Document:

SECURITIES PURCHASE AGREEMENT

Exhibit 10.1

SECURITIES PURCHASE AGREEMENT

Dated as of March 10, 2005

By and Between

CAPCO ENERGY, INC.

and

JVL Global Energy (QP), LP

JVL Global Energy, LP

Navitas Fund, LP

Peninsula Fund, LP

Peninsula Catalyst Fund, LP

Peninsula Catalyst QP Fund, LP

	 	 	 

TABLE OF CONTENTS

Page

ARTICLE I DEFINITIONS

1

Section 1.1 - Definitions

1

Section 1.2 - Other Definitions

3

Section 1.3 - Construction

3

ARTICLE II ISSUANCE AND PURCHASE OF STOCK

3

Section 2.1 - Issuance and Purchase of Stock

3

Section 2.2 - The Closing

3

ARTICLE III REPRESENTATIONS AND WARRANTIES OF THE COMPANY

3

Section 3.1 - Organization

3

Section 3.2 - Due Authorization

4

Section 3.3 - Non-Contravention

4

Section 3.4 – Consents

4

Section 3.5 - Capitalization

4

Section 3.6 - Legal Proceedings

5

Section 3.7 - No Violations

5

Section 3.8 - Permits

5

Section 3.9 - Financial Statements

5

Section 3.10 - No Material Adverse Change

6

Section 3.11 - Disclosure

6

Section 3.12 - Compliance

6

Section 3.13 - Reporting Status

7

Section 3.14 - Properties

7

Section 3.15 - Contracts

7

Section 3.16 - Environmental Matters

8

Section 3.17 – Tax Returns

8

Section 3.18 - Insurance

8

ARTICLE IV REPRESENTATIONS AND WARRANTIES OF THE PURCHASERS

8

Section 4.1 - Authority

8

Section 4.2 - Consents and Approval; No Violation

9

Section 4.3 - Securities Laws

9

ARTICLE V ADDITIONAL AGREEMENTS

12

Section 5.1 - Use of Proceeds

12

Section 5.2 - Access to Information

12

Section 5.3 - Reservation of Common Stock

12

Section 5.4 - Market for Common Stock

12

Section 5.5 - Best Efforts

13

Section 5.6 - Public Announcements

13

Section 5.7 - Restrictive Legends

13

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Section 5.8 - Registration Rights

13

Section 5.9 - Indemnification

16

ARTICLE VI PURCHASERS' CONDITIONS

17

Section 6.1 - Representations and Covenants

17

Section 6.2 - Required Consents and Approvals

17

Section 6.3 - Additional Documents

17

ARTICLE VII COMPANY’S CONDITIONS

17

Section 7.1 - Representations and Covenants

17

Section 7.2 - Required Consents and Approvals

17

Section 7.3 - Additional Documents

17

ARTICLE VIII TERMINATION AND SURVIVAL

18

Section 8.1 - Termination

18

Section 8.2 - Survival; Failure to Close

18

ARTICLE IX MISCELLANEOUS

18

Section 9.1 - Entire Agreement

18

Section 9.2 - Notices

18

Section 9.3 - Governing Law

20

Section 9.4 - Severability

20

Section 9.5 - Expenses

20

Section 9.6 - Descriptive Headings

20

Section 9.7 - Counterparts

20

Section 9.8 - Assignment

21

Section 9.9 - Amendments; Waivers

21

Schedule 3.1 – Subsidiaries of the Company

Schedule 3.5 – Capitalization

Schedule 3.6 – Legal Proceedings

Schedule 4.3(b) – Risk Factors

Exhibit "A" – Form of Warrant

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SECURITIES PURCHASE AGREEMENT

This Securities Purchase Agreement (the "Agreement") is made and entered into as of the 10th  day of March, 2005, by and among Capco Energy, Inc., a Colorado corporation (the "Company"), JVL Global Energy (QP), LP, JVL Global Energy, LP, Navitas Fund, LP, Peninsula Fund, LP, Peninsula Catalyst Fund, LP, and Peninsula Catalyst QP Fund, LP (individually, a "Purchaser", and collectively, the "Purchasers").

ARTICLE I

DEFINITIONS

Section 1.1 - Definitions

.  As used in this Agreement, the following terms have the meanings indicated:

"Agreement" has the meaning ascribed to such term in the first paragraph hereof.

"Closing" has the meaning ascribed to such term in Section 2.2.

"Closing Date" has the meaning ascribed to such term in Section 2.2.

"Common Stock" means the common stock, $0.001 par value per share, of the Company.

"Company" has the meaning ascribed to such term in the first paragraph hereof.

"Contracts" means any indenture, mortgage, deed of trust, loan agreement, note, lease (other than oil and gas leases), license, franchise agreement, permit, certificate, contract or other agreement or instrument to which the Company or any of its Subsidiaries is a party or to which their respective material properties or assets are subject.

"Dolphin Transaction" means the transaction(s) among the Company, Hoactzin Partners, L.P. and Dolphin Direct Equity Partners, LP pursuant to that certain Amended Memorandum of Terms for Investment in Certain Oil and Gas Projects dated February 7, 2005 and the documents and instruments related thereto.

"Environmental Laws" means all (i) all federal statutes regulating or prescribing restrictions regarding the use of property or other activities affecting the environment (air, water, land, animal and plant life), including but not limited to the following:  the Clean Air Act, Clean Water Act, Comprehensive Environmental Response, Compensation and Liability Act, Emergency Planning and Community Right-to-Know Act, Hazardous Materials Transportation Act, National Environmental Policy Act, Occupational Safety and Health Act, Oil Pollution Act of 1990, Resource Conservation and Recovery Act, Safe Drinking Water Act, and Toxic Substances Control Act; (ii) all regulations promulgated under such federal statutes, (iii) all local and state laws, rules and regulations regulating the use of or relating to or affecting the environment, and (iv) all common law rights, duties and obligations relating to the use of or matters affecting the environment.

"Exchange Act" means the Securities Exchange Act of 1934, as amended.

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"Governmental Authority" means the United States, any foreign country, state, county, city or other political subdivision, agency or instrumentality thereof.

"Material Adverse Effect" means any event or condition which, individually or in the aggregate, would reasonably be expected to have a material adverse effect on the business, financial condition or results of operations of the Company and its Subsidiaries, taken as a whole.

"Permits" means any licenses, permits, certificates, consents, orders, approvals and other authorizations from, and all declarations and filings with, all federal, state, local and other Governmental Authorities, all self-regulatory organizations and all courts and other tribunals presently required or necessary to own or lease, as the case may be, and to operate the properties of the Company and its Subsidiaries and to carry on the business of the Company and the Subsidiaries as now or proposed to be conducted as set forth in the SEC Filings.

"Purchaser" and "Purchasers" have the meanings ascribed to such terms in the first paragraph hereof.

"SEC" means the Securities and Exchange Commission.

"SEC Filings" means the Company’s reports and other filings made with the SEC for a period of twelve (12) months prior to the date hereof and all exhibits thereto.

"Securities" means the Common Stock and the Warrants being purchased pursuant to this Agreement and the Warrant Shares issuable upon exercise of the Warrants.

"Securities Act" means the Securities Act of 1933, as amended.

"Subsidiary" means, when used with reference to an entity, any corporation, a majority of the outstanding voting securities of which are owned directly or indirectly by such entity.  Such term shall also refer to any other partnership, limited partnership, limited liability company, joint venture, trust, or other business entity in which such entity has a material interest.  With respect to the Company, as of the date of this Agreement, the Company’s Subsidiaries are set forth on Schedule 3.1 attached hereto.

"Transactions" means the issuance and sale of the Units to the Purchasers and the other transactions and obligations contemplated by this Agreement.

"Unit" means one share of Common Stock and one-half of a Warrant.

"Warrant" or "Warrants" means the Company’s Common Stock Purchase Warrants, each initially exercisable within five (5) years for one share of Common Stock at a purchase price of $0.45 per share and having terms substantially as set forth in Exhibit "A" attached hereto.

"Warrant Certificate" means a certificate evidencing a Warrant in substantially the form attached hereto as Exhibit "A".

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"Warrant Shares" means the shares of Common Stock purchased or purchasable upon the exercise of the Warrants pursuant to the terms thereof, initially being 5,000,000 shares of Common Stock.

Section 1.2 - Other Definitions

.  Other terms defined in this Agreement have the meanings so given them.

Section 1.3 - Construction

.   Whenever the context requires, the gender of all words used in this Agreement includes the masculine, feminine, and neuter.  Except as specified otherwise, all references to Articles and Sections refer to articles and sections of this Agreement, and all references to exhibits and schedules are to Exhibits and Schedules attached to this Agreement, each of which is made a part of this Agreement for all purposes.  The word "including" shall mean "including, without limitation" unless the context otherwise requires.

ARTICLE II

ISSUANCE AND PURCHASE OF STOCK

Section 2.1 - Issuance and Purchase of Stock

.  Subject to the terms and conditions of this Agreement, the Company agrees to issue and sell to the Purchasers, and the Purchasers agree to subscribe for and purchase from the Company, a total of 10 million Units for an aggregate purchase price of $3,000,000 in cash (the "Purchase Price").  The number of Units to be purchased by each Purchaser will be specified in writing to the Company at least three days prior to Closing.

Section 2.2 - The Closing

.  Subject to the terms and conditions of this Agreement, the issuance and purchase of the Units shall take place at a closing (the "Closing") to be held at the offices of the Company, 5555 San Felipe., Suite 725, Houston, Texas 77056, at 10:00 a.m. (Central time) on March 10, 2005, or such other place or time as may be agreed by the parties.  The date on which the Closing occurs is referred to herein as the "Closing Date."  At the Closing, the Company will deliver to Purchasers stock certificates representing the Common Stock purchased and Warrant Certificates for the Warrants Purchased, registered in the name of each Purchaser as specified in accordance with Section 2.1 upon receipt of the Purchase Price by wire transfer of immediately available funds to an account designated by the Company, or by such other method as is mutually agreed to by Purchasers and the Company.  Such certificates shall bear appropriate restrictive legends deemed necessary by the Company to comply with applicable securities and corporate laws, including without limitation those set forth in Section 5.9.

ARTICLE III

REPRESENTATIONS AND WARRANTIES OF THE COMPANY

The Company represents and warrants to Purchasers as of the date hereof as follows:

Section 3.1 - Organization

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.  Each of the Company and its Subsidiaries (i) is duly organized, validly existing and in good standing under the laws of the jurisdiction of its organization, (ii) has full power and authority to own, operate and occupy its properties and to conduct its business as presently conducted, and (iii) is registered or qualified to do business and in good standing in each jurisdiction in which it owns or leases property or transacts business, except where the failure to be so qualified would reasonably be expected to have a Material Adverse Effect, and no proceeding has been instituted in any such jurisdiction revoking, limiting or curtailing, or seeking to revoke, limit or curtail, such power and authority or qualification.  Schedule 3.1 contains a list of the Company’s Subsidiaries, including the jurisdiction of organization of, and direct and indirect ownership of the Company in, each Subsidiary (and whether such ownership is subject to a lien, security interest or other encumbrance).

Section 3.2 - Due Authorization

.  The Company has all requisite power and authority to execute, deliver and perform its obligations under this Agreement, and this Agreement has been duly authorized and validly executed and delivered by the Company and constitutes a legal, valid and binding agreement of the Company enforceable against the Company in accordance with its terms, except as rights to indemnity and contribution may be limited by state or federal securities laws or the public policy underlying such laws, and except as enforceability may be limited by applicable bankruptcy, insolvency, reorganization, moratorium or similar laws affecting creditors’ and contracting parties’ rights generally and general principles of equity (regardless of whether such enforceability is considered in a proceeding in equity or at law).

Section 3.3 - Non-Contravention

.  The execution and delivery of this Agreement, the issuance and sale of the Securities and the consummation of the Transactions will not (assuming the consents referred to in Section 3.4 and the waiver of any pre-emptive rights identified in Schedule 3.5 are obtained) conflict with or constitute a violation of, or default or result in the creation or imposition of any lien or encumbrance on any material asset of the Company or its Subsidiaries under (i) any material Contracts, (ii) the charter, by-laws or other organizational documents of the Company or any of its Subsidiaries, or (iii) to its knowledge, any law, regulation, ordinance or order of any court or governmental agency, arbitration panel or authority binding upon the Company or any of its Subsidiaries or their respective properties, in each case except those that would not reasonably be expected to have a Material Adverse Effect.

Section 3.4 – Consents

.  No consent, approval, authorization or other order of, or registration, qualification or filing with, any regulatory body, administrative agency, or other governmental body in the United States is required for the execution and delivery of this Agreement and the valid issuance and sale of the Units, other than such as have been made or obtained, except for those in connection with the Dolphin Transaction, for any filings required to be made under federal or state securities laws, and where any failure to make or obtain any of the foregoing would not reasonably be expected to have a Material Adverse Effect.

Section 3.5 - Capitalization

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.  The capitalization of the Company as of December 31, 2004 is as set forth in Schedule 3.5 attached hereto and in the SEC Filings.  The Company has not issued any capital stock since that date, except for the issuance of 25,000 shares on February 9, 2005, upon the exercise of a stock option.  The Units have been duly authorized, and when issued and paid for in accordance with the terms of this Agreement, will be duly and validly issued, fully paid and non-assessable.  The outstanding shares of capital stock of the Company have been duly and validly issued and are fully paid and non-assessable, have been issued in compliance with all federal and state securities laws, and were not issued in violation of any preemptive rights or similar rights to subscribe for or purchase securities.  Except as set forth in Schedule 3.5 or disclosed in the SEC Filings, there are no outstanding rights, warrants or options to acquire, or instruments convertible into or exchangeable for, any unissued shares of capital stock or other equity interest in the Company, or any contracts, commitments, agreements, understandings or arrangements of any kind to which the Company is a party relating to such issuance of capital stock or other equity interest in the Company.  Except as disclosed in the SEC Filings, there are no stockholders agreements, voting agreements or other similar agreements with respect to the Common Stock to which the Company is a party.

Section 3.6 - Legal Proceedings

.  Except as disclosed in Schedule 3.6 or in the SEC Filings, there is no material legal or governmental proceedings pending, or to the knowledge of the Company, threatened to which the Company or any of its Subsidiaries is a party or of which the business or property of the Company or any of its Subsidiaries is subject, which would be reasonably likely to have a Material Adverse Effect on the Company.

Section 3.7 - No Violations

.  Neither the Company nor any of its Subsidiaries is (i) in violation of its charter, bylaws or other organizational document, or to its knowledge, (ii) in violation of any law, administrative regulation, ordinance or order of any court or Governmental Authority, arbitration panel or authority applicable to the Company or any of its Subsidiaries, which would be reasonably likely to have a Material Adverse Effect, or (iii) in default in the performance of any material Contracts, which would be reasonably likely to have a Material Adverse Effect.

Section 3.8 - Permits

.  Each of the Company and its Subsidiaries has all necessary Permits that are currently necessary for the operation of the business of the Company and its Subsidiaries as currently conducted and as described in the SEC Filings, except where the failure to currently possess such Permits would not reasonably be expected to have a Material Adverse Effect.

Section 3.9 - Financial Statements

.  The financial statements of the Company and the related notes contained in the SEC Filings present fairly in all material respects, in accordance with generally accepted accounting principles, the consolidated financial position of the Company and its Subsidiaries as of the dates indicated (the "Financial Statements").  Such Financial Statements have been prepared in accordance with generally accepted accounting principles applied on a consistent basis throughout the periods therein specified.

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Section 3.10 - No Material Adverse Change

.  Except as disclosed in the SEC Filings, since September 30, 2004, there has not been (i) any change in the business, financial condition,  operation, or prospects of the Company which would reasonably be expected to have a Material Adverse Effect, (ii) any obligation, direct or contingent, that is material to the Company and its Subsidiaries considered as one enterprise, incurred by the Company or its Subsidiaries, except obligations incurred in the ordinary course of business, (iii) any dividend or distribution of any kind declared, paid or made on the capital stock of the Company, or (iv) any loss or damage (whether or not insured) to the physical property of the Company or any of its Subsidiaries which would reasonably be expected to have a Material Adverse Effect.

Section 3.11 - Disclosure

.  The information contained in the SEC Filings as of the date of such information, and the information contained in this Agreement, including any schedule or exhibit attached hereto, does not and did not, as of the date of such information, contain an untrue statement of a material fact or omit to state a material fact required to be stated therein or necessary to make the statements herein or therein, in light of the circumstances under which they were made, not misleading.

Section 3.12 - Compliance

.  

(a)

The Common Stock is registered pursuant to the Exchange Act and is quoted on the OTC Bulletin Board (the "OTCBB"), and the Company has taken no action designed to, or to its knowledge likely to have the effect of, terminating the registration of the Common Stock under the Exchange Act or the quotation of the Common Stock from the OTCBB, nor has the Company received any notice within the 12 months preceding the date of this Agreement regarding the termination of such registration or quotation.

(b)

As long as any Purchaser owns Common Stock, Warrants or Warrant Shares, the Company covenants to timely file (or obtain extensions in respect thereof and file within the applicable grace period) all reports required to be filed by the Company after the date hereof pursuant to Section 13(a) or 15(d) of the Exchange Act. As long as any Purchaser owns Common Stock, Warrants or Warrant Shares, if the Company is not required to file reports pursuant to Section 13(a) or 15(d) of the Exchange Act, it will prepare and furnish to the Purchasers annual and quarterly financial statements, together with a discussion and analysis of such financial statements in form and substance substantially similar to those that would otherwise be required to be included in reports required by Section 13(a) or 15(d) of the Exchange Act, as well as any other information required thereby, in the time period that such filings would have been required to have been made under the Exchange Act. The Company further covenants that it will take such further action as any Purchaser may reasonably request, all to the extent required from time to time to enable such person to sell Common Stock and Warrant Shares without registration under the Securities Act. Upon the request of any Purchaser, the Company shall deliver to such Holder a written certification of a duly authorized officer as to whether it has complied with such requirements.

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Section 3.13 - Reporting Status

.  The Company has filed all documents that the Company was required to file under the Exchange Act during the 12 months preceding the date of this Agreement.  Copies of such documents have been made available to the Purchasers.

Section 3.14 - Properties

.  Each of the Company and its Subsidiaries has good and defensible title to all property included in the Financial Statements, free and clear of all liens, charges, encumbrances or restrictions, except for Permitted Encumbrances.  As used herein, the term "Good and Defensible Title" means, as to the oil and gas properties of the Company or its Subsidiaries (the "Oil and Gas Properties"), such right, title and interest that is (i) owned or deducible of record (either from the records of the applicable county, parish, country and/or, in the case of Federal leases, from the records of the applicable office in the Bureau of Land Management or Minerals Management Service and/or, in the case of Indian leases, from the applicable office of the Bureau of Indian Affairs, and state leases, from the records of the applicable state land office), or (ii) such that a reasonably prudent purchaser of oil and gas properties would accept the same.  As used herein, the term "Permitted Encumbrances" means: (i) matters described in the SEC Filings or reflected in the Financial Statements; (ii) royalties, overriding royalties, net profits interests, production payments and other burdens on production which do not materially reduce the Company's or its Subsidiaries' net revenue interest in any of the Oil and Gas Properties to less than the interest included in the information in the Financial Statements, (iii) liens for taxes, assessments, labor and materials where payment is not delinquent, (iv) operating agreements, unit agreements, unitization and pooling designations and declarations, gathering and transportation agreements, processing agreements, gas, oil and liquids purchase, sale and exchange agreements, exploration and development agreements, surface agreements, farmout agreements and other similar agreements, provided they do not have a material adverse effect on the ownership of the Oil and Gas Properties or increase the cost burden applicable to any such property in excess of the cost burden included in the information in the Financial Statements, (v) regulatory authority of governmental agencies not presently or previously materially violated, (vi) easements, surface leases and rights, plat restrictions and similar encumbrances, provided that they do not detract from the value, or materially increase the cost of operation of any of the Oil and Gas Properties, (vii) liens, encumbrances and rights granted or arising in connection with the Dolphin Transaction; and (viii) liens, charges, encumbrances and irregularities in the chain of title which, because of remoteness in or passage of time, statutory cure periods, marketable title acts or other similar reasons, have not affected or interrupted, and are not reasonably expected to affect or interrupt, the claimed ownership of the Company or the receipt of production revenues from the Oil and Gas Properties affected thereby, and any other encumbrance or claim which would not reasonably be expected to have a Material Adverse Effect.

Section 3.15 - Contracts

.  All material Contracts are valid, binding and enforceable against the Company or its Subsidiaries, as applicable, and, to the knowledge of the Company, are valid, binding and enforceable against the other party or parties thereto and are in full force and effect with only such exceptions as would not reasonably be expected to have a Material Adverse Effect.  The Company and its Subsidiaries, and to the knowledge of the Company, the other parties thereto, 

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are not in default under any of the material Contracts, which default would reasonably be expected to have a Material Adverse Effect.

Section 3.16 - Environmental Matters

.  Except as would not reasonably be expected to have a Material Adverse Effect and except as disclosed in the SEC Filings, (i) each of the Company and its Subsidiaries is in compliance with and not subject to liability under applicable Environmental Laws, (ii) each of the Company and its Subsidiaries has made all filings and provided all notices required under any applicable Environmental Law, and has in full force and effect and is in compliance with all Permits required under any applicable Environmental Laws, (iii) there is no civil, criminal or administrative action, suit, demand, hearing, notice of violation, proceeding, notice or demand letter or request for information pending or, to the knowledge of the Company, threatened against the Company or its Subsidiaries under any  Environmental Law, (iv) no lien, charge, encumbrance or restriction has been recorded under any Environmental Law with respect to any assets, facility or property owned, operated, leased or controlled by the Company or its Subsidiaries, and (v) neither the Company nor its Subsidiaries has received notice that it has been identified as a potentially responsible party under any Environmental Law.

Section 3.17 – Tax Returns

.  Each of the Company and its Subsidiaries has filed all returns and reports of or relating to any federal, state, local or foreign income, franchise, ad valorem, excise, withholding or other taxes ("Tax Returns") required to be filed on or before the date hereof, except where the failure to so file such Tax Returns would not reasonably be expected to have a Material Adverse Effect, and has paid all taxes shown as due on such Tax Returns, except those contested in good faith by appropriate proceedings.  To the knowledge of the Company, other than taxes which the Company or its Subsidiaries are contesting in good faith and for which the Company or such Subsidiaries have provided adequate reserves, there is no claim against the Company or its Subsidiary for any taxes (including any penalties and interest), and no assessment, deficiency or adjustment has been asserted or proposed that would reasonably be expected to have a Material Adverse Effect.

Section 3.18 - Insurance

.  Each of the Company and its Subsidiaries carries insurance in such amounts and covering such risks as is customary for persons of a similar size in the businesses in which they are engaged.

ARTICLE IV

REPRESENTATIONS AND WARRANTIES OF THE PURCHASERS

Each Purchaser hereby represents and warrants to the Company as follows:

Section 4.1 - Authority

.  The Purchaser has all requisite organizational power and authority, to execute and deliver this Agreement and to consummate the Transactions to be performed by the Purchaser.  The execution and delivery of this Agreement and the consummation of the Transactions to be performed by the Purchaser have been duly and validly authorized by all necessary action on the 

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part of the partners of the Purchaser, and no other partnership proceedings are necessary to authorize the execution and delivery of this Agreement by the Purchaser or to consummate the Transactions to be performed by the Purchaser.  This Agreement has been duly and validly executed and delivered by the Purchaser and, assuming this Agreement constitutes valid and binding obligations of the Company, this Agreement constitutes a valid and binding agreement of the Purchaser, enforceable against him in accordance with its terms, except that the enforcement thereof may be subject to (i) bankruptcy, insolvency, reorganization, fraudulent conveyance, moratorium or other similar laws now or hereafter in effect relating to creditors' rights generally, and (ii) general principles of equity and the discretion of the court before which any proceeding therefor may be brought (regardless of whether such enforcement is considered in a proceeding in equity or at law).

