Exhibit 10.15
NONSTANDARDIZED ADOPTION AGREEMENT
PROTOTYPE CASH OR DEFERRED PROFIT-SHARING PLAN
SPONSORED BY
RETIREMENT ALLIANCE, INC.
The Employer named below hereby establishes a Cash or Deferred Profit-Sharing
Plan for eligible Employees as provided in this Adoption Agreement and the
accompanying Basic Plan Document #01.
I. EMPLOYER INFORMATION
If more than one Employer is adopting the Plan, complete this section
based on the lead Employer. Additional Employers who are members of the
same controlled group or affiliated service group may adopt this Plan
by completing and executing Section XX(A) of the Adoption Agreement.
A. Name And Address:
Sontra Medical Corporation
00 Xxxxxxx Xxxxxx
Xxxxxxxxx, XX 00000
B. Telephone Number: 000-000-0000
C. Employer's Tax ID Number: 00-0000000
D. Form Of Business:
[ ] 1. Sole Proprietor
[ ] 2. Partnership
[X] 3. Corporation
[ ] 4. S Corporation
[ ] 5. Limited Liability Company
[ ] 6. Limited Liability Partnership
[ ] 7. _____________________________
E. Is The Employer Part Of A Controlled Group? [ ] YES [X] NO
Part Of An Affiliated Service Group? [ ] YES [X] NO
F. Name Of Plan: Sontra Medical, Inc. 401(k) Retirement Plan
G. Three Digit Plan Number: 001
H. Employer's Tax Year End: 12/31
I. Employer's Business Code: 541700
II. EFFECTIVE DATE
A. New Plan:
This is a new Plan having an Effective Date of _________________.
B. Amended and Restated Plans:
This is an amendment or restatement of an existing Plan. The
initial Effective Date of the Plan was
________________________________________. The Effective Date of
this amendment or restatement is __________________________.
1 Section 401(k) Plan AA #010
C. Amended or Restated Plans for GUST:
This is an amendment or restatement of an existing Plan to comply
with GUST [The Uruguay Round Agreements, Pub. L. 103-465 (GATT);
The Uniformed Services Employment and Reemployment Rights Act of
1994, Pub. L. 103-353 (USERRA); The Small Business Job Protection
Act of 1996, Pub. L. 104-188 (SBJPA) [including Section 414(u) of
the Internal Revenue Code]; The Taxpayer Relief Act of 1997, Pub.
L. 105-34 (TRA'97); The Internal Revenue Service Restructuring and
Reform Act of 1998, Pub. L. 105-206 (IRSRRA), and The Community
Renewal Tax Relief Act of 2000, Pub. L. 106-554 (CRA). The initial
Effective Date of the Plan was 1/1/99. Except as provided for in
the Plan, the Effective Date of this amendment or restatement is
1/1/02. (The restatement date should be no earlier than the first
day of the current Plan Year. The Plan contains appropriate
retroactive Effective Dates with respect to provisions of GUST.)
Pursuant to Code Section 411(d)(6) and the Regulations issued
thereunder, an Employer cannot reduce, eliminate or make subject
to Employer discretion any Code Section 411(d)(6) protected
benefit. Where this Plan document is being adopted to amend
another plan that contains a protected benefit not provided for in
the Basic Plan Document #01, the Employer may complete Schedule A
as an addendum to this Adoption Agreement. Schedule A describes
such protected benefits and shall become part of this Plan. If a
prior plan document contains a plan feature not provided for in
the Basic Plan Document #01, the Employer may attach Schedule B
describing such feature. Provisions listed on Schedule B are not
covered by the IRS Opinion Letter issued with respect to the Basic
Plan Document #01.
D. Effective Date for Elective Deferrals:
If different from above, the Elective Deferral provisions shall be
effective __________________________.
III. DEFINITIONS
A. "Compensation"
Select the definition of Compensation, the Compensation
Computation Period, any Compensation Dollar Limitation and
Exclusions from Compensation for each Contribution Type from the
options listed below. Enter the letter of the option selected on
the lines provided below. Leave the line blank if no election
needs to be made.
COMPENSATION EXCLUSIONS
EMPLOYER COMPENSATION COMPUTATION COMPENSATION FROM
CONTRIBUTION TYPE DEFINITION PERIOD DOLLAR LIMITATION COMPENSATION
---------------------------------------------------------------------------------
All Contributions b a $ a
---------------------------------------------------------------------------------
Elective Deferrals $
---------------------------------------------------------------------------------
Voluntary After-tax $
---------------------------------------------------------------------------------
Required After-tax $
---------------------------------------------------------------------------------
Safe Harbor $
---------------------------------------------------------------------------------
Non-Safe Harbor
Match Formula 1 $
---------------------------------------------------------------------------------
QNEC/QMAC $
---------------------------------------------------------------------------------
Discretionary $
---------------------------------------------------------------------------------
Non-Safe Harbor
Match Formula 2 $
---------------------------------------------------------------------------------
2 Section 401(k) Plan AA #010
ANTIDISCRIMINATION COMPENSATION COMPENSATION COMPENSATION
TESTS DEFINITION COMPUTATION PERIOD DOLLAR LIMITATION
--------------------------------------------------------------------------
ADP/ACP b a $
--------------------------------------------------------------------------
Compensation Computation Periods must be consistent for all
contribution types, except discretionary. If different Computation
Periods are selected, the selection for ADP/ACP testing will be
deemed to be the election for all purposes except for
Discretionary Contributions.
1. Compensation Definition:
a. Code Section 3401(a) - W-2 Compensation subject to
income tax withholding at the source.
b. Code Section 3401(a) - W-2 Compensation subject to
income tax withholding at the source, with all pre-tax
contributions added.
c. Code Section 6041/6051 - Income reportable on Form W-2.
d. Code Section 6041/6051 - Income reportable on Form W-2,
with all pre-tax contributions added.
e. Code Section 415 - All income received for services
performed for the Employer.
f. Code Section 415 - All income received for services
performed for the Employer, with all pre-tax
contributions excluded.
The Code Section 415 definition will always apply with
respect to sole proprietors and partners.
2. Compensation Computation Period:
a. Compensation paid during a Plan Year while a
Participant.
b. Compensation paid during the entire Plan Year.
c. Compensation paid during the Employer's fiscal year.
d. Compensation paid during the calendar year.
3. Compensation Dollar Limitation: The dollar limitation
section does not need to be completed unless Compensation of
less than the Code Section 401(a)(17) limit of $160,000 (as
indexed) is to be used.
4. Exclusions from Compensation (non-integrated plans only):
a. There will be no exclusions from Compensation under the
Plan.
b. Any amount included in a Participant's gross income due
to the application of Code Sections 125, 132(f)(4),
402(h)(1)(B), 402(e) or 403(b) will be excluded from
the definition of Compensation under the Plan.
c. Overtime
d. Bonuses
e. Commissions
f. Exclusion applies only to Participants who are Highly
Compensated Employees.
3 Section 401(k) Plan AA #010
x. Xxxxxxxxx pay
h. Holiday and vacation pay
i. Other: _______________________________________________
B. "Disability"
[X] 1. As defined in paragraph 1.26 of the Basic Plan Document #01.
[ ] 2. As defined in the Employer's Disability Insurance Plan.
[ ] 3. An individual will be considered to be disabled if he
or she is unable to engage in any substantial gainful
activity by reason of any medically determinable physical or
mental impairment which can be expected to result in death
or to be of long continued and indefinite duration. An
individual shall not be considered to be disabled unless he
or she furnishes proof of the existence thereof in such form
and manner as the Secretary may prescribe.
C. "Highly Compensated Employees - Top-Paid Group Election" For
Plans which are being amended and restated for GUST, please
complete Schedule C outlining the preamendment operation of the
Plan, as well as this section of the Adoption Agreement. The
testing elections made below will apply to the future operation of
the Plan.
[X] 1. Top-Paid Group Election:
In determining who is a Highly Compensated Employee, the
Employer makes the Top-Paid Group election. The effect of
this election is that an Employee (who is not a 5% owner at
any time during the determination year or the look-back
year) who earned more than $80,000, as indexed for the
look-back year, is a Highly Compensated Employee if the
Employee was in the Top-Paid Group for the look-back year.
This election is applicable for the Plan Year in which this
Plan is effective.
[ ] 2. Calendar Year Data Election:
If the Plan Year is not the calendar year, the prior year
computation period for purposes of determining if an
Employee earned more than $80,000, as indexed, is the
calendar year beginning in the prior Plan Year. This
election is applicable for the Plan Year in which this Plan
is effective.
D. "Hour Of Service"
Hours shall be determined by the method selected below. The method
selected shall be applied to all Employees covered under the Plan
as follows:
[ ] 1. Not applicable. For all purposes under the Plan, a
Year of Service (Period of Service) is defined as Elapsed
Time.
[X] 2. On the basis of actual hours for which an Employee is paid
or entitled to payment.
[ ] 3. On the basis of days worked. An Employee shall be
credited with ten (10) Hours of Service if such Employee
would be credited with at least one (1) Hour of Service
during the day.
[ ] 4. On the basis of weeks worked. An Employee shall be
credited with forty-five (45) Hours of Service if the
Employee would be credited with at least one (1) Hour of
Service during the week.
[ ] 5. On the basis of semi-monthly payroll periods. An
Employee shall be credited with
4 Section 401(k) Plan AA #010
ninety-five (95) Hours of Service if such Employee would be
credited with at least one (1) Hour of Service during the
semi-monthly payroll period.
[ ] 6. On the basis of months worked. An Employee shall be
credited with one-hundred-ninety (190) Hours of Service if
such Employee would be credited with at least one (1) Hour
of Service during the month.
E. "Integration Level"
[ ] 1. Not applicable. The Plan's allocation formula is not
integrated with Social Security.
[X] 2. The maximum earnings considered wages for such Plan
Year for Social Security withholding purposes without regard
to Medicare.
[ ] 3. ________% (not more than 100%) of the amount considered
wages for such Plan Year for Social Security withholding
purposes without regard to Medicare.
[ ] 4. $________, provided that such amount is not in excess of
the amount determined under paragraph (E)(2) above.
[ ] 5. One dollar over 80% of the amount considered wages for
such Plan Year for Social Security withholding purposes
without regard to Medicare.
[ ] 6. 20% of the maximum earnings considered wages for such
Plan Year for Social Security withholding purposes without
regard to Medicare.
F. "Limitation Year"
Unless elected otherwise below, the Limitation Year shall be the
Plan Year.
The 12-consecutive month period commencing on January 1 and ending
on December 31.
If applicable, there will be a short Limitation Year commencing on
_________________________ and ending on _________________________.
Thereafter, the Limitation Year shall end on the date specified
above.
G. "Net Profit"
[X] 1. Not applicable. Employer contributions to the Plan are not
conditioned on profits.
[ ] 2. Net Profits are defined as follows:
[ ] a. As defined in paragraph 1.61 of Basic Plan
Document #01.
[ ] b. Net Profits will be defined in a uniform and
nondiscriminatory manner which will not result in a
deprivation of an eligible Participant of any Employer
Contribution.
c. Net Profits are required for the following
contributions:
[ ] i. Employer Non-Safe Harbor Match Formula 1.
[ ] ii. Employer Non-Safe Harbor Match Formula 2.
[ ] iii. Employer QNEC and QMAC.
[ ] iv. Employer discretionary.
Elective Deferrals can always be contributed regardless of
profits. Top-Heavy minimums
5 Section 401(k) Plan AA #010
are required regardless of profits.
H. "Plan Year"
The 12-consecutive month period commencing on January 1 and ending
on December 31.
If applicable, there will be a short Plan Year commencing on
_________________________ and ending on _________________________.
Thereafter, the Plan Year shall end on the date specified above.
I. "QDRO Payment Date"
[X] 1. The date the QDRO is determined to be qualified.
[ ] 2. The statutory age 50 requirement applies for purposes of
making distribution to an alternate payee under the
provisions of a QDRO.
J. "Qualified Joint and Survivor Annuity"
[X] 1. Not applicable. The Plan is not subject to Qualified
Joint and Survivor Annuity rules. The safe harbor provisions
of paragraph 8.7 of the Basic Plan Document #01 apply. The
normal form of payment is a lump sum. No annuities are
offered under the Plan.
[ ] 2. The normal form of payment is a lump sum. The Plan does
provide for annuities as an optional form of payment at
Section XVIII(C) of the Adoption Agreement. Joint and
Survivor rules are avoided unless the Participant elects to
receive his or her distribution in the form of an annuity.
[ ] 3. The Joint and Survivor Annuity rules are applicable and
the survivor annuity will be __________% (50%, 66-2/3%, 75%
or 100%) of the annuity payable during the lives of the
Participant and his or her Spouse. If no selection is
specified, 50% shall be deemed elected.
K. "Qualified Preretirement Survivor Annuity"
Do not complete this section if paragraph (J)(1) was elected.
[ ] 1. The Qualified Preretirement Survivor Annuity shall be 100%
of the Participant's Vested Account Balance in the Plan as
of the date of the Participant's death.
[ ] 2. The Qualified Preretirement Survivor Annuity shall be 50%
of the Participant's Vested Account Balance in the Plan as
of the date of the Participant's death.
