p~i acer® m e m o r a n d u m

147

COUNTY ~ M E M O R A N D U M OF P~I ~ HUMAN RESOURCES

~ acer® TO: Honorable Board of Supervisors DATE: November 14, 2017

FROM: Lori Walsh , Human Resources Director

SUBJECT: Deferred Compensation Plan Amendment

ACTION REQUESTED

Authorize the Director of Human Resources to sign the MassMutual Governmental 401 (k) -Request for Plan Amendment Authorization Form which includes revisions to spousal consent requirements and loan provisions.

BACKGROUND

Placer County has contracted with MassMutual to provide administrative and recordkeeping services for our 401 (k) plan. The County's plan uses a pre-approved Internal Revenue Services (IRS) Volume Submitter document along with a Summary Plan Description that delineates Placer plan specifics to run the program . In April 2016, your Board approved the restatement of these plan documents as is required by the IRS every six years to keep plans current with legislation changes.

Since the plan restatement , current practices with 401 (k) programs necessitate further changes to the 401 (k) plan documents which are accomplished through the attached MassMutual Governmental 401 (k) - Request for Plan Amendment Authorization Form. The requested changes to the plan documents are:

1. Remove spousal consent for participant distributions - no longer needed for 401 (k) program

2. Loans will be permitted from all contribution sources including matching contributions

FISCAL IMPACT

There is no fiscal impact affiliated with this request.

Attachments

Attachment 1 - Governmental 401 (k) - Request for Plan Amendment Authorization Form

148

Group Number: 150005 ATTACHMENT 1 Plan Name: County of Placer 401 (k)

Governmental 401 (k) - Request for Plan Amendment Authorization Form To be completed by the Plan Sponsor or the Plan Administrator or authorized representative on behalf of the Plan Sponsor

Usethisformifyouwantto: e Request a draft Plan amendment/restated Plan Document

Do not use th is form if you: o Have an outside drafted plan that was amended . Please provide a copy of your Plan amendment or restated Plan

Document for MassMutual to review it for recordkeeping purposes. You are looking to add an Automatic Contribution Arrangement, Eligible Automatic Contribution Arrangement, or Qualified Automatic Contribution Arrangement.

Plan Sponsors utilizing MassMutual Retirement Services' Plan Document drafting services may use this form to direct MassMutual to prepare a draft Plan amendment/restated Plan Document for the Plan Sponsor's review and adoption. Plan Sponsors should review the draft Plan amendment/restated Plan Document with their legal and tax advisors and discuss any proposed changes to the draft with a member of their Account Management team before executing the Plan amendment/restated Plan Document.

MassMutual will also prepare a draft Summary of Material Modification or restated Summary Plan Description reflecting the Plan amendment/restated Plan Document as adopted by the Plan Sponsor.

Changes to the Plan's Address and Phone Number will be processed upon receipt of an in good order Plan Amendment Request Form. For all other Changes, the Plan Sponsor must provide an executed copy of the Plan amendment/revised Plan Document to Mass Mutual before the revised Plan provisions are updated on the record keeping system. Also note that the revised Plan provisions are not considered to be in effect until the document is executed.

[i] Plan Sponsor is requesting MassMutual prepare a draft Plan amendmenUrestated Plan Document.

Please note that all pages of the Plan Amendment Request Form must be returned in order for this form to be considered In Good Order.

149

. Group Number 150005

Plan Name County of Placer 401 (k)

CompleteonlyapplicableSection(s) being amended both inthebelowtableof contents and the corresponding page(s) within this form.

Section

IXI Section 1. USection 2.

Section 3. Section 4. Section 5. Section 6. Section 7. Section 8. Section 9. Section 10. Section 11 . Section 12. Section 13.

- Section 14 Section 15. Section 16. Section 17

• Section 18 REQUIRED

Gov401 k

PlanFeature · Paae

Required Information Plan Information Eligibility Requirements Service Calculation Employee Contributions Nan-Safe Harbor Employer Matching Contributions Nan-Safe Harbor Employer Nan-elective Contributions Safe Harbor Employer Contributions Testing Method Vesting Use of Forfeitures RetirementAae Reauirements Definition of Compensation far Contributions Loans Withdrawals Distribution Options Trustee Information Other Requested Amendment Plan Sponsor Authorization and Signature

2 GPlan Level Task Type- PLNAMDREQ

3 3 3 5 5 7 9 10 12 12 13 14 14 15 16 17 17 18 18

150

Group Number 150005 Plan Name County of Placer401(k)

Section· 1. !)~quired Information men : Jtt_w~t? ___ (Must be at/east 30 da;s ram the date this paperwork is

submitted andingood order.)