Section 4.2 - Consents and Approval; No Violation

.  Neither the execution and delivery of this Agreement by the Purchaser, the consummation of the Transactions to be performed by the Purchaser, nor compliance by the Purchaser, with any of the provisions hereof will (i) conflict with or result in any breach of any provisions of the Purchaser’s organizational documents, (ii) require any material consent, approval, authorization or permit of, or filing with or notification to, any Governmental Authority, except for consents, approvals, authorizations, permits, filings or notifications which have been obtained or made, or (iii) result in a default (with or without due notice or lapse of time or both) or give rise to any right of termination, cancellation or acceleration under any of the terms, conditions or provisions of any material agreements or violate any material order, writ, injunction, decree, statute, rule or regulation applicable to the Purchaser, which may adversely effect the Transactions or Purchaser's performance hereunder.

Section 4.3 - Securities Laws

.  Each Purchaser hereby represents and warrants to and covenants with the Company that:

(a)

Purchaser has adequate means of providing for its current needs and possible contingencies, and has no need now, and anticipates no need in the foreseeable future, to sell the Securities.  Purchaser is able to bear the economic risks of this investment, and consequently, without limiting the generality of the foregoing, Purchaser is able to hold the Securities for an indefinite period of time and has sufficient net worth to sustain a loss of the entire investment in the Securities in the event such loss should occur.

(b)

Purchaser recognizes that its investment in the Securities involves a high degree of risk which may result in the loss of the total amount of the investment.  Purchaser acknowledges that it is aware of and has carefully considered all risks incident to the purchase of the Securities, including without limitation those discussed in Schedule 4.3(b).

(c)

Purchaser is acquiring the Securities for its own account (as principal) for investment and not with a view to the distribution or resale thereof.  Purchaser has not offered or sold any portion of the Securities and has no present intention of dividing the Securities with others or of reselling or otherwise disposing of any portion of the Securities.

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(d)

PURCHASER IS AWARE THAT IT MUST BEAR THE ECONOMIC RISK OF ITS INVESTMENT IN THE SECURITIES FOR AN INDEFINITE PERIOD OF TIME BECAUSE THE SECURITIES HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OR UNDER THE SECURITIES LAWS OF ANY STATE, AND THEREFORE CANNOT BE SOLD UNLESS THEY ARE SUBSEQUENTLY REGISTERED UNDER THE SECURITIES ACT AND ANY APPLICABLE STATE SECURITIES LAWS OR UNLESS AN EXEMPTION OR EXCEPTION FROM SUCH REGISTRATION IS AVAILABLE AND, FURTHER, THAT ONLY THE COMPANY CAN TAKE ACTION TO REGISTER THE SECURITIES. PURCHASER ALSO RECOGNIZES THAT NO FEDERAL OR STATE AGENCY HAS PASSED UPON THE SECURITIES OR MADE ANY FINDING OR DETERMINATION AS TO THE FAIRNESS OF AN INVESTMENT IN THE SECURITIES.

(e)

Purchaser (i) acknowledges receipt of sufficient information from the Company concerning the business of the Company and its Subsidiaries in order for Purchaser to make a fully informed investment decision, (ii) has had the opportunity to review and obtain copies of any information which the Company possesses and is desired by Purchaser relating to the Securities and the Company and its Subsidiaries (including without limitation copies of the SEC Filings), and (iii) has been given the opportunity to meet with officials of the Company and to have said officials answer any questions regarding the terms and conditions of this particular investment, and all such questions have been answered to Purchaser’s full satisfaction.  While the Company has attempted to provide information that is as accurate as possible, Purchaser acknowledges and agrees that the Company and its representatives cannot and do not make any assurances, representations or warranties with respect to any such information, except for the representations expressly set forth herein.  All information described in this Section 4.3(e) and otherwise reviewed by Purchaser concerning the Company and its Subsidiaries, including without limitation the information included in the SEC Filings, is qualified in all respects by the Risk Factors discussed in Schedule 4.3(b).  The Purchaser has sufficient knowledge and experience in financial and business matters to enable it to evaluate the merits and risks of an investment in the Securities.  In addition, in reaching the conclusion that it desires to acquire the Securities, Purchaser has carefully evaluated its financial resources and investments, has consulted with such legal, accounting and other experts as necessary or appropriate, and acknowledges and represents that Purchaser is able to bear the economic risks of this investment.  Purchaser acknowledges and understands that none of the information provided or made available by or on behalf of the Company constitutes any legal, tax or investment advice.

(f)

Purchaser is an "accredited investor" as such term is defined in Rule 501 under the Securities Act.  Purchaser will provide to the Company such information as may be reasonably requested by the Company to enable it to satisfy itself as to such status and the knowledge and experience of Purchaser and its ability to bear the economic risk of an investment in the Shares.

(g)

All representations and warranties made by Purchaser in this Agreement and all other oral or written information provided by Purchaser to the Company is and are true, correct and complete in all material respects, and, if there should be any material change in such information prior to the acceptance of this Agreement, Purchaser will immediately furnish such revised or corrected information to the Company.

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(h)

The address and social security number or federal tax identification number set forth on the signature page hereof is its true and correct state (or other jurisdiction) of residence and social security number or federal tax identification number.  Purchaser has no present intention of becoming a resident of any other state or jurisdiction.  Purchaser is not subject to backup withholding and will provide such forms and documents as may be required by the Company to evidence its exemption from backup or other withholding taxes and hereby consents to withholding of any applicable taxes from its distributions from the Company.

(i)

Purchaser acknowledges and understands that certain of the information that it has received regarding the Company and its Subsidiaries may be material, non-public information, and that Purchaser will not be able to trade in the Common Stock while in possession of such information until that information has been properly disseminated to the public or becomes immaterial to the Company and its Subsidiaries.

(j)

Purchaser acknowledges and agrees that if Purchaser is purchasing the Units in a fiduciary capacity, the representations, warranties and agreements contained herein shall be deemed to have been made on behalf of the person or persons for whom the Purchaser is so purchasing and that the representations and warranties of the Purchaser as set forth herein shall continue in effect following the sale of the Units pursuant hereto.  In the event that execution hereof by Purchaser is performed by any person as agent for or other representative of the Purchaser, such person represents that he is duly authorized and empowered to sign and deliver this document on behalf of the Purchaser in the capacity stated and that the Purchaser will be bound by this Agreement.

(k)

Purchaser acknowledges that it understands the meaning and legal consequences of the representations, warranties and covenants set forth in this Section 4.3 and that the Company has relied and will rely upon such representations, warranties, covenants and certifications, AND PURCHASER HEREBY AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE COMPANY AND ITS OFFICERS, DIRECTORS, CONTROLLING PERSONS, AGENTS AND EMPLOYEES, FROM AND AGAINST ANY AND ALL LOSS, DAMAGE OR LIABILITY, JOINT OR SEVERAL, AND ANY ACTION IN RESPECT THEREOF, TO WHICH ANY SUCH PERSON MAY BECOME SUBJECT DUE TO OR ARISING OUT OF A BREACH OF ANY OF PURCHASER’S REPRESENTATIONS, WARRANTIES OR COVENANTS.

	11

ARTICLE V

ADDITIONAL AGREEMENTS

Section 5.1 - Use of Proceeds

.  The cash proceeds to the Company from the issuance of the Units shall be used by the Company on and after the Closing Date to acquire and develop oil and gas properties and for general corporate purposes.

Section 5.2 - Access to Information

(a)

Between the date hereof and the Closing Date, the Company will afford to Purchasers and their authorized representatives full access during normal business hours to the facilities and properties and to the books and records of the Company and its Subsidiaries, will permit Purchasers and their authorized representatives to make reasonable inspections and will cause its officers and those of its Subsidiaries to furnish Purchasers and their authorized representatives with such financial and operating data and other information with respect to the business, assets and properties of the Company and its Subsidiaries, as applicable, as Purchasers and their authorized representatives may from time to time request.

(b)

Purchasers and their representatives shall hold strictly confidential all information they obtain with respect to the Company or its Subsidiaries; provided, that Purchasers shall not be obligated to hold confidential information which (i) was or becomes generally available to the public other than as a result of a disclosure by any Purchaser or its representatives, (ii) was or becomes available to Purchasers on a non-confidential basis from a source other than the Company or its representatives, so long as such source is not bound by a confidentiality agreement with the Company or otherwise prohibited from transmitting the information to Purchasers, or (iii) is required to be disclosed in order to comply with any applicable law, order, regulation or ruling; provided further, that Purchasers shall notify the Company prior to any disclosure under (iii) above and provide the Company the opportunity to dispute or contest such disclosure before any disclosure is made.

Section 5.3 - Reservation of Common Stock

.  The Company will reserve and keep reserved for issuance, out of the authorized and unissued shares of the Common Stock, a number of shares of Common Stock sufficient to provide for issuance upon exercise of the outstanding Warrants and shall keep such shares free of any legal or contractual preemptive rights.  The Company will take all steps necessary to keep the Warrant Shares duly authorized for issuance by all requisite corporate and other action, and to assure that such Warrant Shares when issued upon exercise of the Warrants, as the case may be, will be validly issued, fully paid and non-assessable.

Section 5.4 - Market for Common Stock

.  The Company shall use its commercially reasonable efforts to satisfy the requirements within the control of the Company for its Common Stock to be quoted on the OTCBB or, at the option of the Company, listed on a recognized stock exchange.

	12

Section 5.5 - Best Efforts

.  Subject to the terms and conditions herein provided, the Company and Purchasers agree to use their best efforts to take, or cause to be taken, all actions, and to do, or cause to be done, all things necessary, proper or advisable under applicable laws and regulations to consummate and make effective the Transactions.

Section 5.6 - Public Announcements

.  Purchasers shall not issue any press release or otherwise make any public statements with respect to the existence of this Agreement or the Transactions, and the Company shall issue such press releases or make such public statements as may be required by law.

Section 5.7 - Restrictive Legends

.  Unless counsel to the Company shall have advised the Company that such legend is no longer needed, each certificate evidencing the Securities shall bear a legend in substantially the following form:

"THE SECURITIES EVIDENCED BY THIS CERTIFICATE HAVE NOT BEEN REGISTERED PURSUANT TO THE SECURITIES ACT OF 1933, AS AMENDED, OR ANY STATE SECURITIES LAW, AND SUCH SECURITIES MAY NOT BE SOLD, TRANSFERRED OR OTHERWISE DISPOSED OF UNLESS THE SAME ARE REGISTERED AND QUALIFIED IN ACCORDANCE WITH APPLICABLE STATE AND FEDERAL SECURITIES LAWS, OR IN THE OPINION OF COUNSEL REASONABLY SATISFACTORY TO THE COMPANY SUCH REGISTRATION AND QUALIFICATION ARE NOT REQUIRED."

Section 5.8 - Registration Rights

(a)

Within 90 days after the Closing Date, the Company shall prepare and file with the SEC a "shelf" registration statement (the "Common Shares Registration Statement") covering all Common Stock purchased hereunder (the "Registrable Common Shares") for a secondary or resale offering to be made on a continuous basis pursuant to Rule 415.  The Common Shares Registration Statement shall be on Form S-3 (or if such form is not available to the Company on another form appropriate for such registration in accordance herewith). The Company shall use its best efforts to cause the Common Shares Registration Statement to be declared effective under the Securities Act not later than 180 days after the Closing Date (including filing, if appropriate, with the Commission a request for acceleration of effectiveness in accordance with Rule l2d1-2 promulgated under the Exchange Act within five (5) business days of the date that the Company is notified (orally or in writing, whichever is earlier) by the Commission that a Common Shares Registration Statement will not be "reviewed," or not be subject to further review) and to keep such Common Shares Registration Statement continuously effective under the Securities Act until such date as is the earlier of (x) the date when all of the Registrable Common Shares covered by such Common Shares Registration 

	13

Statement have been sold or (y) three years from the date the Common Shares Registration Statement is declared effective under the Securities Act; provided, that the effectiveness of the Common Shares Registration Statement may be delayed or suspended for a reasonable period of time, but not in excess of 60 days, if the Company determines that such registration or the transfer of the Registrable Common Shares would materially interfere with, or require premature disclosure of, any financing acquisition, reorganization or similar event involving the Company or any of its Subsidiaries.  The Common Shares Registration Statement also shall cover, to the extent allowable under the Securities Act and the Rules promulgated thereunder (including Securities Act Rule 416), such indeterminate number of additional shares of Common Stock resulting from stock splits, stock dividends or similar transactions with respect to the Registrable Common Shares.

(b)

Within 90 days after the exercise of the Warrants by Purchasers for at least 50% of the total number of Warrant Shares, the Company shall prepare and file with the SEC a "shelf" registration statement (the "Warrant Shares Registration Statement") covering the Warrant Shares purchased upon such exercise (the "Registrable Warrant Shares") for a secondary or resale offering to be made on a continuous basis pursuant to Rule 415.  The Warrant Shares Registration Statement shall be on Form S-3 (or if such form is not available to the Company on another form appropriate for such registration in accordance herewith). The Company shall use its best efforts to cause the Warrant Shares Registration Statement to be declared effective under the Securities Act not later than 180 days after the Closing Date (including filing, if appropriate, with the Commission a request for acceleration of effectiveness in accordance with Rule l2d1-2 promulgated under the Exchange Act within five (5) business days of the date that the Company is notified (orally or in writing, whichever is earlier) by the Commission that a Warrant Shares Registration Statement will not be "reviewed," or not be subject to further review) and to keep such Warrant Shares Registration Statement continuously effective under the Securities Act until such date as is the earlier of (x) the date when all of the Registrable Warrant Shares covered by such Warrant Shares Registration Statement have been sold or (y) three years from the date the Warrant Shares Registration Statement is declared effective under the Securities Act; provided, that the effectiveness of the Warrant Shares Registration Statement may be delayed or suspended for a reasonable period of time, but not in excess of 60 days, if the Company determines that such registration or the transfer of the Registrable Warrant Shares would materially interfere with, or require premature disclosure of, any financing acquisition, reorganization or similar event involving the Company or any of its Subsidiaries.  The Warrant Shares Registration Statement also shall cover, to the extent allowable under the Securities Act and the Rules promulgated thereunder (including Securities Act Rule 416), such indeterminate number of additional shares of Common Stock resulting from stock splits, stock dividends or similar transactions with respect to the Registrable Warrant Shares.  As used herein, the Registrable Warrant Shares and Registrable Common Shares are referred to collectively as the "Registrable Shares".

(c)

For a period of five (5) years from the Closing Date, if the Company proposes to file a registration statement to register any Common Stock (other than registrations on Form S-8 or Form S-4) under the Securities Act for sale to the public, it will at each such time give written notice to the Purchaser of its intention to do so and, upon the written request of the Purchaser made within thirty (30) calendar days after the 

	14

receipt of any such notice (which request must specify the number of Registrable Shares which the Purchaser intends to dispose under this Section 5.8(c), the "Piggy-Back Shares"), the Company will use its best efforts to include the Piggy-Back Shares in such registration and to cause such registration to become effective; provided, however, that if the offering is underwritten and the managing underwriter shall state in writing that inclusion of all or any of the Piggy-Back Shares would, in such managing underwriter’s opinion, materially interfere with the proposed distribution and marketing of the Common Stock with respect to which the registration was originally to be effected (such writing to state the basis of such opinion and the maximum number of Piggy-Back Shares which may be distributed without such interference), then the Company may, upon written notice to the Purchaser, have the right to exclude from such registration such number of Piggy-Back Shares which it would otherwise be required to register hereunder as is necessary to reduce the total amount of Common Stock to be so registered to the maximum amount set by the managing underwriter; and provided further, that if such registration includes shares being offered by other selling shareholders, any reduction in the number of shares of Common Stock to be included in the registration as recommended by the managing underwriter shall be shared prorata among Purchaser and such other selling shareholders (subject to any superior rights of such other selling shareholders) based upon the number of shares of Common Stock sought to be registered by each such selling shareholder (including Purchaser) as compared to the total number of shares of Common Stock sought to be registered by all selling shareholders (including Purchaser).  As used herein, the Common Shares Registration Statement, the Warrant Shares Registration and any registration statement covering Piggy-Back Shares are referred to as the "Registration Statements".

(d)

The costs and expenses (other than underwriting discounts and commissions related to the Registrable Shares included in the applicable Registration Statement which shall be the responsibility of Purchasers) of the registrations under the Securities Act and of all other actions the Company is required to take or effect pursuant to this Section 5.9 shall be paid by the Company (including, without limitation, all registration and filing fees, printing expenses, fees and expenses of complying with Blue Sky laws, and fees and disbursements of counsel for the Company and of independent public accountants). 

(e)

No such Registration Statement or any amendment thereto shall be filed under this Section 5.8 by the Company until Purchasers and one counsel representing all of them shall have had a reasonable opportunity of not less than five (5) days to review the same and to approve or disapprove any portion of the Registration Statement describing or referring to Purchasers.

(f)

The Company shall furnish to Purchasers such number of copies of any such Registration Statement and of each such amendment and supplement thereto and such number of copies of the prospectus included in such Registration Statement as may be reasonably requested by Purchasers.

(g)

The only representations and warranties a Purchaser shall be required to make in connection with any such underwriting or registration shall be with respect to each Purchaser’s ownership of the Registrable Shares to be sold by it and its ability to convey title thereto free and clear of all liens, encumbrances or adverse claims and such 

	15

other customary representations and warranties reasonably requested by the underwriters, if any, and each Purchaser shall not be required to make any indemnity in connection therewith, except with respect to any misrepresentation by such Purchaser with respect to such underwriting or registration or any information provided by such Purchaser to the Company or any underwriter in connection therewith.

(h)

It shall be a condition precedent to the obligations of the Company to take any action pursuant to this Section 5.8 with respect to the Registrable Shares that each Purchaser shall:

(i)

Furnish to the Company such information regarding the Purchaser, the number of the Registrable Shares owned by it, and the intended method of disposition of such securities as shall be required to effect the registration of such Registrable Shares, and to cooperate with the Company in preparing such Registration Statement;

(ii)

Agree to sell its Registrable Shares to the underwriters at the same price and on substantially the same terms and conditions as the Company or the other persons on whose behalf any Registration Statement was being filed have agreed to sell their securities, and to execute the underwriting agreement; and

(iii)

Pending any amendment or supplement to the Registration Statement or related prospectus, each such Purchaser shall cease making offers or transfers of Registerable Shares pursuant to the prior prospectus.

(i)

The Company may at its discretion include for registration in any Registration Statement shares of Common Stock owned by selling shareholders other than the Purchasers (the "Other Selling Shareholders") so long as the total number of shares of Common Stock to be included in such Registration Statement on behalf of such Other Selling Shareholders does not exceed the total number of Registrable Shares being registered under such Registration Statement.

Section 5.9 - Indemnification

(a)

The Company agrees to indemnify and hold harmless the Purchasers, their affiliates, each of their officers, directors, employees and agents and their respective successors and assigns, from and against any losses, damages, or expenses which are caused by or arise out of (i) any breach or default in the performance by the Company of any covenant or agreement made by the Company  in this Agreement or in any of the schedules or exhibits attached hereto, (ii) any and all third party actions, suits, proceedings, claims, demands, judgments, costs and expenses (including reasonable legal fees and expenses) incident to any of the foregoing.

(b)

Each Purchaser, severally and not jointly, agrees to indemnify and hold harmless the Company, its affiliates, each of their officers, directors, employees and agents and their respective successors and assigns, from and against any losses, damages, or expenses which are caused by or arise out of (i) any breach or default in the performance by the Purchaser of any covenant or agreement made by the Purchaser in this Agreement or in any of the related schedules or exhibits, or  (ii) any and all third 

	16

party actions, suits, proceedings, claims, demands, judgments, costs and expenses (including reasonable legal fees and expenses) incident to any of the foregoing.

ARTICLE VI

PURCHASERS' CONDITIONS

The obligations of Purchasers to effect the Closing are subject to the satisfaction of the following conditions, any one or more of which may be waived by Purchasers.

Section 6.1 - Representations and Covenants

.  The representations and warranties of the Company contained in Article III hereof shall be true and correct in all material respects on and as of the Closing Date as if made, and shall be deemed to have been remade, on and as of the Closing Date.  The Company shall have complied in all material respects with its obligations contained herein the performance of which is required on or prior to the Closing Date.

Section 6.2 - Required Consents and Approvals

.  All filings, consents, approvals and waivers necessary to the consummation of the purchase and sale of the Securities and the Transactions shall have been obtained.

Section 6.3 - Additional Documents

.  The Purchasers shall have received such other certificates, instruments and documents from the Company as it may reasonably request pursuant to this Agreement.

ARTICLE VII

COMPANY’S CONDITIONS

The obligations of the Company to issue and sell the Units are subject to the satisfaction of the following conditions any one or more of which may be waived by the Company: 

Section 7.1 - Representations and Covenants

.  The representations and warranties of each Purchaser contained in Article IV hereof shall be true and correct in all material respects on and as of the Closing Date as if made, and shall be deemed to be remade, on and as of the Closing Date.  Each Purchaser shall have complied in all material respects with its obligations contained herein performance of which is required on or prior to the Closing Date.

Section 7.2 - Required Consents and Approvals

.  All consents, approvals and waivers necessary to the consummation of the purchase and sale of the Securities and the Transactions shall have been obtained.

Section 7.3 - Additional Documents

.  The Company shall have received such other certificates, instruments and documents from each Purchaser as it may reasonably request pursuant to this Agreement.

	17

ARTICLE VIII

TERMINATION AND SURVIVAL

Section 8.1 - Termination

.  The Transactions contemplated hereby may be abandoned at any time prior to the Closing, as follows:

(a)

by the mutual written consent of the Company and the Purchasers;

(b)

by either the Company, on one hand, or the Purchasers acting as one party, on the other hand, in the event any required consent, approval or waiver is not obtained necessary for the consummation of the Transactions; or

(c)

by the Company, on one hand, or Purchasers acting as one party, on the other hand collectively as one party, if there shall have been a material breach by the other party of any of the covenants contained herein or if any representation or warranty made by any other party is untrue in any material respect, in either case in a manner not capable of being cured on or before the Closing Date.

Section 8.2 - Survival; Failure to Close

.  If this Agreement is terminated without Closing, all representations, warranties, indemnities, and covenants contained herein or made in writing by any party in connection herewith will automatically terminate and be of no further force or effect, except the provisions of this Section 8.2 and Sections 4.3, 5.2(b) and 9.5 shall survive any such termination.

ARTICLE IX

MISCELLANEOUS

Section 9.1 - Entire Agreement

.  This Agreement constitutes the entire agreement among the parties with respect to the subject matter hereof and supersedes all prior agreements and understandings, both written and oral, between the parties with respect to the subject matter hereof.

Section 9.2 - Notices

.  All notices, requests, claims, demands and other communications hereunder shall be in writing and shall be deemed to have been duly given when delivered in person, by facsimile, with confirmation of receipt, or by registered or certified mail (postage prepaid, return receipt requested) to the respective parties as follows (or to such other address as a party may designate in a notice to the other party given pursuant to this Section 9.2):

	18

If to the Company:

Capco Energy, Inc.