L. "Valuation of Plan Assets"
The assets of the Plan shall be valued on the last day of the Plan
Year and on the following Valuation Date(s):
[ ] 1. There are no other mandatory Valuation Dates.
[X] 2. The Valuation Dates are applicable for the contribution type
specified below:
6 Section 401(k) Plan AA #010
CONTRIBUTION TYPE VALUATION DATE
-----------------------------------------------------------
All Contributions a
-----------------------------------------------------------
Elective Deferrals
-----------------------------------------------------------
Voluntary After-tax
-----------------------------------------------------------
Required After-tax
-----------------------------------------------------------
Safe Harbor
-----------------------------------------------------------
Non-Safe Harbor Match Formula 1
-----------------------------------------------------------
QNEC/QMAC
-----------------------------------------------------------
Discretionary
-----------------------------------------------------------
Non-Safe Harbor Match Formula 2
-----------------------------------------------------------
a. Daily valued.
b. The last day of each month.
c. The last day of each quarter in the Plan Year.
d. The last day of each semi-annual period in the Plan
Year.
e. At the discretion of the Plan Administrator.
f. Other: _____________________________________________.
7 Section 401(k) Plan AA #010
IV. ELIGIBILITY REQUIREMENTS
Complete the following using the eligibility requirements as specified
for each contribution type. To become a Participant in the Plan, the
Employee must satisfy the following eligibility requirements.
ELIGIBILITY
MINIMUM SERVICE CLASS COMPUTATION
CONTRIBUTION TYPE AGE REQUIREMENT EXCLUSIONS PERIOD ENTRY DATE
------------------------------------------------------------------------------------
All Contributions 21 1 1, 2 2 3
------------------------------------------------------------------------------------
Elective Deferrals
------------------------------------------------------------------------------------
Voluntary After-tax
------------------------------------------------------------------------------------
Required After-tax
------------------------------------------------------------------------------------
Safe Harbor Contribution*
------------------------------------------------------------------------------------
Non-Safe Harbor Match -
Formula 1
------------------------------------------------------------------------------------
QNECs
------------------------------------------------------------------------------------
QMACs
------------------------------------------------------------------------------------
Employer Discretionary
------------------------------------------------------------------------------------
Non-Safe Harbor Match -
Formula 2
------------------------------------------------------------------------------------
*If any age or Service requirement selected is more restrictive than
that which is imposed on any Employee contribution, that group of
Employees will be subject to the ADP and/or ACP testing as prescribed
under IRS Notices 98-52, 2000-3 and any applicable IRS Regulations.
A. Age:
1. No age requirement.
2. Insert the applicable age in the chart above. The age may
not be more than 21.
B. Service:
1. No Service requirement.
2. _______ months of Service (insert number of months
applicable to the specified contribution type).
3. _______ months of Service (insert number of months
applicable to the specified contribution type).
4. 1 Year of Service or Period of Service.
5. 2 Years of Service or Periods of Service.
6. 1 Expected Year of Service. May enter after six (6) months
of actual Service.
7. 1 Expected Year of Service. May enter after __________
months of actual Service [must be less than one (1) Year].
8. 1 Expected Year of Service. May enter after __________
months of actual Service [must be less than one (1) Year].
8 Section 401(k) Plan AA #010
9. Completion of ___________ Hours of Service within the
___________ month(s) time period following an Employee's
commencement of employment.
No more than 83 1/3 Hours of Service may be required during each
such month; provided, however, that the Employee shall become a
Participant no later than upon the completion of 1,000 Hours of
Service within an Eligibility Computation Period and the
attainment of the minimum age requirement.
The maximum Service requirement for Elective Deferrals is 1 year.
For all other contributions, the maximum is 2 years. If a Service
requirement greater than 1 year is selected, Participants must be
100% vested in that contribution.
A Year of Service for eligibility purposes is defined as follows
(choose one):
Do not enter this definition in the table above.
[ ] 10. Not applicable. There is no Service requirement.
[X] 11. Not applicable. The Plan is using Expected Year of
Service or has a Service requirement of less than one
(1) year.
[ ] 12. Hours of Service method. A Year of Service will be
credited upon completion of ____________ Hours of Service. A
Year of Service for eligibility purposes may not be less
than 1 Hour of Service nor greater than 1,000 hours by
operation of law. If left blank, the Plan will use 1,000
hours.
[ ] 13. Elapsed Time method.
C. Employee Class Exclusions:
1. Employees included in a unit of Employees covered by a
collective bargaining agreement between the Employer and
Employee Representatives, if benefits were the subject of
good faith bargaining and if two percent or less of the
Employees are covered pursuant to the agreement are
professionals as defined in Section 1.410(b)-9 of the
Regulations. For this purpose, the term "employee
representative" does not include any organization more than
half of whose members are owners, officers, or executives of
the Employer.
2. Employees who are non-resident aliens [within the
meaning of Code Section 7701(b)(1)(B)] who receive no Earned
Income [within the meaning of Code Section 911(d)(2)] from
the Employer which constitutes income from sources within
the United States [within the meaning of Code Section
861(a)(3)].
3. Employees compensated on an hourly basis.
4. Employees compensated on a salaried basis.
5. Employees compensated on a commission basis.
6. Leased Employees.
7. Highly Compensated Employees.
8. The Plan shall exclude from participation any
nondiscriminatory classification of Employees determined as
follows: __________________________________________________
___________________________________________________________
D. Eligibility Computation Period: The initial Eligibility
Computation Period shall commence on the date on which an Employee
first performs an Hour of Service and the first anniversary
9 Section 401(k) Plan AA #010
thereof. Each subsequent Computation Period shall commence on:
1. Not applicable. The Plan has a Service requirement of
less than one (1) year or uses the Elapsed Time method to
determine eligibility.
2. The anniversary of the Employee's employment commencement
date and each subsequent 12-consecutive month period
thereafter.
3. The first day of the Plan Year which commences prior to the
first anniversary date of the Employee's employment
commencement date and each subsequent Plan Year thereafter.
E. Entry Date Options:
1. The first day of the month coinciding with or next
following the date on which an Employee meets the
eligibility requirements.
2. The first day of the payroll period coinciding with or
next following the date on which an Employee meets the
eligibility requirements.
3. The earlier of the first day of the Plan Year, or the first
day of the fourth, seventh or tenth month of the Plan Year
coinciding with or next following the date on which an
Employee meets the eligibility requirements.
4. The earlier of the first day of the Plan Year or the
first day of the seventh month of the Plan Year coinciding
with or next following the date on which an Employee meets
the eligibility requirements.
5. The first day of the Plan Year following the date on
which the Employee meets the eligibility requirements. If
this election is made, the Service waiting period cannot be
greater than one-half year and the minimum age requirement
may not be greater than age 20 1/2.
6. The first day of the Plan Year nearest the date on
which an Employee meets the eligibility requirements. This
option can only be selected for Employer related
contributions.
7. The first day of the Plan Year during which the
Employee meets the eligibility requirements. This option can
only be selected for Employer related contributions.
8. The Employee's date of hire.
F. Employees on Effective Date:
[X] 1. All Employees will be required to satisfy both the
age and Service requirements specified above.
[ ] 2. Employees employed on the Plan's Effective Date do not
have to satisfy the age requirement specified above.
[ ] 3. Employees employed on the Plan's Effective Date do not
have to satisfy the Service requirement specified above.
G. Special Waiver of Eligibility Requirements:
The age and/or Service eligibility requirements specified above
shall be waived for those eligible Employees who are employed on
the following date for the contribution type(s) specified. This
waiver applies to either the age or service requirement or both as
elected below:
10 Section 401(k) Plan AA #010
WAIVER OF AGE WAIVER OF SERVICE
WAIVER DATE REQUIREMENT REQUIREMENT CONTRIBUTION TYPE
------------------------------------------------------------------------------
All Contributions
------------------------------------------------------------------------------
Elective Deferrals
------------------------------------------------------------------------------
Employer Discretionary
------------------------------------------------------------------------------
Non-Safe Harbor Match Formula 1
------------------------------------------------------------------------------
Safe Harbor Contribution
------------------------------------------------------------------------------
QNEC
------------------------------------------------------------------------------
QMAC
------------------------------------------------------------------------------
Non-Safe Harbor Match Formula 2
V. RETIREMENT AGES
A. Normal Retirement:
[X] 1. Normal Retirement Age shall be age 65 (not to exceed 65).
[ ] 2. Normal Retirement Age shall be the later of attaining
age ________ (not to exceed age 65) or the ________ (not to
exceed the fifth) anniversary of the first day of the first
Plan Year in which the Participant commenced participation
in the Plan.
3. The Normal Retirement Date shall be:
[X] a. as of the date the Participant attains Normal
Retirement Age.
[ ] b. the first day of the month next following the
Participant's attainment of Normal Retirement Age.
B. Early Retirement:
[ ] 1. Not applicable.
[X] 2. The Plan shall have an Early Retirement Age of 55
(not less than age 55) and completion of 0 Years of Service.
3. The Early Retirement Date shall be:
[X] a. as of the date the Participant attains Early
Retirement Age.
[ ] b. the first day of the month next following the
Participant's attainment of Early Retirement Age.
VI. EMPLOYEE CONTRIBUTIONS
A. Elective Deferrals:
[ ] 1. Up to ____________%.
[ ] 2. Participants shall be permitted to make Elective
Deferrals in any amount from a minimum of _______% to a
maximum of _______% of their Compensation not to exceed
$_____________.
[ ] 3. Participants shall be permitted to make Elective
Deferrals in a flat dollar amount from a minimum of
$______________ to a maximum of $_____________, not to
exceed ______% of their Compensation.
[X] 4. Up to the maximum percentage of Compensation and dollar
amount permissible under Section 402(g) of the Internal
Revenue Code not to exceed the limits of Code Sections
401(k), 404 and 415.
11 Section 401(k) Plan AA #010
B. Bonus Option:
[ ] 1. Not applicable.
[X] 2. Bonuses paid by the Employer are included in the definition
of Compensation and the Employer permits a Participant to
amend their deferral election to defer to the Plan, an
amount not to exceed 100% or $_________ of any bonus
received by the Participant for any Plan Year.
C. Automatic Enrollment: The Employer elects the automatic enrollment
provisions as follows:
[ ] 1. New Employees. Employees who have not met the eligibility
requirements shall have Elective Deferrals withheld in the
amount of ________% of Compensation or $________ of
Compensation upon entering the Plan.
[ ] 2. Current Participants. Current Participants who are deferring
at a percentage less than the amount selected herein shall
have Elective Deferrals withheld in the amount of ________%
of Compensation or $________ of Compensation.
[ ] 3. Current Employees. Employees who are eligible to participate
but not deferring shall have Elective Deferrals withheld in
the amount of ______ % of Compensation or $_________ of
Compensation.
Employees and Participants shall have the right to amend the
stated automatic Elective Deferral percentage or receive cash in
lieu of deferral into the Plan.
D. Voluntary After-tax Contributions:
[X] 1. The Plan does not permit Voluntary After-tax Contributions.
[ ] 2. Participants may make Voluntary After-tax Contributions in
any amount from a minimum of ________% to a maximum of
______% of their Compensation or a flat dollar amount from a
minimum of $____________ to a maximum of $______________.
If recharacterization of Elective Deferrals has been elected at
Section XII(D) in this Adoption Agreement, Voluntary After-tax
Contributions must be permitted in the Plan by completing the
section above.
E. Required After-tax Contributions (Thrift Savings Plans only):
[X] 1. The Plan does not permit Required After-tax Contributions.
[ ] 2. Participants shall be required to make Required After-tax
Contributions as follows:
[ ] a. ________% of Compensation.
[ ] b. A percentage determined by the Employee.
F. Rollover Contributions:
[ ] 1. The Plan does not accept Rollover Contributions.
[ ] 2. Participants may make Rollover Contributions after meeting
the eligibility requirements for participation in the Plan.
[X] 3. Employees may make Rollover Contributions prior to meeting
the eligibility
12 Section 401(k) Plan AA #010
requirements for participation in the Plan.
G. Elective Plan to Plan Transfer Contributions:
[X] 1. The Plan does not accept Transfer Contributions.
[ ] 2. Participants may make Transfer Contributions after meeting
the eligibility requirements for participation in the Plan.
[ ] 3. Employees may make Transfer Contributions prior to meeting
the eligibility requirements for participation in the Plan.
H. Changes to Elective Deferrals:
Participants shall be permitted to terminate their Elective
Deferrals at any time upon proper and timely notice to the
Employer. Modifications to Participants' Elective Deferrals will
become effective on a prospective basis as provided for below:
[ ] 1. On a daily basis.
[ ] 2. Upon _____ (not to exceed 90) days notice to the Plan
Administrator.
[X] 3. On the first day of each quarter.
[ ] 4. On the first day of the next month.
[ ] 5. The beginning of the next payroll period.
I. Reinstatement of Elective Deferrals:
Participants who terminate their Elective Deferrals shall be
permitted to reinstate their Elective Deferrals on a prospective
basis as provided for below:
[ ] 1. On a daily basis.