- Section 2. Plan Information ,. · ASA·and Contract Amendment maybe required , . DEmployer Name: ________________________ _

{If Plan is also changing , please complete Plan name change below)

DEmployer Name change due to merger/acquisition

DCity, State, Zip Code:--------------------

O PO BoxAddress {If applicable} with City, State, Zip Code: --------

O Phone Number:-----------

O Sponsor Business:

DC Corp DPartnership OS Corp DSole Proprietorship OT ax Exempt/Not For Profit

Dlimited Liability DProfessional Services Corp

DOther: (Must be legal entity recognized under federal income tax laws)

Participating Employers- NOTE: All employees of member companies of your controlled group of corporations and/or affiliated service group (ifapplicable)arecovered byyourretirementplan unless specifically excluded in the 'Covered Employees' portion found in section 3 of this paperwork.

DNew Plan Name: ---------------------~ DChange Plan Year: New Plan Year End: ___ Short Plan Year: __ _

DChange Fiscal Year: New Fiscal Year End: __ _

Section 3. Eligibility Re.quirerrients _ DChangeAge and Service Requirements-Specify minimum age and/or service requirements an employee must complete to become a Participant in the plan.

Age Requirement:

DNo age requirement DAge requirement of ___ (Not more than age21}

Gov 401 k 3 GPlan Level

Task Type- PLNAMDREQ

151

Group Number 150005 Plan Name County of Placer401 (k)

Minimum Service Requirement:

D No service D 1Yearofservice 02 Years of service (Employer contributions only must be 100% vested)

D Months of service Doth er ~~~~~-----~

Eligibility requirements stated above will apply to ALL contribution sources unless otherwise specified:

Dcovered Employees-The plan must satisfy Code Section 41 O(b) coverage testing when a class of Employees is excluded, with the exception of the collectively bargained and nonresident alien exclusions named below. The exclusion must represent a reasonable classification and either the ratio percentage test or average benefits must demonstrate compliance with Code Section 410(b).

D No excluded Employees

D Exclude collectively bargained (Union) Employees

D Exclude non-resident aliens with no U.S. source

Dlncome exclude highly compensated Employees

D Exclude leased Employees

D Excludethefollowing location:-----------

O Other excluded class of Employees: _________ _

Exclusions will apply to ALL contributions unless otherwise specified:

Dehan~ Entry Dates LJoate requirements met DFirst day of the month coinciding with or next following date requirements are met DFirst day of the quarter coinciding with or next following date requirements are met DFirst day of Plan Year or first day of 1th month coinciding with or next following date requirements met D Other (An Employee who is in a covered class and has satisfied the maximum age (21) and service requirements (1 year or 2 years if full and in mediate vesting) must commence participation no later than the earlier of (a) 6 months after such requirements are satisfied, or (b) the first day of the first Plan Year after such requirements are satisfied.)

The entry dates specified above will apply to ALL contributions unless otherwise specified:

Gov 401 k 4 GPlan Level


152

Group Number 150005

Plan Name County of Placer401 (k}

DEligibility Service Calculations O Elapsed Time (Le. period of service with no minimum hours required) O Hours of Service Method

Hours Requirement {If Hours of Service Method is selected above) 01 ,000 hours of service within eligibility computation period 0 (Cannot exceed 1,000) hours of service within eligibility computation period

Eligibility Computation Period (If Hours of Service Method is selected above) Initially the eligibility period must be the Employee's first anniversary of employment. For Employees who do not satisfy the hours,{equirement during their first year of employment, subsequent eligibility computation periods will :

U Be based on subsequent anniversari es of the Employee's employment date O Shift to the plan year

Equivalency Method of counting hours must be defined for any Employees for who records of actual hours of service are not maintained or available (i.e .. salaried employees). An Employee will be credited with the indicated numberof hours of service th~ Employee completes one hour of service

U No Equivalency- Hours are available for all Employees O Days worked- 10 hours per day Dweeks worked- 45 hours perweek Osemi-monthly payroll periods worked-95 hours per semi-monthly pay period O Months worked- 190 hours per month (Default)

Servicecreditwithotherspecified Employers:--------- --

O Service with Employers listed above will be recognized for:

Gov401k

Dvesting service DEligibi lity service Dcontribution service

Source Employee Pre-Tax Roth 401(k) After Tax Voluntary Rollover

Add D D D --D

Change Remove D D

-6- D D

D I I

5

Please CompletE Section A Section B ~~~Qfl c

GPlan Level TaskType-PLNAMDREQ

153

Group Number 150005 Plan Name untyotPlacer401 (k)

Section A-Employee Pre-Tax Elective Deferrals

Deferral Limits-Limits the Employerwants to place on Employees' salary elective deferrals (i .e. Pre-tax and Roth401 (k) Contributions, if applicable}

OUpto __ Yo 0From __ %to __ % OUptothe maximum amount allowed by law

Additional deferral limits for Highly Compensated employees (HCEs) O No additional limit for HCEs 0 __ % of compensation OAdministratordetermines and communicates deferral limitannually based on prioryear's participation by NHCEs

** Plan document allows the Administrator to suspend HCE elective deferrals (Other than catch-up contributions) in order to assure ADP limitation wil l be satisfied during any given plan year.