5555 San Felipe, Suite 725

Houston, Texas  77056

Telephone:  (713) 622-5550

Facsimile:  (713) 622-5552

Attn:  Ilyas Chaudhary

If to Purchasers:

JVL Global Energy (QP), LP

717 Texas Ave., Suite 3000

Houston, Texas  77002

Telephone:  (713) 238-2050

Facsimile:  (713) 238-2051

Attn:  John Lovoi

JVL Global Energy, LP

717 Texas Ave., Suite 3000

Houston, Texas  77002

Telephone:  (713) 238-2050

Facsimile:  (713) 238-2051

Attn:  John Lovoi

Navitas Fund, LP717 Texas Ave., Suite 3000

Houston, Texas  77002

Telephone:  (713) 238-2050

Facsimile:  (713) 238-2051

Attn:  John Lovoi

Peninsula Fund, LP

c/o Peninsula Capital Management, Inc.

One Sansome Street, Suite 3134

San Francisco, California 94104

Telephone:  (415) 288-2480

Facsimile:  (415) 288-2485

Peninsula Catalyst Fund, LP

c/o Peninsula Capital Management, Inc.

One Sansome Street, Suite 3134

San Francisco, California 94104

Telephone:  (415) 288-2480

Facsimile:  (415) 288-2485

Peninsula Catalyst QP Fund, LP

c/o Peninsula Capital Management, Inc.

	19

One Sansome Street, Suite 3134

San Francisco, California 94104

Telephone:  (415) 288-2480

Facsimile:  (415) 288-2485

with a copy to:

Jay B. Marcus 

Marcus Law Offices

504 North Fourth Street

Suite 105

Fairfield, Iowa 52556

Telephone: 641-472-5945

Facsimile: 641-472-5404

Section 9.3 - Governing Law

.  THIS AGREEMENT SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS IN THE STATE OF TEXAS, WITHOUT REFERENCE TO CONFLICTS OF LAWS PRINCIPLES, EXCEPT TO THE EXTENT GOVERNED BY THE CORPORATION LAWS OF THE STATE OF COLORADO AS IT APPLIES TO THE COMPANY AND THE SECURITIES.

Section 9.4 - Severability

.  Whenever possible, each provision of this Agreement will be interpreted in such manner as to be effective and valid under applicable law, but if any provision of this Agreement is held to be prohibited by or invalid under applicable law, such provision will be ineffective only to the extent of such prohibition or invalidity, without invalidating the remainder of this Agreement unless the consummation of the Transactions contemplated hereby is materially and adversely affected thereby.

Section 9.5 - Expenses

.  Except as otherwise provided herein, each party shall bear and pay all costs and expenses incurred by him or it or on his or its behalf in connection with transactions contemplated hereby, including fees and expenses of his or its representatives.

Section 9.6 - Descriptive Headings

.  The descriptive headings of this Agreement are inserted for convenience of reference only and do not constitute a part of and shall not be utilized in interpreting this Agreement.

Section 9.7 - Counterparts

.  This Agreement may be executed in two or more counterparts, each of which shall be deemed an original, but all of which shall constitute one and the same agreement.  Faxed signatures of this Agreement shall be deemed and shall constitute binding signatures for all purposes.

	20

Section 9.8 - Assignment

.  None of the Purchasers nor the Company may assign its rights or obligations under this Agreement.

Section 9.9 - Amendments; Waivers

.  No amendment or waiver of any provision of this Agreement, nor consent to any departure by the Company or any Purchaser therefrom, shall in any event be effective unless the same shall be in writing and signed by Purchasers and the Company in the case of amendments, and the affected party, in the case of waivers.

[Remainder of Page Intentionally Left Blank]

	21

IN WITNESS WHEREOF, the parties have caused this agreement to be executed and delivered as of the day and year first above written.

CAPCO ENERGY, INC.

By:

Name:

Title:

JVL GLOBAL ENERGY (QP), LP

By:  ___________________________,

its general partner

By:

Name:

Title:

JVL GLOBAL ENERGY, LP

By:  ___________________________,

its general partner

By:

Name:

Title:

NAVITAS FUND, LP

By:  ___________________________,

its general partner

By:

Name:

Title:

	22

PENINSULA FUND, LP

By:  ___________________________,

its general partner

By:

Name:

Title:

PENINSULA CATALYST FUND, LP

By:  ___________________________,

its general partner

By:

Name:

Title:

PENINSULA CATALYST QP FUND, LP

By:  ___________________________,

its general partner

By:

Name:

Title:

	23

Schedule 3.1

to

Securities Purchase Agreement

dated March 10, 2005

by and between

Capco Energy, Inc.

and  JVL Global Energy (QP), LP

JVL Global Energy, LP

Navitas Fund, LP

Peninsula Fund, LP

Peninsula Catalyst Fund, LP

Peninsula Catalyst QP Fund, LP

Subsidiaries of the Company

Capco Offshore, Inc. (100% owned), a Texas corporation

Packard Gas Company (100% owned), a Texas corporation

Capco Asset Management, Inc. (100% owned), a Nevada corporation

Bison Energy Company (80% owned), a Wyoming corporation

All of the Company's ownership in its subsidiaries is pledged to secure indebtedness of the Company in connection with the Dolphin Transaction.

	Mid: 010474\000001\449786.11

	 	Schedule 3.1

Schedule 3.5

to

Securities Purchase Agreement

dated March 10, 2005

by and between

Capco Energy, Inc.

and  JVL Global Energy (QP), LP

JVL Global Energy, LP

Navitas Fund, LP

Peninsula Fund, LP

Peninsula Catalyst Fund, LP

Peninsula Catalyst QP Fund, LP

I.

Common Stock, $0.001 par value

A.

Authorized and Issued

1.

150,000,000 shares authorized

2.

99,755,768 shares issued and outstanding

B.

Stock Options and Warrants

1.

21,585,000 shares reserved for issuance for stock options, including 16,585,000 shares subject to currently outstanding stock options

2.

5,005,000 shares reserved for issuance upon exercise of currently outstanding warrants

C.

Convertible Securities

1.

9,358,333 shares underlying convertible notes issued in 2000 and 2004

D.

Other future rights for issuance of shares

1.

1,144,815 share grants authorized by Board of Directors; shares to be Issued in first quarter of year 2005

2.

1,000,000 shares to be issued in connection with acquisition of oil property

3.

1,000,000 shares to be issued in connection with private financing

	Mid: 010474\000001\449786.11

	 	Schedule 3.5

II.

Preemptive Rights

A.

J. Michael Myers holds preemptive rights with respect to the issue of Common Stock or securities convertible or exercisable into Common Stock pursuant to that certain First Amendment to Stock Exchange Agreement dated effective December 1, 2003 between Mr. Myers and the Company.

	Mid: 010474\000001\449786.11

	 	Schedule 3.5

Schedule 3.6

to

Securities Purchase Agreement

dated March 10, 2005

by and between

Capco Energy, Inc.

and JVL Global Energy (QP), LP

JVL Global Energy, LP

Navitas Fund, LP

Peninsula Fund, LP

Peninsula Catalyst Fund, LP

Peninsula Catalyst QP Fund, LP

Legal Proceedings

Hearing requested by Capco Offshore, Inc. before the Texas Railroad Commission for reduction of Capco's financial assurance (bonding) requirements.

	Mid: 010474\000001\449786.11

	 	Schedule 3.6

Schedule 4.3(b)

to

Securities Purchase Agreement

dated March 10, 2005

by and between

Capco Energy, Inc.

and JVL Global Energy (QP), LP

JVL Global Energy, LP

Navitas Fund, LP

Peninsula Fund, LP

Peninsula Catalyst Fund, LP

Peninsula Catalyst QP Fund, LP

Capco Energy, Inc.

Risk Factors

Investment in the Securities involves a significant degree of risk, including the possible loss of the entire investment.  No guarantee or representation is or can be made as to the Company's performance.  The Company encourages each Purchaser to seek advice from legal, accounting and financial professionals prior to purchasing the Securities.  In considering investing in the Securities, each Purchaser should carefully review and consider the terms of this Agreement, the SEC Filings and the other information provided by the Company, and the investment considerations and risks associated with this investment including, but not limited to, the following (references to the "Company," "we," "our" or "us" refer to the Company and its Subsidiaries, and references to "Purchaser" are to each Purchaser and to the Purchasers as a group as the context may require):

Lack of Operating History

In recent years, the Company has substantially changed its business plan.  As a result, the Company's operating history under its current business plan is limited.  Such limited operating history of the Company and its Subsidiaries may not provide sufficient information for Purchaser to base an evaluation of likely performance.

Acquisition Risks

Much of the Company's recent growth has been the result of acquisitions of oil and gas properties.  The Company anticipates that it will continue to evaluate and pursue acquisition opportunities.  To the extent such opportunities are not available to the Company on terms acceptable to management or if the properties acquired do not produce results as anticipated, the Company's ability to sustain such growth may be adversely effected.

	Mid: 010474\000001\449786.11

	S-1

	Schedule 4.3(b)

Risks Related to Projections and Estimates

All statements, other than statements of historical facts included in the SEC Filings, or any other information provided to a potential investor regarding the financial position, business strategy, plans and objectives of management for future operations of the Company and its Subsidiaries are projections and estimates based upon current information available to the Company.  While we believe that such projections and estimates are based upon reasonable assumptions, there are significant risks and uncertainties that could significantly effect expected results.  Important factors that could cause actual results to differ materially from those in the projections and estimates include, without limitation, the Risk Factors discussed herein, and many of those factors are beyond our control.  All written and oral projections and estimates and "forward looking" statements attributable to the Company, whether contained in the SEC Filings or otherwise, are expressly qualified in their entirety by such factors.  Purchaser should expect the assumptions and related projections and estimates to change as additional information becomes available.  However, the Company does not intend to update or otherwise revise the projections and estimates provided to reflect events or circumstances after the date of such information or to reflect the occurrence of unanticipated events.  Purchaser should carefully review and consider the assumptions and estimates, and obtain the advice of legal and accounting experts and other professionals regarding these matters.  Actual results may differ materially from any business descriptions and operating estimates contained in the information provided or available to Purchaser.

Determination of Offering Price

The Purchase Price for the Securities was determined arbitrarily by the Company, based upon, among other things, the short-term capital needs of the Company and recent market prices for the Common Stock.  However, the Purchase Price should not be considered as any indication of the future market price or value of the Common Stock or the other Securities.

Dependence On Key Personnel

The Company depends to a large extent on the services of its executive officers and the officers.  The loss of the services of any of those persons could have a material adverse effect on the Company and its Subsidiaries.

Volatility of Oil and Gas Prices

The Company's financial results will be affected by the price received for its oil and gas production.  Historically, the markets for oil and gas have been volatile and may continue to be volatile in the future.  Prices of oil and gas are subject to wide fluctuations in response to market uncertainty, changes in supply and demand and a variety of additional factors, all of which are beyond the control of the Company.  These factors include domestic and foreign political conditions, the overall level of supply of and demand for oil and gas, the price of imported oil and gas, weather conditions, the price and availability of alternative fuels and overall economic conditions.  The Company's future financial condition and results of operations will be affected by the prices received for oil and gas production.  Any substantial or extended decline in the price of oil and gas would have a material adverse effect on the Company's financial condition and results of operations.

	Mid: 010474\000001\449786.11

	S-2

	Schedule 4.3(b)

Availability of Capital Resources

Currently, the Company's capital resources are expected to be limited to the net proceeds from the sale of the Units and net income from operations of the Company.  The Company does not currently have any cash flow with which to fund capital expenditures.  In the event the Company's current capital resources, and any net cash flow from operations, are insufficient to fund the Company's operations and capital expenditures, the Company may be required to seek other sources of capital including debt or sales of equity.  No assurance can be given that any other sources of capital will be available or economical, and a lack of capital resources may have a material adverse effect on the Company.

Uncertainty of Estimates of Proved Reserves and Future Net Cash Flows

The Company relies upon, and information provided to Purchaser may include, reserve estimates of oil and gas properties.  There are numerous uncertainties in estimating quantities of proved reserves and in projecting future rates of production and the timing of development expenditures, including many factors beyond the control of the Company.  Any reserve data provided to Purchaser or used by the Company are estimates only.  Although the Company believes such estimates to be reasonable, reserve estimates are imprecise and should be expected to change as additional information becomes available.  Furthermore, estimates of oil and gas reserves, of necessity, are projections based on engineering data, and there are uncertainties inherent in the interpretation of such data as well as the projection of future rates of production and the timing of development expenditures.  Reserve engineering is a subjective process of estimating underground accumulations of oil and gas that cannot be exactly measured, and the accuracy of any reserve estimate is a function of the quality of available data and of engineering and geological interpretation and judgment.  Accordingly, estimates of the economically recoverable quantities of oil and gas attributable to any particular group of properties, classifications of such reserves based on risk of recovery, and estimates of the future net cash flows expected therefrom prepared by different engineers or by the same engineers at different times may vary substantially.  Moreover, there can be no assurance that the reserves will ultimately be produced or that the proved undeveloped reserves will be developed within the periods anticipated.  Variances from such estimates could be material.  In addition, estimates of future net revenues from proved reserves and the present value thereof are based upon certain assumptions about production levels, prices and costs, which may not be correct.  The Company emphasizes with respect to such estimates that the discounted future net cash flows should not be construed as representative of the fair market value of the oil and gas properties.  The meaningfulness of such estimates is highly dependent upon the accuracy of the assumptions upon which they were based.  Actual results may differ materially from the results estimated. 

Nonoperating Risk

The Company does not operate all of the oil and gas properties in which it has an interest.  As a result, the financial results from such non–operated properties will be dependent, in part, upon the ability of the operator.  The development of and production from any such properties will be controlled by the operator and not the Company.  Any such lack of control with respect to a significant portion of the Company's property may have a material adverse effect on the Company's financial results.

	Mid: 010474\000001\449786.11

	S-3

	Schedule 4.3(b)

Other Oil and Gas Risks

Oil and gas properties are subject to hazards and risks inherent in the drilling for and production and transportation of oil and gas, any of which can result in loss of hydrocarbons, environmental pollution, personal injury or loss of life, severe damage to and destruction of properties, and suspension of operations.  Among those risks is the risk that no hydrocarbons will be found in commercial quantities.  The Company's properties are also affected from time to time in varying degrees by political developments and federal, state and local laws and regulations, including environmental regulations.  In particular, oil and gas production, operations and economics are or have been significantly affected by price controls, taxes and other laws relating to the oil and gas industry, by changes in such laws and by changes in administrative regulations.  In addition, the discharge of oil, gas or other pollutants into the air, soil or water may give rise to significant liabilities for remediation under environmental regulations.  The Company cannot predict how existing laws and regulations may be interpreted by enforcement agencies or court rulings, whether additional laws and regulations will be adopted, or the effect such changes may have on the Company's financial results.

Reserve Depletion Risk

With respect to any interest in oil and gas properties acquired by the Company, the volume of production from oil and gas properties declines as reserves are depleted, with the rate of decline depending on reservoir characteristics.  Except to the extent successful development activities are conducted on the Company's properties, the reserves of the Partnership will decline as reserves are produced.  There can be no assurance that the future development of the properties in which the Company owns or acquires an interest will result in additional reserves or that productive wells at acceptable costs will be drilled.

High Risk in Exploratory Drilling

The highest risk to be encountered in the exploration for oil and gas is in the drilling of exploratory wells, which are wells drilled in a relatively unproven location, or an unproven zone or depth which involves a higher degree of risk.  It is anticipated that the Company may drill or participate in the drilling of wells in this high risk category and there is a substantial risk that dry holes will result on these proposed wells.

Possible Offshore Drilling

The Company participates in the drilling or workover of wells which involve offshore drilling operations.  Offshore activities involve risks not encountered on land.  Such risks include damage and interruption of operations resulting from storms and more frequent maintenance work and mechanical failures resulting from corrosion.  Well blowouts with respect to offshore wells usually involve greater damages in the form of pollution and greater well control costs.  Offshore drilling rigs and production platforms are subject to damage from nautical collisions.  All such risks are encountered both in shallow and deep water offshore activities, but costs and liabilities tend to be higher with respect to deep water drilling.

	Mid: 010474\000001\449786.11

	S-4

	Schedule 4.3(b)

Competition

The Company will encounter substantial competition in the oil and gas business.  Many competitors have substantially larger financial resources, staffs and facilities than the Company. The Company believes that its services will not come into direct conflict with those larger competitors, but to the extent it is placed in a competitive situation with such a competitor, the Company may be at a severe disadvantage.

Marketability of the Securities

The Common Stock is traded on the OTC Bulletin Board.  However, the shares of Common Stock purchased hereunder and the Warrant Shares have not been registered under applicable securities laws, and therefore cannot be transferred unless so registered or pursuant to an exemption from registration.  In addition, the market in the Common Stock is not actively traded, and the low volume of trading may have a significant effect on the trading price of the Common Stock unrelated to the performance of the Company.  Due to the foregoing Purchaser may not be able to liquidate such shares when he desires to do so, and may be required to retain the investment for an indefinite period of time.

The Warrants will not be readily marketable, will not be redeemable at the option of the holder, have not been registered under applicable securities laws and we have no intention to so register those securities.  Acquisition, ownership and transfer of the Warrants will be restricted in order for the Company to maintain an exemption from registration under applicable state and federal securities laws.  There is no public market for the Warrants, and none is expected to develop.  An investor must plan to retain the Warrants for an indefinite period of time.

Dilution

The purchase price of the shares of Common Stock purchased hereunder and the exercise price of the Warrants represent a purchase price share per share of Common Stock that is in excess of the net tangible book value per share of Common Stock as of September 30, 2004.  As a result, Purchaser may experience immediate dilution in the book value of the shares acquired, in which case the existing stockholders of the Company will have an immediate increase in the net book value of the partnership interests owned prior to this transaction.

THE FOREGOING SUMMARY OF CERTAIN CONSIDERATIONS AND RISKS DO NOT PURPORT TO BE A COMPLETE EXPLANATION OF THE RISKS INVOLVED IN THIS INVESTMENT.  PROSPECTIVE INVESTORS SHOULD READ THE ENTIRE SECURITIES PURCHASE AGREEMENT, THE SEC FILINGS AND OTHER INFORMATION PROVIDED BY THE COMPANY BEFORE DETERMINING TO INVEST IN THE SECURITIES.

	Mid: 010474\000001\449786.11

	S-5

	Schedule 4.3(b)

EXHIBIT "A"

Form of Warrant Certificate

THIS WARRANT, THE PURCHASE RIGHTS EVIDENCED BY THIS WARRANT AND ANY WARRANT SHARES WHICH MAY BE ISSUED UPON EXERCISE OF THIS WARRANT HAVE NOT BEEN REGISTERED PURSUANT TO THE SECURITIES ACT OF 1933, AS AMENDED (THE "SECURITIES ACT"), OR ANY STATE SECURITIES LAW, AND THIS WARRANT, SUCH PURCHASE RIGHTS AND WARRANT SHARES MAY NOT BE SOLD, TRANSFERRED OR OTHERWISE DISPOSED OF UNLESS THE SAME ARE REGISTERED AND QUALIFIED IN ACCORDANCE WITH THE SECURITIES ACT AND ANY APPLICABLE STATE SECURITIES LAWS, OR IN THE OPINION OF COUNSEL REASONABLY SATISFACTORY TO THE COMPANY SUCH REGISTRATION AND QUALIFICATION ARE NOT REQUIRED.

No. 1

Warrant to Purchase

[__________] shares of Common Stock

Dated:

March 10, 2005

(subject to adjustment

as described herein)

WARRANT CERTIFICATE

Representing Common Stock Purchase Warrant

CAPCO ENERGY, INC.

Purchase Price of Common Stock:

$0.45 per share (subject to adjustment)

THIS WARRANT CERTIFICATE (this "Warrant") CERTIFIES that, for value received,  ____________, its registered assigns or the Holder (as defined below) hereof, is entitled, at any time prior to the close of business on the Expiration Date defined below, to purchase the number of shares stated above (subject to adjustment as herein provided) of Common Stock of Capco Energy, Inc., a Colorado corporation (the "Company"), at the purchase price per share stated above (subject to adjustment as herein provided) (the "Purchase Price") upon surrender of this Warrant at the Principal Office of the Company and payment of such Purchase Price in cash or by bank cashier's or certified check. 

This Warrant is issued by the Company pursuant to a Securities Purchase Agreement dated as of March 10, 2005 between the Company and the purchasers named therein (the "Purchase Agreement").

Section 1.  Definitions.  The following terms have the meanings set forth below.  Additional terms are defined elsewhere herein.

"Common Stock" means the Common Stock, par value $0.001 per share, of the Company.

	Mid: 010474\000001\449786.11

	A-1

	Exhibit "A"

"Exercise Date" means each date on which Warrant Shares are to be issued upon exercise of the Warrant.

"Expiration Date" means March 10, 2010.

"Holder" means the registered holder or holders of this Warrant and any related Warrant Shares.

"Principal Office" means the principal office of the Company which, on the date hereof, is located at 5555 San Felipe, Suite 725, Houston, Texas 77056.  The Company shall notify each Warrant holder of any change in its principal office.

"Purchase Price" has the meaning assigned to that term in the introductory paragraph hereof.

"Securities Act" means the Securities Act of 1933, as amended.

"Warrant Shares" means the shares of Common Stock purchased or purchasable by the Holder upon the exercise of this Warrant pursuant to Section 2 hereof.

Any capitalized term not otherwise defined herein shall have the meaning specified in the Purchase Agreement.

Section 2.  Exercise.

A.

General.  Subject to any limitation set forth herein or in the Purchase Agreement or imposed by applicable law, Holder shall be entitled to exercise this Warrant, in whole or in part, at any time or from time to time commencing on the date of issuance of the Warrant until 5:00 p.m., Central time, on the Expiration Date.

B.

Manner of Exercise.  In order to exercise this Warrant in whole or in part, the Holder shall complete one of the subscription forms attached hereto, deliver the Warrant to the Company at its Principal Office and make payment of the Purchase Price pursuant to one of the payment options provided in this Section 2.B.  Payment of the Purchase Price shall be made at the option of the Holder by one or more of the following methods: (1) by delivery to the Company of cash, a certified check or a bank cashier's check in an amount equal to the then aggregate Purchase Price, (2) by instructing the Company to withhold a number of Warrant Shares then issuable upon exercise of the particular Warrant with an aggregate Fair Market Value (as defined below) equal to such Purchase Price, or (3) by surrendering to the Company shares of Common Stock previously acquired by the Holder with an aggregate Fair Market Value equal to such Purchase Price, or any combination of the foregoing.  Upon receipt thereof by the Company, the Holder shall immediately be deemed to be a holder of record of the shares of Common Stock specified in said subscription form, and the Company shall, as promptly as practicable, and in any event within 10 business days thereafter, execute and deliver or cause to be delivered to the Holder a certificate or certificates representing the aggregate number of shares of Common Stock specified in said subscription form.  Each stock certificate so delivered shall be registered in the name of such Holder or such other name as shall be designated by such Holder, subject to compliance with federal and state securities laws and Section 4 hereof.  If the Warrant shall have been exercised only in part, the Company shall, at the time of delivery of said 

	Mid: 010474\000001\449786.11

	A-2

	Exhibit "A"

stock certificate or certificates, deliver to the Holder a Warrant in the form of this Warrant representing the right to purchase the remaining number of shares purchasable thereunder.  The Company shall pay all expenses, taxes and other charges payable in connection with the preparation, execution and delivery of stock certificates pursuant to this Section 2, except that, in case such stock certificates shall be registered in a name or names other than the name of the Holder, funds sufficient to pay all stock transfer taxes which shall be payable upon the execution and delivery of such stock certificate or certificates shall be paid by the Holder to the Company at the time of delivering the Warrant to the Company.  As used herein "Fair Market Value" on any day shall mean (i) the average of the daily closing sale prices of the Common Stock during the 20 trading days immediately preceding the day as of which "Fair Market Value" is being determined, on the principal securities exchange on which the Common Stock is then listed, or if there shall have been no sales of the Common Stock on such exchange on such day, the mean of the closing bid and asked prices on such exchange at the end of such day, or (ii) if the Common Stock is not so listed, the average of the high and low bid and prices on such day in a domestic over-the-counter market, or (iii) any time the Common Stock is not listed on any domestic exchange or quoted in a domestic over-the-counter market, the "Fair Market Value" shall be determined by the Board of Directors of the Company.