[ ] 2. Upon _____ (not to exceed 90) days notice to the Plan
Administrator.
[X] 3. On the first day of each quarter.
[ ] 4. On the first day of the next month.
[ ] 5. The beginning of the next payroll period.
VII. SAFE HARBOR PLAN PROVISIONS
[ ] The Employer elects to comply with the Safe Harbor Cash or Deferred
Arrangement provisions of Article XI of Basic Plan Document #01 and
elects one of the following contribution formulas:
A. Safe Harbor Tests:
[ ] 1. Only the ADP and not the ACP Test Safe Harbor provisions are
applicable.
[ ] 2. Both the ADP and ACP Test Safe Harbor provisions are
applicable. If both ADP and ACP provisions are applicable:
[ ] a. No additional Matching Contributions will be made in
any Plan Year in which the Safe Harbor provisions are
used.
00 Xxxxxxx 000(x) Xxxx XX #000
[ ] b. The Employer may make Matching Contributions in
addition to any Safe Harbor Matching Contributions
elected below. (Complete provisions in Article VIII
regarding Matching Contributions that will be made in
addition to those Safe Harbor Matching Contributions
made below.)
[ ] B. Designation of Alternate Plan to Receive Safe Harbor Contribution:
If the Safe Harbor Contribution as elected below is not being made
to this Plan, the name of the other plan that will receive the
Safe Harbor Contribution is: ____________________________________
_________________________________________________________________
[ ] C. Basic Matching Contribution Formula:
Matching Contributions will be made on behalf of Participants in
an amount equal to 100% of the amount of the Eligible
Participant's Elective Deferrals that do not exceed 3% of the
Participant's Compensation and 50% of the amount of the
Participant's Elective Deferrals that exceed 3% of the
Participant's Compensation but that do not exceed 5% of the
Participant's Compensation.
[ ] D. Enhanced Matching Contribution Formula:
Matching Contributions will be made in an amount equal to the sum
of:
[ ] 1. _________% (may not be less than 100%) of the Participant's
Elective Deferrals that do not exceed _________% (if more
than 6% or if left blank, the ACP Test will apply) of the
Participant's Compensation, plus
[ ] 2. _________% of the Participant's Elective Deferrals that
exceed _________% of the Participant's Compensation but do
not exceed _________% (if more than 6% or if left blank the
ACP Test will apply) of the Participant's Compensation.
This section must be completed so that at any rate of Elective
Deferrals, the Matching Contribution is at least equal to the
Matching Contribution received if the Employer used the Basic
Matching Contribution Formula. The rate of match cannot increase
as Elective Deferrals increase. If an additional discretionary
match is made, the dollar amount may not exceed 4% of the
Participant's Compensation.
[ ] E. Guaranteed Non-Elective Contribution Formula:
The Employer shall make a Non-Elective Contribution equal to
_________% (not less than 3%) of the Compensation of each Eligible
Participant.
[ ] F. Flexible Non-Elective Contribution Formula:
This provision provides the Employer with the ability to amend the
Plan to comply with the Safe Harbor provisions during the Plan
Year. To provide such option, the Employer must amend the Plan and
indicate on Schedule D that the Safe Harbor Non-Elective
Contribution (not less than 3%) will be made for the specified
Plan Year. Such election must comply with all the applicable
notice requirements.
Additional Non-Safe Harbor contributions may be made to the Plan
pursuant to Article XI of Basic Plan Document #01.
[ ] G. Limitations on Safe Harbor Matching Contributions:
If a Safe Harbor Matching Contribution is made to the Plan:
[ ] 1. The Employer will annualize the Safe Harbor Matching
Contributions.
14 Section 401(k) Plan AA #010
[ ] 2. The Employer will not annualize the Safe Harbor Matching
Contributions and elects to match actual Elective Deferrals
made:
[ ] a. on a payroll basis.
[ ] b. on a monthly basis.
[ ] c. on a Plan Year quarterly basis.
If no election is made, the payroll period method will be
used. If one of the Matching Contribution calculation
periods at Section VII(G)(2) above is selected Matching
Contributions must be deposited to the Plan not later than
the last day of the calendar quarter next following the
quarter following to which they relate.
If the Safe Harbor Plan provisions are elected, the antidiscrimination
tests at Article XI of the Basic Plan Document #01 are not applicable.
Safe Harbor Contributions made are subject to the withdrawal
restrictions of Code Section 401(k)(2)(B) and Treasury Regulations
Section 1.401(k)-1(d); such contributions (and earnings thereon) must
not be distributable earlier than separation from Service, death,
Disability, an event described in Code Section 401(k)(10), or in the
case of a profit-sharing or stock bonus plan, the attainment of age 59
1/2. Safe Harbor Contributions are NOT available for Hardship
withdrawals.
The ACP Test Safe Harbor is automatically satisfied if the only
Matching Contribution to the Plan is either a Basic Matching
Contribution or an Enhanced Matching Contribution that does not provide
a match on Elective Deferrals in excess of 6% of Compensation. For
Plans that allow Voluntary or Required After-tax Contributions, the ACP
Test is applicable with regard to such contributions.
Employees eligible to make Elective Deferrals to this Plan must be
eligible to receive the Safe Harbor Contribution in the Plan listed
above, to the extent required by IRS Notices 98-2 and 2000-3.
15 Section 401(k) Plan AA #010
VIII. EMPLOYER CONTRIBUTIONS
The Employer shall make contributions to the Plan in accordance with
the formula or formulas selected below. The Employer's contribution
shall be subject to the limitations contained in Articles III and X.
For this purpose, a contribution for a Plan Year shall be limited by
Compensation earned in the Limitation Year which ends with or within
such Plan Year.
Do not complete this Section of the Adoption Agreement if the Plan only
offers a Safe Harbor Contribution. A Plan that offers both a Safe
Harbor Matching Contribution as well as an additional Matching
Contribution which is specified below, must complete both Sections VII
and VIII of the Adoption Agreement.
A. Matching Employer Contribution:
Select the Matching Contribution Formula, Computation Period and
special Limitations for each contribution type from the options
listed below. Enter the letter of the option(s) selected on the
lines provided. Leave the line blank if no election is required.
NON-SAFE NON-SAFE
HARBOR MATCHING HARBOR MATCHING
TYPE OF MATCHING COMPUTATION MATCHING COMPUTATION
CONTRIBUTION FORMULA 1 PERIOD LIMITATIONS FORMULA 2 PERIOD LIMITATIONS
----------------------------------------------------------------------------------------
Elective c d
Deferrals
----------------------------------------------------------------------------------------
Voluntary
After-tax
----------------------------------------------------------------------------------------
Required
After-tax
----------------------------------------------------------------------------------------
403(b)
Deferrals
----------------------------------------------------------------------------------------
If any election is made with respect to "403(b) Deferrals" above,
and if this Plan is used to fund any Employer Contributions,
Employer Contributions will be based on the Elective Deferrals
made to an existing 403(b) plan sponsored by the Employer.
Name of corresponding 403(b) plan: ______________________________
1. Matching Contribution Formulas:
Elective Deferral Matching Contribution Formulas:
a. Percentage of Deferral Match: The Employer shall
contribute to each eligible Participant's account an
amount equal to _________% of the Participant's
Elective Deferrals up to a maximum of _________% or
$_________ of Compensation.
b. Uniform Dollar Match: The Employer shall contribute to
each eligible Participant's account $________ if the
Participant who contributes at least ________% or
$__________ of Compensation. The Employer's
contribution will be made up to a maximum of _____% of
Compensation.
16 Section 401(k) Plan AA #010
c. Discretionary Match: The Employer's Matching
Contribution shall be determined by the Employer with
respect to each Plan Year. The Matching Contribution
shall be contributed to each eligible Participant in
accordance with the nondiscriminatory formula
determined by the Employer. If this Plan is also
utilizing a Safe Harbor Contribution, pursuant to
Section VII of this Adoption Agreement, Discretionary
Matching Contributions may not exceed 4% of
Compensation.
d. Tiered Match: The Employer shall contribute to each
eligible Participant's account an amount equal to:
________% of the first ________% of the Participant's
Compensation contributed, and
________% of the next ________% of the Participant's
Compensation contributed, and
________% of the next ________% of the Participant's
Compensation contributed.
The Employer's contribution will be made up to the [ ]
greater of [ ] lesser of _________% of Compensation, or
$__________.
The percentages specified above may not increase as the
percentage of Participant's contribution increases.
e. Percentage of Compensation Match: The Employer shall
contribute to each eligible Participant's account
________% of Compensation if the eligible Participant
contributes at least ________% of Compensation.
The Employer's contribution will be made up to the [ ]
greater of [ ] lesser of _________% of Compensation, or
$__________.
f. Proportionate Compensation Match: The Employer shall
contribute to each eligible Participant who defers at
least ________% of Compensation, an amount determined
by multiplying such Employer Matching Contribution by a
fraction, the numerator of which is the Participant's
Compensation and the denominator of which is the
Compensation of all Participants eligible to receive
such an allocation.
The Employer's contribution will be made up to the [ ]
greater of [ ] lesser of _________% of Compensation, or
$__________.
g. Length of Service Match: The Employer shall make
Matching Contributions equal to the formula determined
under the following schedule:
Participant's Total Matching
Years of Service Contribution Formula
------------------- --------------------
_________ ____________________
_________ ____________________
_________ ____________________
Each separate matching percentage contribution must
satisfy Code Section 401(a)(4) nondiscrimination
requirements and the ACP test.
Voluntary After-tax Matching Contribution Formulas:
h. Percentage of Deferral Match: The Employer shall
contribute to each eligible
17 Section 401(k) Plan AA #010
Participant's account an amount equal to ______% of the
Participant's Voluntary After-tax Contributions up to a
maximum of ______% or $__________ of Compensation.
i. Uniform Dollar Match: The Employer shall contribute to
each eligible Participant's account $________ if the
Participant at contributes least ________% or $________
of Compensation. The Employer's contribution will be
made up to a maximum of _____% of Compensation.
j. Discretionary Match: The Employer's Matching
Contribution shall be determined by the Employer with
respect to each Plan Year. The Matching Contribution
shall be contributed to each eligible Participant in
accordance with the nondiscriminatory formula
determined by the Employer.
Required After-tax Matching Contribution Formulas:
k. Percentage of Deferral Match: The Employer shall
contribute to each eligible Participant's account an
amount equal to ________% of the Participant's Required
After-tax Contributions up to a maximum of ________% or
$__________ of Compensation.
l. Uniform Dollar Match: The Employer shall contribute to
each eligible Participant's account $________ if the
Participant contributes at least _______% or
$__________ of Compensation. The Employer's
contribution will be made up to a maximum of ______% of
Compensation.
m. Discretionary Match: The Employer's Matching
Contribution shall be determined by the Employer with
respect to each Plan Year. The Matching Contribution
shall be contributed to each eligible Participant in
accordance with the nondiscriminatory formula
determined by the Employer.
If the Matching Contribution formula selected by the
Employer is 100% vested and may not be distributed to the
Participant before the earlier of the date the Participant
separates from Service, retires, becomes disabled, attains
59 1/2, or dies, it may be treated as a Qualified Matching
Contribution.
403(b) Matching Contribution Formulas:
n. Percentage of Deferral Match: The Employer shall
contribute to each eligible Participant's account an
amount equal to ________% of the Participant's 403(b)
Deferrals up to a maximum of ________% or $__________
of Compensation.
o. Uniform Dollar Match: The Employer shall contribute to
each eligible Participant's account $________ if the
Participant contributes at least ______% or
$___________ of Compensation. The Employer's
contribution will be made up to a maximum of ______% of
Compensation.
p. Discretionary Match: The Employer's Matching
Contribution shall be determined by the Employer with
respect to each Plan Year. The Matching Contribution
shall be contributed to each eligible Participant in
accordance with the nondiscriminatory formula
determined by the Employer.
18 Section 401(k) Plan AA #010
2. Matching Contribution Computation Period: The Compensation
or any dollar limitation imposed in calculating the match
will be based on the period selected below. Matching
Contributions will be calculated on the following basis:
a. Weekly
b. Bi-weekly
c. Semi-monthly
d. Monthly
e. Quarterly
f. Semi-annually
g. Annually
h. Payroll Based
The calculation of Matching Contributions based on the
Computation Period selected above has no applicability as to
when the Employer remits Matching Contributions to the
Trust.
3. Limitations on Matching Formulas:
a. Annualization of Matching Contributions. The Employer
elects to annualize Matching Contributions made to the
Plan.
If this election is not made, Matching Contributions
will not be annualized.
b. Contributions to Participants who are not Highly
Compensated Employees: Contribution of the Employer's
Matching Contribution will be made only to eligible
Participants who are Non-Highly Compensated Employees.
c. Deferrals withdrawn prior to the end of the Matching
Computation Period: Matching Contributions (whether or
not Qualified) will not be made on Employee
contributions withdrawn prior to the end of the [ ]
Matching Computation Period, or [ ] Plan Year.
If elected [ ], this requirement shall apply in the
event of a withdrawal occurring as the result of a
termination of employment for reasons of retirement,
Disability or death.