Separate election for bonuses ONoseparate election for bonuses QA Participant may make a separate election to defer upto __ % of any bonus

Catch Up Contributions OWill be accepted by the plan OWill be matched (Standard is for catch up contributions to be matched)

.. Note If any member of the controlled group or affiliated service group to which the Employer isa part that maintains its own 401 (k) plan, the Plan(s)ofsuch member(s) must permit catch upcoritrihutioris inorderforthis Plan to permitthem.

Section B- Roth 401{k) Contributions

The Plan will permit Participants to defer Roth 401 (k) Contributions. (Note: Unless specified otherwise, when adding Roth Contributions, investment allocations will mirror Elective Deferral Contributions).

Rollover Contributions: The Plan will accept direct rollover amounts attributed to Roth 401 (k) Contributions and such rollovers will be treated as Roth401 (k) Contributionsforthe purposes of n-servicewithdrawals unless otherwise specified :--------------------

Qistributions: Elgibility, distribution and loan availability of Roth 401 (k) Contributions will mirror Pre-tax Contributions unless otherwise specified : --------------

Corrective Distributions: The plan will distribute §402(g) excess deferrals, ADP excess contributions, and §415 excess aQ.Qual additions from: (Select one below)

U Pre-tax 401 (k) Contributions first (Standard and default t no selection is made) DRoth 401 (k) Contributions first

Gov401k

D Hgh1y Compensatc;d Employee.; 1 nay o~:::. i\:j1 ,ate whether the corr vctive distribution is first rncidr: from Pre-lax or Roth 401 (k) Contributions. If the Participant does not make an election, the Plan will distribute the Corrective Distribution from Pre-tax 401 (k) Contributions first.

6 GPlan Level

TaskType-PLNAMDREQ

154


Changes to when Participants may modify Elective Deferral Elections O First day of the plan year OAny day of the plan year O First day of the calendar quarter O Dates prescribed by Administrator Doth er: (Must be at least once each calendaryear)

Section C- After-Tax Voluntary Contributions

Participants may contribute to the Plan on a traditional After-tax basis. (Note: These are not Roth 401(k) Contributions.)

DFrom %~ % OMatchAfter-tax Contributions in addition to 401 (k) Contributions

Note: Eligibility/Entry Dates will mirror Pre-Tax 401 (k) Contributions and After-tax Contributions may be withdrawn at any time -

Section D- Rollover Contributions

Elgible Rollover Distributions may be accepted by the plan from a §401 (a) or §403(a) qualified plan (including After-tax Voluntary Employee Contributions that are directly rolled over and including Roth 401 (k) Contributions if your plan allows ongoing Roth 401 (k) Contributions); a §403(b) annuity contract, a §457(b) plan maintained by a governmental unit; and a §408(a)or§408(b) IRA unless otherwise specified : --------------

Employees eligible to make rollover contributions include: OAII coverea Employees who have met applicable age and/or service requirements D Participants Only

Section 6. Non-.Safe Harbor l:mploy~r Matching Contributions . . · ff iJIBQ Is. 'B{J/J/ng source. please alS01COmp/ete Sections 3, ., t, · 12.. 16

OAdd Dchange ORemove

Employer Matching Contnbut1on Formula:

Gov401k

D Discretionarv • Cap

DNo cap on Elective Deferrals matched O Upto % of the Participant's Elective Deferrals OUpto $ __ O Upto %of the Participant'sdeferred compensation or$ , if less O Discretionary Cap on Electiv_; 8efe~rals m::itched

• Varying Match OThe level of matching contributions may be different for different Employee groups, as defined by

the Administrator pursuant to determinable and non-discriminatory classifications (I RC coverage uirements must be satisfied.