C.

Transfer Restriction Legend.  Each certificate for Warrant Shares issued upon exercise or conversion of this Warrant, unless at the time of exercise or conversion such Warrant Shares are registered under the Securities Act, shall bear the legends described in Section 5.9 of the Purchase Agreement.

D.

Character of Warrant Shares.  All Warrant Shares issuable upon the exercise of the Warrants shall be duly authorized, validly issued, fully paid and nonassessable.

Section 3.  Ownership and Exchange of the Warrants.

A.

Registered Holder.  The Company may deem and treat the person in whose name the Warrant is registered as the Holder and owner thereof (notwithstanding any notations of ownership or writing thereon made by anyone other than the Company) for all purposes and shall not be affected by any notice to the contrary, until presentation of the Warrant for exchange or transfer as provided in this Section 3.

B.

Exchange and Replacement.  This Warrant is exchangeable upon the surrender thereof by the Holder to the Company at its Principal Office for a new Warrant or Warrants of like tenor and date representing in the aggregate the right to purchase the number of shares purchasable thereunder, each new Warrant to represent the right to purchase such number of shares as shall be designated by the Holder at the time of surrender.  Subject to compliance with Section 4, each Warrant and all rights thereunder are transferable in whole or in part upon the books of the Company by the Holder thereof in person or by duly authorized attorney, and a new Warrant shall be made and delivered by the Company, of the same class, tenor and date as the Warrant but registered in the name of the transferee, upon surrender of the Warrant, duly endorsed, at the Principal Office of the Company.  The Company will issue replacement Warrant certificates in the event of the loss, theft, destruction or mutilation thereof upon receipt of appropriate affidavit(s) and bonds reasonably requested by the Company.  Warrants shall be promptly canceled by the Company upon the surrender thereof in connection with any exchange, transfer or replacement.  The Company shall pay all expenses, taxes (other than stock transfer 

	Mid: 010474\000001\449786.11

	A-3

	Exhibit "A"

taxes) and other charges payable in connection with the preparation, execution and delivery of Warrants pursuant to this Section 3.

Section 4.  Transfer of Warrants or Warrant Shares.  This Warrant and the related Warrant Shares shall not be transferable except in accordance with the terms and conditions specified in the Purchase Agreement and in accordance with applicable law.

Section 5.  Adjustment Provisions.  The aggregate number of shares of Common Stock issuable upon exercise of the Warrant, and the Purchase Price per share, shall be subject to adjustment in the events and to the extent set forth in Exhibit I.

Section 6.  Notices.  Any notice or other document required or permitted to be given or delivered to the Holder shall be delivered at, or sent by certified or registered mail to Holder at, the address set forth for Holder on the signature page hereof or to such other address as shall have been furnished to the Company in writing by Holder. Any notice or other document required or permitted to be given or delivered to the Company shall be sent by certified or registered mail to the Company, at its Principal Office, attention: President, or other such address as shall have been furnished to the Holders by the Company.

Section 7.  No Rights as Stockholder; Limitation of Liability.  This Warrant shall not entitle any Holder thereof to any of the rights of a stockholder of the Company.  No provision hereof, in the absence of affirmative action by the Holder to purchase shares of Common Stock, and no enumeration herein of the rights or privileges of the Holder of a Warrant, shall give rise to any liability of such Holder for the Purchase Price or as a stockholder of the Company, whether such liability is asserted by the Company or by creditors of the Company.

Section 8.  Miscellaneous.  This Warrant shall be governed by, and construed and enforced in accordance with, the laws of the State of Texas, except to the extent governed by the Corporation laws of the State of Colorado.  This Warrant and any provision hereof may be changed, waived, discharged or terminated only by an instrument in writing signed by the party (or any predecessor in interest thereof) against which enforcement of the same is sought.  The headings in this Warrant are for purposes of reference only and shall not affect the meaning or construction of any of the provisions hereof.

	Mid: 010474\000001\449786.11

	A-4

	Exhibit "A"

WITNESS the due execution of this Warrant by a duly authorized officer of the Company.

CAPCO ENERGY, INC.,

a Colorado corporation

By:

Name:

Title:

ATTEST:

Secretary

ACCEPTED this ____ day of March, 2005:

[Holder]

[Holder's address]

	Mid: 010474\000001\449786.11

	A-5

	Exhibit "A"

FULL SUBSCRIPTION FORM

____ To Be Executed by the Registered Holder

if It Desires to Exercise the Warrant in Full

The undersigned hereby exercises the right to purchase the __________ shares of Common Stock covered by the attached Warrant at the date of this subscription and herewith makes payment of the sum of $____________ representing the Purchase Price of $______________ per share in effect at this date.  Certificates for such shares shall be issued in the name of and delivered to the undersigned, unless otherwise specified in written instructions signed by the undersigned and accompanying this subscription.

Dated: _________, ____

[                                            ]

 Signature ______________________ 

 Address: _______________________ 

    _______________________

	Mid: 010474\000001\449786.11

	A-6

	Exhibit "A"

PARTIAL SUBSCRIPTION FORM

___ To Be Executed by the Registered Holder

if It Desires to Exercise the Warrant in Part

The undersigned hereby exercises the right to purchase __________ shares of the total number of shares of Common Stock covered by the attached Warrant at the date of this subscription and herewith makes payment of the sum of $__________ representing the Purchase Price of __________ per share in effect at this date.  Certificates for such shares and a new Warrant of like tenor and date for the balance of the shares not subscribed for shall be issued in the name of and delivered to the undersigned, unless otherwise specified in written instructions signed by the undersigned and accompanying this subscription.

(The following paragraph need be completed only if the Purchase Price and number of shares of Common Stock specified in the attached Warrant have been adjusted pursuant to Exhibit I thereof.)

The shares hereby subscribed for constitute __________ shares of Common Stock (rounded to the nearest whole share) resulting from adjustment of ______________ shares of the total of _______________ shares of Common Stock covered by the attached Warrant, as said shares were constituted at the date of the Warrant, leaving a balance of ________ shares of Common Stock, as constituted at the date of the Warrant, to be covered by the new Warrant.

Dated:  _________,____

[                                               ]

 Signature _______________________

 Address:  _______________________ 

     _______________________

	Mid: 010474\000001\449786.11

	A-7

	Exhibit "A"

EXHIBIT I

ANTI-DILUTION PROVISIONS

The number of Warrant Shares purchasable upon the exercise of this Warrant and the Purchase Price shall be subject to adjustment from time to time upon the happening of certain events as hereinafter described.  Capitalized terms used but not defined herein have the meanings assigned thereto in the Warrant.

1.

Special Definitions.  For purposes of this Exhibit I, the following definitions shall apply:

(A)

"Option" shall mean rights, options or warrants to subscribe for, purchase or otherwise acquire Common Stock or Convertible Securities, excluding rights, options or shares granted or issued to employees, vendors, officers, directors and executives of, and consultants or shareholders to, the Company in an amount not exceeding the number of Reserved Employee Shares.

(B)

"Original Issue Date" shall mean the date of this Warrant.

(C)

"Convertible Securities" shall mean any evidences of indebtedness, shares or other securities directly or indirectly convertible into or exchangeable for Common Stock.

(D)

"Additional Shares of Common Stock" shall mean all shares of Common Stock issued (or, pursuant to Section 3 below, deemed to be issued) by the Company after the Original Issue Date, other than Reserved Employee Shares and other than shares of Common Stock issued or issuable:

(1)

by reason of a stock dividend, stock split, split-up or other distribution on shares of Common Stock; or

(2)

upon the exercise of Options.

(E)

"Reserved Employee Shares" shall mean shares of Common Stock issued to employees, officers, directors, shareholders and executives of, and consultants or vendors to, the Company either directly as compensation or upon the exercise of options granted by the Company.

(F)

"Rights to Acquire Common Stock" (or "Rights") shall mean all rights issued by the Company to acquire Common Stock whether by exercise of a warrant, option or similar call, or conversion of any existing instruments, in either case for consideration fixed, in amount or by formula, as of the date of issuance.

2.

No Adjustment of Exercise Prices.  No adjustment in the number of Warrant Shares shall be made (i) unless the consideration per share (determined pursuant to Section 5 below) for an Additional Share of Common Stock issued or deemed to be issued by the Company is less than the Purchase Price in effect on the date of, and immediately prior to, the 

	Mid: 010474\000001\449786.11

	I-1

	Exhibit "I"

issue of such Additional Shares of Common Stock, or (ii) if, prior to such issuance, the Company receives written consent from the holders of at least a majority of the voting power of all then outstanding Warrants agreeing that no such adjustment shall be made as the result of the issuance of Additional Shares of Common Stock.

3.

Issue of Securities Deemed Issue of Additional Shares of Common Stock.  If the Company at any time or from time to time after the Original Issue Date shall issue any Options or Convertible Securities or Rights to Acquire Common Stock, then the maximum number of shares of Common Stock (as set forth in the instrument relating thereto without regard to any provision contained therein for a subsequent adjustment of such number) issuable upon the exercise of such Options, Rights or, in the case of Convertible Securities, the conversion or exchange of such Convertible Securities, shall be deemed to be Additional Shares of Common Stock issued as of the time of such issue; provided, however, that Additional Shares of Common Stock shall not be deemed to have been issued unless the consideration per share (determined pursuant to Section 5 hereof) of such Additional Shares of Common Stock would be less than the Purchase Price in effect on the date of and immediately prior to such issue, or such record date, as the case may be, and provided, further, that in any such case:

(A)

No further adjustment in the Purchase Price shall be made upon the subsequent issue of shares of Common Stock upon the exercise of such Options, Rights or conversion or exchange of such Convertible Securities;

(B)

Upon the expiration or termination of any unexercised Option, Right or Convertible Security, the Purchase Price shall be adjusted immediately to reflect the Purchase Price which would have been in effect had such Option, Right or Convertible Security (to the extent outstanding immediately prior to such expiration or termination) never been issued; and

(C)

In the event of any change in the number of shares of Common Stock issuable upon the exercise, conversion or exchange of any Option, Right or Convertible Security, including, but not limited to, a change resulting from the anti-dilution provisions thereof, the Purchase Price then in effect shall forthwith be readjusted to such Purchase Price as would have been obtained had the Purchase Price adjustment that was originally made upon the issuance of such Option, Right or Convertible Security which were not exercised or converted prior to such change been made upon the basis of such change, but no further adjustment shall be made for the actual issuance of Common Stock upon the exercise or conversion of any such Option, Right or Convertible Security.

4.

Adjustment of Conversion Prices upon Issuance of Additional Shares of Common Stock.  If the Company shall at any time after the Original Issue Date issue Additional Shares of Common Stock (including Additional Shares of Common Stock deemed to be issued pursuant to Section 3, but excluding shares issued as a dividend or distribution as provided in Section 7 or upon a stock split or combination as provided in Section 6), without consideration, or for a consideration per share less than the Purchase Price in effect on the date of and immediately prior to such issue, or without the requisite consent contemplated by Section 2 hereof, then and in such event, the Purchase Price shall be reduced by a full ratchet anti-dilution adjustment to such lesser price (calculated to the nearest cent).

	Mid: 010474\000001\449786.11

	I-2

	Exhibit "I"

5.

Determination of Consideration.  For purposes of this Exhibit I, the consideration received by the Company for the issue of any Additional Shares of Common Stock shall be computed as follows:

(A)

Cash and Property.  Such consideration shall:

(1)

insofar as it consists of cash, be computed at the aggregate of cash received by the Company, excluding amounts paid or payable for accrued interest or accrued dividends;

(2)

insofar as it consists of property other than cash, be computed at the fair market value thereof at the time of such issue, as determined in good faith by the Board; and

(3)

in the event Additional Shares of Common Stock are issued together with other shares or securities or other assets of the Company for consideration which covers both, be the proportion of such consideration so received, computed as provided in clauses (1) and (2) above, as determined in good faith by the Board.

(B)

Options, Rights and Convertible Securities. The consideration per share received by the Company for Additional Shares of Common Stock deemed to have been issued pursuant to Section 3, relating to Options, Rights and Convertible Securities, shall be determined by dividing

(1)

the total amount, if any, received or receivable by the Company as consideration for the issue of such Options, Rights or Convertible Securities, plus the minimum aggregate amount of additional consideration (as set forth in the instruments relating thereto, without regard to any provision contained therein for a subsequent adjustment of such consideration) payable to the Company upon the exercise of such Options, Rights or the conversion or exchange of such Convertible Securities, by

(2)

the maximum number of shares of Common Stock (as set forth in the instruments relating thereto, without regard to any provision contained therein for a subsequent adjustment of such number) issuable upon the exercise of such Options, Rights or the conversion or exchange of such Convertible Securities.

6.

Adjustment for Stock Splits and Combinations.  If the Company shall at any time or from time to time after the Original Issue Date effect a subdivision of the outstanding Common Stock, the Purchase Price then in effect immediately before that subdivision shall be proportionately decreased. If the Company shall at any time or from time to time after the Original Issue Date combine the outstanding shares of Common Stock, the Purchase Price then in effect immediately before the combination shall be proportionately increased.  Any adjustment under this paragraph shall become effective at the close of business on the date the subdivision or combination becomes effective.

7.

Adjustment for Certain Dividends and Distributions.  In the event the Company at any time or from time to time after the Original Issue Date shall make or issue a dividend or 

	Mid: 010474\000001\449786.11

	I-3

	Exhibit "I"

other distribution payable in shares of Common Stock, then and in each such event the Purchase Price shall be decreased as of the time of such issuance, by multiplying the Purchase Price by a fraction, the numerator of which shall be the total number of shares of Common Stock issued and outstanding immediately prior to the time of such issuance, and the denominator of which shall be the total number of shares of Common Stock issued and outstanding immediately prior to the time of such issuance plus the number of shares of Common Stock issuable in payment of such dividend or distribution.

8.

Adjustments for Other Dividends and Distributions.  In the event the Company at any time, or from time to time after the Original Issue Date shall make or issue, a dividend or other distribution payable in securities of the Company other than shares of Common Stock, then and in each such event provision shall be made so that the Holder shall receive upon exercise of the Warrant in addition to the number of shares of Common Stock receivable thereupon, the amount of securities of the Company that they would have received had the Warrant been exercised into Warrant Shares on the date of such event and had thereafter retained such securities receivable by them as aforesaid during such period given application to all adjustments called for during such period, under this paragraph with respect to the rights of the Holder.

9.

Adjustment for Reclassification, Exchange, or Substitution.  If the Warrant Shares shall be changed into the same or a different number of shares of any class or classes of stock, whether by capital reorganization, reclassification, or otherwise (other than a subdivision or combination of shares or stock dividend provided for above), then and in each such event the Holder shall have the right thereafter to convert such share into the kind and amount of shares of stock and other securities and property receivable upon such reorganization, reclassification, or other change, by holders of the number of shares of Common Stock into which the Warrant might have been exercised immediately prior to such reorganization, reclassification, or change, all subject to further adjustment as provided herein.

10.

No Impairment.  The Company will not, by amendment of its Certificate of Incorporation or through any reorganization, transfer of assets, consolidation, merger, dissolution, issue or sale of securities or any other voluntary action, avoid or seek to avoid the observance or performance of any of the terms to be observed or performed hereunder by the Company, but will at all times in good faith assist in the carrying out of all the provisions of this Exhibit I and in the taking of all such action as may be necessary or appropriate in order to protect the exercise rights of the Holder against impairment to the extent required hereunder.

11.

Certificate as to Adjustments.  Upon the occurrence of each adjustment or readjustment of the Purchase Price pursuant to this Exhibit I, the Company at its expense shall promptly compute such adjustment or readjustment in accordance with the terms hereof and shall file a certificate setting forth such adjustment or readjustment and showing in detail the facts upon which such adjustment or readjustment is based with its corporate records.  The Company shall, upon the reasonable written request of the Holder furnish or cause to be furnished to the Holder a similar certificate setting forth (i) such adjustments and readjustments, (ii) the Purchase Price then in effect, and (iii) the number of shares of Common Stock and the amount, if any, of other property which then would be received upon the exercise of this Warrant. Despite such adjustment or readjustment, the form of the Warrant, if the same shall reflect the initial or any subsequent Purchase Price, need not be changed in order for the adjustments or readjustments to be valid in accordance with the provisions of this Warrant, which shall control.

	Mid: 010474\000001\449786.11

	I-4

	Exhibit "I"Exhibit 10.12

 

 

 

SCUDDER
TRUST COMPANY

PROTOTYPE
DEFINED CONTRIBUTION PLAN

 

FULL-FLEX PROFIT SHARING PLAN (With 401(k) Option)

Non-Standardized (003)

 

ADOPTION
AGREEMENT

 

 

Amended
for the Uruguay Round Agreements Act (“GATT”), the Uniform Services Employment
and Reemployment Rights Act (“USERRA”), the Small Business Job Protection Act
of 1996 (“SBJPA”), the Taxpayer Relief Act of 1997 (“TRA '97”), the Internal
Revenue Service Restructuring and Reform Act of 1998 and the Community Renewal
Tax Relief Act of 2000 (collectively referred to as “GUST”).

 

 

	
   

  	
   

  	
  National Office Letter

  
	
   

  	
   

  	
  Date:

  
	
   

  	
   

  	
  Serial Number:

  

 

 

SCUDDER TRUST COMPANY

PROTOTYPE DEFINED CONTRIBUTION PLAN

 

TABLE OF CONTENTS

 

	
  A.

  	
  Preamble

  	
   

  
	
   

  	
   

  	
   

  
	
  B.

  	
  Lead and
  Participating Employer Information

  	
   

  
	
   

  	
  Lead Employer: [Plan Sec. 2.40]

  	
   

  
	
   

  	
  Participating
  Employers: [Plan Secs. 2.50 and 15.1]

  	
   

  
	
   

  	
   

  	
   

  
	
  C.

  	
  Plan
  Information

  	
   

  
	
   

  	
  Plan: [Plan Sec. 1.1]

  	
   

  
	
   

  	
  Plan Year: [Plan Sec. 2.58]

  	
   

  
	
   

  	
  Plan
  Administrator: [Plan Secs. 2.54 and 14.1]

  	
   

  
	
   

  	
  Funding
  Vehicle: [Plan Secs. 1.3 and 2.32]

  	
   

  
	
   

  	
  Controlling Law
  State: [Plan Sec. 1.4]

  	
   

  
	
   

  	
   

  	
   

  
	
  D.

  	
  Eligibility and
  Service Requirements

  	
   

  
	
   

  	
  Excluded
  Employment Categories: [Plan Sec. 2.14(a)]

  	
   

  
	
   

  	
  Age
  and Service Requirements: [Plan Sec. 3.1(a)]

  	
   

  
	
   

  	
  Entry: [Plan Secs.
  2.27 and 3.1(a)]

  	
   

  
	
   

  	
  Hours of Service:
  [Plan Sec. 2.64]

  	
   

  
	
   

  	
  Method
  to Determine Service for Eligibility Purposes: [Plan Sec. 2.64]

  	
   

  
	
   

  	
  Method
  to Determine Service for Vesting Purposes: [Plan Sec. 2.64]

  	
   

  
	
   

  	
  Break
  in Service Rules for Eligibility and Vesting: [Plan Secs. 2.8, 3.3 and
  10.2(m)]

  	
   

  
	
   

  	
  Predecessor Employer
  Credit: [Plan Secs. 2.59 and 2.64(c)]

  	
   

  
	
   

  	
  Waiver
  of Entry Requirements: [Plan Sec. 3.1(f)]

  	
   

  
	
   

  	
  Election
  Not to Participate: [Plan Sec. 3.5]

  	
   

  
	
   

  	
   

  	
   

  
	
  E.

  	
  Plan
  Compensation

  	
   

  
	
   

  	
  Plan Compensation:
  [Plan Sec. 2.56]

  	
   

  
	
   

  	
  Plan
  Compensation for the Plan Year: [Plan Sec. 2.57]

  	
   

  
	
   

  	
  Imputed Earnings While
  Disabled: [Plan Sec. 2.56(e)]

  	
   

  
	
   

  	
   

  	
   

  
	
  F.

  	
  Employee Pre-Tax
  Component

  	
   

  
	
   

  	
  Employee
  Pre-Tax Contributions: [Plan Sec. 4.1]

  	
   

  
	
   

  	
  Age
  and Service Requirements: [Plan Sec. 3.1(a)]

  	
   

  
	
   

  	
  Entry: [Plan Secs.
  2.27 and 3.1(a)]

  	
   

  
	
   

  	
  Pay
  Reduction Contributions – Minimums/Maximums: [Plan Sec. 4.1(a)]

  	
   

  
	
   

  	
  Pay
  Reduction Agreements: [Plan Sec. 4.1(a)]

  	
   

  
	
   

  	
  Cash
  or Deferred Contributions: [Plan Sec. 4.1(c)]

  	
   

  
	
   

  	
  In-Service
  Withdrawals: [Plan Sec. 11.2]

  	
   

  
	
   

  	
   

  	
   

  
	
  G.

  	
  Employer After-Tax
  Component

  	
   

  
	
   

  	
  Employer
  After-Tax Contributions: [Plan Sec. 4.2]

  	
   

  
	
   

  	
  Age
  and Service Requirements/Entry:
  [Plan Secs. 2.27 and 3.1(a)]

  	
   

  
	
   

  	
  Payroll
  Withholding Contributions: [Plan Sec. 4.2(a)]

  	
   

  
	
   

  	
  Direct
  Contributions: [Plan Sec. 4.2(c)]

  	
   

  
	
   

  	
  Required Contributions – Thrift
  Plan: [Plan Sec. 4.2(b)]

  	
   

  
	
   

  	
  In-Service
  Withdrawals: [Plan Sec. 11.2]

  	
   

  
	
   

  	
   

  	
   

  
	
  H.

  	
  Employer Safe-Harbor
  Component

  	
   

  
	
   

  	
  Employer
  Safe-Harbor Contributions [Plan Secs. 5.1 and 6.1]

  	
   

  
	
   

  	
  Age
  and Service Requirements: [Plan Sec. 3.1(a)]

  	
   

  
	
   

  	
  Employer
  Safe-Harbor Contributions [Plan Sec. 5.1]

  	
   

  
	
   

  	
  In-Service
  Withdrawals: [Plan Sec. 11.2]

  	
   

  
	
   

  	
   

  	
   

  
	
  I.

