exceeding      % of the Participant’s Compensation.

 

 

 

 

 

 

 

 

 

(ii)

[   ]

Tiered formula. A Matching Contribution equal to the specified matching rate for the corresponding level of each Participant’s Elective Deferral percentage. A Participant’s Elective Deferral percentage is equal to the Participant’s Elective Deferrals divided by his/her Compensation.

 

Elective Deferral Percentage

Matching Rate

         %

         %

         %

         %

         %

         %

 

 

 

 

(iii)

Time period. For purposes of this Election 30(i)(2)a., “Compensation” and “Elective Deferrals” mean Compensation and Elective Deferrals for:                                                      .

[Note: The Employer must complete the blank line with the applicable time period for computing the Additional Match, e.g., each payroll period, each calendar month, each Plan Year quarter OR the Plan Year. If the Employer elects a match under both (i) and (ii) and will apply a different time period to each match, the Employer may indicate as such in the blank line.]

 

 

© 2014 Great-West Trust Company, LLC or its suppliers

194530-01 (effective December 1, 2016)

20



 

Nonstandardized 401(k) Plan

 

 

 

b.

[   ]

Discretionary Additional Matching Contribution. The Employer may make a Discretionary Additional Matching Contribution. If the Employer makes a Discretionary Matching Contribution, the Discretionary Matching Contribution will not apply as to Elective Deferrals exceeding      % of the Participant’s Compensation (complete the blank if applicable or leave blank).

 

 

 

 

 

 

 

 

(i)

Time period. For purposes of this Election 30(i)(2)b., “Compensation” and “Elective Deferrals” mean Compensation and Elective Deferrals for:                                                                                                                                                                 .

[Note: The Employer must complete the blank line with the applicable time period for computing the Additional Discretionary Matching Contribution, e.g., each payroll period, each calendar month, each Plan Year quarter OR the Plan Year. If the Employer fails to specify a time period, the Employer is deemed to have elected to compute its Additional Matching Contribution based on the Plan Year.]

 

 

 

 

 

 

 

c.

[   ]

Describe Additional Matching Contribution formula and time period:                                                                                  

(The formula described must satisfy the definitely determinable requirement under Treas. Reg. §1.401-1(b) and, if the Employer elects to satisfy the ACP safe harbor under Election 38(a)(2)a., the formula must comply with Section 3.05(G).)

 

 

 

 

 

[Note: If the Employer elects to satisfy the ACP safe harbor under Election 38(a)(2)a. then as to any and all Matching Contributions, including Fixed Additional Matching Contributions and Discretionary Additional Matching Contributions: (i) the matching rate may not increase as the Elective Deferral percentage increases; (ii) no HCE may be entitled to a greater rate of match than any NHCE; (iii) the Employer must limit Elective Deferrals taken into account for the Additional Matching Contributions to a maximum of 6% of Plan Year Compensation; (iv) the Plan must apply all Matching Contributions to Catch-Up Deferrals; and (v) in the case of a Discretionary Additional Matching Contribution, the contribution amount may not exceed 4% of the Participant’s Plan Year Compensation.]

 

 

 

 

 

(j)

[   ]

Multiple Safe Harbor Contributions in disaggregated Plan. The Employer elects to make different Safe Harbor Contributions and/or Additional Matching Contributions to disaggregated parts of its Plan under Treas. Reg. §1.401(k)-1(b)(4) as follows:                                                                                                                                                                                     

(Specify contributions for disaggregated plans, e.g., as to collectively bargained employees a 3% Nonelective Safe Harbor Contribution applies and as to non-collectively bargained employees, the Basic Matching Contribution applies).

 

31.    ALLOCATION CONDITIONS (3.06(B)/(C)). The Plan does not apply any allocation conditions to: (i) Elective Deferrals; (ii) Safe Harbor Contributions; (iii) Additional Matching Contributions which will satisfy the ACP test safe harbor; (iv) Employee Contributions; (v) Rollover Contributions; (vi) Designated IRA Contributions; (vii) SIMPLE Contributions; or (viii) Prevailing Wage Contributions. To receive an allocation of Matching Contributions, Nonelective Contributions or Participant forfeitures, a Participant must satisfy the following allocation condition(s) (Choose one of (a) or (b). Choose (c) if applicable.):

 

(a)

[   ]

No conditions. No allocation conditions apply to Matching Contributions, to Nonelective Contributions or to forfeitures.

 

 

 

 

 

(b)

[X]

Conditions. The following allocation conditions apply to the designated Contribution Type and/or forfeitures (Choose one or more of (1) through (7). Choose Contribution Type as applicable.):

 

 

 

 

 

[Note: For this Election 31, except as the Employer describes otherwise in Election 31(b)(7) or as provided in Sections 3.03(C)(2) and 3.04(C)(2) regarding Operational QMACs and Operational QNECs, Matching includes all Matching Contributions and Nonelective includes all Nonelective Contributions to which allocation conditions may apply. The Employer under Election 31(b)(7) may not impose an Hour of Service condition exceeding 1,000 Hours of Service in a Plan Year.]

 

 

 

 

 

(1)

 

 

 

(2)

 

(3)

 

(4)