7 GPlan Level TaskType-PLNAMDREQ

155


D Required (Choose one of the following) D %of Elective Deferrals upto % of the Participant's compensation D % of Elective Deferrals upto $ __ _ D %of Elective Deferrals upto %of the Participant's compensation or$ fess ---

D %of Elective Deferrals upto % of the Participant's compensation plus __ _ % of Elective Deferrals which do not exceed % of the Participant's compensation D %of Elective Deferrals upto $ of the Participant's compensation plus % of Elective Deferrals which do not exceed$ of the Participant's compensation. D % of Elective Deferrals upto % of the Participant's compensation or$ __ _ f less plus % of Elective Deferrals which do not exceed % of the Participant's compensation or $ , if less.

First Plan Year Compensation Compensation forthe Plan Year in which an Employee is first eligible to enter the Plan shall be:

.. · DThe ErnpT6yee's compensation from the time the Employee becomes a Participant in the Plan DThe Employee's compensation for the entire Plan Year

Period of Determination And any Compensation or dollar flmitation used in determining the match will be based on the appl cable period:

D Each month D Each payroll period D Each calendar quarter D Each plan year DEach payroll period D Each plan year or, if the Employer so chooses, atthesametime Tax-Deferred Contributions are contributed or any other time as permitted by law and regulation

Qualifying Participants Entitled to Matching Contributions A qualifying Participantwill be entitled to matching contributions forthe plan year only if the Participant makes deferral contributions (Pre-tax and Roth 401 (k) contributions, of selected) and satisfies the following conditions: (Select one option below.)

DOption 1- No additional requirements (Must be selected if matching contributions are made and allocated more frequently than annually) D Option 2-A Participant must complete at least 501 hours of service during the plan year, unless otherwise specified (Applies only to Participants who terminate during the plan year). All Participants employed on the last day of the plan yearwill receive an allocation. (May be selected only if matching contributions are made and allocated annually.) Doption 3-Select applicable boxes below: (May be selected only if matching contributions are made and allocated annually.)

D Hours of Service Requirement-A Participant must complete at east hours of service during the plan year

(Not more than 1,000)

D Last Day Requirement-A Participant must be employed on the last day of the plan year

The conditions in Option 2 and/or 3 above will be waived as a result of a Participant's: (Check all that apply) DAttainment of Early or Normal Retirement Age Doeath Ooisability

Gov401k 8 GPlan Level TaskType-PLNAMDREQ

156

Group Number 150005


OAdd Dchange D Remove

]:rofits: Non-Safe Harbor Employer Non-Elective Contributions will be based on a discretionary formula and will not be contingent on profits unless otherwise specified:----------------

Employer Nern-Elective Contribution Formula D Discretionary ratio of Qualifying Participant's compensation to total compensation of all Qualifying Participants D Discretionary fiat dollar will be allocated to each Qualifying Participant D Discretionary fiat dollar amount for each hour of service completed by a Qualifying Participant D % of compensation to each Qualifying Participant D $ to each Qualifying Participant D Integrated formula. The integration level shall be:

DTaxablewage base D Dollar amount of$ (Must be less than the taxable wage base) D Percentage of % (Not more than 100%)ofthetaxablewage base D Percentage of % (Not more than 100%) of the taxable wage base plus$ __ _ D Percentage of % (Not more than 100%) of the taxable wage base minus$ __ _

First Plan Year Compensation Compensation for the plan year in which an Employee is first eligible to enter the Plan shall be:

DThe Employee's compensation from the time the Employee becomes a Participant in the Plan DThe Employee's compensation for the entire plan year

Qualifying Participants Entitled to the Employer NonElective Contribution: A Qualifying Participant will be entitled to the Employer Non-Elective Contribution for the plan year if the Participant is a Participant for at least one day of such plan year and satisfies the following condition: (Select one option below)

Ooption 1- No additional requirements. (Must be selected if Employer Non-Elective Contributions are made and allocated more frequently than annually) Doption 2-A Participant must complete at least 501 hours of service during the plan year, unless otherwise specified (applies only to Participants who terminate during the Plan Year). All Participants employed on the last day of the plan year will receive an allocation. (May be selected only if Employer Non-Elective Contributions are made and allocated annually) Ooption 3- Select applicable boxes below: (May be selected only if Employer Non-Elective Contributions are made and allocated annually)

D Hours of Service Requirement- A Participant must complete at least (Not more than 1,000) hours of service during the plan year D Last Day Requirement-A Participant must be emr.,loyed on Lhe last day of the plan year.