  	
  Employer Regular
  Matching Component

  	
   

  
	
   

  	
  Employer
  Regular Matching Contributions: [Plan Sec. 5.2]

  	
   

  
	
   

  	
  Excluded
  Employment Categories: [Plan Sec. 2.14(a)]

  	
   

  
	
   

  	
  Age
  and Service Requirements: [Plan Sec. 3.1(a)]

  	
   

  
	
   

  	
  Entry: [Plan Secs.
  2.27 and 3.1(a)]

  	
   

  
	
   

  	
  Requirements
  to Receive an Employer Regular Matching Contribution: [Plan Sec. 5.2(a) or
  (b)]

  	
   

  
	
   

  	
  Matching
  Formula: [Plan Sec. 5.2(a) or (b)]

  	
   

  
	
   

  	
  Minimums and
  Maximums: [Plan Sec. 5.2(d)]

  	
   

  
	
   

  	
  Vesting
  Schedule for Employer Regular Matching Component: [Plan Sec. 10.2(e)]

  	
   

  
	
   

  	
  Treatment
  of Forfeitures: [Plan Sec. 5.2(g)]

  	
   

  
	
   

  	
  In-Service
  Withdrawals: [Plan Sec. 11.2]

  	
   

  
	
   

  	
   

  	
   

  
	
  J.

  	
  Employer
  Regular Profit Sharing Component

  	
   

  
	
   

  	
  Profit
  Sharing Contributions: [Plan Sec. 6.2]

  	
   

  
	
   

  	
  Excluded
  Employment Categories: [Plan Sec. 2.14(a)]

  	
   

  
	
   

  	
  Age
  and Service Requirements: [Plan Sec. 3.1(a)]

  	
   

  
	
   

  	
  Entry: [Plan Secs.
  2.27 and 3.1(a)]

  	
   

  
	
   

  	
  Requirements
  to Share in the Employer Regular Profit Sharing Contribution: [Plan Sec.
  6.2(a) or (b)]

  	
   

  
	
   

  	
  Contribution/Allocation
  Formula: [Plan Sec. 6.2(a) or (b)]

  	
   

  
	
   

  	
  Vesting Schedule for Employer
  Regular Profit Sharing Component: [Plan Sec. 10.2(e)]

  	
   

  
	
   

  	
  Treatment
  of Forfeitures: [Plan Sec. 6.2(d)]

  	
   

  
	
   

  	
  In-Service
  Withdrawals: [Plan Sec. 11.2]

  	
   

  
	
   

  	
   

  	
   

  
	
  K.

  	
  Employer
  Qualified Matching and Profit Sharing Component

  	
   

  
	
   

  	
  Employer
  Qualified Contributions: [Plan Secs. 5.3 and 6.3]

  	
   

  
	
   

  	
  Employer
  Qualified Matching Contributions (QMACs): [Plan Sec. 5.3]

  	
   

  
	
   

  	
  Employer
  Qualified Profit Sharing Contributions (QNECs): [Plan Sec. 6.3]

  	
   

  
	
   

  	
  In-Service
  Withdrawals: [Plan Sec. 11.2]

  	
   

  
	
   

  	
   

  	
   

  
	
  L.

  	
  Employee Rollover
  Component

  	
   

  
	
   

  	
  Employee
  Rollover Contributions: [Plan Sec. 4.5]

  	
   

  
	
   

  	
  In-Service Withdrawals: [Plan
  Sec. 11.2]

  	
   

  
	
   

  	
   

  	
   

  
	
  M.

  	
  Retirement,
  Disability and Hardship

  	
   

  
	
   

  	
  Retirement
  Age: [Plan Secs. 2.19 and 2.47]

  	
   

  
	
   

  	
  Disability: [Plan Sec.
  2.18]

  	
   

  
	
   

  	
  Hardship: [Plan Sec. 2.33]

  	
   

  
	
   

  	
   

  	
   

  
	
  N.

  	
  Special Vesting Rules

  	
   

  
	
   

  	
  Vesting Schedule: [Plan
  Sec. 10.2(e)]

  	
   

  
	
   

  	
  Service Disregarded
  for Vesting: [Plan Sec. 10.2(f)]

  	
   

  
	
   

  	
  Special
  Vesting Events: [Plan Sec. 10.2(b)]

  	
   

  
	
   

  	
  Forfeitures: [Plan
  Sec. 10.2(g)]

  	
   

  
	
   

  	
  Vesting
  Formula for Partially Vested: [Plan Sec. 10.2(c) and (g)]

  	
   

  
	
   

  	
  Reinstatement
  upon Return to Service: [Plan Sec. 10.2(h)]

  	
   

  
	
   

  	
  Special
  Vesting Rules for Life Insurance: [Plan Sec. 10.3]

  	
   

  
	
   

  	
   

  	
   

  
	
  O.

  	
  Employer Securities

  	
   

  
	
   

  	
  Employer
  Securities: [Plan Sec. 14.15 and 14.16]

  	
   

  
	
   

  	
  Voting
  Provisions: [Plan Secs. 14.15(d) and 14.16]

  	
   

  
	
   

  	
  Tender
  Provisions: [Plan Secs. 14.15(e) and 14.16]

  	
   

  
	
   

  	
  In-Kind Distribution
  Option: [Plan Sec. 12.3(c)]

  	
   

  

 

i

 

	
  P.

  	
  Payment of Benefits

  	
   

  
	
   

  	
  Balances Less Than
  Cash-Out Amount: [Plan Sec. 12.4]

  	
   

  
	
   

  	
  Balances
  More Than Cash-Out Amount: [Plan Sec. 12.3(a)]

  	
   

  
	
   

  	
  Payment
  Forms: [Plan Secs. 12.3(b) and 12.6]

  	
   

  
	
   

  	
  Payment Medium:
  [Plan Sec. 12.3(c)]

  	
   

  
	
   

  	
  Beneficiary:
  [Plan Secs. 13.1 and 13.3]

  	
   

  
	
   

  	
  Minimum Distributions: [Plan
  Secs. 2.62 and 12.7]

  	
   

  
	
   

  	
   

  	
   

  
	
  Q.

  	
  Top-Heavy Provisions

  	
   

  
	
   

  	
  Top-Heavy
  Eligible Participant: [Plan Sec. 17.4(k)]

  	
   

  
	
   

  	
  Top-Heavy
  Contribution Requirement: [Plan Sec. 17.1]

  	
   

  
	
   

  	
  Top-Heavy Vesting Schedule:
  [Plan Sec. 17.2]

  	
   

  
	
   

  	
  Coordination With Other
  Qualified Plans: [Plan Sec. 17.1]

  	
   

  
	
   

  	
   

  	
   

  
	
  R.

  	
  Code § 415
  Coordination

  	
   

  
	
   

  	
  415 Compensation:
  [Plan Sec. 18.4(b)]

  	
   

  
	
   

  	
  Limitation
  Year: [Plan Sec. 18.4(h)]

  	
   

  
	
   

  	
  Correction
  Method: [Plan Sec. 18.1(b)]

  	
   

  
	
   

  	
  Coordination
  With Other Plans: [Plan Sec. 18.2 and 18.3]

  	
   

  
	
   

  	
   

  	
   

  
	
  S.

  	
  Special Testing Rules

  	
   

  
	
   

  	
  Highly
  Compensated Employees: [Plan Sec. 2.35]

  	
   

  
	
   

  	
  ADP/ACP
  Testing Method: [Plan Sec. 19.2 and 19.3]

  	
   

  
	
   

  	
  Other
  Elections Regarding ADP/ACP Testing: [Plan Sec. 19.2, 19.3 and
  19.4]

  	
   

  
	
   

  	
  Gain or Loss on Excess
  Contributions: [Plan Sec. 19.1(d), 19.2(d) and 19.3(d)]

  	
   

  
	
   

  	
   

  	
   

  
	
  T.

  	
  Special Effective Date
  Rules

  	
   

  
	
   

  	
   

  	
   

  
	
  U.

  	
  Frozen Contributions
  Accounts

  	
   

  
	
   

  	
   

  	
   

  
	
  V.

  	
  Other
  Information for the Participating Employers

  	
   

  
	
   

  	
   

  	
   

  
	
  W.

  	
  Sponsor of the Prototype

  	
   

  
	
   

  	
   

  	
   

  
	
  X.

  	
  Reliance on IRS
  Opinion Letter

  	
   

  
	
   

  	
   

  	
   

  
	
  Y.

  	
  Lead Employer Signature

  	
   

  
	
   

  	
   

  	
   

  
	
  Z.

  	
  Trustee or Custodian
  Signature

  	
   

  

 

ii

 

SCUDDER TRUST COMPANY

PROTOTYPE DEFINED CONTRIBUTION PLAN

 

FULL-FLEX PROFIT SHARING PLAN (With 401(k) Option)

Non-Standardized (003)

 

ADOPTION AGREEMENT

 

A.            Preamble

 

	
  A.1.

  	
  BY THIS AGREEMENT, the Lead Employer hereby ... [check one]:

  
	
   

  	
   

  
	
  a.

  	
  o

  	
  adopts a new profit sharing
  plan as of ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  1.

  	
  Original Effective Date:
         [month
  day, year].

  
	
   

  	
   

  	
   

  	
   

  
	
  b.

  	
  ý

  	
  amends/restates its
  existing profit sharing plan effective as of ... [complete 1. and 2.]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  1.

  	
  Amendment Effective Date:

  	
  August 1, 2004  [month day, year].

  
	
   

  	
   

  	
  2.

  	
  Original Effective Date:

  	
  October 1, 1993 
  [month day, year]. [NOTE:
  Insert the original effective date of this Plan, whether as this prototype,
  another prototype, or in any other form. If two or more plans have been
  merged or consolidated, insert the original effective date of the plan shown
  as the surviving plan for government filing purposes (e.g., Form 5500).]

  

 

B.    Lead and Participating Employer Information

 

	
  Lead Employer:

  	
  B.1.

  	
  Lead Employer Name:  Clayton Williams Energy, Inc.

  
	
  [Plan Sec.
  2.40]

  	
   

  	
   

  
	
   

  	
  B.2.

  	
  Lead Employer EIN:  75-2396863.

  
	
   

  	
   

  	
   

  
	
  Participating Employers:

  [Plan Secs. 2.50 and 15.1]

  	
  B.3.

  	
  The Participating Employers
  are the ... [check each that applies]:
  [NOTE: If there are more than three Participating
  Employers, attach the Participating Employer Addendum.]

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  ý

  	
  Lead Employer.

  
	
   

  	
  b.

  	
  ý

  	
  following Controlled Group
  Members ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  Participating Employer:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Name:  Warrior Gas Company.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Employer EIN:
   75-2470727.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  2.

  	
  Participating Employer:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Name:  Southwest Royalties, Inc.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Employer EIN:
   75-1917432.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  3.

  	
  Participating Employer:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Name:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Employer EIN:
        .

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  [NOTE: A Controlled Group Member will immediately cease to be a
  Participating Employer as of the date it ceases to be a Controlled Group
  Member.]

  

 

C.    Plan Information

 

	
  Plan:

  [Plan Sec. 1.1]

  	
  C.1.

  	
  Plan Name: Clayton Williams
  Energy, Inc. 401(k) Plan.

  
	
   

  	
  C.2.

  	
  Plan Number: 001. [NOTE:
  This is the three-digit identifying number (e.g., 001) that the employer
  assigns for government filing purposes (e.g., Form 5500).]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Plan Year:

  	
  C.3.

  	
  The
  Plan Year is the twelve-consecutive-month period ending each December 31

  

 

1

 

	
  [Plan Sec.
  2.58]

  	
   

  	
  [month day] [check each that applies]:

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  The first Plan Year is a
  short year that began on the Original Effective Date and ended
         [month
  day, year].

  
	
   

  	
  b.

  	
  o

  	
  The Plan Year has been
  amended. The last Plan Year before the amendment ended
         [month
  day, year], and the short Plan Year resulting from the amendment
  began the next day and ended        [month day, year].

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Plan Administrator:

  [Plan Secs. 2.54 and 14.1] 

  	
  C.4.

  	
  The Plan Administrator is
  the ... [check one]:

  
	
   

  	
  a.

  	
  ý

  	
  Lead Employer. [NOTE:
  The Lead Employer may delegate administrative authority to an individual or
  committee.]

  
	
   

  	
  b.

  	
  o

  	
  following individual or
  entity ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Name:          .

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  o

  	
  following committee of
  individuals ... [check one]: [NOTE: Either the name of the committee or the individual
  committee members must be specified.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Name of committee:
        .

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  Committee members ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Name:            .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Name:            .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Name:            .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Name:            .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Name:            .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Name:            .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Name:            .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Funding Vehicle:

  [Plan Secs. 1.3 and 2.32]

  	
  C.5.

  	
  The
  Funding Vehicle(s) for the Plan include ... [check
  each that applies]:

  
	
   

  	
  a.

  	
  ý

  	
  a Trust Fund with ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  individual trustee(s). [NOTE:
  Individual trustee(s) may serve on a discretionary or directed basis pursuant
  to the Trust Agreement.]

  
	
   

  	
   

  	
   

  	
  2.

  	
  ý

  	
  a financial organization
  serving pursuant to the Trust Agreement ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  ý

  	
  for a Directed Trustee.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  with a Discretionary
  Trustee Option.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  b.

  	
  o

  	
  a Custodial Account. [NOTE:
  This option is appropriate only for a plan maintained by an unincorporated
  business and that covers Self-Employed Individuals. Also, the Custodian must
  be a bank or other organization authorized to act as a custodian with respect
  to qualified plans.]

  
	
   

  	
  c.

  	
  o

  	
  Annuity Funding
  Contract(s).

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Controlling Law State:

  [Plan Sec. 1.4]

  	
  C.6.

  	
  The Plan will be construed
  and administered in accordance with the laws of the State or Commonwealth of
  New Hampshire to the extent that such laws are not preempted by the laws of
  the United States of America.

  

 

2

 

D.    Eligibility and Service Requirements

 

	
  Excluded Employment Categories:

  [Plan Sec. 2.14(a)]

  	
  D.1.

  	
  Covered Employment does not
  include employment as ... [check each of a.
  through l. that applies, or check m. or n.]:  [NOTE:  Covered Employment only includes employment
  with a Participating Employer. 
  However, it does not include employment as a Collective
  Bargaining Employee unless the collective bargaining agreement provides for
  participation in the Plan under the terms set forth in this Adoption
  Agreement.]

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  a non-resident alien who
  receives no earned income (within the meaning of Code § 911(d)(2)) from
  a Participating Employer which constitutes income from sources within the
  United States (within the meaning of Code § 861(a)(3)), or who receives
  such earned income but it is all exempt from income tax in the United States
  under the terms of an income tax convention.

  
	
   

  	
  b.

  	
  o

  	
  a Highly Compensated
  Employee.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  [NOTE:  Excluding any of the
  following categories may result in failure to satisfy the coverage
  requirements of Code § 410(b).]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  o

  	
  a Key Employee.

  
	
   

  	
  d.

  	
  o

  	
  a Leased Employee.

  
	
   

  	
  e.

  	
  o

  	
  a Self-Employed Individual (that is, a sole
  proprietor or partner with respect to a Participating Employer).

  
	
   

  	
  f.

  	
  o

  	
  a salaried Employee.

  
	
   

  	
  g.

  	
  o

  	
  an hourly-wage Employee.

  
	
   

  	
  h.

  	
  o

  	
  an Employee paid primarily on a commission basis.

  
	
   

  	
  i.

  	
  o

  	
  an Employee working outside the United States.

  
	
   

  	
  j.

  	
  o

  	
  a citizen or resident of a foreign country, except
  those who work in the United States under the following VISA or NAFTA
  categories ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  All categories are excluded
  except as expressly required by United States Immigration Law.

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  The following categories
  are included [specify]:
        .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  k.

  	
  o

  	
  an Employee in any of the following units or
  locations [specify]:
         [NOTE: To
  exclude all Employees of a Controlled Group Member, do not designate
  that Controlled Group Member as a Participating Employer.]

  
	
   

  	
  l.

  	
  o

  	
  other [specify]:
        .

  
	
   

  	
   

  	
   

  
	
  Collective

  Bargaining

  Only Plan

  	
  m.

  	
  o

  	
  The Plan is exclusively a
  collective bargaining plan – thus, the only Employees in Covered Employment
  are those Collective Bargaining Employees who are covered by the following
  collective bargaining agreement(s) that provides for participation in the
  Plan ... [complete]: [NOTE:  All other Employees are excluded from all
  Components.]

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.           .

  
	
   

  	
   

  	
   

  	
  2.           .

  
	
   

  	
   

  	
   

  	
  3.           .

  
	
   

  	
   

  	
   

  	
  4.           .

  
	
   

  	
   

  	
   

  	
  5.           .

  
	
   

  	
   

  	
   

  	
   

  
	
  Prevailing Wage

  Only Plan

  	
  n.

  	
  o

  	
  The Plan is exclusively a
  “prevailing wage” plan – thus, the only Employees in Covered Employment are
  those who are employed on prevailing wage projects specified in J.8.f. or on
  the Prevailing Wage Addendum.  [NOTE:  All other Employees are excluded from all
  Components.]

  

 

3

 

	
   

  	
  D.2.

  	
  Covered Employment ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  does not include
  employment during the transition period following a stock or asset
  acquisition described in Code § 410(b)(6)(C) ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  subject to the following
  exceptions [complete]: [NOTE:
  For each listed acquisition, employment becomes Covered Employment as of the
  Effective Date listed for that acquisition (unless the employment is excluded
  under D.1.).]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Acquisition:

  	
  .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Effective Date:

  	
  .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Acquisition:

  	
  .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Effective Date:

  	
  .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Acquisition:

  	
  .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Effective Date:

  	
  .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  b.

  	
  ý

  	
  includes employment during the transition period
  following a stock or asset acquisition described in Code § 410(b)(6)(C)
  (unless the employment is excluded under D.1.).

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  [NOTE:  This provision applies
  only to an individual who becomes an Employee as a result of the
  acquisition.  The “transition period”
  begins on the date of such acquisition and ends on the last day of the first
  Plan Year beginning after the date of such acquisition (or, if earlier, upon
  any significant change in coverage of the Plan other than as a result of
  subsequent acquisition).]

  
	
   

  	
   

  	
   

  
	
  Age and Service Requirements:

  [Plan Sec. 3.1(a)]

  	
  D.3.

  	
  The age requirement for
  participation will be determined separately for each Component, as specified
  in F.2., G.2., H.2., I.3. and J.3.

  
	
   

  	
  D.4.

  	
  The service requirement for
  participation will be determined separately for each Component, as specified
  in F.3., G.2., H.2., I.4. and J.4.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Entry:

  [Plan Secs. 2.27 and 3.1(a)]

  	
  D.5.

  	
  An Employee in Covered
  Employment will become an Active Participant in a Component on the Entry Date
  that coincides with or next follows the date he/she satisfies the age and
  service requirements for such Component, except as otherwise provided in J.5.
  with respect to the Employer Regular Profit Sharing Component.

  
	
   

  	
   

  	
   

  
	
   

  	
  D.6.

  	
  The Entry Dates will be
  determined separately for each Component, as specified in F.5., G.2., H.2.,
  I.6. and J.6.

  
	
   

  	
   

  	
   

  
	
  Hours of Service:

  [Plan Sec. 2.64]

  	
  D.7.

  	
  An Employee for whom a record
  of actual hours is not maintained or available (e.g., salaried employees) will be
  credited with ... [check one]:

  
	
   

  	
   

  	
   

  
	
  [complete if hours are used for any
  purpose – e.g., eligibility, vesting or allocations]

  	
   

  	
  a.

  	
  o    190
  Hours of Service for each month

  
	
  b.

  	
  o     95
  Hours of Service for each semi-monthly payroll period

  
	
  c.

  	
  ý     45
  Hours of Service for each week

  
	
  d.

  	
  o     10
  Hours of Service for each day

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ... in which he/she has one
  or more Hours of Service.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  D.8.

  	
  An Employee for whom a
  record of actual hours is maintained and available will be credited with ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  ý    actual
  Hours of Service.

  
	
   

  	
  b.

  	
  o    the
  same equivalency as specified in D.7.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Method to Determine Service for Eligibility Purposes:

  	
  D.9.

  	
  Service will be determined
  for eligibility purposes using the ... [check
  one]:

  

 

4

 

	
  [Plan Sec.
  2.64]

  	
  a.

  	
  o

  	
  hour count method ... [complete as necessary]  [NOTE:  This option should be elected if the hour
  count method is used to determine Service under any Component.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  [complete only if a service requirement
  is imposed on participation in one or more Components]

  	
   

  	
   

  	
  1.

  	
  An Employee must complete
  at least        [1,000 or less] Hours of Service during an eligibility
  computation period for it to count as a year of Service.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  2.

  	
  The eligibility computation
  period is the twelve-consecutive-month period beginning on the Service
  Commencement Date and each ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Plan Year beginning after
  the Service Commencement Date.

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  anniversary of the Service
  Commencement Date.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  3.

  	
  An Employee will have
  satisfied the service requirement as of the ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  end of the eligibility
  computation period during which

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  date during the eligibility
  computation period as of which

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ... he/she has completed
  the required Hours of Service.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  4.

  	
  The hour count method applies to ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  all Employees.

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Employees who are ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  classified as “full-time”

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  classified as “part-time”

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  classified as “temporary” or “seasonal”

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  paid on an hourly-wage basis

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  5.

  	
  o

  	
  paid on a salaried basis

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  6.

  	
  o

  	
  employed with the following Participating Employers
  [specify]:
        ,

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... and the elapsed time method applies to all
  other Employees.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  b.

  	
  ý

  	
  elapsed time method.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Method to Determine Service for Vesting Purposes:

  	
  D.10.

  	
  Service will be determined for vesting purposes
  using the ... [check one]:

  
	
  [Plan Sec.
  2.64]

  	
  a.

  	
  o

  	
  hour count method ... [complete as necessary]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  [complete only if a vesting schedule
  applies with respect to the Employer Regular Matching or Regular Profit
  Sharing Component]

  	
   

  	
   

  	
  1.

  	
  An Employee must complete at least
         [1,000
  or less] Hours of Service during a vesting computation period for
  it to count as a year of Service.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  2.

  	
  The vesting computation period is the ... [check one of a. through c., and check d. if it
  applies]:

  
	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Plan Year.

  
	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  twelve-consecutive-month period ending each
         [month
  day].

  
	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  twelve-consecutive-month period beginning on the
  Service Commencement Date and each anniversary of the Service Commencement
  Date.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  [check d. if the vesting
  computation period has been amended]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  d.

  	
  o

  	
  The vesting computation period has been amended.
  The last vesting computation period before the amendment ended
         [month
  day, year], the special vesting computation period resulting from
  the amendment began        [month day, year] and ended
         [month
  day, year], and the vesting computation period after the amendment
  is specified above beginning        [month day, year]. [NOTE:
  The special vesting computation period must be twelve months in length.]

  

 

5

 

	
   

  	
   

  	
   

  	
  3.

  	
  A Break in Service will occur if the Employee has
         [500
  or less] or fewer Hours of Service during a vesting computation
  period.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  4.

  	
  The hour count method applies to ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  all Participants.

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Participants who are ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  classified as “full-time”

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  classified as “part-time”

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  classified as “temporary”
  or “seasonal”

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  paid on an hourly-wage
  basis

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  5.

  	
  o

  	
  paid on a salaried basis

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  6.

  	
  o

  	
  employed with the following
  Participating Employers [specify]:
        ,

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... and the elapsed time
  method applies to all other Participants, with Service calculated based on
  completed years of Service (disregarding fractional years).

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  b.

  	
  ý

  	
  elapsed time method, with
  Service for vesting purposes being calculated at Termination of Service based
  on ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  ý

  	
  completed years of Service (disregarding fractional
  years).

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  completed and fractional
  years of Service, with fractional years calculated based on completed... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  days (365 completed days
  equals one year).

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  months (12 completed months
  equals one year).

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Break in Service Rules for Eligibility and Vesting:

  [Plan Secs. 2.8, 3.3 and 10.2(m)] 

  	
  D.11.

  	
  Service prior to a Break in
  Service of one year or more ... [check one]:

  
	
   

  	
   

  
	
  a.