4. Qualified Matching Contributions (QMAC):
[ ] a. For purposes of the ADP or ACP Test, all Matching
Contributions made to the Plan will be deemed
"Qualified" for purposes of calculating the Actual
Deferral Percentage and/or Actual Contribution
Percentage. All Matching Contributions must be fully
vested when made and are not available for in-service
withdrawal.
[X] b. For purposes of the ADP or ACP Test, only Matching
Contributions made to the Plan that are needed to meet
the Actual Deferral Percentage or Actual Contribution
Percentage Test will be deemed "Qualified" for purposes
of calculating the Actual Deferral Percentage and/or
Actual Contribution Percentage. All such Matching
Contributions used must be fully vested when made and
are not available for in-service withdrawal.
5. Qualified Non-Elective Contributions (QNEC):
[ ] a. For purposes of the ADP or ACP Test, all Non-Elective
Contributions made to the Plan will be deemed
"Qualified" for purposes of calculating the Actual
Deferral Percentage and/or Actual Contribution
Percentage. All Non-Elective Contributions must be
fully vested when made and are not available for
in-service withdrawal.
19 Section 401(k) Plan AA #010
[X] b. For purposes of the ADP or ACP Test, only the
Non-Elective Contributions made to the Plan that are
needed to meet the Actual Deferral Percentage or Actual
Contribution Percentage Test will be deemed "Qualified"
for purposes of calculating the Actual Deferral
Percentage and/or Actual Contribution Percentage. All
such Non-Elective Contributions used must be fully
vested when made and are not available for in-service
withdrawal.
B. Qualified Matching (QMAC) and Qualified Non-Elective (QNEC)
Employer Contribution Formulas:
[ ] 1. QMAC Contribution Formula: The Employer may contribute to
each eligible Participant's Qualified Matching account an
amount equal to (select one or more of the following):
[ ] a. $________ or _______% of the Participant's Elective
Deferrals.
[ ] b. $________ or _______% of the Participant's Voluntary
After-tax Contributions.
[ ] c. $________ or _______% of the Participant's Required
After-tax Contributions.
[ ] 2. Discretionary QMAC Contribution Formula: The Employer shall
have the right to make a discretionary QMAC contribution.
The Employer's Matching Contribution shall be determined by
the Employer with respect to each Plan Year's eligible
Participants. This part of the Employer's contribution shall
be fully vested when made.
[ ] 3. Discretionary Percentage QNEC Contribution Formula: The
Employer shall have the right to make a discretionary QNEC
contribution which shall be allocated to each eligible
Participant's account in proportion to his or her
Compensation as a percentage of the Compensation of all
eligible Participants. This part of the Employer's
contribution shall be fully vested when made. This
contribution will be made to:
[ ] a. All eligible Participants.
[ ] b. Only eligible Participants who are Non-Highly
Compensated Employees.
[ ] 4. Discretionary Uniform Dollar QNEC Contribution Formula: The
Employer shall have the right to make a discretionary QNEC
contribution which shall be allocated to each eligible
Participant's account in a uniform dollar amount to be
determined by the Employer and allocated in a
nondiscriminatory manner. This part of the Employer's
contribution shall be fully vested when made and not
available for in-service withdrawal. This contribution will
be made to:
[ ] a. All eligible Participants.
[ ] b. Only eligible Participants who are Non-Highly
Compensated Employees.
[X] 5. Corrective QNEC Contribution Formula: The Employer shall
have the right to make a QNEC contribution in the amount
necessary to pass the ADP/ACP Test or the maximum permitted
under Code Section 415. This contribution will be allocated
to some or all Non-Highly Compensated Participants
designated by the Plan Administrator. The allocation will be
the lesser of the amount required to pass the ADP/ACP Test,
or the maximum permitted under Code Section 415 and is not
available for in-service withdrawal. This part of the
Employer's contribution shall be fully vested when made.
[ ] C. Discretionary Employer Contribution - Non-Integrated Formula: The
Employer shall have the right to make a discretionary
contribution. The Employer's contribution for the Plan Year shall
be made to the accounts of eligible Participants as follows:
[ ] 1. Such contribution shall be allocated as a percentage of the
Employer's Net Profits.
20 Section 401(k) Plan AA #010
[ ] 2. Such contribution shall be allocated as a percentage of
Compensation of eligible Participants for the Plan Year.
[ ] 3. Such contribution shall be allocated in an amount fixed by
an appropriate action of the Employer as of the time
prescribed by law.
[ ] 4. Such contribution shall be allocated equally in a uniform
dollar amount to each eligible Participant.
[ ] 5. Such contribution shall be allocated in the same dollar
amount to each eligible Participant per Hour of Service the
Participant is entitled to Compensation.
[X] D. Discretionary Employer Contribution - Excess Integrated Allocation
Formula: The Employer shall have the right to make a discretionary
contribution. The Employer's contribution for the Plan Year shall
be allocated to the accounts of eligible Participants as follows:
Only one plan maintained by the Employer may be integrated with
Social Security. Any Plan utilizing a Safe Harbor formula provided
in Section VII of this Adoption Agreement may not apply the Safe
Harbor Contribution to the integrated allocation formula. If the
Plan is not Top-Heavy or if the Top-Heavy minimum contribution or
benefit is provided under another Plan covering the same
Employees, paragraphs (1) and (2) below may be disregarded and
5.7%, 5.4% or 4.3% may be substituted for 2.7%, 2.4% or 1.3% where
it appears in paragraph (3) below.
1. Step One: To the extent contributions are sufficient, all
Participants will receive an allocation equal to 3% of their
Compensation.
2. Step Two: Any remaining Employer contributions will be
allocated up to a maximum of 3% of excess Compensation of
all Participants to Participants who have Compensation in
excess of the Integration Level (excess Compensation). Each
such Participant will receive an allocation in the ratio
that his or her excess Compensation bears to the excess
Compensation of all Participants. If Employer contributions
are insufficient to fund to this level, the Employer must
determine the uniform allocation percentage to allocate to
those Participants who have Compensation in excess of the
Integration Level. To determine this uniform allocation
percentage, the Employer must take the remaining
contribution and divide that amount by the total excess
Compensation of Participants.
3. Step Three: Any remaining Employer contributions will be
allocated to all Participants in the ratio that their
Compensation plus excess Compensation bears to the total
Compensation plus excess Compensation of all Participants.
Participants may only receive an allocation of up to 2.7% of
their Compensation plus excess Compensation, under this
allocation step. If the Integration Level defined at Section
III(E) is less than or equal to the greater of $10,000 or
20% of the maximum, the 2.7% need not be reduced. If the
amount specified is greater than the greater of $10,000 or
20% of the maximum Taxable Wage Base, but not more than 80%,
2.7% must be reduced to 1.3%. If the amount specified is
greater than 80% but less than 100% of the maximum Taxable
Wage Base, the 2.7% must be reduced to 2.4%. If Employer
contributions are insufficient to fund to this level, the
Employer must determine the uniform allocation percentage to
allocate to those Participants who have Compensation up to
the Integration Level and excess Compensation. To determine
this uniform allocation percentage, the Employer must take
the remaining contribution and divide that amount by the
total Compensation including excess Compensation of
Participants.
4. Step Four: Any remaining Employer contributions will be
allocated to all Participants in the ratio that each
Participant's Compensation bears to all Participants'
Compensation.
[ ] E. Discretionary Employer Contribution - Base Integrated Allocation
Formula: The Employer shall have the right to make a discretionary
contribution. To the extent that such contributions
21 Section 401(k) Plan AA #010
are sufficient, they shall be allocated as follows:
________% of each eligible Participant's Compensation, plus
________% of Compensation in excess of the Integration Level
defined at Section III(E) hereof.
The percentage of excess Compensation may not exceed the lesser of
(i) the amount first specified in this paragraph or (ii) the
greater of 5.7% or the percentage rate of tax under Code Section
3111(a) as in effect on the first day of the Plan Year
attributable to the Old Age (OA) portion of the OASDI provisions
of the Social Security Act. If the Employer specifies an
Integration Level in Section III(E) which is lower than the
Taxable Wage Base for Social Security purposes (SSTWB) in effect
as of the first day of the Plan Year, the percentage contributed
with respect to excess Compensation must be adjusted. If the
Plan's Integration Level is greater than the larger of $10,000 or
20% of the SSTWB but not more than 80% of the SSTWB, the excess
percentage is 4.3%. If the Plan's Integration Level is greater
than 80% of the SSTWB but less than 100% of the SSTWB, the excess
percentage is 5.4%.
Only one Plan maintained by the Employer may be integrated with
Social Security. Any Plan utilizing a Safe Harbor formula as
provided in Section VII of this Adoption Agreement may not apply
the Safe Harbor Contributions to the integrated allocation
formula.
[ ] F. Uniform Points Allocation Formula: The allocation for each
eligible Participant will be determined by a uniform points
method. Each eligible Participant's allocation shall bear the same
relationship to the Employer contribution as the Participant's
total points bears to all points awarded. Each eligible
Participant will receive _____ points for each of the following:
[ ] 1. _____ year(s) of age.
[ ] 2. _____ Year(s) of Service determined:
[ ] a. In the same manner as determined for eligibility.
[ ] b. In the same manner as determined for vesting.
[ ] c. Points will not be awarded with respect to Year(s)
of Service in excess of ________.
[ ] 3. $_________ (not to exceed $200) of Compensation.
[ ] G. Additional Adopting Employers:
[ ] 1. All participating Employers' contributions under Section
VIII entitled "Employer Contributions" above and
forfeitures, if applicable, attributable to each specific
contribution source shall be pooled together and allocated
uniformly among all eligible Participants.
[ ] 2. Each participating Employer's contribution under Section
VIII above and forfeitures attributable to each specific
contribution source made by such Employer shall be allocated
only to eligible Participants of the participating Employer.
Where contributions and forfeitures are to be allocated to
eligible Participants by participating Employers, each such
Employer must maintain data demonstrating that the allocations by
group satisfy the nondiscrimination rules under Code Section
401(a)(4).
22 Section 401(k) Plan AA #010
[X] H. Minimum Employer Contribution Formula Under Top-Heavy Plans:
For any Plan Year during which the Plan is Top-Heavy, the sum of
the contributions (excluding Elective Deferrals and/or Matching
Contributions) allocated to non-Key Employees shall not be less
than the amount required under the Basic Plan Document #01. The
eligibility of a Participant to receive Top-Heavy Contributions
mirrors the eligibility for any contribution with the earliest
Entry Date. Top-Heavy minimums will be allocated to:
[ ] 1. all eligible Participants.
[X] 2. only eligible non-Key Employees who are Participants.
IX. ALLOCATIONS TO PARTICIPANTS
A. This is a Safe Harbor Plan:
[ ] Employer Non-Elective and/or Matching Contributions will be made
to all Employees who have satisfied the Safe Harbor eligibility
requirements.
B. Allocation Accrual Requirements:
A Year of Service for eligibility to receive an allocation of
Employer contributions will be determined on the basis of the:
[ ] 1. Elapsed Time method.
[X] 2. Hours of Service method. A Year of Service will be credited
upon completion of the requirements below. A Year of Service
for allocation accrual purposes cannot be less than 1 Hour
of Service nor greater than 1,000 hours by operation of law.
If left blank, the Plan will use 1,000 hours. Enter whole
digit numbers only.
a. Active Participants:
CONTRIBUTION TYPE HOURS OF SERVICE REQUIREMENT
--------------------------------------------------------------
All contributions
--------------------------------------------------------------
Non-Safe Harbor Match Formula 1 1
--------------------------------------------------------------
Employer Discretionary 1000
--------------------------------------------------------------
QNECs
--------------------------------------------------------------
QMACs
--------------------------------------------------------------
Non-Safe Harbor Match Formula 2
--------------------------------------------------------------
b. Terminated Participants:
CONTRIBUTION TYPE HOURS OF SERVICE REQUIREMENT
--------------------------------------------------------------
All contributions
--------------------------------------------------------------
Non-Safe Harbor Match Formula 1 1
--------------------------------------------------------------
Employer Discretionary 1000
--------------------------------------------------------------
QNECs
--------------------------------------------------------------
QMACs
--------------------------------------------------------------
Non-Safe Harbor Match Formula 2
--------------------------------------------------------------
C. Allocation of Contributions to Participants:
Employer contributions for a Plan Year will be allocated to all
Participants who have met the allocation accrual requirements at
Section IX(B) above and who have met the following allocation
accrual requirements (check all applicable boxes):
23 Section 401(k) Plan AA #010
Match Match
Formula 1 Formula 2 QNEC QMAC Discretionary
--------- --------- ---- ---- -------------
1. For Plans using the Elapsed Time
method, contributions will be
allocated to terminated Participants
who have completed __________
(not more than 12) months of Service [ ] [ ] [ ] [ ] [ ]
2. Employed on the last day
of the Plan Year [ ] [ ] [ ] [ ] [ ]
3. The Hours of Service or Period of
Service requirement in the Plan
Year of termination is waived due to:
a. Retirement [ ] [ ] [ ] [ ] [X]
b. Disability [ ] [ ] [ ] [ ] [X]
c. Death [ ] [ ] [ ] [ ] [X]
d. Other [ ] [ ] [ ] [ ] [ ]
______________________________________*
e. No last day of the Plan Year
requirement in Plan Year of
any of the above events [ ] [ ] [ ] [ ] [ ]
* The event designated by the Employer may be applied to all Participants in a
nondiscriminatory manner.