The conditions in Option 2or 3 above Wm be waived as a result of a Participant's: (Check all that apply) D Attainment of Early or Normal RetirementAge D Death

D Disabilit

Gov401k 9 GPlan Level

TaskType-PLNAMDREQ

157

Group Number 150005

Plan Name County of Placer401(k)

The waiver will apply to the: D Hours of service required {Options 2 or 3) DLast day requirement {Option 3) Dconditions in Option 2 or 3 will NOT be waived

Section 8 .. Safe Harbor Employer Contributions:--~ . . ·--,, ,ifan is adding sour~e. a/ease als,j:complete Sections 3 an_d 16

Source f Safe Harbor Em lo er Match

Add D D

Chan e Remove D D D

Please Complete ection A

SectionB ~

Please note: If you are removing a Safe Harbor Contribution during the middle of a plan year, the following rules must be satisfied:

Safe Harbor Matching Contributions must be funded through the lesser of: { 1) 30 daysafteryou provide eligible Employees with noticethatthe Safe HarborContribution is being

eliminated (MassMutual can provide a sample notice}, (2) The date the plan amendmenUplan document restatement is effective, or (3) 30 days after the date the plan amendmenUplan document restatement is signed •• Full year ADP andACP nondiscrimination testing will be required if a Safe Harbor Matching Contribution is removed mid-year

Safe Harbor Non-Elective Contributions may NOT be removed mid-year unless the sponsor incurs a substantial business hardship as described in IRC Section 412(c). In addition, Safe Harbor Non-Elective Contributions must be funded through the later of:

(1) 30 days after you provide eligible Employees with notice that the Safe Harbor Contribution is being eliminated (MassMutual can provide a sample notice),

(2) The date the plan amendmenUplan document restatement is effective, or (3) 30 days after the date the plan amendmenUplan document restatement is signed .. Full year ADP and ACP nondiscrimination testing wil l be required ifa Safe Harbor Matching Contribution is. removed mid-year

Safe Harbor Employer Contributions for the coming Plan Year: Dsafe Harbor Matching Contributions Dsafe Harbor Non-Elective Contributions

Note: If you are 'ADDI NG' Safe Harbor Employer Contributions, Eligibility & Entry dates will mirror401 (k) Contributions unless you make notation that you would like to use the statutory age 21 and one year of service requirements in the Eligibility Section (Section 3) of this papeiWork.

Gov401k GPlan Level


158

Group Number 150005


Section A: Safe Harbor Matching Employer Contributions

Participant deferred compensation is matched, which includes Pre-tax and Roth 401 (k) Contributions, if selected. (Select one of the following)

D B.asic Match- Employerwill match 100% of a Participant's Elective Deferrals upto 3% of their compensation, plus50%oftheirElective Deferrals which exceed 3%, but do not exceed 5%oftheircompensation. O Enhanced Match- Employer will match 100% of Participant's Elective Deferrals that do not exceed* ( 1) ___ % of their compensation , plus (2) % of their Elective Deferrals that exceed (3) % of their compensation and that do not exceed (4) % of their compensation.

Note: If the Plan permits Catch-up Contributions, they must be included in applying the Safe Harbor Matching formula above.

First Plan Year Compensation Compensation forthe plan year in which an Employee is first eligible to enter the Plan shall be:

DThe Employee's compensation from the time the Employee becomes a Participant inthe Plan DThe Employee's compensation for the entire plan year.

Contribution Period The Safe Harbor Matching Contribution will be made on the following basis and compensation for such purposes will be based orube applicable period:

UEach payroll period OAII payroll periods ending within each month OAII payroll ending within the plan year quarter 0The entire plan year (Contribution must be annualized if sent into the Plan before the end of the plan year)

If the Plan has regular Non-Safe Harbor Matching Contributions in addition to Safe Harbor Matching Contributions specified above:

U Eliminate the regular Non-Safe Harbor Matching Contributions OLimitthe regular Non-Safe Harbor Matching Contributions soastoavoidACP nondiscrimination testing. The limitwill be4 % of an eligible Employee's compensation with no allocation requirements and only deferrals upto 6% of compensation may be matched OR, if a fixed matching contribution formula is included inyour plan, 6% of an eligible Employee's compensation. O Make no changes to the regular Non-Safe Harbor Matching Contributions. If the Plan makes additional matching contributions in any given plan year, ACP nondiscrimination testing requirements may apply.

Section B: Safe Harbor Non-Elective Employer Contributions

The Safe Harbor Non-Elective Contributions will be an amount equal to ___ % (Not less than 3%) of the Participant's annual compensation.

First Plan Year Compensation Compensation for the plan year in which an Employee is first eligible to enter the Plan shall be:

0The Employee's comperi~ation from theti"10the Employee becomes a Partiripr1nt in the r1::-~ 0The Employee's compensation for the entire plan year.