  	
  ý

  	
  will be taken into account
  for eligibility and vesting purposes immediately upon a subsequent return to
  employment under all Components (unless disregarded under D.12.).

  
	
   

  	
  b.

  	
  o

  	
  will not be taken into
  account for eligibility or vesting purposes under the ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Employer Regular Matching
  Component

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  Employer Regular Profit
  Sharing Component

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... until the Employee
  completes one year of Service after the Break in Service (in which case
  Service will be retroactively restored to the Employee).  However, such Service will be taken into
  account immediately upon a subsequent return to employment under each other
  Component (unless otherwise disregarded under D.12).  [NOTE:  Use of this option b. may require that
  retroactive Employer Regular Matching or Regular Profit Sharing Contributions
  be made on behalf of the Participant.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  D.12.

  	
  In the case of a
  Participant who had no vested interest in his/her Account prior to a period
  of five or more consecutive one-year Breaks in Service (other than a vested
  interest in an Employee After-Tax, Deductible, Forfeiture Restoration or
  Rollover Contribution Account), Service prior to such period ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  ý

  	
  will not

  
	
   

  	
  b.

  	
  o

  	
  will

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ... be taken into account for
  eligibility or vesting purposes after a subsequent return to employment.  [NOTE:  In all other cases and for all Participants
  with a vested interest in their Accounts, Service prior to a Break in Service
  will be counted after a subsequent return to employment (subject to any
  restrictions specified in D.11).]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Predecessor
  Employer

  Credit:

  	
  D.13.

  	
  Employment with the
  following Predecessor Employer(s) which did not maintain the Plan ... [complete as appropriate]: [NOTE:
  Code § 414(a) requires that service with a Predecessor Employer be taken
  into account if a plan of the Predecessor Employer

  
										

 

6

 

	
  [Plan
  Secs. 2.59 and 2.64(c)]

  	
   

  	
  is maintained by a Controlled Group Member. The service credit under
  this D.13. is in addition to that required under Code § 414(a).] [NOTE: If there is more than one
  Predecessor Employer, attach the Predecessor Employer Addendum.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Name:
        .

  
	
   

  	
   

  	
  Employer Identification
  Number:       .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ... counts as Service for ...
  [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  eligibility purposes, with
  Service with the Predecessor Employer calculated based on ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Hours of Service from ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  last date of hire.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  original date of hire.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  other [specify]:
        .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  elapsed time from ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  last date of hire.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  original date of hire.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  other [specify]:
        .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  vesting purposes, with
  Service with the Predecessor Employer calculated based on ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Hours of Service from ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  last date of hire.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  original date of hire.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  other [specify]:
        .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  elapsed time from ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  last date of hire.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  original date of hire.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  other [specify]:
        .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  However, prior service
  credit for vesting purposes will be limited to    years. [complete if desired.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  determining whether the
  Participant is entitled to share in the Employer Regular Matching or Regular
  Profit Sharing Contribution. For such Participant, the compensation paid by
  the Predecessor Employer ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  is not

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  is

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... counted as Plan
  Compensation for purposes of determining or allocating the Employer Regular
  Matching or Regular Profit Sharing Contribution for the first year of
  participation under this Plan.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Waiver of Entry Requirements:

  [Plan Sec. 3.1(f)]

  	
  D.14.

  	
  An Employee in Covered
  Employment ... [check one]:

  
	
   

  	
   

  
	
  a.

  	
  ý

  	
  must always satisfy the age
  and/or service requirements to become an Active Participant.

  
	
   

  	
  b.

  	
  o

  	
  will become an Active
  Participant on the ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Original Effective Date

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  following date:
        
  [month day, year]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... even if he/she has not
  satisfied the ... [check each that applies]:

  

 

7

 

	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  age

  
	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  service

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... requirement for
  participation in the Component.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  This age and/or service
  waiver applies with respect to ... [check
  5., or check each of 6. through 8. that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  5.

  	
  o

  	
  all Components.

  
	
   

  	
   

  	
   

  	
  6.

  	
  o

  	
  the Employee Pre-Tax
  Component (and those Components with eligibility and entry tied to such
  Component).

  
	
   

  	
   

  	
   

  	
  7.

  	
  o

  	
  the Employer Regular
  Matching Component.

  
	
   

  	
   

  	
   

  	
  8.

  	
  o

  	
  the Employer Regular Profit
  Sharing Component.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  [NOTE:  The waiver also applies
  with respect to the Employee After-Tax Component, if any, if eligibility and
  entry is tied to that Component  under
  G.2.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Election Not to Participate:

  [Plan Sec. 3.5]

  	
  D.15.

  	
  May an Employee elect not
  to participate in the Plan? [check one]:

  
	
   

  	
  a.

  	
  ý

  	
  No.  [Skip to
  Section E.]

  
	
   

  	
  b.

  	
  o

  	
  Yes ... [check one]:  [NOTE:  This option may result in failure to
  satisfy the coverage requirements of Code § 410(b) unless it is limited
  to Highly Compensated Employees.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  if he/she has a religious
  objection to participation in the Plan.

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  for any reason ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  but only if he/she is a
  Highly Compensated Employee.

  

 

E.             Plan
Compensation

 

[NOTE:  Plan Compensation will be
used for nondiscrimination testing unless the Plan Administrator expressly
directs that a different definition of compensation be used for such testing
for a particular Plan Year.  Testing
compensation may be used to determine an Employer Qualified Profit Sharing Contribution
if so elected in K.5. notwithstanding the elections in this Item E.]

 

	
  Plan Compensation:

  [Plan Sec. 2.56]

  	
  E.1.

  	
  Plan Compensation means ... [check one]:

  
	
   

  	
  a.

  	
  o

  	
  earnings required to be
  reported in the Wages, Tips and Other Compensation box of Form W-2.

  
	
   

  	
  b.

  	
  ý

  	
  earnings for purposes of
  Code § 415(c)(3).

  
	
   

  	
  c.

  	
  o

  	
  earnings for purposes of
  federal income tax withholding.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  [NOTE:  Unless specifically
  excluded below, Plan Compensation includes Employee Pre-Tax Contributions,
  other Elective Deferrals and amounts that are excluded from income under Code
  § 125.]

  

 

8

 

	
   

  	
  E.2.

  	
  Plan Compensation does not
  include ... [check each that applies]:  

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  With respect to

  the Employee

  Pre-Tax or

  After-Tax

  Components and

  the Employer

  Safe-Harbor,

  Regular or

  Qualified

  Matching

  Component

  	
   

  	
  With respect to

  the Employer

  Safe-Harbor,

  Regular or

  Qualified*

  Profit Sharing

  Component

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  ý

  	
   

  	
  ý

  	
   

  	
  Employee Pre-Tax Contributions and other Elective Deferrals.

  
	
   

  	
  b.

  	
  o

  	
   

  	
  o

  	
   

  	
  amounts that are excluded from income under Code § 125 (cafeteria
  plan).

  
	
   

  	
  c.

  	
  o

  	
   

  	
  o

  	
   

  	
  reimbursements or other expense allowances, fringe benefits (cash and
  non-cash), moving expenses, deferred compensation and welfare benefits.

  
	
   

  	
   

  	
   

  
	
  
  

  

  

  
	
   

  	
   

  	
  *                      Except as
  otherwise elected in K.5. with respect to the Employer Qualified Profit
  Sharing Component.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  [NOTE: The following exclusions (d. through k.) do not apply for
  purposes of the Employer Safe-Harbor Matching or Safe-Harbor Profit Sharing
  Component.  Also, the exclusions do not
  apply for purposes of the Employer Regular Profit Sharing Component if
  Employer Regular Profit Sharing Contributions are determined or allocated
  under an integrated formula.]  [NOTE:
  Excluding any of the following items will require the definition of Plan
  Compensation to be tested for discrimination under Code § 414(s).]

  
	
   

  	
   

  	
   

  
	
   

  	
  d.

  	
  o

  	
   

  	
  o

  	
   

  	
  amounts in excess of
  $     .  [NOTE:  The amount that may be taken into account
  for a Plan Year is already limited under Code § 401(a)(17).  Include an amount here only if a limit less
  than the otherwise applicable limit is intended.]

  
	
   

  	
  e.

  	
  o

  	
   

  	
  o

  	
   

  	
  severance pay paid at or
  prior to Termination of Service.  [NOTE:  Severance pay or other amounts paid after
  Termination of Service are automatically excluded.]

  
	
   

  	
  f.

  	
  o

  	
   

  	
  o

  	
   

  	
  bonuses.

  
	
   

  	
  g.

  	
  o

  	
   

  	
  o

  	
   

  	
  commissions.

  
	
   

  	
  h.

  	
  o

  	
   

  	
  o

  	
   

  	
  overtime.  [NOTE:  Excluding overtime payments with respect to
  certain contribution types may raise issues under Federal and/or State Wage
  and Hour Laws.]

  
	
   

  	
  i.

  	
  o

  	
   

  	
  o

  	
   

  	
  amounts
  paid in any form other than cash.

  
	
   

  	
  j.

  	
  ý

  	
   

  	
  ý

  	
   

  	
  amounts
  contributed under the following incentive, bonus or equity plan(s) [specify]: Stock Options.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  [NOTE:  Amounts paid after an
  Employee ceases to be an Active Participant in any Component are
  automatically excluded from Plan Compensation for that Component.]

  
										

 

9

 

	
  Plan Compensation for the Plan Year:

  [Plan Sec. 2.57]

  	
  E.3.

  	
  Plan Compensation for the
  Plan Year means the Plan Compensation paid within the Plan Year ... [check if applicable]:

  
	
   

  	
  a.

  	
  o

  	
  except for purposes of the
  ... [check each that applies]:

  
	
  [complete only if the Plan includes an
  Employer Regular Matching or Regular Profit Sharing Component]

  	
   

  	
   

  	
  1.

  	
  o

  	
  Employer Regular Matching
  Component,

  
	
   

  	
   

  	
  2.

  	
  o

  	
  Employer Regular Profit
  Sharing Component,

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ... where Plan Compensation
  for the Plan Year means Plan Compensation paid within the
  twelve-consecutive-month period that ends each
         [month
  day] within the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  In the case of a
  Participant hired during such twelve-consecutive-month period, Plan
  Compensation for the Plan Year means Plan Compensation paid within ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  such
  twelve-consecutive-month period.

  
	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  E.4.

  	
  Plan Compensation for the
  Plan Year does not include amounts paid prior to the Entry Date ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  except for purposes of the
  ... [check one or both of 1. and 2., or
  check 3.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Employer Regular Matching
  Component,

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  Employer Regular Profit
  Sharing Component,

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  Employer Contribution
  Components (Employer Safe-Harbor, Regular and Qualified Matching Components,
  and Employer Safe-Harbor, Regular and Qualified Profit Sharing Components, as
  applicable)

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... where Plan Compensation
  for the Plan Year includes amounts paid during the determination period in
  E.3., but prior to the Entry Date.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Imputed Earnings While Disabled:

  	
  E.5.

  	
  Plan Compensation ... [check one]:

  
	
  [Plan Sec. 2.56(e)]

  	
  a.

  	
  ý

  	
  will not

  
	
  

  [complete only if the Plan includes an Employer Regular Profit Sharing
  Component]

  	
  b.

  	
  o

  	
  will

  
	
   

  	
  ... be imputed to a
  Participant during periods of total disability (as defined in Code
  § 22(e)(3)) for purposes of determining or allocating Employer Regular
  Profit Sharing Contributions.

  
	
   

  	
   

  

 

F.             Employee
Pre-Tax Component

 

	
  Employee Pre-Tax Contributions:

  [Plan Sec. 4.1]

  	
  F.1.

  	
  Employee Pre-Tax
  Contributions ... [check one]:

  
	
   

  	
   

  
	
  a.

  	
  o

  	
  will not [Skip to Section G.]

  
	
  b.

  	
  ý

  	
  will

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ... be allowed under the
  Plan.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Age and Service Requirements:

  [Plan Sec. 3.1(a)]

  	
  F.2.

  	
  For an Employee to
  participate in the Employee Pre-Tax Component, he/she must have attained age
  ... [check one]:

  
	
  a.

  	
  ý

  	
  21 [21 or less].

  
	
  b.

  	
  o

  	
  N/A – there is no age
  requirement.

  

 

10

 

	
   

  	
  F.3.

  	
  For an Employee to
  participate in the Employee Pre-Tax Component, he/she must have completed ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  one year of Service
  (determined under D.9.).

  
	
   

  	
  b.

  	
  ý

  	
  3 [12 or less] months of Service determined using the
  elapsed time method (irrespective of the election in D.9.).

  
	
   

  	
  c.

  	
  o

  	
  N/A – there is no service
  requirement.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Entry:

  [Plan Secs. 2.27 and 3.1(a)]

  	
  F.4.

  	
  An Employee in Covered
  Employment will become an Active Participant in the Employee Pre-Tax
  Component on the Entry Date that coincides with or next follows the date
  he/she satisfies the age and service requirements for such Component.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  F.5.

  	
  The Entry Dates for the
  Employee Pre-Tax Component are the ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  first day of each Plan Year
  and the first day of the seventh month of each Plan Year.

  
	
   

  	
  b.

  	
  o

  	
  first day of each quarter
  of each Plan Year.

  
	
   

  	
  c.

  	
  ý

  	
  first day of each month.

  
	
   

  	
  d.

  	
  o

  	
  first day of each payroll
  period.

  
	
   

  	
  e.

  	
  o

  	
  day on which the age and
  service requirements are satisfied.

  
	
   

  	
  f.

  	
  o

  	
  first day of each Plan
  Year.  [NOTE:  This option is permitted only if (i) there
  is no age requirement or the age requirement specified in F.2.a. does not
  exceed 201⁄2, and (ii) there is no service requirement or the service
  requirement specified in F.3.b. or c. does not exceed 6 months.]

  
	
   

  	
  g.

  	
  o

  	
  other [specify]:
        .  [NOTE:  The Entry Dates specified must be at least
  as favorable as one of the choices in a. – f.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Pay Reduction Contributions – Minimums/Maximums:

  [Plan Sec. 4.1(a)]

  	
  F.6.

  	
  Employee Pre-Tax
  Contributions are permitted by means of pay reduction in any whole ... [check one or both of a. and b., and check c. if it
  applies]:

  
	
   

  	
  a.

  	
  ý

  	
  percentage, subject to the
  following minimum and maximum per payroll period ... [check each of 1. and 2. that applies, or check 3.]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  ý

  	
  Minimum: 1% of Plan
  Compensation.

  
	
   

  	
   

  	
   

  	
  2.

  	
  ý

  	
  Maximum [complete]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  100% of Plan Compensation
  with respect to any Non-Highly Compensated Employee, and

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  100% [not to exceed the percentage in a.] of
  Plan Compensation with respect to any Highly Compensated Employee.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  such minimum and maximum as
  the Lead Employer may specify in written action taken prior to the
  first day of the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  b.

  	
  o

  	
  dollar amount, subject to
  the following minimum and maximum per payroll period ... [check each of 1. and 2. that applies, or check 3.]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Minimum ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  $     .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
        %
  of Plan Compensation.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  Maximum:  $     .

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  such minimum and maximum as
  the Lead Employer may specify in written action taken prior  to the first day of the Plan Year.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  [check c.
  only if an annual maximum is desired that is less than the limit under
  Code § 402(g)].

  
	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  o

  	
  provided that the aggregate
  Employee Pre-Tax Contributions of a Participant for the Plan Year may not
  exceed ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  $    .

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
     % of Plan
  Compensation for the Plan Year.

  

 

11

 

	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  the lesser of $    or     %
  of Plan Compensation for the Plan Year.

  
	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  such maximum as the Lead
  Employer may specify in written action taken prior to the first day of
  the Plan Year.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  [NOTE: Employee Pre-Tax Contributions are limited by Code
  § 402(g).]

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  [NOTE: If the Plan provides for Employer Safe-Harbor Matching
  Contributions, the maximum under a., b. and c., above, for a Non-Highly
  Compensated Employee must be at least sufficient to allow the Participant to
  receive the maximum Employer Safe-Harbor Matching Contribution.]

  
	
   

  	
   

  	
   

  
	
  Catch-Up Election

  	
  F.7.

  	
  If a Participant has
  contributed less than the maximum amount for prior payroll periods within the
  Plan Year, he/she ... [check one]:

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  ý

  	
  may not

  
	
   

  	
  b.

  	
  o

  	
  may ... [check one]:

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  at any time

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  at any time during the
  final month of the Plan Year

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  at any time during the final
  quarter of the Plan Year

  
	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  at any time during the Plan
  Year in which the Employee Pre-Tax Component becomes effective (but not later
  Plan Years)

  
	
   

  	
   

  	
  ... increase his/her pay
  reductions above the maximum in subsequent payroll periods to account for no
  prior pay reductions, or pay reductions at less than the maximum. [NOTE: In
  such case, the total pay reductions for the Plan Year may not exceed the
  maximum(s) specified above applied by reference to Plan Compensation for the
  Plan Year.]

  
	
   

  	
   

  	
   

  
	
  Automatic Enrollment

  	
  F.8.

  	
  Upon initial entry into the
  Employee Pre-Tax Component, a Participant will be deemed to have elected a
  pay reduction of ... [check one]:
  [NOTE: Some State laws may prohibit or limit automatic
  enrollments.]

  
	
   

  	
  a.

  	
  ý

  	
  N/A – the automatic enrollment
  provision does not apply.

  
	
   

  	
  b.

  	
  o

  	
       %
  [5% or less] of Plan
  Compensation per payroll period unless he/she affirmatively elects a
  different percentage or amount or elects not to receive Employee Pre-Tax
  Contributions.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Special Effective Date [complete
  if desired]:

  
	
   

  	
   

  	
   

  	
  This provision will be
  effective as of       [month day, year] with respect to individuals who become ...
  [check one of 1. or 2., and check 3. if it
  applies]

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Employees

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  Active Participants in the
  Employee Pre-Tax Component

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... on or after that date....

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  This provision will also
  apply effective as of that date to each then current Active Participant in
  the Employee Pre-Tax Component who ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  does not then have a pay
  reduction agreement in effect ... [check if
  applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  and who has not revoked
  such an agreement in the last     [specify number] months.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  does not then have a pay
  reduction agreement in effect, or who has a pay reduction agreement in effect
  of less than the automatic enrollment percentage above.

  
	
   

  	
   

  	
   

  
	
  Pay Reduction Agreements:

  [Plan Sec. 4.1(a)]

  	
  F.9.

  	
  The initial pay reduction
  agreement made by a Participant may be effective as soon as administratively
  practicable after his/her initial Entry Date. Thereafter, if a Participant
  does not have a pay reduction agreement in effect (because he/she has not
  previously filed one, or because it has been revoked), a pay reduction
  agreement may be effective 

  

 

12

 

	
   

  	
   

  	
  as soon as administratively
  practicable on or after ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  any Entry Date.

  
	
   

  	
  b.

  	
  o

  	
  the first day of any Plan
  Year or the first day of the seventh month of any Plan Year.

  
	
   

  	
  c.

  	
  o

  	
  the first day of any Plan
  Year.

  
	
   

  	
  d.

  	
  o

  	
  the first day of any
  quarter of any Plan Year.

  
	
   

  	
  e.

  	
  o

  	
  the first day of any month.

  
	
   

  	
  f.

  	
  ý

  	
  the date the election is
  made.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  F.10.

  	
  A pay reduction agreement
  may be modified effective as soon as administratively practicable on
  or after ... [check one]:

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  any Entry Date.

  
	
   

  	
  b.

  	
  o

  	
  the first day of any Plan
  Year or the first day of the seventh month of any Plan Year.

  
	
   

  	
  c.

  	
  o

  	
  the first day of any Plan
  Year.

  
	
   

  	
  d.

  	
  o

  	
  the first day of any
  quarter of any Plan Year.

  
	
   

  	
  e.

  	
  o

  	
  the first day of any month.

  
	
   

  	
  f.

  	
  ý

  	
  the date the election is
  made.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  F.11.

  	
  A pay reduction agreement
  may be revoked effective as soon as administratively practicable on or
  after ... [check one]:

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  any Entry Date.

  
	
   

  	
  b.

  	
  o

  	
  the first day of any Plan
  Year or the first day of the seventh month of any Plan Year.

  
	
   

  	
  c.

  	
  o

  	
  the first day of any Plan
  Year.

  
	
   

  	
  d.

  	
  o

  	
  the first day of any
  quarter of any Plan Year.

  
	
   

  	
  e.

  	
  o

  	
  the first day of any month.

  
	
   

  	
  f.

  	
  ý

  	
  the date the election is
  made.

  
	
   

  	
   

  	
   

  	
   

  
	
  Cash or Deferred Contributions:

  [Plan Sec. 4.1(c)]

  	
  F.12.

  	
  A cash or deferred option
  is available with respect to ... [check one]:
  [NOTE: If a cash or deferred option is available with
  respect to an item of compensation, a general pay reduction agreement will
  not apply to that item.]

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  ý

  	
  N/A – a cash or deferred
  option is not available. [Skip to F.15.]

  
	
   

  	
  b.

  	
  o

  	
  bonuses paid during the
  Plan Year and designated as eligible for this option by the Lead Employer.

  
	
   

  	
  c.

  	
  o

  	
  payments in lieu of a cash
  distribution of accrued but unused vacation time.

  
	
   

  	
  d.

  	
  o

  	
  employer credits under a
  cafeteria plan that are otherwise made available under such plan as a cash
  distribution to the Participant.

  
	
   

  	
  e.

  	
  o

  	
  the following incentive,
  bonus or equity plan(s) [specify]:         .

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  F.13.

  	
  The contributions made
  pursuant to this cash or deferred option may not exceed ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
          % of
  the designated payments subject to the cash or deferred option.

  
	
   

  	
  b.

  	
  o

  	
  $      per
  Plan Year.

  

 

13

 

	
   

  	
  F.14.

  	
  The contributions made
  pursuant to this cash or deferred option ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  are

  
	
   

  	
  b.

  	
  o

  	
  are not

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ... eligible for Employer
  Regular Matching Contributions. [NOTE: If the Plan provides for
  Employer Safe-Harbor Matching Contributions, the contributions made pursuant
  to this cash or deferred option are eligible for such Employer Safe-Harbor
  Matching Contributions.]

  
	
   

  	
   

  	
   

  
	
  In-Service Withdrawals:

  [Plan Sec. 11.2]

  	
  F.15.

  	
  Withdrawals are allowed
  from Employee Pre-Tax Contribution Accounts ... [check a., or check each of b. and c. that applies]:

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  N/A – in-service
  withdrawals are not allowed.

  
	
   

  	
  b.

  	
  ý

  	
  for any reason after... [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Normal Retirement Age (or
  age 591/2, if later).

  
	
   

  	
   

  	
   

  	
  2.

  	
  ý

  	
  age 591/2.

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  age       [60 or more].

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  ý

  	
  at any age on account of
  Hardship.

  

 

G.            Employee
After-Tax Component

 

	
  Employee After-Tax Contributions:

  [Plan Sec. 4.2]

  	
  G.1.

  	
  Employee After-Tax
  Contributions ... [check one]:

  
	
  a.

  	
  ý

  	
  will not [Skip to Section H.]

  
	
  b.

  	
  o

  	
  will

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ... be allowed under the
  Plan.

  
	
   

  	
   

  	
   

  
	
  Age and Service Requirements/Entry:

  [Plan Secs. 2.27 and 3.1(a)]

  	
  G.2.

  	
  The eligibility and entry
  requirements for the Employee After-Tax Component are the same as for the ...
  [check one]:

  
	
   

  	
   

  
	
  a.

  	
  o

  	
  Employee Pre-Tax Component.