[ ] D. Contributions to Disabled Participants:
The Employer will make contributions on behalf of a Participant
who is permanently and totally disabled. These contributions will
be based on the Compensation each such Participant would have
received for the Limitation Year if the Participant had been paid
at the rate of Compensation paid immediately before becoming
permanently and totally disabled. Such imputed Compensation for
the disabled Participant may be taken into account only if the
Participant is not a Highly Compensated Employee. These
contributions will be 100% vested when made.
X. DISPOSITION OF FORFEITURES
[X] A. Not applicable. All contributions are fully vested.
If (A) is selected, do not complete (B) or (C) below.
24 Section 401(k) Plan AA #010
B. Forfeiture Allocation Alternatives:
Select the method in which forfeitures associated with the
contribution type will be allocated (number each item in order
of use).
Employer Contribution Type
---------------------------------------
All Non-Safe Harbor All Other
Disposition Method Matching Contributions Contributions
------------------------------------------------------- ---------------------- ---------------
1. Restoration of Participant's forfeitures. _______________ _______________
2. Used to reduce the Employer's
contribution under the Plan. _______________ _______________
3. Used to reduce the Employer's
Matching Contribution. _______________ _______________
4. Used to offset Plan expenses. _______________ _______________
5. Added to the Employer's contribution
(other than Matching) under the Plan. _______________ _______________
6. Added to the Employer's Matching
Contribution under the Plan. _______________ _______________
7. Allocate to all Participants
eligible to share in the allocations
in the same proportion that each
Participant's Compensation for the
year bears to the Compensation of all
other Participant's for such year. _______________ _______________
8. Allocate to all NHCEs eligible to share
in the allocations in proportion to each such
Participant's Compensation for the year. _______________ _______________
9. Allocate to all NHCEs eligible to share in the
allocations in proportion to each such
Participant's Elective Deferrals for the year. _______________ _______________
10. Allocate to all Participants eligible to share in
the allocations in the same proportion that
each Participant's Elective Deferrals for the year
bears to the Elective Deferrals of all Participants
for such year. _______________ _______________
Participants eligible to share in the allocation of other Employer
Contributions under Section VIII shall be eligible to share in the
allocation of forfeitures except where allocations are only to
Non-Highly Compensated Employees.
C. Timing of Allocation of Forfeitures:
If no distribution or deemed distribution has been made to a
former Participant, nonvested portions shall be forfeited at the
end of the Plan Year during which the former Participant incurs
his or her fifth consecutive one-year Break in Service.
If a former Participant has received the full amount of his or her
vested interest, the nonvested portion of his or her account shall
be forfeited and shall be disposed of:
25 Section 401(k) Plan AA #010
[ ] 1. during the Plan Year following the Plan Year in which the
forfeiture arose.
[ ] 2. as of any Valuation or Allocation Date during the Plan Year
(or as soon as administratively feasible following the close
of the Plan Year) in which the former Participant receives
payment of his or her vested benefit.
[ ] 3. at the end of the Plan Year during which the former
Participant incurs his or her ___________ (0xx, 0xx, 0xx,
0xx or 5th) consecutive one-year Break in Service.
[ ] 4. as of the end of the Plan Year during which the former
Participant received full payment of his or her vested
benefit.
[ ] 5. as of the earlier of the first day of the Plan Year, or the
first day of the seventh month of the Plan Year following
the date on which the former Participant has received full
payment of his or her vested benefit.
[ ] 6. as of the next Valuation or Allocation Date following the
date on which the former Participant receives full payment
of his or her vested benefit.
XI. MULTIPLE PLANS MAINTAINED BY THE EMPLOYER, LIMITATIONS ON ALLOCATIONS,
AND TOP-HEAVY CONTRIBUTIONS
A. Plans Maintained By The Employer:
[X] 1. This is the only Plan the Employer maintains. In the event
that the allocation formula results in an Excess Amount,
such excess, after distribution of Employee contributions
pursuant to paragraph 10.2 of the Basic Plan Document #01,
shall be:
[X] a. Placed in a suspense account for the benefit of the
Participant without the crediting of gains or losses
for the benefit of the Participant.
[ ] b. Reallocated as additional Employer contributions to all
other Participants to the extent that they do not have
any Excess Amount.
If no method is specified, the suspense account method will be
used.
[ ] 2. The Employer does maintain another Plan [including a Welfare
Benefit Fund or an individual medical account as defined in
Code Section 415(l)(2)], under which amounts are treated as
Annual Additions and has completed the proper sections
below.
a. If the Participant is covered under another qualified
Defined Contribution Plan maintained by the Employer,
other than a Master or Prototype Plan:
[ ] i. The provisions of Article X of the Basic Plan
Document #01 will apply as if the other plan
were a Master or Prototype Plan.
[ ] ii. The Employer has specified below the method
under which the plans will limit total Annual
Additions to the Maximum Permissible Amount,
and will properly reduce any Excess Amounts in
a manner that precludes Employer discretion.
_______________________________________________
_______________________________________________
_______________________________________________
Employers who maintained a qualified Defined Benefit
Plan, prior to January 1, 2000, should complete
Schedule C to document the preamendment operation of
the Plan.
26 Section 401(k) Plan AA #010
b. Allocation of Excess Annual Additions: In the event
that the allocation formula results in an Excess
Amount, such excess, after distribution of Employee
contributions, shall be:
[ ] i. Placed in a suspense account for the benefit of
the Participant without the crediting of gains
or losses for the benefit of the Participant.
[ ] ii. Reallocated as additional Employer
contributions to all other Participants to the
extent that they do not have any Excess Amount.
If no method is specified, the suspense account method will
be used.
B. Top-Heavy Provisions:
In the event the Plan is or becomes Top-Heavy, the minimum
contribution or benefit required under Code Section 416 relating
to Top-Heavy Plans shall be satisfied in the elected manner:
[X] 1. This is the only Plan the Employer maintains or ever
maintained. The minimum contribution will be satisfied by
this Plan.
[ ] 2. The Employer does maintain another Defined Contribution
Plan. The minimum contribution will be satisfied by:
[ ] a. this Plan.
[ ] b. ______________________________________________________
(Name of other Qualified Plan)
[ ] 3. The Employer maintains a Defined Benefit Plan. A method is
stated below under which the minimum contribution and
benefit provisions of Code Section 416 will be satisfied.
____________________________________________________________
____________________________________________________________
XII. ANTIDISCRIMINATION TESTING
For Plans which are being amended and restated for GUST, please
complete Schedule C outlining the preamendment operation of the Plan,
as well as this section of the Adoption Agreement. The testing
elections made below will apply to the future operation of the Plan.
[ ] A. The Plan is not subject to ADP or ACP testing. The Plan does not
offer Voluntary After-tax or Required After-tax Contributions and
it either meets the Safe Harbor provisions of Section VII of this
Adoption Agreement, or it does not benefit any Highly Compensated
Employees.
[X] B. Testing Elections:
[X] 1. This Plan is using the Prior Year testing method for
purposes of the ADP and ACP Tests.
[ ] 2. This Plan is using the Current Year testing method for
purposes of the ADP and ACP Tests.
If no election is made, the Plan will use the Current Year testing
method.
This election cannot be rescinded for a Plan Year unless (1) the
Plan has been using the Current Year testing method for the
preceding 5 Plan Years or, if lesser, the number of Plan Years the
Plan has been in existence; or (2) the Plan otherwise meets one of
the conditions specified in IRS Notice 98-1 (or other superseding
guidance) for changing from the Current Year testing method.
27 Section 401(k) Plan AA #010
A Prototype Plan must use the same testing method for both the ADP
and ACP tests for Plan Years beginning on or after the date the
Employer adopts its GUST-restated Plan document.
[ ] C. Testing Elections for the First Plan Year:
Complete only when Prior Year testing method election is made.
[ ] 1. If this is not a successor Plan, then for the first Plan
Year this Plan permits (a) any Participant to make Employee
contributions, (b) provides for Matching Contributions or
(c) both, the ACP used in the ACP Test for Participants who
are Non-Highly Compensated Employees shall be such first
Plan Year's ACP. Do not select this option if the Employer
is using the "deemed 3%" rule.
[ ] 2. If this is not a successor Plan, then for the first Plan
Year this Plan permits any Participant to make Elective
Deferrals, the ADP used in the ADP Test for Participants who
are Non-Highly Compensated Employees shall be such first
Plan Year's ADP. Do not select this option if the Employer
is using the "deemed 3%" rule.
[ ] D. Recharacterization:
Elective Deferrals may be recharacterized as Voluntary After-tax
Contributions to satisfy the ADP Test. The Employer must have
elected to permit Voluntary After-tax Contributions in the Plan
for this election to be operable.
XIII. VESTING
Participants shall always have a fully vested and nonforfeitable
interest in their Employee contributions (including Elective Deferrals,
Required After-tax and Voluntary After-tax Contributions), Qualified
Matching Contributions ("QMACs"), Qualified Non-Elective Contributions
("QNECs") or Safe Harbor Matching or Non-Elective Contributions and
their investment earnings.
Each Participant shall acquire a vested and nonforfeitable percentage
in his or her account balance attributable to Employer contributions
and their earnings under the schedule(s) selected below except in any
Plan Year during which the Plan is determined to be Top-Heavy. In any
Plan Year in which the Plan is Top-Heavy, the Two-twenty vesting
schedule [option (B)(4)] or the three-year cliff schedule [option
(B)(3)] shall automatically apply unless the Employer has already
elected a faster vesting schedule. If the Plan is switched to option
(B)(4) or (B)(3), because of its Top-Heavy status, that vesting
schedule will remain in effect even if the Plan later becomes
non-Top-Heavy until the Employer executes an amendment of this Adoption
Agreement.
A. Vesting Computation Period:
A Year of Service for vesting will be determined on the basis of
the (choose one):
[X] 1. Not applicable. All contributions are fully vested.
[ ] 2. Elapsed Time method.
[ ] 3. Hours of Service method. A Year of Service will be
credited upon completion of __________ Hours of Service. A
Year of Service for vesting purposes will not be less than 1
Hour of Service nor greater than 1,000 hours by operation of
law. If left blank, the Plan will use 1,000 hours.
The computation period for purposes of determining Years of
Service and Breaks in Service for purposes of computing a
Participant's nonforfeitable right to his or her account balance
derived from Employer contributions:
[X] 4. shall not be applicable since Participants are always fully
vested.
28 Section 401(k) Plan AA #010
[ ] 5. shall not be applicable, as the Plan is using Elapsed Time.
[ ] 6. shall commence on the date on which an Employee first
performs an Hour of Service for the Employer and each
subsequent 12-consecutive month period shall commence on the
anniversary thereof.
[ ] 7. shall commence on the first day of the Plan Year during
which an Employee first performs an Hour of Service for the
Employer and each subsequent 12-consecutive month period
shall commence on the anniversary thereof.
For Plans not using Elapsed Time, a Participant shall receive
credit for a Year of Service if he or she completes the number of
hours specified above at any time during the 12-consecutive month
computation period. A Year of Service may be earned prior to the
end of the 12-consecutive month computation period and the
Participant need not be employed at the end of the 12-consecutive
month computation period to receive credit for a Year of Service.
B. Vesting Schedules:
Select the appropriate schedule for each contribution type and
complete any blank vesting percentages from the list below and
insert the option number in the vesting schedule chart below.
Years of Service
--------------------------------------------------------
1 2 3 4 5 6 7
--- --- --- --- --- --- ---
1. Full and immediate Vesting
2. ___% 100%
3. ___% ___% 100%
4. ___% 20% 40% 60% 80% 100%
5. ___% ___% 20% 40% 60% 80% 100%
6. 10% 20% 30% 40% 60% 80% 100%
7. ___% ___% ___% ___% 100%
8. ___% ___% ___% ___% ___% ___% 100%
The percentages selected for schedule (8) may not be less for any
year than the percentages shown at schedule (5 ).
Vesting Schedule Chart Employer Contribution Type
---------------------- ----------------------------------------------------
1 All Employer Contributions
______________________ Safe Harbor Contributions (Matching or Non-Elective)
1 QMACs and QNECs
______________________ Non-Safe Harbor Match - Formula 1
______________________ Non-Safe Harbor Match - Formula 2
______________________ Match on Voluntary After-tax Contributions
______________________ Match on Required After-tax Contributions
______________________ Discretionary Contributions
1 Top-Heavy Minimum Contribution
______________________ Other Employer Contribution
29 Section 401(k) Plan AA #010
C. Service Disregarded for Vesting:
[X] 1. Not applicable. All Service is recognized.
[ ] 2. Service prior to the Effective Date of this Plan or a
predecessor plan is disregarded when computing a
Participant's vested and nonforfeitable interest.
[ ] 3. Service prior to a Participant having attained age 18 is
disregarded when computing a Participant's vested and
nonforfeitable interest.