Gov401k GPlan Level TaskType-PLNAMDREQ

159

Group Number1sooos Plan Name County of Placer 401 (k)

fthe Plan has regular Non-Safe Harbor Matching Contributions in addition to Safe Harbor Matching Contributions specified above:

OEliminatethe regular Non-Safe Harbor Matching Contributions O Limit the regular Non-Safe Harbor Matching Contributions so as to avoidACP nondiscrimination testing . The limit will be4 % of an eligible Employee's compensation with no allocation requirements and only deferrals up to 6% of compensation may be matched OR, if a fixed matching contribution formula is included in your plan , 6% of an eligible Employee's compensation. O Make no changes to the regular Non-Safe Harbor Matching Contributions. If the Plan makes additional matching contributions in any given plan year, ACP nondiscrimination testing requirements may apply.

Safe Harbor Contributions must be immediately 100% vested and may not be withdrawn prior to termination of em lo ment unless the Plan ermits distributions at attainment of a e 59 !4.

Testing Method The testing method used for ACPIADP nondiscrimination testing shall be:

OCurrent Year (Must be selected if this is a Safe Harbor Cash or Deferred Arrangement) OPriorYear (Not recommended for plans with a discretionary employer match)

I Note: Your testing method can not switch from the Current Year testing method to the Prior Year testing method for a years. Prior Year testing method to Current Year testing method can be done at any time.

HCE Determination For purposes of determining who is a Highly Compensated Employee, the Top-paid Group election: (Select one)

OWillapply OWill not apply

OAdd OChan e O Remove

O Full and immediate vesting Other Schedule: Years of Service Vesting Percentage

3 yearcliff:0%inYears 1&2, 100%after3years

4 yeargraded:25%peryear, 100%after4years

5 yeargraded: 20% peryear, 100% after 5 years

6 yeargraded: 20%after2years, plus20% peryear,

100% after 6 years

Gov401k

%

%

%

%

%

100%

GPlan Level

TaskType-PLNAMDREQ

160

Group Number 150005


Non-Safe Harbor Employer Non-Elective Contribution Vesting Schedule DAdd Dchange DRemove

D Full and immediate vesting Other Schedule: Years of SeNice Vesting Percentage

D 3 year cliff: 0% in Years 1&2, 100%after 3 years

D4yeargraded: 25% peryear, 100%after4years

D 5 year graded: 20% per year, 100% after 5 years

D 6yeargraded: 20% after 2years, plus20% per year,

100% after 6 years

Vesting Service Years of service and breaks-in-service for purposes of determining vesting will be based on:

O Elapsed Time (i .e.· period of seNicewith no minimum hours required) D Hours of Service Method

a) Hours Requirement D 1,000 hours of service within vesting computation period

100%

D (Cannot exceed 1,000) hours of seNice within vesting computation period

b) Vesting Computation Period D Anniversary of each Employee's D Employment date plan year

Equivalency Method

%

%

%

9-0

%

Equivalency Method of counting hours must be defined for any Employees for who records of actual hours of service are not maintained or available (i.e. salaried employees). An Employee will be credited with the indicated number of hours of seNice the. Employee completes one hour of seNice:

U No equivalency- Hours are available for all Employees Doays worked- 1 O hours per day Dweeks worked- 45 hours per week D Semi-monthly payroll periods worked- 95 hours per semi-monthly pay period D Months worked-190 hours per month (Standard)

Equivalency Methods will apply to: . D All Employees

. D Employeesforwhom records of actual hours of seNice are not maintained or available (i .e. salaried employees)

Forfeiture Requirements The Plan may, at the Plan Administrator's discretion, use forfeitures to pay for Plan expenses.

Forfeitures of Non-Safe Harbor Employer Non-Elective Contributions will be: D Used to reduce an Em lo er contribution

Gov401k GPlan Level

Task Type-PLNAMDREQ

161

Group Number150005 Plan Name County of Placer 401 (k)

OAllocated to all Participants eligible to share in the allocations of Employer Non-Elective Contributions in the same proportion that each Participant's compensation for the plan year bears to the compensation of all Participants for such year OAllocated to all Participants eligible to share in the allocations of Employer Non-Elective Contributions under the same formula as ongoing Non-Elective Contributions

Forfeitures of Non-Safe Harbor Matching Contributions will be: O Used to reduce any Employer contribution OAdded to any Employer matching contribution and allocated as an additional matching contribution OAllocated to all Participants eligible to share in the allocations of Non-Elective Contributions in the same proportion that each Participant's compensation for the plan year bears to the compensation of all Participants for such year

Normal and Early Retirement are identified as 'protected benefits ' in Internal Revenue Code Section 411 and cannot be made more restrictive or eliminated.