  
	
   

  	
  b.

  	
  o

  	
  Employer Regular Matching
  Component.

  
	
   

  	
  c.

  	
  o

  	
  Employer Regular Profit
  Sharing Component.

  
	
   

  	
   

  	
   

  
	
  Payroll Withholding Contributions:

  [Plan Sec. 4.2(a)]

  	
  G.3.

  	
  Employee After-Tax
  Contributions ... [check one]:

  
	
   

  	
   

  
	
  a.

  	
  o

  	
  will not be allowed
  by means of payroll withholding.

  
	
  b.

  	
  o

  	
  will be allowed by means of
  payroll withholding in any whole ... [check
  one or both of 1. and 2., and check 3. if it applies]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  percentage, subject to the
  following minimum and maximum per payroll period ... [check each of a. and b. that applies, or check c.]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Minimum:     %
  of Plan Compensation.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Maximum [complete 1., and complete 2. if it applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  Maximum ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
       %
  of Plan Compensation with respect to any Non-Highly Compensated Employee,
  and

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
       %
  [not to exceed the percentage in a.] of
  Plan Compensation with respect to any Highly Compensated Employee.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  Combined Maximum [complete if desired]: The Employee
  Pre-Tax and After-Tax Contributions of a Participant in combination may not
  exceed       % of Plan Compensation per payroll
  period (other than as a result of a catch-up election under F.7.).

  

 

14

 

	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  such minimum and maximum as
  the Lead Employer may specify in written action taken prior to the
  first day of the Plan Year.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  dollar amount, subject to
  the following minimum and maximum per payroll period ... [check each a. and b. that applies, or check c.]:

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Minimum ... [check one]:

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  $    .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
       %
  of Plan Compensation.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Maximum [complete 1., and complete 2. if it applies]:

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  Maximum: $    .

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  Combined Maximum [complete if desired]: The Employee
  Pre-Tax and After-Tax Contributions of a Participant in combination may not
  exceed $     per payroll period (other than as a
  result of a catch-up election under F.7.).

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  such minimum and maximum as
  the Lead Employer may specify in written action taken prior to the
  first day of the Plan Year.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  [check 3.
  only if an annual maximum is desired]

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  provided that the aggregate
  Employee After-Tax Contributions of a Participant for the Plan Year may not
  exceed ... [check one]:

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  $   .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
       %
  of Plan Compensation for the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  the lesser of $    or     %
  of Plan Compensation for the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  d.

  	
  o

  	
  such maximum as the Lead
  Employer may specify in written action taken prior to the first day of
  the Plan Year.

  
	
   

  	
   

  	
   

  
	
  Direct Contributions:

  [Plan Sec. 4.2(c)]

  	
  G.4.

  	
  Employee After-Tax
  Contributions ... [check one]:

  
	
   

  	
  a.

  	
  o

  	
  will not be allowed
  by means other than payroll withholding.

  
	
   

  	
  b.

  	
  o

  	
  will be allowed by such
  means (other than payroll withholding) as may be prescribed from time to time
  by the Lead Employer (e.g., personal
  checks). ... [check if applicable]:

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  The maximum amount of the
  Employee After-Tax Contributions allowed in any Plan Year (including by
  payroll withholding, if allowed) is ... [check
  one]:

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  $    .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
       %
  of Plan Compensation for the Plan Year.

  
	
   

  	
   

  	
   

  
	
  Required
  Contributions – Thrift Plan:

  [Plan Sec. 4.2(b)]

  	
  G.5.

  	
  An Active Participant will
  be required to make Employee After-Tax Contributions equal to ... [check one]:

  
	
   

  	
   

  
	
  a.

  	
  o

  	
  N/A – such contributions
  will not be required.

  
	
  b.

  	
  o

  	
       %
  of Plan Compensation per payroll period.

  
	
   

  	
  c.

  	
  o

  	
  the percentage, not less
  than      %, of Plan Compensation per payroll
  period that is selected by the Participant upon his/her enrollment in the
  Employee After-Tax Component.

  
	
   

  	
   

  	
   

  
	
  In-Service Withdrawals:

  [Plan Sec. 11.2]

  	
  G.6.

  	
  Withdrawals are allowed
  from Employee After-Tax Contribution Accounts ... [check one]:

  

 

15

 

	
   

  	
  a.

  	
  o

  	
  N/A – in-service
  withdrawals are not allowed.

  
	
   

  	
  b.

  	
  o

  	
  for any reason and at any
  time. ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Employee After-Tax
  Contributions will be suspended for        [not more than 12] months after such a
  withdrawal.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  o

  	
  for any reason after ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1

  	
  o

  	
  Normal Retirement Age.

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  age 591/2.

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  age      .

  

 

H.            Employer Safe-Harbor Component

 

	
  Employer Safe-Harbor Contributions:

  [Plan Secs. 5.1 and 6.1]

  	
  H.1.

  	
  This Plan ... [check one]:

  
	
   

  	
   

  
	
  a.

  	
  o

  	
  is not intended to
  be a Safe-Harbor Plan. [Skip to Section
  I.]

  
	
  b.

  	
  ý

  	
  is intended to be a
  Safe-Harbor Plan, and safe-harbor contributions will be made under ... [check one]:

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  ý

  	
  this Plan.

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  the following defined contribution
  plan [specify]:
        .
  [Skip to Section I.] [NOTE:
  The other plan must have the same Plan Year as this Plan.]

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  [NOTE: Employee After-Tax Contributions (if any) will remain subject
  to the Actual Contribution Percentage Test of Code § 401(m) regardless of
  whether this Plan is a Safe-Harbor Plan. Further, Employer Safe-Harbor and
  Regular Matching Contributions will remain subject to the Actual Contribution
  Percentage Test of Code § 401(m) if any such contribution is made based on
  Employee Pre-Tax and/or After-Tax Contributions in excess of 6% of Plan
  Compensation or the Plan otherwise fails to satisfy the requirements of Code
  § 401(m)(11)(B).]

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Special Effective Date [complete
  if applicable]:

  
	
   

  	
   

  	
   

  	
  The designation as a
  Safe-Harbor Plan is effective as of January 1, 2001 [month day, year] [no earlier than the first day of
  the first Plan Year beginning on or after January 1, 1999]. [NOTE: A
  designation as a Safe-Harbor Plan can be effective only as of the first day of a Plan Year (including a
  short first Plan Year) or as of the date on which the Employee Pre-Tax
  Component is first effective under the Plan. The Adoption Agreement adding an
  Employer Safe-Harbor Matching Component to this Plan must be executed before
  the Component becomes effective. The Adoption Agreement adding an Employer
  Safe-Harbor Profit Sharing Component to this Plan must be executed at least
  30 days before the end of the Plan Year in which the Component becomes
  effective.]

  
	
   

  	
   

  	
   

  	
   

  
	
  Age and Service Requirements:

  [Plan Sec. 3.1(a)]

  	
  H.2.

  	
  For an Employee to
  participate in the Employer Safe-Harbor Matching or Safe-Harbor Profit
  Sharing Component, he/she must have ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  attained age 21 and
  completed one year of Service (determined under D.9.). [NOTE: If this
  option is elected, the portion of the Employee Pre-Tax Component covering
  Participants who have not satisfied these age and service requirements must
  be disaggregated, and must separately satisfy Code § 410(b) and the Average
  Deferral Percentage Test of Code § 401(k).] [NOTE: If this option is elected,
  the Entry Dates for the Employer Safe-Harbor Matching or Safe-Harbor Profit
  Sharing Component are the first day of the Plan Year and the first day of the
  seventh month of the Plan Year.]

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  b.

  	
  ý

  	
  satisfied the same age and
  service requirements as for the Employee Pre-Tax Component.

  

 

16

 

	
  Employer Safe-Harbor Contributions:

  [Plan Sec. 5.1]

  	
  H.3.

  	
  The Employer Safe-Harbor
  Contribution will be an ... [check one]:

  
	
   

  	
   

  	
   

  
	
  a.

  	
  ý

  	
  Employer Safe-Harbor
  Matching Contribution made in accordance with ... [check 1. or 2., and complete 3. and 4.]:

  
	
   

  	
   

  	
   

  	
   

  
	
  Basic Matching Formula

  	
   

  	
   

  	
  1.

  	
  o

  	
  the following schedule ... [complete schedule]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  The Employer

  Safe-Harbor Matching

  Contribution will be:

  	
   

  	
   

  	
   

  	
  Of Match

  Eligible

  Contributions*:

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  A

  	
   

  	
   

  	
   

  	
  B

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  1

  	
   

  	
  100%

  	
   

  	
  of the first:

  	
   

  	
  3

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  2

  	
   

  	
       %

  	
  [50% or more, but not more than
  1A%]

  	
   

  	
  of the next:

  	
   

  	
  2

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  3

  	
   

  	
       %

  	
  [not more than 2A%]

  	
   

  	
  of the next:

  	
   

  	
  1

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  [NOTE: If the following are used, the Plan will satisfy the 401(k)
  Safe-Harbor but not the 401(m) Safe-Harbor.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  4

  	
   

  	
       %

  	
  [not more than 3A%]

  	
   

  	
  of
  the next:

  	
   

  	
         

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  5

  	
   

  	
       %

  	
  [not more than 4A%]

  	
   

  	
  of
  the next:

  	
   

  	
         

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  6

  	
   

  	
       %

  	
  [not more than 5A%]

  	
   

  	
  of
  the next:

  	
   

  	
         

  	
  %

  
	
   

  
	
  
  

  

  

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  *Of Match Eligible Contributions
  (expressed as a percentage of Plan Compensation) for payroll periods ending
  within the Matching Contribution Period.

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  [NOTE: To satisfy the minimum
  requirements for an Employer Safe-Harbor Matching Contribution, 2.A. must be
  completed.]

  
	
   

  
	
  Enhanced Matching Formula

  	
   

  	
   

  	
  2.

  	
  ý

  	
  the following schedule ... [complete schedule]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  The Employer

  Safe-Harbor Matching

  Contribution will be:

  	
   

  	
   

  	
   

  	
  Of Match

  Eligible

  Contributions*:

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  A

  	
   

  	
   

  	
   

  	
  B

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  1

  	
   

  	
  100%

  	
   

  	
  of the first:

  	
   

  	
  4

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  2

  	
   

  	
       %

  	
  [not more than 1A%]

  	
   

  	
  of the next:

  	
   

  	
  1

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  3

  	
   

  	
       %

  	
  [not more than 2A%]

  	
   

  	
  of the next:

  	
   

  	
  1

  	
  %

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  [NOTE: If the following are used, the
  Plan will satisfy the 401(k) Safe-Harbor but not the 401(m) Safe-Harbor.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  4

  	
   

  	
       %

  	
  [not more than 3A%]

  	
   

  	
  of the next:

  	
   

  	
        

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  5

  	
   

  	
       %

  	
  [not more than 4A%]

  	
   

  	
  of the next:

  	
   

  	
        

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  6

  	
   

  	
       %

  	
  [not more than 5A%]

  	
   

  	
  of the next:

  	
   

  	
        

  	
  %

  

 

17

 

	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  *Of Match Eligible Contributions
  (expressed as a percentage of Plan Compensation) for payroll periods ending
  within the Matching Contribution Period.

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  [NOTE: To satisfy the minimum
  requirements for an Employer Safe-Harbor Matching Contribution, no items need
  to be completed.]

  
	
   

  
	
   

  	
   

  	
   

  	
  3.

  	
  The Match Eligible Contributions
  are the Employee Pre-Tax Contributions ... [check
  if applicable]:

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  and Employee After-Tax
  Contributions.

  
	
   

  
	
   

  	
   

  	
   

  	
  4.

  	
  The Matching Contribution
  Period is ... [check one]:

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  each Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  each payroll period.

  
	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  ý

  	
  each month.

  
	
   

  	
   

  	
   

  	
   

  	
  d.

  	
  o

  	
  each quarter of each Plan
  Year.

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
  [NOTE: Employer Safe-Harbor Matching Contributions will be calculated
  based on the Match Eligible Contributions and Plan Compensation for each
  Matching Contribution Period. However, if H.2.a. is elected, Match Eligible
  Contributions and Plan Compensation prior to the Entry Date for the Employer
  Safe-Harbor Matching Component will be disregarded in calculating the
  Employer Safe-Harbor Matching Contributions unless otherwise specified in
  E.4. with respect to Plan Compensation.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  [NOTE: Employer Safe-Harbor Matching Contributions should not be
  deposited or allocated until the end of the Matching Contribution Period.]

  
	
   

  
	
  Profit Sharing Formula

  	
  b.

  	
  o

  	
  Employer Safe-Harbor Profit
  Sharing Contribution in the amount of      % [3% or more] of the Participant’s Plan
  Compensation for the Plan Year. [NOTE: If the Plan is Top-Heavy,
  the contribution formula for the Employer Safe-Harbor Profit Sharing
  Contributions will be applied with the applicable modifications described in
  Plan Sec. 17.1(b) unless an additional contribution is elected in Q.2.]

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  [NOTE: If H.2.a. is elected, Plan Compensation prior to the Entry
  Date for the Employer Safe-Harbor Profit Sharing Component will be
  disregarded in calculating the Employer Safe-Harbor Profit Sharing
  Contributions unless otherwise specified in E.4.]

  
	
   

  	
   

  	
   

  	
   

  
	
  In-Service Withdrawals:

  [Plan Sec. 11.2]

  	
  H.4.

  	
  Withdrawals are allowed
  from Employer Safe-Harbor Matching and/or Safe-Harbor Profit Sharing
  Contribution Accounts ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  N/A – in-service
  withdrawals are not allowed.

  
	
   

  	
  b.

  	
  ý

  	
  for any reason after... [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Normal Retirement Age (or
  age 591/2 if later).

  
	
   

  	
   

  	
   

  	
  2.

  	
  ý

  	
  age 591/2.

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  age        [60 or more]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  o

  	
  for Hardship after age 591/2.

  

 

18

 

I.              Employer Regular Matching Component

 

	
  Employer Regular Matching Contributions:

  [Plan Sec. 5.2]

  	
  I.1.

  	
  Employer Regular Matching
  Contributions ... [check one]:

  
	
   

  	
   

  	
   

  
	
  a.

  	
  ý

  	
  will not [Skip to Section J.]

  
	
  b.

  	
  o

  	
  will

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ... be made under the Plan.

  
	
   

  	
   

  	
   

  	
   

  
	
  Excluded Employment Categories:

  [Plan Sec. 2.14(a)]

  	
  I.2.

  	
  Covered Employment with
  respect to the Employer Regular Matching Component does not include ... [check one]: [NOTE:
  Any exclusions below are in addition to any exclusions in D.1.]

  
	
   

  	
   

  	
   

  
	
  a.

  	
  o

  	
  N/A – there are no
  additional exclusions.

  
	
   

  	
  b.

  	
  o

  	
  employment ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  as a Highly Compensated
  Employee.

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  as a Key Employee.

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  on prevailing wage projects
  covered by J.8.f.

  
	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  other [specify]:       .
  [NOTE:
  Specify a group whose exclusion will not result in discrimination in favor of
  Highly Compensated Employees.]

  
	
   

  	
   

  	
   

  	
   

  
	
  Age and Service

  Requirements:

  [Plan Sec. 3.1(a)]

  	
  I.3.

  	
  For an Employee to
  participate in the Employer Regular Matching Component, he/she must have
  attained age ... [check one]:

  
	
   

  	
   

  	
   

  
	
  a.

  	
  o

  	
       [21
  or less].

  
	
   

  	
  b.

  	
  o

  	
  N/A – there is no age
  requirement.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  I.4.

  	
  For an Employee to
  participate in the Employer Regular Matching Component, he/she must have
  completed ... [check one]: [NOTE: If
  more than one year of Service (12 months of elapsed time Service) is required
  for eligibility, the Plan must provide for full and immediate vesting of
  Employer Regular Matching Contribution Accounts.]

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  one year of Service
  (determined under D.9.).

  
	
   

  	
  b.

  	
  o

  	
  two years of Service
  (determined under D.9.).

  
	
   

  	
  c.

  	
  o

  	
        [24
  or less] months of
  Service determined using the elapsed time method (irrespective of the
  election in D.9.).

  
	
   

  	
  d.

  	
  o

  	
  N/A - there is no service
  requirement.

  
	
   

  	
   

  	
   

  	
   

  
	
  Entry:

  [Plan Secs. 2.27 and 3.1(a)]

  	
  I.5.

  	
  An Employee in Covered
  Employment will become an Active Participant in the Employer Regular Matching
  Component on the Entry Date that coincides with or next follows the date
  he/she satisfies the age and service requirements for such Component.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  I.6.

  	
  The Entry Dates for the
  Employer Regular Matching Component are the ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  first day of each Plan Year
  and the first day of the seventh month of each Plan Year.

  
	
   

  	
  b.

  	
  o

  	
  first day of each quarter
  of each Plan Year.

  
	
   

  	
  c.

  	
  o

  	
  first day of each month.

  
	
   

  	
  d.

  	
  o

  	
  first day of each payroll
  period.

  
	
   

  	
  e.

  	
  o

  	
  day on which the age and
  service requirements are satisfied.

  
	
   

  	
  f.

  	
  o

  	
  first day of each Plan
  Year. [NOTE: This option is permitted only if (i) there is
  no age requirement or the age requirement specified in I.3.a. does not exceed
  201⁄2, and (ii) there is no service requirement or the service requirement
  specified in I.4.c. or d. does not exceed 6 months, or 18 months if full and
  immediate vesting.]

  
	
   

  	
  g.

  	
  o

  	
  other [specify]:       .
  [NOTE: The Entry Dates specified must be at least as
  favorable as one of the choices in a. – f.]

  

 

19

 

	
  Requirements to Receive an Employer Regular Matching
  Contribution:

  [Plan Sec. 5.2(a) or (b)]

  	
  I.7.

  	
  To receive an Employer
  Regular Matching Contribution for a Plan Year, a Participant must be an
  Active Participant in the Employer Regular Matching Component at some time
  during the Plan Year ... [check one]:
  [NOTE: Employer Regular Matching Contributions should not
  be made on behalf of any Participant until he/she has satisfied the
  conditions imposed on the receipt of such contributions.]

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  but need not be an Employee
  on the last day of the Plan Year or have completed any specified number of
  Hours of Service.

  
	
   

  	
  b.

  	
  o

  	
  and must either be
  an Employee on the last day of the Plan Year or must have completed at
  least        [1,000
  or less] Hours of Service during the Plan Year. However, these
  requirements do not apply if the Participant’s Termination of Service
  occurred during the Plan Year because he/she ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  died.

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  became Disabled.

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  retired after ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Normal Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Early Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  age [specify]:
        .

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  o

  	
  and must both be an
  Employee on the last day of the Plan Year and must have completed at
  least        [1,000
  or less] Hours of Service during the Plan Year. However, ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  these requirements do not
  apply

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  the last day requirement
  does not apply

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... if the Participant’s
  Termination of Service occurred during the Plan Year because he/she ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  died.

  
	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  became Disabled.

  
	
   

  	
   

  	
   

  	
  5.

  	
  o

  	
  retired after ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Normal Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Early Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  age [specify]:
        .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  d.

  	
  o

  	
  and must be an Employee on
  the last day of the Plan Year. However, this requirement does not apply if
  the Participant’s Termination of Service occurred during the Plan Year
  because he/she ... [check each that
  applies]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  died.

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  became Disabled.

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  retired after ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Normal Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Early Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  age [specify]:       .

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  e.

  	
  o

  	
  and must have completed at
  least        [1,000
  or less] Hours of Service during the Plan Year. However, this
  requirement does not apply if the Participant’s Termination of Service occurred
  during the Plan Year because he/she ... [check
  each that applies]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  died.

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  became Disabled.

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  retired after ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Normal Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Early Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  age [specify]:       .

  

 

20

 

	
  Matching Formula:

  [Plan Sec. 5.2(a) or (b)]

  	
  I.8.

  	
  Employer Regular Matching
  Contributions will be ... [check one]:

  
	
   

  	
   

  	
   

  
	
  Fixed Contributions – based on Percentage of Match Eligible
  Contributions to Plan Compensation

  	
   

  	
  a.

  	
  o

  	
  determined under the
  following schedule ... [complete schedule
  and the items that follow]:

  
	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  The Employer Regular

  Matching

  Contribution will be:

  	
   

  	
   

  	
   

  	
  Of the Match Eligible

  Contributions*:

  	
   

  
	
  Optional:

  – Profits Contingency

  – Discretionary Contributions

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  A

  	
   

  	
   

  	
   

  	
  B

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  1

  	
   

  	
       %

  	
   

  	
  of the first:

  	
   

  	
        

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  2

  	
   

  	
       %

  	
  [less than 1A%]

  	
   

  	
  of the next:

  	
   

  	
        

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  3

  	
   

  	
       %

  	
  [less than 2A%]

  	
   

  	
  of the next:

  	
   

  	
        

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  4

  	
   

  	
       %

  	
  [less than 3A%]

  	
   

  	
  of the next:

  	
   

  	
        

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  5

  	
   

  	
       %

  	
  [less than 4A%]

  	
   

  	
  of the next:

  	
   

  	
        

  	
  %

  

 

	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  *Of Match Eligible Contributions
  (expressed as a percentage of Plan Compensation) for payroll periods ending
  within the Matching Contribution Period.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  The Match Eligible
  Contributions are the ... [check each that
  applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Employee Pre-Tax
  Contributions (except as provided in F.14.).

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Employee After-Tax
  Contributions. ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  except that the Employer
  Regular Matching Contributions made on Employee After-Tax Contributions will
  be a discretionary amount determined by the Lead Employer. [NOTE:
  The Lead Employer may specify in a written action taken prior to the
  first day of the Plan Year that the Employer Regular Matching Contributions
  will be made on Employee After-Tax Contributions in accordance with a
  schedule that conforms with a schedule in a., b. or c. Otherwise, the
  Employer Regular Matching Contributions made for a Plan Year on Employee
  After-Tax Contributions will be allocated in proportion of the Employee
  After-Tax Contributions for payroll periods ending within the Plan Year.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  2.

  	
  The Matching Contribution
  Period is ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  each Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  each payroll period.

  
	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  each month.

  
	
   

  	
   

  	
   

  	
   

  	
  d.

  	
  o

  	
  each quarter of each Plan
  Year.

  
	
   

  	
   

  	
   

  	
   

  	
  e.

  	
  o

  	
  each half of each Plan
  Year.

  
	
   

  	
   

  	
   

  	
   

  	
  f.

  	
  o

  	
  other [specify]:       .
  [Note:
  Specify a period longer than a Plan Year.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  [NOTE: Employer Regular Matching Contributions will be calculated
  based on the Match Eligible Contributions and Plan Compensation for each
  Matching Contribution Period – “true-up” contributions may be elected under
  3.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  [NOTE: Employer Regular Matching Contributions should not be
  deposited or allocated until the end of the Matching Contribution Period.]

  
										

 

21

 

	
   

  	
   

  	
   

  	
  3.

  	
  The Employer Regular
  Matching Contributions will be calculated separately for each Matching
  Contribution Period and ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  N/A – the Matching
  Contribution Period is the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  “true-up” contributions
  will not be made.

  
	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  then will be recalculated
  based on the Match Eligible Contributions and Plan Compensation for the Plan
  Year, and “true-up” contributions will be made accordingly, with respect to
  each eligible Participant described in I.7 ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  who is an Employee on the
  last day of the Plan Year. However, this requirement does not apply if the
  Participant’s Termination of Service occurred during the Plan Year because
  he/she ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  died.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  became Disabled.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  retired after ... [check each that applies]:

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Normal Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Early Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  age [specify]:       .