[ ] D. Full Vesting of Employer Contributions for Current Participants:
Notwithstanding the elections above, all Employer contributions
made to a Participant's account shall be 100% fully vested if the
Participant is employed on the Effective Date of the Plan (or such
other date as entered herein):___________________________.
XIV. SERVICE WITH PREDECESSOR ORGANIZATION
[X] A. Not applicable. The Plan does not recognize Service
with any predecessor organization.
[ ] B. The Plan recognizes Service with all predecessor
organizations.
[ ] C. Service with the following organization(s) will be
recognized for the Plan purpose indicated:
Allocation
Eligibility Accrual Vesting
----------- ---------- -------
_________________________________ [ ] [ ] [ ]
_________________________________ [ ] [ ] [ ]
Attach additional pages as necessary.
XV. IN-SERVICE WITHDRAWALS
A. In-Service Withdrawals:
[ ] 1. In-service withdrawals are not permitted in the Plan.
[X] 2. In-service withdrawals are permitted in the Plan.
Participants may withdraw the following contribution types
after meeting the following requirements (select one or more
of the following options):
WITHDRAWAL RESTRICTIONS
CONTRIBUTION TYPES A B C D E F G
------------------ --------------------------------------------------------
a. All Contributions [ ] n/a n/a [X] [X] n/a n/a
b. Voluntary After-tax [ ] [ ] [ ] [ ] [ ] [ ] n/a
c. Required After-tax [ ] [ ] [ ] [ ] [ ] [ ] n/a
d. Rollover [ ] [ ] [ ] [ ] [ ] [ ] n/a
e. Transfer [ ] [ ] [ ] [ ] [ ] [ ] [ ]
f. Elective Deferrals [ ] n/a n/a [ ] [ ] n/a n/a
g. Qualified Non-Elective [ ] n/a n/a [ ] [ ] n/a n/a
30 Section 401(k) Plan AA #010
h. Qualified Matching [ ] n/a n/a [ ] [ ] n/a n/a
i. Safe Harbor Matching [ ] n/a n/a [ ] [ ] n/a n/a
j. Safe Harbor Non-
Elective [ ] n/a n/a [ ] [ ] n/a n/a
k. Vested Non-Safe Harbor
Matching Formula 1 [ ] [ ] [ ] [ ] [ ] [ ] [X]
l. Vested Non-Safe Harbor
Matching Formula 2 [ ] [ ] [ ] [ ] [ ] [ ] [ ]
m. Vested Discretionary [ ] [ ] [ ] [ ] [ ] [ ] [X]
WITHDRAWAL RESTRICTION KEY
A. Not available for in-service withdrawals.
B. Available for in-service withdrawals.
C. Participants having completed five years of Plan
participation may elect to withdraw all or any part of
their Vested Account Balance.
D. Participants may withdraw all or any part of their
Account Balance after having attained the Plan's Normal
Retirement Age.
E. Participants may withdraw all or any part of their
Vested Account Balance after having attained age 59.5
(not less than age 59 1/2).
F. Participants may elect to withdraw all or any part of
their Vested Account Balance which has been credited to
their account for a period in excess of two years.
G. Available for withdrawal only if the Participant is
100% vested.
B. Hardship Withdrawals:
[X] 1. Hardship withdrawals are not permitted in the Plan.
[ ] 2. Hardship withdrawals are permitted in the Plan and will be
taken from the Participant's account as follows (select one
or more of these options):
[ ] a. Participants may withdraw Elective Deferrals.
[ ] b. Participants may withdraw Elective Deferrals and any
earnings credited as of December 31, 1988 (or if later,
the end of the last Plan Year ending before July 1,
1989).
[ ] c. Participants may withdraw Rollover Contributions plus
their earnings.
[ ] d. Participants may withdraw Transfer Contributions plus
their earnings.
[ ] e. Participants may withdraw fully vested Employer
contributions plus their earnings.
[ ] f. Participants may withdraw vested Non-Safe Harbor
Matching Formula 1 Contributions plus their earnings.
[ ] g. Participants may withdraw vested Non-Safe Harbor
Matching Formula 2
31 Section 401(k) Plan AA #010
Contributions plus their earnings.
[ ] h. Participants may withdraw Qualified Matching
Contributions and Qualified Non-Elective Contributions
plus their earnings, and the earnings on Elective
Deferrals which have been credited to the Participant's
account as of December 31, 1988 (or if later, the end
of the last Plan Year ending before July 1, 1989).
XVI. LOAN PROVISIONS
[X] A. Participant loans are permitted in accordance with the Employer's
established loan procedures.
[X] B. Loan payments will be suspended under the Plan as permitted under
Code Section 414(u) in compliance with the Uniformed Services
Employment and Reemployment Rights Act of 1994.
XVII. INVESTMENT MANAGEMENT
A. Investment Management Responsibility:
[ ] 1. The Employer shall appoint a discretionary Trustee to manage
the assets of the Plan.
[ ] 2. The Employer shall retain investment management
responsibility and/or authority.
[X] 3. The party designated below shall be responsible for the
investment of the Participant's account.
By selecting a box, the Employer is making a designation as
to whom will have authority to issue investment directives
with respect to the specified contribution type (check all
applicable boxes):
32 Section 401(k) Plan AA #010
Trustee Employer Participant
------- -------- -----------
a. All Contributions n/a n/a [X]
b. Employer Contributions [ ] [ ] [ ]
c. Elective Deferrals [ ] [ ] [ ]
d. Voluntary After-tax [ ] [ ] [ ]
e. Required After-tax [ ] [ ] [ ]
f. Safe Harbor Contributions [ ] [ ] [ ]
g. Non-Safe Harbor Match Formula 1 [ ] [ ] [ ]
h. QMACs [ ] [ ] [ ]
i. QNECs [ ] [ ] [ ]
j. Non-Safe Harbor Match Formula 2 [ ] [ ] [ ]
k. Rollover Contributions [ ] [ ] [ ]
l. Transfer Contributions [ ] [ ] [ ]
To the extent that Participant self-direction was previously
permitted, the Employer shall have the right to either make the
assets part of the general fund, or leave them as self-directed
subject to the provisions of the Basic Plan Document #01.
B. Limitations on Participant Directed Investments:
[X] 1. Participants are permitted to invest among only those
investment alternatives made available by the Employer under
the Plan.
[ ] 2. Participants are permitted to invest in any investment
alternative permitted under the Basic Plan Document #01.
[ ] C. Insurance:
The Plan permits insurance as an investment alternative.
[X] D. ERISA Section 404(c):
The Employer intends to be covered by the fiduciary liability
provisions with respect to Participant directed investments under
ERISA Section 404(c).
XVIII. DISTRIBUTION OPTIONS
A. Timing of Distributions [both (1) and (2) must be completed]:
1. Distributions payable as a result of termination for reasons
other than death, Disability or retirement shall be paid c
[select from the list at (A)(3) below].
2. Distributions payable as a result of termination for death,
Disability or retirement shall be paid c [select from the
list at (A)(3) below].
3. Distribution Options:
a. As soon as administratively feasible on or after the
Valuation Date following
33 Section 401(k) Plan AA #010
the date on which a distribution is requested or is
otherwise payable.
b. As soon as administratively feasible following the
close of the Plan Year during which a distribution is
requested or is otherwise payable.
c. As soon as administratively feasible following the date
on which a distribution is requested or is otherwise
payable. (This option is recommended for daily
valuation plans.)
d. As soon as administratively feasible after the close of
the Plan Year during which the Participant incurs
___________ (cannot be more than 5) consecutive
one-year Breaks in Service. [This formula can only be
used in (A)(1).]
e. As soon as administratively feasible after the close of
the Plan Year during which the Participant incurs
___________ (cannot be more than 5) consecutive
one-year Breaks in Service. [This formula can only be
used in (A)(2).]
f. Only after the Participant has attained the Plan's
Normal Retirement Age or Early Retirement Age, if
applicable.
B. Required Beginning Date:
The Required Beginning Date of a Participant with respect to a
Plan is (select one from below):
[ ] 1. The April 1 of the calendar year following the calendar year
in which the Participant attains age 70 1/2.
[ ] 2. The April 1 of the calendar year following the calendar year
in which the Participant attains age 70 1/2 except that
distributions to a Participant (other than a 5% owner) with
respect to benefits accrued after the later of the adoption
of this Plan or Effective Date of the amendment of this Plan
must commence no later than the April 1 of the calendar year
following the later of the calendar year in which the
Participant attains age 70 1/2 or the calendar year in which
the Participant retires.
[X] 3. The later of the April 1 of the calendar year following the
calendar year in which the Participant attains age 70 1/2 or
retires except that distributions to a 5% owner must
commence by the April 1 of the calendar year following the
calendar year in which the Participant attains age 70 1/2.
Except that such Participant [X] may [ ] may not elect to
begin receiving distributions as of April 1 of the calendar
year following the calendar year in which the Participant
attains age 70 1/2. Any distributions made pursuant to such
an election will not be considered required minimum
distributions. Such distributions will be considered
in-service distributions and as such, will be subject to
applicable withholding.
Plans which are an amendment or restatement of an existing Plan
which provided for the provisions of Code Section 401(a)(9)
currently in effect prior to the amendment of the Small Business
Job Protection Act of 1996 must complete Schedule C.
C. Forms of Payment (select all that apply):
[X] 1. Lump sum.
[X] 2. Installment payments.
[ ] 3. Partial payments; the minimum amount will be $___________.
[ ] 4. Life annuity.
[ ] 5. Term certain annuity with payments guaranteed for
___________ years (not to exceed 20).
[ ] 6. Joint and [ ] 50%, [ ] 66?%, [ ] 75% or [ ] 100% survivor
annuity.
34 Section 401(k) Plan AA #010
[ ] 7. The default form of payment will be a direct rollover into
an individual retirement account or annuity for any "cash
out" distribution made pursuant to Code Sections 411(a)(7),
411(a)(11) and 417(e)(1).
[ ] 8. Cash.
[ ] 9. Employer securities.
[ ] 10. Other marketable securities.
The normal form of payment is determined at Section III(J) of this
Adoption Agreement.
D. Recalculation of Life Expectancy:
[ ] 1. Recalculation is not permitted.
[X] 2. Recalculation is permitted. When determining installment
payments in satisfying the minimum distribution requirements
under the Plan, and life expectancy is being recalculated:
[ ] a. only the Participant's life expectancy shall be
recalculated.
[ ] b. both the Participant's and Spouse's life expectancy
shall be recalculated.
[X] c. the Participant will determine whose life expectancy is
recalculated.
XIX. SPONSOR INFORMATION AND ACCEPTANCE
This Plan may not be used and shall not be deemed to be a Prototype
Plan unless an authorized representative of the Sponsor has
acknowledged the use of the Plan. Such acknowledgment that the Employer
is using the Plan does not represent that the Adoption Agreement (as
completed) and Basic Plan Document have been reviewed by a
representative of the Sponsor or constitute a qualified retirement
plan.
Acknowledged and accepted by the Sponsor this 26th day of August, 2002.
Name: Xxxxxx Xxxxx
Title: Principal
Signature: /s/ Xxxxxx Xxxxx
---------------------
Questions concerning the language contained in and qualification of the
Prototype should be addressed to: Retirement Alliance, Inc.
(Position): Pension Administrator (Phone Number): 000-000-0000
In the event that the Sponsor amends, discontinues or abandons this
Prototype Plan, notification will be provided to the Employer's address
provided on the first page of this Adoption Agreement.
35 Section 401(k) Plan AA #010
XX. SIGNATURES
The Sponsor recommends that the Employer consult with its legal counsel
and/or tax advisor before executing this Adoption Agreement.
A. Employer:
This Adoption Agreement and the corresponding provisions of Basic
Plan Document #01 are adopted by the Employer this__________ day
of _____________________, ___________.
Name of Employer: Sontra Medical Corporation
Executed on behalf of the Employer by: Xxxxxx Xxxxxxx
Title: Trustee
Signature: /s/ Xxxxxx Xxxxxxx
---------------------
Participating Employer:
Name and address of any Participating Employer.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
This Adoption Agreement and the corresponding provisions of Basic
Plan Document #01 are adopted by the Participating Employer
this__________ day of _____________________, ___________.
Executed on behalf of the
Participating Employer by: _____________________________________
Title: _____________________________________
Signature: _____________________________________
Attach additional signature pages as necessary.
The Employer understands that its failure to properly complete or
amend this Adoption Agreement may result in failure of the Plan to
qualify or disqualification of the Plan. The Employer by executing
this Adoption Agreement acknowledges that this is a legal document
with significant tax and legal ramifications.
Employer's Reliance: The adopting Employer may rely on an Opinion
Letter issued by the Internal Revenue Service as evidence that the
Plan is qualified under Section 401 of the Internal Revenue Code
only to the extent provided in Announcement 2001-77, 2001-30
I.R.B. The Employer may not rely on the Opinion Letter in certain
other circumstances or with respect to certain qualification
requirements, which are specified in the Opinion Letter issued
with respect to the Plan and in Announcement 2001-77. In order to
obtain reliance in such circumstances or with respect to such
qualification requirements, application for a determination letter
must be made to Employee Plans Determinations of the Internal
Revenue Service.