Normal Retirement Participant will be 100% vested upon satisfaction of the Normal Retirement requirements) OAge· (Not more than 65) O Age (Not more than 65) or, if later, the (Not to exceed 5) anniversary of commencement of:

Early Retirement

OParticipation in the plan, or O Employment

OAge __ _ OAge AND at least ___ years of vesting of service

Participant will become fully vested upon attainment of Early Retirement Date: OYes O No

Section, 13: Definition of 0Qmpens~tion for_~_ontributions

Definition of Compensation for a Plan Year: (Select one) OW-2 D 3401(a} 0415 modified 0General415

The above specified definition of compensation will apply to all contributions unless otherwise specified:

Gov401k GPlan Level

Task Type-PLNAMDREQ

162

Group Number 150005 Plan Name County of Placer 401 (k) ompensat1on w1 :

O Exclude (Non standard) amounts excluded from taxable compensation attributable to Employee elective contributions made to a 401 (k) , 403(b), 457(b), SEP, Cafeteria plan or qualified transportation fringe.

Compensation Exclusions (Contribution purposes only) Excluding these forms of compensation (Other than Safe Harbor Fringe Benefits) will result in the need for additional compliance testing:

Oovertime O Commissions O Bonuses O Safe Harbor Fringe Benefits (Reimbursements or other expense allowances, fringe benefits, moving expenses, deferrea compensation , and welfare benefits are all excluded from compensation) Oother: -------- --------~

Section 14. Loans May reauif~ ASA-AmMdment. Plan wi/1 rec'eive Loan _Program outlining loan provisions.

Are Participant loans available? Yes ONo

Please note: Employees with outstand ing loans must be allowecP continue making repayments on those loan notes.

O Loans are available for any reason, minimum of $ __ _ (May not exceed $1 ,000).

O Loans are limited to financial hardship.

Loan Interest Rate will be: (Select one) DPrime 0Prime+1 0Prime+2 Oother: --------

Applicable repayment payroll frequencies: (Select one) Oweekly O Every Two Weeks 0Twice a Month O Monthly Oother: _____ _

Caution: Allowing multiple loans can increase administrative complexity.

Residential loan repayments may exceed the 5 year repayment period: DY es O No

Loans will be permitted from all contribution sources unless otherwise specified: Permit matching contributions

AND, if loans are restricted to certain accounts, the limitations of Code Section 72(p) and the adequate security requirem~t of the DOL Regulations will be applied:

Gov401k

ll By determining the 'imitsonly considerin~ the restricted accounts O By determining the limits taking into account a Participant's entire interest in the Plan

GPlan Level TaskType-PLNAMDREQ

163

Group Number 150005 .Plan Name County of Placer401 (k)

Withdrawals permitted prior to termination from employment (Select from ~ems 1-5 below)

1. Disabilit Withdrawals OAdd

2. Attainment of Normal RetirementA e OAdd

3. Hardship Withdrawals a. Elective Deferrals (Pre-tax and Roth 401 (k) contributions, if selected, unless O Add otherwise specified) b. Employer Matching Contributions other than Safe Harbor. If 'Yes', select one OAdd below:

D ·Mustbe 100%vested Dvested amount

c. Employer Non-Elective Contributions other than Safe Harbor. lf'Yes', select one below:

D Must be 100% vested Dvested amount

d. Rollovers .... ...... .. .. .. .................. .. ........ .. .. ........... .. ... .. ... . e. Other: ----------------~~ (Please note: Plan cannot allow hardship withdrawals from QNEC, QMAC, or Safe Harbor Contributions.)

Elective Deferrals are subject to a 6 month suspension following hardship withdrawal. The hardship withdrawal of any other contribution will not subject the Participant to a suspension unless otherwise specified

4. Non-Hardship Withdrawals Upon Attainment of Age 59 %

OAdd

OAdd OAdd

a. Elective Deferrals (Pre-tax and Roth 401(k) contributions, if selected, unless OAdd otherwise specified) ---------------b. Employer Matching Contributions other than Safe Harbor. If 'Yes', select one OAdd below:

D Must be 100% vested D Vested amount

c. Employer Non-Elective Contributions other than Safe Harbor. If 'Yes', select one below:

D Must be 100% vested Dvested amount

d. Safe Harbor Contributions .......... ...... ...... ............... ........ ............... . . e. Rollovers .. .. ... .............. ........ ... ... .. .. ..... .......... .... .... ...... ............... ..

