Distribution Notice - No J&S
Participant: _______________________________________ _
A. a Partioipant you have accumulated benefits that will be paid to you under the provisions of the Plan. This notice explains your
distribution options and rights under the Plan.
MINIMUM/MAXIMUM NOTICE PERIOD For at least 30 days after you receive this notice, you have the right 10 consider your
decision whether to consent to a distribution of your vested account balance and whether to elecl a direcl rollover of any portion of
your eligible rollover distribution. If you sign and return the attached PARTICIPANT DISTRIBUTION ELI"CTION form 10 the Plan
Administrator less than 30 d.ys after you receive this notice, the Plan Administrator's receipt of your si~ned form is your affirmative
waiver of .ny unexpired portion of the minimum 30-day poriod and your affirmative election of a distribution or a direct rollover. If your
election is returned more than 1 eo (lays after you receive this ~olice, than a new election form will need to b signed Thase time
periods are required under IRS rules,
SPECIAL RULES FOR SMALL AMOUNT DISTRIBUTIONS. If you do not return a completed Partioipant Distribution Election
and your vested account balance is less Ihan $1,000, payment will be made to you in a lump sum as of a date that is not more than
180 days or less than 30 days after the delivery date printed on your Distribution Election Form. Further, 20% federal income tax plus
any applicable state tax will be withheld from the taxable portions of your account. If your payment is less than $200. no federal
income tax will be withheld.
1. Forms, We have provided you the following forms:
PARTICIPANT DISTRIBUTION ELECTION. Use this form to elect payment of your benefits. See the explanation of your benefit
options in 2. below.
SPECIAL TAX NOTICE REGARDING PLAN PAYMENTS. This notice explains your right to elect a direct rollover of your Vested
account balance to another plan or 10 an IRA. This notice also explains the income tax withholding rules if you elect to receive a direct
payment from the Plan.
POSTPONEMENT OF DISTRIBUTION ELECTION(if applicable). If you do not wish to receive payment or elect a direct rollover
at this time, complete this form instead of the PARTICIPANT DISTRIBUTION ELECTION form. You cannot use this form if you have
reached the latest time under the Plan for commencing distribution. See 3 below. NOTE: Postponement of distribution is not
avail.ble if your account balance does not exceed $1,000.
2. Benefit payment options, If your Vested benefit under the Plan does not exceed $5,000, then your benefit may only be paid to
you in a single lump-sum paymenl or directly rolled over to another plan or IRA. If your Vested benefit under the Plan exceeds $5,000.
then you may elect distribution in the following forms'
a Direct rollover.
b Lump-sum payment
You also may elect one form of payment for one part of your vested account balance and another form of payment for another
part of your vested account balance. For example, you may elect direct rollover for part of your vested account balance and a
lump-sum payment for the other part. See the SPECIAL TAX NOTICE: REGARDING PLAN PAYMENTS for rules on splitting your
distriblltion
If yOu are 10S$ than 100% vested in your account balance and you elect to receive your entire vested interest in the Plan (called a
"cash-out") prior to the time you have incurred five consecutive breaks in service, then the nonvested portion of your account balance
will be forfeited. Your eleclion of a cash-out distribulion is a consent to this forfeiture If you return 10 employment with the Employer
before your fifth consecutive break in service, the Plan provides you a 5-year period during which you may repay the entire amount of
your cash-out distribution and restore your forfeited nonvested account balance.
3. Postponement of Distribution, If you do not wish to commence distribution at this time, yOll must complete the
POSTPONEMENT OF DISTRIBUTION ELECTION form. This form allows you to elect a delayed distribution dale. You will receive a
notice frOm the Plan shortly before that delayed distribution date explaining your distribution rights. Under a postponement electron,
your Vested account balance will be subject 10 adjustment for investment gains or losses. 6eC<!use of the investment performance of
the trust fund, the amount the Plan ultimalely pays you at your postponed distribution date could be more or less than the value of
your vested account balance described in this notice. If you fail to complete and return the PARTICIPANT OI$TRIBUTION ELECTION
form or if you fail to specify a laler distribution date in the POSTPONEMENT OF DISTRIBUTION ELECTION form, then the Plan
Administrator Will treat your failur. as an election to defer your distribution until the later af age 62 or Normal Retirement Age
However, unless the Plan imposes a restriction on the timing of your distribution, you may revoke your elecllon to defer distribution
and receive a distribution in accordance with the Plan.