This Adoption Agreement may only be used in conjunction with Basic
Plan Document #01.
36 Section 401(k) Plan AA #010
B. Trustee:
Trust Agreement:
[ ] Not applicable. Plan assets will be invested in Group
Annuity Contracts. There is no Trustee and the terms of the
contract(s) will apply.
[X] The Trust provisions used will be as contained in the Basic
Plan Document #01.
[ ] The Trust provisions used will be as contained in the
accompanying executed Trust Agreement between the Employer
and the Trustee attached hereto.
Complete the remainder of this section only if the Trust
provisions used are as contained in the Basic Plan Document #01.
Name and address of Trustee:
Xxxxxx Xxxxxxx, Xxxx X. Xxxxx
Employer's Address
The assets of the Plan shall be invested in accordance with
Article XIII of the Basic Plan Document #01. The Employer's Plan
and Trust as contained herein is accepted by the Trustee this
____________ day of ____________________, ___________.
Accepted on behalf of the Trustee by: Xxxxxx Xxxxxxx
Title: President and CEO
-------------------------------------
Signature: /s/ Xxxxxx Xxxxxxx
-------------------------------------
Accepted on behalf of the Trustee by: Xxxx X. Xxxxx
Title: CFO
-------------------------------------
Signature: /s/ Xxxx X. Xxxxx
-------------------------------------
Accepted on behalf of the Trustee by:
Title: _____________________________________
Signature: _____________________________________
37 Section 401(k) Plan AA #010
C. Custodian:
Custodial Agreement:
[X] Not applicable. There is no Custodian.
[ ] Not applicable. Plan assets will be invested in Group
Annuity Contracts. There is no Custodian and the terms of
the contract(s) will apply.
[ ] The Custodial provisions used will be as contained in Basic
Plan Document #01.
[ ] The Custodial provisions used will be as contained in the
accompanying executed Custodial Agreement between the
Employer and the Custodian attached hereto.
Complete the remainder of this section only if the Custodial
provisions used are as contained in the Basic Plan Document #01.
Name and address of Custodian:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
The assets of the Plan shall be invested in accordance with
Article XIII of the Basic Plan Document #01. The Employer's Plan
and Custodial Account as contained herein are accepted by the
Custodian this __________ day of ________________, __________.
Accepted on behalf of the
Custodian by: _____________________________________
Title: _____________________________________
Signature: _____________________________________
38 Section 401(k) Plan AA #010
SCHEDULE A
PROTECTED BENEFITS
This Schedule includes any prior Plan protected benefits which are not available
in Basic Plan Document #01. Complete as applicable.
1. Plan Provision:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Effective Date: _________________________________
2. Plan Provision:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Effective Date: _________________________________
3. Plan Provision:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Effective Date: _________________________________
4. Plan Provision:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Effective Date: _________________________________
5. Plan Provision:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Effective Date: _________________________________
39 Section 401(k) Plan AA #010
SCHEDULE B
PRIOR PLAN PROVISIONS
This Schedule should be used if a prior plan contains provisions not found in
Basic Plan Document #01, or where the Employer wishes to document transactions
or historical provisions of the Employer's Plan.
1. Plan Provision:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Effective Date: _________________________________
2. Plan Provision:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Effective Date: _________________________________
3. Plan Provision:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Effective Date: _________________________________
4. Plan Provision:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Effective Date: _________________________________
5. Plan Provision:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Effective Date: _________________________________
40 Section 401(k) Plan AA #010
SCHEDULE C
PREAMENDMENT OPERATION OF THE PLAN
The following are the adopting Employer's elective Plan provisions which conform
the terms of this Prototype Plan to the preamendment operation of the Plan
during the transition period between the earliest effective date under GUST (as
defined below) and the effective date of adoption of this Prototype Plan and
Trust which takes into account all of the changes in the qualification
requirements made by the following: The Uruguay Round Agreements, Pub. L.
103-465 (GATT); The Uniformed Services Employment and Reemployment Rights Act of
1994, Pub. L. 103-353 (USERRA); The Small Business Job Protection Act of 1996,
Pub. L. 104-188 (SBJPA) [including Section 414(u) of the Internal Revenue Code];
The Taxpayer Relief Act of 1997, Pub. L. 105-34 (TRA'97); and The Internal
Revenue Service Restructuring and Reform Act of 1998, Pub. L. 105-206 (IRSRRA);
and The Community Renewal Tax Relief Act of 2000, Pub. L. 106-554 (CRA),
hereinafter referred to collectively as GUST.
Complete as applicable and appropriate.
I. Plan Provision: Highly Compensated Employees
For Plan Years beginning after 1996, the Employer may elect a "Top-Paid
Group" election and the Calendar Year Data election to determine the
definition of Highly Compensated Employee:
[ ] A. Top-Paid Group Election: A Participant (who is not a 5%
owner at any time during the determination year or the
look-back year) who earned more than $80,000 as indexed for
the look-back year is a Highly Compensated Employee if the
Employee was in the Top-Paid Group for the look-back year.
The election was applicable for:
[ ] 1. 1997 Plan Year.
[ ] 2. 1998 Plan Year.
[ ] 3. 1999 Plan Year.
[ ] 4. 2000 Plan Year.
[ ] 5. 2001 Plan Year.
[ ] B. Calendar Year Data Election: In determining who is a Highly
Compensated Employee (other than a 5% owner) the Employer
makes a calendar year data election. The look-back year is
the calendar year beginning with or within the look-back
year. The election was applicable for:
[ ] 1. 1998 Plan Year.
[ ] 2. 1999 Plan Year.
[ ] 3. 2000 Plan Year.
[ ] 4. 2001 Plan Year.
If the elections above are made, such election shall apply to all
Plans maintained by the Employer.
[ ] C. Calendar Year Calculation Election (for 1997 Plan Year
only): Indicate below whether the Calendar Year calculation
election was made for Plan Years beginning in 1997:
[ ] Yes [ ] No
II. Plan Provision: Family Aggregation
Did the Pre-SBJPA Family Aggregation rules of Code Sections
401(a)(17)(a) and 414(q)(6), both in effect for Plan Years beginning
before January 1, 1997, continue to apply for any purpose for Plan
Years beginning after 1996?
[X] Xx
00 Xxxxxxx 000(x) Xxxx XX #000
[ ] Yes; explain the application:_____________________________________
__________________________________________________________________
__________________________________________________________________
If this rule was subsequently discontinued, indicate when rule no
longer applied: __________________________________________________
__________________________________________________________________
Employers who adopt this Prototype Plan may not elect to continue to
apply the pre-SBJA Family Aggregation rules.
III. Plan Provision: Combined Plan Limit of Code Section 415(e)
Did the Employer maintain a Defined Benefit Plan prior to
January 1, 2000?
[ ] Yes [X] No
Did the Plan continue to apply the combined Plan limit of Code Section
415(e) (as in effect for Limitation Years beginning before
January 1, 2000) in limitation years beginning after December 31, 1999,
to the extent that such election conforms to the Plan's operation?
[ ] Yes [ ] No
If yes, specify provisions below that will satisfy the 1.0 limitation
of Code Section 415(e). Such language must preclude Employer
discretion. The Employer must also specify the interest and mortality
assumptions used in determining Present Value in the Defined Benefit
Plan.
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Employers who adopt this Prototype Plan may not elect to continue to
apply the combined Plan limit of Code Section 415(e) in years beginning
after the date the Employer adopts its GUST-related Plan.
IV. Plan Provision: Nondiscrimination Testing
The Small Business Job Protection Act permits the Employer to use the
ADP and/or ACP of Non-Highly Compensated Employees for the prior year
or current year in determining whether the plan satisfied the
nondiscrimination tests.
Employers who adopt this Prototype Plan must use the same testing
method for both the ADP and ACP tests for Plan Years beginning on or
after the date the Employer adopts this GUST-restated Plan. This
restriction does not apply with respect to Plan Years beginning before
the date the Employer adopts this GUST-restated plan.
1. ADP Testing Election:
[X] a. Current year data for all Participants was used.
[ ] 1. 1997 Plan Year.
[ ] 2. 1998 Plan Year.
[ ] 3. 1999 Plan Year.
[X] 4. 2000 Plan Year.
[X] 5. 2001 Plan Year.
[ ] b. Prior year data for Participants who are Non-Highly
Compensated Employees was used.
[ ] 1. 1997 Plan Year.
[ ] 2. 1998 Plan Year.
42 Section 401(k) Plan AA #010
[ ] 3. 1999 Plan Year.
[ ] 4. 2000 Plan Year.
[ ] 5. 2001 Plan Year.
2. ACP Testing Election:
[ ] a. Current year data for all Participants was used.
[ ] 1. 1997 Plan Year.
[ ] 2. 1998 Plan Year.
[ ] 3. 1999 Plan Year.
[ ] 4. 2000 Plan Year.
[ ] 5. 2001 Plan Year.
[ ] b. Prior year data for Participants who are Non-Highly
Compensated Employees was used.
[ ] 1. 1997 Plan Year.
[ ] 2. 1998 Plan Year.
[ ] 3. 1999 Plan Year.
[ ] 4. 2000 Plan Year.
[ ] 5. 2001 Plan Year.
V. Plan Provision: First Plan Year Testing Elections
For a new 401(k) Plan, the Employer could use either the current or
prior year testing methods as well as a rule that deems the prior year
ADP/ACP to be 3%.
1. ADP Testing Election:
[ ] a. Current year data for all Participants was used.
[ ] 1. 1997 Plan Year.
[ ] 2. 1998 Plan Year.
[ ] 3. 1999 Plan Year.
[ ] 4. 2000 Plan Year.
[ ] 5. 2001 Plan Year.
[ ] b. Current year data for Participants who are Highly
Compensated Employees will be used. The ADP for Participants
who are Non-Highly Compensated Employees was assumed to be
3% or the actual ADP if greater.
[ ] 1. 1997 Plan Year.
[ ] 2. 1998 Plan Year.
[ ] 3. 1999 Plan Year.
[ ] 4. 2000 Plan Year.
[ ] 5. 2001 Plan Year.
2. ACP Testing Election:
[ ] a. Current year data for all Participants was used.
[ ] 1. 1997 Plan Year.
[ ] 2. 1998 Plan Year.
[ ] 3. 1999 Plan Year.
[ ] 4. 2000 Plan Year.
[ ] 5. 2001 Plan Year.
43 Section 401(k) Plan AA #010
[ ] b. Current year data for Participants who are Highly
Compensated Employees will be used. The ACP for Participants
who are Non-Highly Compensated Employees was assumed to be
3% or the actual ACP if greater.
[ ] 1. 1997 Plan Year.
[ ] 2. 1998 Plan Year.
[ ] 3. 1999 Plan Year.
[ ] 4. 2000 Plan Year.
[ ] 5. 2001 Plan Year.
VI. Plan Provision: Distribution Alternatives For Participants Who Are Not
A More Than 5% Owner
Select (A), (B), (C) and/or (D), whichever is applicable. Subsection
(D) must be selected to the extent that there would otherwise be an
elimination of a pre-retirement age 70 1/2 distribution option for
Employees other than those listed above.
[X] A. Any Participant who has not had a separation from Service
who had attained age 70 1/2 in years after 1995 may elect by
April 1 of the calendar year following the calendar year in
which the Participant attained age 70 1/2 (or by December
31, 1997, in the case of a Participant attaining age 70 1/2
in 1996) to defer distributions until the calendar year in
which the Participant retires. If no such election is made,
the Participant will begin receiving distributions by the
April 1 of the calendar year following the calendar year in
which the Participant attained age 70 1/2 (or by December
31, 1997, in the case of a Participant attaining age 70 1/2
in 1996).
[ ] B. Any Participant who has not had a separation from Service
and is currently in benefit payment status because of
attainment of age 70 1/2 in years prior to 1997 may elect to
stop distributions and recommence by the April 1 of the
calendar year following the calendar year in which the
Participant retires. There is either (select one):
[ ] 1. a new Annuity Starting Date upon recommencement,
or
[ ] 2. no new Annuity Starting Date upon recommencement.
[ ] C. Any Participant who has not had a separation from Service,
and is currently in benefit payment status because of
attainment of age 70 1/2 in 1997 or in a later year (or
attained age 70 1/2 in 1996, but had not commenced required
minimum distributions in 1996) may elect to stop
distributions and recommence by the April 1 of the calendar
year following the calendar year in which the Participant
retires. There is either (select one):
[ ] 1. a new Annuity Starting Date upon recommencement,
or
[ ] 2. no new Annuity Starting Date upon recommencement.
[ ] D. The pre-retirement distribution option is only eliminated
with respect to Employees who reach age 70 1/2 in or after a
calendar year that begins after the later of December 31,
1998, or the adoption of the amendment to the Plan. The
pre-retirement age 70 1/2 distribution option is an optional
form of benefit under which benefits are payable in a
particular distribution form (including any modifications
that may be elected after benefit commencement) and
commencing at a time during the period that begins on or
after January 1 of the calendar year in which an Employee
attains age 70 1/2 and ends April 1 of the immediately
following calendar year.
