Contribution Election. I hereby elect to have my current compensation either: (1) not reduced (by circling $0.00), or (2) reduced by the amount I indicate below, in any increment of $0.25, for each hour worked or paid, and to have that amount contributed to the Plan on my behalf by my Employer on a pre-tax basis as a deferral or "401(k)" contribution. CIRCLE $0.00 OR WRITE IN ELECTED AMOUNT*: $0.00 OR $ (any increment of $0.25, e.g., $0.75, $2.25, etc.) * IMPORTANT NOTES TO PARTICIPANTS: During 2023, the maximum 401(k) deferral amount permitted to the Plan by any Participant under the Internal Revenue Code is $22,500 OR $30,000 for those eligible to make "catch-up" deferrals. A Participant is eligible to make "catch-up" deferrals if s/he is at least age 50 in 2023, or will turn age 50 by the end of 2023. Any contributions in excess of the relevant limit would be returned in accordance with applicable Plan and IRS rules. Acknowledgment by Employee: In making a Contribution Election of an elected amount, I acknowledge that such Election will apply only to compensation earned after this Form is signed and returned to my Employer and that it will take effect as soon as is reasonably possible after the submission date indicated below. I also acknowledge that my Election is subject to all of the terms and conditions of the Plan, which are subject to change. I further acknowledge that my Election must normally remain in effect for 90 days, and it will generally remain in effect after that period until I elect a change. I also acknowledge that I may elect to change my Election from my elected amount to $0.00 at any time, but once I do, I must wait for at least 90 days before making any new Contribution Election of an elected amount. Also, I acknowledge that my Contribution Election will expire on the day my employment relationship with my Employer ends. Your Name (please print): Address: Signature: SSN #: Phone #: Birth Year: Date signed: Date Submitted to Employer: (Participant insert date)
Contribution Election. If you have authorized your employer to withhold a percentage of your pay, convert that percentage to an approximate dollar amount. Total pre-tax employee contributions $ Employee Pre-Tax Salary Deferred Employer $ $ $ $ $ $ $ $ Total amount $ $ Total employer contributions $ Total or approximate contributions per pay period $ Employer Payroll Schedule: Weekly Monthly Twice per month Contributions will begin • I am eligible as an employee of either an educational organization (pursuant to Internal Revenue Code Section 170(b) (1)(A)(ii)) or a tax exempt organization (pursuant to Internal Revenue Code Section 501(c)(3)), to elect salary reductions under a 403(b) plan and consent to Thrivent acting as joint payment agent for annuities. • I request that my current employer or authorized representative of the employer remit my 403(b) contributions for purchase of an annuity contract as indicated above. • I have verified that the information on this form is correct and I have determined that the sum of all salary deferrals to all 403(b) plans, 401(k) plans, SIMPLE plans or SARSEP IRA plans I participate in are at or below IRS salary deferral limits for the current year. Neither Thrivent, Thrivent Investment Management Inc., nor the Custodian (if applicable) shall have the responsibility in this regard. This verification is not intended to be an employee self-certification. • I understand that employee 403(b) contributions are in lieu of the compensation payable directly to me. • I agree that if instructions on this agreement are inconsistent with the annuity application, this agreement will control. • I understand that this request shall supersede all prior agreements. Contributions will be allocated according to the contracts listed on this form for new business and/or existing annuities. • I understand that Thrivent must be an approved vendor with the employer sponsoring the plan in order to receive 403(b) contributions.
Contribution Election. Upon becoming a Participant, an Eligible Employee may elect to reduce his or her Pay by an amount which does not exceed the Contribution Dollar Limit or the limits described in the Contribution Percentage Limits paragraph of this Section 3, and have such amount contributed to the Plan by the Employer as a 401(k)
Contribution Election. Effective with respect to amounts earned on or after , 20 (which date is subsequent to the date of execution of this Agreement), your gross pay will be reduced by the percentage or amount indicated below and contributed to the Princeton University Retirement Savings Plan. Princeton University agrees to contribute the elected amount to my Retirement Savings Plan. This amount will not exceed my statutory limitation under IRC 415 or 402(g), whichever is less. If I am age 50 or over, this amount will include any additional catch- up contribution permitted under IRC 414(v). I understand that this Agreement shall be legally binding and will continue until further notice from me. If I have elected to contribute a percentage of my base salary to my 403(b) account, this contribution may increase automatically as my salary increases. If I have elected the maximum contribution, this contribution may increase as the IRC statutory limitations under Section 402(g) increase. To choose your investments log onto xxx.xxxx.xxx/xxxxxxxxx
Contribution Election. I hereby elect to have my current compensation either: (1) not reduced (by circling $0.00), or
Contribution Election. This election is irrevocable and must be made within 60 days of the date of initial eligibility. Contributions will be made on a bi-weekly basis. Hire Date: If you have been previously employed by Genesee County your contribution election must remain as originally elected. Please include your previous employment dates below: Hire Date: Termination Date: Elect one of the mandatory contribution percentages based on the collective bargaining group to which you belong. A 3% default will be elected if no selection is made. NOTE: AFSCME is American Federation of State, County and Municipal Employees. Group A: ⬜ 3% or ⬜ 5% of compensation • AFSCME 496-00 • AFSCME 496-01 • AFSCME 496-03 • AFSCME 916 Supervisors • Teamsters 214 FOC Supervisors • Teamsters 214 Parks Maintenance Group B: ⬜ 3% or ⬜ 7% of compensation • AFSCME 496-02 • AFSCME 916-05 Sergeants • AFSCME 916-06 Lieutenants and Captains • Judicial Administrative Secretaries • Non-Union Employees • Professional Court Officers Association (PCOA) Social Service Workers • Police Officers Association of Michigan (POAM) Beneficiary Designation IMPORTANT NOTES: 1) Allocations must total 100% for each category of beneficiary; and 2) If you designate a single primary or contingent beneficiary and do not list a percentage, it will be designated as 100%. ⬜ I have additional beneficiaries. If you want to designate more than 2 of each type of beneficiary, you may attach a page with the additional beneficiary information. Allocations must still total 100% for each category. Primary Beneficiary(ies) (Allocations must total 100%):
1. Full Name: Allocation: % Relationship: SSN: Date of Birth: Address: Phone:
2. Full Name: Allocation: % Relationship: SSN: Date of Birth: Address: Phone:
3. Full Name: Allocation: % Relationship: SSN: Date of Birth: Address: Phone:
4. Full Name: Allocation: % Relationship: SSN: Date of Birth: Address: Phone: Contingent Beneficiary(ies) (Allocations must total 100%):
1. Full Name: Allocation: % Relationship: SSN: Date of Birth: Address: Phone:
2. Full Name: Allocation: % Relationship: SSN: Date of Birth: Address: Phone:
3. Full Name: Allocation: % Relationship: SSN: Date of Birth: Address: Phone:
4. Full Name: Allocation: % Relationship: SSN: Date of Birth: Address: Phone: Funding Options Lifetime Income Builder Target Date Serie (fund determined by birth year) % NCIT American Funds Lifetime Income Builder % Fidelity® Contrafund (K6) Target Date Series % New World Fund(SM) (Class R6) % Xxxxx & ...