4. Financial Effect of Distribution Options. A direct rollover means the Plan pays the distribution amount directly to another plan
or to a traditional IRA. See SPECIAL TAX NOTICE REGARDING PLAN PAYMENTS, included with your package. A lump-sum
payment means you receive a Single payment of the distribution amount
5. Plan administration and investment fees, Assuming you do not elect to take distribution of your Account and pay immediate
tax on the distribution, you may elect to leave your account in the Plan until a later date or roll over your account to another retirement
plan vehicle (including an IRA). In determining the economic consequences of your choice, you should compare the administration
costs and the investment options (including fees) you will have if your account remains in the Plan to those options you may have
outside the Plan. The Plan may have available a special class of investments with a fee structure that does not apply outside the Plan.
The following information will help you in making the determination:
a. Administration fees/expenses.
After you terminate employment, the Plan will charge your account for its share of the Plan's administration fees/expenses in
the same manner as an active Employee's Account is charged, regardless of whether the Employer pays some or all of
these fees/expenses for current Employees. Please refer to the Summary Plan Description regarding the oharges to your
Account, including, fees charged for the processing of distributions.
The Employer may ohoose to have the Plan (rather than the Employer) pay the administration fee$lexpenses. If the Plan
pays these amounts, the Plan will charge your account for its share of the fees/expenses,
b. Plan investments and investment fees.
The plan has the ability to offer investments that are not available outside the Plan due to each respective mutual fund
company's determination over which share classes can be made available outside a corporate sponsored retirement plan.
For instance, some mutual fund companies have created share classes that can only be used inside corporate sponsored
retirement plans and may nat be used for IRA accounts or on an individual basis. In addition, the Plan offers mutual funds
that have waived any front-end sales charges. The same cla.s of shares outside of the plan may have a front-end sales
charge based on the amount of money being invested. You may contact your Plan Administrator and/or Advisor to obtain
information on the plan investments and investment fees before making your decision to distribute from the Plan.
6. SUbsequont allocations. If subsequent to the distribution, but no more than 180 days from the date the Plan Administrator
prOVided you With the PartiCipant Distribution Notice, the Plan Administrator determines you are eligible for an additional allocation of
e.rnings, fOlieiture. or employer contribution., the Plan Administrator will treat this consent to the distribution as applicable to the
subsequent allocation and will make a subsequent distribution of such amounts in accordance with your election.
7. Boneliciary deslgn.tlon, If you previously signed a DESIGNATION OF BENEFICIARY form, you neod nat sign another
DESIGNATION OF BENEFICIARY form unless you want to change your beneficiary.
6. lJistributlon Charge, I understand the Plan may oharge a reasonable fee for the processing of the distribution.
S. Further information, If you have any question regarding the infollllation provided in this notice or any form included with your
distribution package, please contact the Plan Administralor.
10. Waiver of minimum notice period, I consent to an immediate distribution of my vested account balance. I affirmatively waive
any unexpired portion Of the minimum 30.day notice period during which I may consent to a distribution from the Plan.
EXECUTED this __________ _ day of ______________ , 20_~ _
Signature of Participant
Street Addr~ss (include apartni~nt no) Social Security Number
City State Zip Code Date of Birth
11. Plan Administration, To be completed by the Plan Administrator:
PartiCipant's Dat@ of Termination
Total Hours worked by the PartiCipant in the Plan Year of termination: _____ - __ _
Date the final deposit of Participant's deferrals was made to the plan: ________ _
Date Notice Delivered
NOTE TO PARTtCIPANT: KEEP A COpy OF THIS NOTICE FOR YOUR RECORDS AND RETURN COMPLETED NOTtCE WITH
YOUR COMPLETED ELECTION FORM.