VII. Plan Provision: Mandatory Cash-out Rule
[X] For Plan Years beginning after August 9, 1997, the $3,500 cash-out
limit is increased to $5,000.
VIII. Plan Provision: 30-Day Waiver Period
For Plan Years beginning after December 31, 1996, if the Plan is
subject to the Joint and Survivor rules did the Plan provide
distributions prior to the expiration of the 30-day waiting period?
44 Section 401(k) Plan AA #010
[ ] Yes [ ] No
IX. Plan Provision: Suspension of Loan Repayments
On or after December 12, 1994, did the Employer permit the suspension
of loan repayments due to qualified military leave?
[ ] Yes [X] No
Effective Date: _______________________________________________________
X. Plan Provision: Hardship Distributions Treated as Eligible Rollover
Distributions
The Employer had the option with respect to Hardship distributions made
after December 31, 1998 to treat as eligible rollover distributions, or
to delay the Effective Date until January 1, 2000. Hardship
distributions were not treated as eligible rollover distributions
effective as of:
[ ] January 1, 1999
[ ] January 1, 2000
[ ] Other (specify date): ____________________________________________
XI. Plan Provision: 401(k) Safe Harbor Provisions
For Plan Years beginning after 1998, the Employer may implement safe
harbor provisions under Code Sections 401(m)(11) and 401(k)(12). Did
the Plan elect safe harbor status?
[ ] Yes
[X] No
If yes, enter the formulas below:
DATE PLAN YEAR BEGINS SECTION 401(k) SECTION 401(m)
-------------------------------------------------------------------
______/_______/99
-------------------------------------------------------------------
______/_______/00
-------------------------------------------------------------------
______/_______/01
-------------------------------------------------------------------
XII. Other Plan Provisions:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Effective Date: _______________________________________________________
45 Section 401(k) Plan AA #010
SCHEDULE D
SAFE HARBOR ELECTIONS FOR FLEXIBLE NON-ELECTIVE CONTRIBUTION
The following elections are made with regard to the Plan's Safe Harbor status
pursuant to Section VII herein. For Plan Years indicated below, the Plan hereby
invokes a Safe Harbor status in accordance with IRS Notices 98-52 and 2000-3.
For all Plan Years in which this Safe Harbor election is being made, the
limitations and restrictions found in Section VII herein apply.
1. For the Plan Year beginning _____ and ending _____, the Employer hereby
invokes a Safe Harbor status as provided in IRS Notice 2000-3. The Safe
Harbor Contribution will be an amount equal to _____% (not less than 3%) of
Compensation. This election is made on this _____ day of _____, _____ (date
may not be later than 30 days prior to the end of the Plan Year in which
such election is being made).
2. For the Plan Year beginning _____ and ending _____, the Employer hereby
invokes a Safe Harbor status as provided in IRS Notice 2000-3. The Safe
Harbor Contribution will be an amount equal to _____% (not less than 3%) of
Compensation. This election is made on this _____ day of _____, _____ (date
may not be later than 30 days prior to the end of the Plan Year in which
such election is being made).
3. For the Plan Year beginning _____ and ending _____, the Employer hereby
invokes a Safe Harbor status as provided in IRS Notice 2000-3. The Safe
Harbor Contribution will be an amount equal to _____% (not less than 3%) of
Compensation. This election is made on this _____ day of _____, _____ (date
may not be later than 30 days prior to the end of the Plan Year in which
such election is being made).
4. For the Plan Year beginning _____ and ending _____, the Employer hereby
invokes a Safe Harbor status as provided in IRS Notice 2000-3. The Safe
Harbor Contribution will be an amount equal to _____% (not less than 3%) of
Compensation. This election is made on this _____ day of _____, _____ (date
may not be later than 30 days prior to the end of the Plan Year in which
such election is being made).
5. For the Plan Year beginning _____ and ending _____, the Employer hereby
invokes a Safe Harbor status as provided in IRS Notice 2000-3. The Safe
Harbor Contribution will be an amount equal to _____% (not less than 3%) of
Compensation. This election is made on this _____ day of _____, _____ (date
may not be later than 30 days prior to the end of the Plan Year in which
such election is being made).
46 Section 401(k) Plan AA #010
SCHEDULE E
COLLECTIVE AND COMMINGLED FUNDS
The Trustee is authorized to invest all or any part of the Fund in the following
Collective and Commingled Funds as provided for in the Basic Plan Document #01:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
47 Section 401(k) Plan AA #010
AMENDMENT
TO THE
NONSTANDARDIZED
CASH OR DEFERRED PROFIT-SHARING PLAN
ADOPTION AGREEMENT #010
1. Except as otherwise noted, effective as of the first day of the first
Plan Year beginning after December 31, 2001, Section VI of the
Nonstandardized Cash or Deferred Profit-Sharing Adoption Agreement #010
entitled "EMPLOYEE CONTRIBUTIONS" is amended by adding the following
new sections:
"J". Catch-up Contributions (select one):
[X] 1. Shall apply to contributions after 12/31/01.
(enter December 31, 2001 or a later date).
[ ] 2. Shall not apply.
K. Direct Rollovers:
The Plan will accept a Direct Rollover of an Eligible
Rollover Distribution from (check each that apply):
[X] 1. A Qualified Plan described in Code Section 401(a)
or 403(a), excluding Voluntary After-tax
Contributions.
[ ] 2. A Qualified Plan described in Code Section 401(a)
or 403(a), including Voluntary After-tax
Contributions.
[X] 3. An annuity contract described in Code Section
403(b), excluding Voluntary After-tax
Contributions.
[X] 4. An eligible plan under Code Section 457(b) which
is maintained by a state, political subdivision of
a state, or an agency or instrumentality of a
state or political subdivision of a state.
L. Participant Rollover Contributions from Other Plans:
The Plan will accept a Participant Rollover Contribution of
an Eligible Rollover Distribution from (check only those
that apply):
[X] 1. A Qualified Plan described in Code Section 401(a)
or 403(a).
[X] 2. An annuity contract described in Code Section
403(b).
[X] 3. An eligible plan under Code Section 457(b) which
is maintained by a state, political subdivision of
a state, or any agency or instrumentality of a
state or political subdivision of a state.
M. Participant Rollover Contributions from IRAs:
The Plan (select one):
[X] 1. will
[ ] 2. will not
accept a Participant Rollover Contribution of the portion of
a distribution from an Individual Retirement Account [which
was not used as a conduit] or Annuity described in Code
Section
1 Section 401(k) Plan AA #010
408(a) or 408(b) that is eligible to be rolled over and
would otherwise be includable in gross income.
N. Effective Date of Direct Rollover and Participant Rollover
Contribution Provisions:
The provisions of (K), (L) and (M) above as they apply to Paragraph 4.4
of the Basic Plan Document #01 entitled "Rollover Contributions" shall
be effective 01/01/2002 (enter a date no earlier than January 1,
2002)."
2. Section VIII(A) of the Nonstandardized Cash or Deferred Profit-Sharing
Plan Adoption Agreement #010 entitled, "Matching Employer Contrbutions"
will be amended effective ___________________________ by the addition
of a new paragraph 6, which shall read as follows:
6. Catch-Up Contributions:
[ ] a. Catch-Up contributions made by the Participants
will not be matched by the Employer.
[X] b. Catch-Up Contributions made by the Participants
will be matched on the same formula, terms and
conditions as provided in Section VIII of the
Adoption Agreement. A Matching Contribution will
be made on the basis of the contribution type(s)
selected below:
[X] i. Elective Deferrals
[ ] ii. 403(b) Deferrals"
3. Section XI of the Nonstandardized Cash or Deferred Profit-Sharing Plan
Adoption Agreement #010 entitled, "MULTIPLE PLANS MAINTAINED BY THE
SAME EMPLOYER, LIMITATIONS ON ALLOCATIONS, AND TOP-HEAVY CONTRIBUTIONS"
will be amended effective _____________ by the addition of a new
paragraph (C) which shall read as follows:
"C. Minimum Benefits for Employees Also Covered Under Another
Plan:
The Employer should describe below the extent, if any, to
which the Top-Heavy Minimum Benefit requirements of Code
Section 416(c) and paragraph 14.2 of the Basic Plan Document
#01 shall be met in another plan. Please list the name of
the other plan, the minimum benefit that will be provided
under such other plan, and the Employees who will receive
the minimum benefit under such other plan."
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
4. Section XIII of the Nonstandardized Cash or Deferred Profit-Sharing
Adoption Agreement #010 entitled, "VESTING" will be amended effective
__________________ by the addition of a new paragraph (E) which shall
read as follows:
Note: First select to whom the vesting schedule will apply.
Number 1 should be elected if only active Participants'
Matching Contributions accounts will be affected. Letter (a)
should be selected if the Employer wishes only to change the
vesting schedule for contributions made to the Plan after
December 31, 2001. Letter (b) should be selected if the
Employer wants to change the vesting schedule for all
Matching Contributions to the Plan (regardless of when
made). Number 2 should be selected if the Employer wants to
change the vesting schedule on Matching Contributions for
all Participants - regardless of whether they are active or
inactive. The applicable vesting schedule shall be selected
from number 3 through 7 below.
2 Section 401(k) Plan AA #010
E. Vesting of Employer Matching Contributions:
[ ] 1. Participants who have completed one Hour of
Service after 2001
[ ] a. The vesting schedule of Employer Matching
Contributions as described in paragraph 9.2
of the Basic Plan Document #01 shall be
selected below and shall apply only to
account balances derived from Employer
Matching Contributions attributable to a Plan
Year beginning after December 31, 2001.
[ ] b. The vesting schedule of Employer Matching
Contributions as described in paragraph 9.2
of the Basic Plan Document #01 shall be
selected below and shall apply to all
Participants with an account balance derived
from Employer Matching Contributions.
[ ] 2. All Plan Participants:
[ ] a. The vesting schedule of Employer Matching
Contributions as described in paragraph 9.2
of the Basic Plan Document #01 shall be
selected below and shall apply to all
Participants with an account balance derived
from Employer Matching Contributions.
The vesting schedule for Employer Matching Contributions shall be
as follows:
[ ] 3. Not applicable. There are no Matching
Contributions made to the Plan.
[X] 4. Not applicable. The current formula(s) are equal
to or greater than the three year cliff or six
year graded vesting schedules.
[ ] 5. A Participant's account balance derived from
Employer Matching Contributions shall be fully and
immediately vested.
[ ] 6. A Participant's account balance derived from
Employer Matching Contributions shall be
nonforfeitable upon the Participant's completion
of three (3) years of vesting Service.
[ ] 7. A Participant's account balance derived from
Employer Matching Contributions shall vest
according to the following schedule:
Years of Vesting Service Vested Percentage
------------------------ -----------------
2 20%
3 40%
4 60%
5 80%
6 100%
5. Section XV of the Nonstandardized Cash or Deferred Profit-Sharing Plan
Adoption Agreement #010 entitled, "IN-SERVICE WITHDRAWALS" will be
amended by the addition of a new paragraph (C) which shall read as
follows:
"C. Suspension Period for Hardship Distribution (select one):
[ ] 1. A Participant who receives a distribution in calendar year
2001 on account of Hardship shall be prohibited from making
Elective Deferrals and Voluntary After-tax Contributions
under this and all other plans of the Employer for six (6)
months after receipt of the distribution or until
January 1, 2002, if later.
3 Section 401(k) Plan AA #010
[ ] 2. A Participant who receives a distribution in calendar year
2001 on account of Hardship shall be prohibited from making
Elective Deferrals and Voluntary After-tax Contributions
under this and all other plans of the Employer for the
period specified in the provisions of the Plan relating to
suspension of Elective Deferrals that were in effect prior
to this Amendment."
6. Section XVIII of the Nonstandardized Cash or Deferred Profit-Sharing
Plan Adoption Agreement #010 entitled, "DISTRIBUTION OPTIONS" will be
amended effective 01/01/2002 by the addition of two new paragraphs (E)
and (F) which shall read as follows:
E. Treatment of Rollovers in Application of Involuntary Cash-out
Provisions:
The Employer (select one):
[X] Elects
[ ] Does not elect
to exclude Rollover Contributions in determining the value of the
Participant's nonforfeitable account balance for purposes of the
Plan's involuntary cash-out rules.
If the Employer has elected to exclude Rollover Contributions, the
election shall apply with respect to distributions made after
01/01/2002 (enter a date no earlier than December 31, 2001) with
respect to Participants who separated from Service after
01/01/2002 (enter the date; this date may be earlier than December
31, 2001).
F. Distribution Upon Severance from Employment:
Distribution upon severance from employment as described in
paragraph 6.6(d) of the Basic Plan Document #01 shall apply for
distributions after 01/01/2002 (enter a date no earlier than
December 31, 2001):
[X] regardless of when the severance from employment occurred.
[ ] for severance from employment occurring after __________
(enter the Effective Date if different than the Effective
Date above)."
Executed, this 9th day of September.
Sontra Medical Corporation
--------------------------
Name of Employer
Xxxxxx Xxxxxxx
--------------------------
Signed By
/s/ Xxxxxx Xxxxxxx
--------------------------
Signature
Section 401(k) Plan AA #010
4
5 Section 401(k) Plan AA #010