5. Other Non-Ha, 6hip Withdrawal Provisions: a. Employer Matching Contributions other than Safe Harbor. Select all that apply:

OAge __

D Participated in the Plan for at least years Select one below as it applies to the selection s above :

OAdd

OAdd OAdd

OAdd

,.,

DDelete

Doelete

DDelete

Doelete

D Delete

D Delete Doelete

D Delete

D Delete

Doelete

D Delete D Delete

DDelete

Gov401k GPlan Level


I

164

Group Number 150005

Plan Name County of Placer401 (k)

LJ Must be 100% vested D Vested amount

b. Employer Non-Elective Contributions other than Safe Harbor. Select all that apply:

OAge D Participated in the Plan for at east years (Select one below as it applies to the selection(s) above}:

D Must be 100% vested D Vested amount

c. Rollovers at any time .. .. .. .. .. .. .... .. .. .. .. .... ........ .. .. .... .. ........ .... ...... .. .

· .. Section ~16. Distribution Options ·

Installments: . 0 Add O Remove

Annuities: DAdd DRemove

OAdd D Delete

OAdd D Delete

Doptional form of benefit (No spouse consent requ ired unless a married participant elects a single ife annuity}. D Normal form of benefit (Spouse consent required}. The survivor portion of the Qualified Joint and Survivor Annuity is:

D 50% (Standard} D 100% DOther %(Nomorethan 100%}

f-.bte: If this Plan contair1 sMone; Purchase Pension Pan assets, annuities cm not be elm hated.

Mandatory Cash-out Distributions The Mandatory cash-out eve! for severed Participants shall be:

D Shall not apply 0$5,ooo 0$1 ,ooo OOther: $ __

Trustee Information (Select one of the following}:

D Named lndividual(s} to add:--------------------Namedlndividual(s}to remove: ____________________ _

Please attach a Board ofDirectors Resolution naming the new individual(s}as Trustee.

DAs Plan Sponsor, I elect to appoint an individual(s} as Trustee(s}. Please attach a Board of Directors Resolution naming the following as Trustee(s):

Gov 401k 17 GPlan Level Task Type- PLNAMDREQ

165

Group Number 150005


Amen ment to Plan Provisions not re lected in the preceding Sections. Please remove spousal consent needed for distributions.

Plan Sponsor Authorization and Signature

As an authorized representative of the Plan Administrator with authority to provide the directions contained herein on behalfofthe Plan Sponsor, the Plan Sponsor acknowledges and agrees that: 1 )the Plan Sponsor has hadopportunityto consultwith its own legal and tax advisors regarding the requested amendments to the Plan and has determined the Plan allows the amendments and/or changes requested herein ; 2) to the extent required by the Plan and/or the Sponsor's governing body, the Sponsor has , or will cause to have, taken the appropriate actions totimelyeffectthe Plan changes consistent with this form; 3) upon receipt of this properly completed and executed form, MassMutual is hereby directed to prepare an amendment to the Plan or restated Plan Document consistent with these instructions for the Plan Sponsor's review, approval and timely adoption; 4) MassMutual will not reflect any changes or updates to its record keeping system, as applicable, until the Plan Administrator provides a returned , executed copy of the Plan amendmenUrestated Plan Document prepared by MassMutual; 5) upon MassMutual's receipt of the executed Plan amendmenUrestated Plan Document, the Plan Administrator directs MassMutual to update its recordkeeping system in accordance with the executed Plan amendmenUrestated Plan Document, consistent with the administrative services agreement between the Plan Sponsor and MassMutual; 6) MassMutual has not provided any legal or tax advice to me, the Plan , the Plan Sponsororthe Plan Administrator; ?)the Plan Sponsor and PlanAdministratorwill operate, or cause to be operated , the Plan in a manner consistent with these instructions and the Plan amendmenUrestated Plan Document on the requested effective date specified on this form ; and 8) the Plan Sponsor and Plan Administrator remain solely responsible for timely notifying participants of the changes to the Plan .

Please Note: In addition if your plan is subject to the U.S. Department of Labor's participant-level fee disclosure 404(a)(5) regulation, certain changes to the operation of your plan, your plan's list of investment options, or the administrative and individual fees associated with plan participation may be triggering events under the regulation requiring notice of the changes to your participants. Under the regulations, change notifications must generally be distributed at least 30 but not more than 90 days before the effective date of the change, except when such notice is not possible ( such as the immediate elimination


166

Group Number 150005

Plan Name County of Placer401 (k)

of an investment option that has been determined to no longer be a suitable investment alternative), in which case, the plan must generally provide notice of the change as soon as practicable. For your convenience, we have developed a sample change notification letter that you can download and adapt for use with your participants. Please consult with your Plan's legal counsel to determine the applicability of the DOL's 404(a)(5) participant-level disclosure regulations to your Plan.

Authorized Representative of the Plan Sponsor:

Print Name: Date: -------- · ----- --~- ·-- ---· ~~~~~~~~~~~~~

Please note that you may also receive an updated Administrative Service Agreement (ASA) or an updated Contract.


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