AGREEMENT FOR SALARY REDUCTION FOR EMPLOYEE CONTRIBUTIONS UNDER ALSAC EMPLOYEE RETIREMENT PLANSalary Reduction Agreement • June 28th, 2011
Contract Type FiledJune 28th, 2011PARTICIPANT INFORMATION Last Name First Name Have you contributed pre-tax or Roth dollars to a 403(b) or 401(k) plan through another employer in the current year?❏ Yes ❏ No If the answer is yes, total contributed to date $ . SECTION 1: AUTO ENROLL/AUTO SAVE (NEW EMPLOYEES ONLY) ❏ The initial amount of my salary reduction is 3% of base salary per pay period (on a pre-tax basis). I can change or stop mydeduction, or switch all or a portion to a Roth elective deferral, at any time by completing a new Agreement for Salary Reduction. ❏ I do not wish to participate in the Plan at this time. SECTION 2: FIXED CONTRIBUTION Effective date: ❏ I would like to contribute (% of base salary per pay period) to the Plan not to exceed the 401(k) limit per year from all employers. (Must complete online enrollment application).❏ I am currently contributing to the Plan. I would like to change my contribution to (% of base salary per pay period).❏ I would like to cancel my contributions to the Plan.