  
	
   

  
	
   

  	
   

  	
   

  	
  4.

  	
  The Employer Regular
  Matching Contribution is ... [check one]:
  [NOTE: If Employer Regular Matching Contributions are
  contingent on Net Profits, the Matching Contribution Period must be
  the Plan Year and the contributions should not be deposited or allocated
  until after the end of the Plan Year.]

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  not contingent on Net
  Profits.

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  contingent on ... [check one]:

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  current (for the fiscal
  year ending with or within the Plan Year)

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  accumulated

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... Net Profits of the
  Participating Employers, determined under ... [check one]:

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  GAAP o before o after the payment of discretionary bonuses.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  other [specify]:       .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  5.

  	
  The Lead Employer may
  direct that an additional Employer Regular Matching Contribution be made for
  a Plan Year which, if made, will be allocated in proportion to the ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  N/A - such contributions
  will not be made.

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Employer Regular Matching
  Contributions received under the above schedule for the Plan Year. The
  allocation will be made among all eligible Participants described in I.7 ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  who are Non-Highly
  Compensated Employees.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  Match Eligible
  Contributions of each eligible Participant that do not exceed
       % of his/her Plan Compensation for the Plan
  Year. The allocation will be made among all eligible Participants described
  in I.7 ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  who are Non-Highly
  Compensated Employees.

  

 

22

 

	
  Fixed Contributions – based on Dollar Amount of Match
  Eligible Contributions

  	
   

  	
  b.

  	
  o

  	
  determined under the
  following schedule ... [complete schedule
  and the items that follow]:

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  The Employer Regular

  Matching

  Contribution will be:

  	
   

  	
   

  	
   

  	
  Of the Match Eligible

  Contributions*:

  	
   

  
	
  Optional:

  – Profits Contingency

  – Discretionary Contributions

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  A

  	
   

  	
   

  	
   

  	
  B

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  1

  	
   

  	
       %

  	
   

  	
  of the first:

  	
   

  	
  $     .

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  2

  	
   

  	
       %

  	
  [less
  than 1A%]

  	
   

  	
  of the next:

  	
   

  	
  $     .

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  3

  	
   

  	
       %

  	
  [less than 2A%]

  	
   

  	
  of the next:

  	
   

  	
  $     .

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  4

  	
   

  	
       %

  	
  [less than 3A%]

  	
   

  	
  of the next:

  	
   

  	
  $     .

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  5

  	
   

  	
       %

  	
  [less than 4A%]

  	
   

  	
  of the next:

  	
   

  	
  $     .

  	
   

  

 

	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  *Of Match Eligible Contributions
  (expressed as a dollar amount) for payroll periods ending within the Matching
  Contribution Period.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  The Match Eligible
  Contributions are the ... [check each that
  applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Employee Pre-Tax
  Contributions (except as provided in F.14.).

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Employee After-Tax
  Contributions. ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  except that the Employer
  Regular Matching Contributions made on Employee After-Tax Contributions will
  be a discretionary amount determined by the Lead Employer. [NOTE:
  The Lead Employer may have specified in a written action taken prior to
  the first day of the Plan Year that the Employer Regular Matching
  Contributions will be made on Employee After-Tax Contributions in accordance
  with a schedule that conforms with a schedule in a., b. or c. Otherwise, the
  Employer Regular Matching Contributions made for a Plan Year on Employee
  After-Tax Contributions will be allocated in proportion of the Employee
  After-Tax Contributions for payroll periods ending within the Plan Year.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  2.

  	
  The Matching Contribution
  Period is ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  each Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  each payroll period.

  
	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  each month.

  
	
   

  	
   

  	
   

  	
   

  	
  d.

  	
  o

  	
  each quarter of each Plan
  Year.

  
	
   

  	
   

  	
   

  	
   

  	
  e.

  	
  o

  	
  each half of each Plan
  Year.

  
	
   

  	
   

  	
   

  	
   

  	
  f.

  	
  o

  	
  other [specify]:       . [Note: Specify a period
  longer than a Plan Year.]

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
  [NOTE: Employer Regular Matching Contributions will be calculated
  based on the Matching Eligible Contributions and Plan Compensation for each
  Matching Contribution Period –”true-up” contributions may be elected under
  3.]

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
  [NOTE: Employer Regular Matching Contributions should not be
  deposited or allocated until the end of the Matching Contribution Period.]

  
	
   

  
	
   

  	
   

  	
   

  	
  3.

  	
  The Employer Regular
  Matching Contribution will be calculated separately for each Matching
  Contribution Period and ... [check one]:

  

 

23

 

	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  N/A – the Matching
  Contribution Period is the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  “true-up” contributions
  will not be made.

  
	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  then will be recalculated
  based on the Match Eligible Contributions and Plan Compensation for the Plan
  Year, and “true-up” contributions will be made accordingly, with respect to
  each eligible Participant described in I.7. ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  who is an Employee on the
  last day of the Plan Year. However, this requirement does not apply if the
  Participant’s Termination of Service occurred during the Plan Year because
  he/she ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1

  	
  o

  	
  died.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  became Disabled.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  retired after ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Normal Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Early Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  age [specify]:      .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  4.

  	
  The Employer Regular
  Matching Contribution is ... [check one]:
  [NOTE: If Employer Regular Matching Contributions are
  contingent on Net Profits, the Matching Contribution Period must be
  the Plan Year and the contributions should not be deposited or allocated
  until after the end of the Plan Year.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  not contingent on Net Profits.

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  contingent on ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  current (for the fiscal
  year ending with or within the Plan Year)

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  accumulated

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... Net Profits of the
  Participating Employers, determined under ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  GAAP o before o after the payment of discretionary bonuses.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  other [specify]:       .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  5.

  	
  The Lead Employer may
  direct that an additional Employer Regular Matching Contribution be made for
  a Plan Year which, if made, will be allocated in proportion to the ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  N/A - such contributions
  will not be made.

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Employer Regular Matching
  Contributions received under the above schedule for the Plan Year. The
  allocation will be made among all eligible Participants described in I.7 ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  who are Non-Highly
  Compensated Employees.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  Match Eligible
  Contributions of each eligible Participant that do not exceed $    for the Plan Year. The allocation will be made among all eligible
  Participants described in I.7 ... [check
  if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  who are Non-Highly
  Compensated Employees.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Fixed Contributions – based on Years of Credited Service:

  	
   

  	
  c.

  	
  o

  	
  determined under the
  following schedule ... [complete schedule
  and the items that follow]: [NOTE:
  Use of this option will require benefits, rights and features testing under
  Code § 401(a)(4).] [NOTE: If
  this option is elected, the Matching Contribution Period is the Plan Year and
  contributions should not be deposited or allocated until after the end of the
  Plan Year.]

  
														

 

24

 

	
  Optional:

  – Profits Contingency

  – Discretionary Contributions

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  The Employer Regular

  Matching

  Contribution will be:

  	
   

  	
   

  	
   

  	
  Of Match Eligible Contributions

  for Participants with at least the

  following number of

  years of credited service:

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  A

  	
   

  	
   

  	
   

  	
  B

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  1

  	
   

  	
       %

  	
   

  	
   

  	
   

  	
  1 yr. [NOTE: If
  more than one year of Service is required to participate in the Employer
  Regular Matching Component, that service requirement must be satisfied to
  receive a contribution.]

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2

  	
   

  	
       %

  	
  [more than
  1A%]

  	
   

  	
   

  	
   

  	
     yrs.
  [more than 1B]

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  3

  	
   

  	
       %

  	
  [more than 2A%]

  	
   

  	
   

  	
   

  	
     yrs.
  [more than 2B]

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  4

  	
   

  	
       %

  	
  [more than 3A%]

  	
   

  	
   

  	
   

  	
     yrs.
  [more than 3B]

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  5

  	
   

  	
       %

  	
  [more than 4A%]

  	
   

  	
   

  	
   

  	
     yrs.
  [more than 4B]

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  The Match Eligible
  Contributions are the ... [check each that
  applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Employee Pre-Tax
  Contributions (except as provided in F.14.).

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Employee After-Tax
  Contributions. ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  except that the Employer
  Regular Matching Contributions made on Employee After-Tax Contributions will
  be a discretionary amount determined by the Lead Employer. [NOTE:
  The Lead Employer may specify in a written action taken prior to the
  first day of the Plan Year that the Employer Regular Matching Contributions
  will be made on Employee After-Tax Contributions in accordance with a
  schedule that conforms with a schedule in a., b. or c. Otherwise, the
  Employer Regular Matching Contributions made for a Plan Year on Employee
  After-Tax Contributions will be allocated in proportion of the Employee
  After-Tax Contributions for payroll periods ending within the Plan Year.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  2.

  	
  The Participant’s years of
  credited service for this purpose means ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  the number of Plan Years in
  which the Participant had        [1,000 or less] or more Hours of
  Service.

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  the number of years of
  elapsed time Service of the Participant as of the last day of the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  3.

  	
  The Employer Regular
  Matching Contribution is ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  not contingent on Net
  Profits.

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  contingent on ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  current (for the fiscal
  year ending with or within the Plan Year)

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  accumulated

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... Net Profits of the
  Participating Employers, determined under ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  GAAP o before o after the payment of discretionary bonuses.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  other [specify]:       .

  
																				

 

25

 

	
   

  	
   

  	
   

  	
  4.

  	
  The Lead Employer may
  direct that an additional Employer Regular Matching Contribution be made for
  a Plan Year which, if made, will be allocated in proportion to the ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  N/A – such contributions
  will not be made.

  
	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Employer Regular Matching
  Contributions received under the above schedule for the Plan Year. The
  allocation will be made among all eligible Participants described in I.7 ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  who are Non-Highly
  Compensated Employees.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  Match Eligible
  Contributions of each eligible Participant that do not exceed
      % of his/her Plan Compensation for the Plan Year. The
  allocation will be made among all eligible Participants described in I.7 ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  who are Non-Highly
  Compensated Employees.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Discretionary Contributions

  	
   

  	
  d.

  	
  o

  	
  a discretionary amount
  determined by the Lead Employer.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  The Lead Employer may
  specify in a written action taken prior to the first day of the Plan
  Year that Employer Regular Matching Contributions will be made for such Plan
  Year in accordance with a schedule that conforms with a schedule specified in
  a., b. or c., above. A separate schedule may apply to Employee Pre-Tax
  Contributions and Employee After-Tax Contributions.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  If such written action is not
  taken prior to the first day of the Plan Year, then any Employer Regular
  Matching Contribution made for the Plan Year on Employee Pre-Tax
  Contributions will be allocated ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  in proportion to Employee
  Pre-Tax Contributions (except as provided in F.14.) for payroll periods
  ending within the Plan Year that do not exceed ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  N/A – no limit.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  $    .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
       %
  of Plan Compensation for the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  d.

  	
  o

  	
  the lesser of $     or     %
  of Plan Compensation for the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  under the following
  schedule ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  The following

  percent of the Employer

  Regular Matching

  Contribution for

  the Plan Year:

  	
   

  	
   

  	
   

  	
  Will be allocated in

  proportion to Employee

  Pre-Tax Contributions

  (except as provided in

  F.14.) that do not exceed

  the following percent of

  Plan Compensation for

  the Plan Year:

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  A

  	
   

  	
   

  	
   

  	
  B

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  1

  	
   

  	
  %

  	
   

  	
   

  	
   

  	
     

  	
  %

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  2

  	
   

  	
  %

  	
   

  	
   

  	
   

  	
     

  	
  %

  	
  [less than 1B%]

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  3

  	
   

  	
  %

  	
   

  	
   

  	
   

  	
     

  	
  %

  	
  [less than 2B%]

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  Total = 100%

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  [NOTE: The steps in the allocation formula provide cumulative
  contributions at lower deferral levels.]

  
																					

 

26

 

	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  under the following
  schedule ... [complete]:

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  The following dollar

  amount of the Employer

  Regular Matching

  Contribution for

  the Plan Year:

  	
   

  	
   

  	
   

  	
  Will be allocated in

  proportion to Employee

  Pre-Tax Contributions

  (except as provided in

  F.14.) that do not exceed

  the following percent of

  Plan Compensation for

  the Plan Year:

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  A

  	
   

  	
   

  	
   

  	
  B

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1

  	
   

  	
  The
  first:

  	
   

  	
  $      .

  	
   

  	
   

  	
   

  	
  %

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2

  	
   

  	
  The
  next:

  	
   

  	
  $      .

  	
   

  	
   

  	
   

  	
  %

  	
   

  	
  [less than 1B%]

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  3

  	
   

  	
  The remainder:

  	
   

  	
   

  	
   

  	
  %

  	
   

  	
  [less than 2B%]

  	
   

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  [NOTE: The steps in the allocation
  formula provide cumulative contributions at lower deferral levels.]

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Any Employer Regular
  Matching Contribution made for the Plan Year on Employee After-Tax
  Contributions will be allocated in proportion of Employee After-Tax
  Contributions for payroll periods ending within the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  [NOTE: If the Plan provides for discretionary Employer Safe-Harbor
  Matching Contributions, Employer Safe-Harbor Matching and Regular Matching
  Contributions will remain subject to the Actual Contribution Percentage Test
  of Code § 401(m) if discretionary contributions made on behalf of any
  Participant exceed 4% of his/her Plan Compensation for the Plan Year.]

  
	
   

  	
   

  	
   

  
	
  Minimums and Maximums:

  [Plan Sec. 5.2(d)]

  	
  I.9.

  	
  The minimum Employer
  Regular Matching Contribution that any Participant who has Match Eligible
  Contributions can receive for any Plan Year is ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  N/A – no minimum (except as
  results from the matching schedule).

  
	
   

  	
  b.

  	
  o

  	
  $     .

  
	
   

  	
  c.

  	
  o

  	
       %
  of Plan Compensation for the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  I.10.

  	
  The maximum Employer
  Regular Matching Contribution that any Participant can receive for any Plan
  Year is ... [check one]: [NOTE: A
  separate maximum needs to be specified only if the match is discretionary and
  a maximum is desired, or if a matching schedule applies and a maximum is
  desired that is less than the maximum otherwise resulting from the matching
  schedule.]

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  N/A – no maximum (except as results from the
  matching schedule).

  
	
   

  	
  b.

  	
  o

  	
  $     .

  
	
   

  	
  c.

  	
  o

  	
        % of Plan
  Compensation for the Plan Year.

  
	
   

  	
  d.

  	
  o

  	
  the lesser of $     or
       % of Plan Compensation for the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  
	
  Vesting Schedule for Employer Regular Matching Component:

  [Plan Sec. 10.2(e)]

  	
  I.11.

  	
  A Participant’s vested
  percentage in his/her Employer Regular Matching Contribution Account will be ...
  [check one]:

  
	
   

  	
   

  
	
  a.

  	
  o

  	
  100% at all times.

  
	
  b.

  	
  o

  	
  determined under the following schedule ... [complete as desired]:

  
																				

 

27

 

	
   

  	
   

  	
   

  	
   

  	
   

  	
  Years of

  Service

  	
   

  	
   

  	
   

  	
  Vested

  Percentage

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  0

  	
   

  	
   

  	
   

  	
  0

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  1

  	
   

  	
   

  	
   

  	
   

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  2

  	
   

  	
   

  	
   

  	
   

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  3

  	
   

  	
   

  	
   

  	
   

  	
  %

  	
  [20% or more]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  4

  	
   

  	
   

  	
   

  	
   

  	
  %

  	
  [40% or more]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  5

  	
   

  	
   

  	
   

  	
   

  	
  %

  	
  [60% or more]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  6

  	
   

  	
   

  	
   

  	
   

  	
  %

  	
  [80% or more]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  7
  or more

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  o

  	
  determined under the
  following schedule ... [complete as
  desired]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Years of

  Service

  	
   

  	
   

  	
   

  	
  Vested

  Percentage

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  0

  	
   

  	
   

  	
   

  	
  0

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  1

  	
   

  	
   

  	
   

  	
   

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  2

  	
   

  	
   

  	
   

  	
   

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  3

  	
   

  	
   

  	
   

  	
   

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  4

  	
   

  	
   

  	
   

  	
   

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  5
  or more

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  [NOTE: If the Plan is Top-Heavy, and if the vesting schedule
  specified above does not satisfy the vesting requirements appropriate for a
  Top-Heavy Plan under Plan Sec. 17.2, the vested percentage of the Participant
  will be the greater of the vested percentage determined under the vesting
  schedule specified above or the applicable vesting schedule specified in Plan
  Sec. 17.2. If the Plan was, but has ceased to be Top-Heavy, the appropriate
  vesting schedule will be determined under Q.3.]

  
	
   

  	
   

  	
   

  
	
   

  	
  I.12.

  	
  The vesting schedule
  specified above applies to the Employer Regular Matching Contribution
  Accounts ... [check one]: [NOTE: If
  the vesting schedule is amended, special rules (including a participant
  election) may apply under Plan Sec. 10.2(k).]

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  of all Participants.

  
	
   

  	
  b.

  	
  o

  	
  of Participants who become ...
  [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Employees

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  Active Participants in the
  Employer Regular Matching Component

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... on or after       
  [month day, year] (and the
  vesting schedule in effect prior to such date will apply to all other
  Participants).

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  o

  	
  reflecting Employer Regular
  Matching Contributions made for periods on or after       
  [month day, year] (and the
  vesting schedule in effect prior to such date will apply to all Employer
  Regular Matching Contributions made for periods prior to such date).

  
	
   

  	
   

  	
   

  	
   

  
	
  Treatment of Forfeitures:

  [Plan Sec. 5.2(g)]

  	
  I.13.

  	
  A Pending Allocation
  Account that reflects Forfeitures from Employer Regular Matching Contribution
  Accounts ... [check one]:

  
	
   

  	
   

  	
   

  
	
  [complete only if a vesting  schedule applies with  respect to any part or all  of the Employer Regular Matching
  Contribution Account]

  	
   

  	
  a.

  	
  o

  	
  can

  
	
   

  	
  b.

  	
  o

  	
  cannot

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ... be applied to pay
  administrative expenses of the Plan if so directed by the Plan Administrator.

  

 

28

 

	
   

  	
   

  	
  I.14.

  	
  A Pending Allocation
  Account that reflects Forfeitures from Employer Regular Matching Contribution
  Accounts (to the extent not applied to pay administrative expenses if
  permitted in I.13.) will be ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  applied as a credit against
  ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Employer Safe-Harbor and/or
  Regular Matching Contributions

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  Employer Safe-Harbor and/or
  Regular Profit Sharing Contributions

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ... that are made under the
  Plan, as and when directed by the Lead Employer.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  b.

  	
  o

  	
  allocated as of the last
  day of the Plan Year as an additional ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Employer Regular Matching
  Contribution.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  Employer Regular Profit
  Sharing Contribution. [NOTE: If the Plan provides for a
  fixed contribution determined under an integrated formula, the allocation
  will be made in proportion to Plan Compensation for the Plan Year.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  The allocation will be made
  in the same manner as (and as part of) any variable contribution, or in
  proportion to any fixed contribution, under the Plan. [NOTE: If
  the Plan provides for a variable contribution (e.g., a discretionary
  contribution), and a contribution is not made for a Plan Year, the allocation
  will be made in the same manner as the variable contribution would have been
  allocated.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  allocated as of the last
  day of the Plan Year in proportion to Plan Compensation for the Plan Year.
  The allocation will be among all eligible Participants described in I.7.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  In-Service Withdrawals:

  [Plan Sec. 11.2]

  	
   

  	
  I.15.

  	
  Withdrawals are allowed
  from Employer Regular Matching Contribution Accounts...[check a., or check each of b. through d. that
  applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  N/A – in-service
  withdrawals are not allowed.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  for any reason after... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Normal Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  age 591/2.

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  age       
  [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  and completion of       
  years of ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  vesting Service.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  participation in the Plan. [NOTE:
  Participation is measured on an elapsed time basis from the Entry Date.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  but only if at the time of
  the withdrawal the Participant is ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  fully vested

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  at least       %
  vested

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... in his/her Employer
  Regular Matching Contribution Account.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  completion of       
  years of ... [check one]:

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  vesting Service.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  participation in the Plan. [NOTE:
  Participation is measured on an elapsed time basis from the Entry Date.]

  
	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  at any age on account of
  Hardship ... [check if applicable]:

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  but only if at the time of
  the withdrawal the Participant is ... [check
  one]:

  

 

29

 

	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  fully vested

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  at least     %
  vested

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... in his/her Employer
  Regular Matching Contribution Account.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  d.

  	
  o

  	
  for any reason, but only if
  at the time of the withdrawal the Participant is fully vested in his/her
  Employer Regular Matching Contribution Account, and provided the withdrawal
  may not include amounts allocated to the Contribution Account within two
  years prior to the withdrawal ... [check
  if applicable]: [NOTE: The calculation of the
  maximum amount available for withdrawal is set forth in Plan Sec. 11.2(a).]

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  unless the Participant has
  completed five years of participation in the Plan. [NOTE:
  Participation is measured on an elapsed time basis from the Entry Date.]

  

 

J.     Employer Regular Profit Sharing Component

 

	
  Profit Sharing 

  Contributions:

  [Plan Sec. 6.2] 

  	
  J.1.

  	
  Employer Regular Profit
  Sharing Contributions ... [check one]:

  
	
   

  	
   

  	
   

  
	
  a.

  	
  ý

  	
  will

  
	
  b.

  	
  o

  	
  will not [Skip to Section K.]

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... be made under the Plan.

  
	
   

  	
   

  	
   

  	
   

  
	
  Excluded Employment Categories:

  [Plan Sec. 2.14(a)]

  	
   

  	
  J.2.

  	
  Covered Employment with
  respect to the Employer Regular Profit Sharing Component does not include ...
  [check one]: [NOTE:
  Any exclusions below are in addition to any exclusions in D.1.]

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  N/A – there are no
  additional exclusions.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  employment ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  as a Highly Compensated
  Employee.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  as a Key Employee.

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  other [specify]:       .
  [Note:
  Specify a group whose exclusion will not result in discrimination in favor of
  Highly Compensated Employees.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Age and Service Requirements:

  [Plan Sec. 3.1(a)]

  	
   

  	
  J.3.

  	
  For an Employee to
  participate in the Employer Regular Profit Sharing Component, he/she must
  have attained age ... [check one]:

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  21 [21 or less].

  
	
   

  	
   

  	
  b.

  	
  o

  	
  N/A – there is no age
  requirement.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  J.4.

  	
  For an Employee to
  participate in the Employer Regular Profit Sharing Component, he/she must
  have completed ... [check one]:
  [NOTE: If more than one year of Service (12 months of
  elapsed time Service) is required for eligibility, the Plan must provide for
  full and immediate vesting of Employer Regular Profit Sharing Contribution
  Accounts.]

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  one year of Service (determined
  under D.9.).

  
	
   

  	
   

  	
  b.

  	
  o

  	
  two years of Service
  (determined under D.9.).

  
	
   

  	
   

  	
  c.

  	
  ý

  	
  3 [24 or less] months of Service determined using the
  elapsed time method (irrespective of the election in D.9.).

  
	
   

  	
   

  	
  d.

  	
  o

  	
  N/A – there is no service
  requirement.

  
	
   

  	
   

  	
   

  	
   

  
	
  Entry:

  [Plan Secs. 2.27 and 3.1(a)]

  	
   

  	
  J.5.

  	
  An Employee in Covered
  Employment will become an Active Participant in the Employer Regular Profit
  Sharing Component on the Entry Date that ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  coincides with or next
  follows

  
	
   

  	
   

  	
  b.

  	
  o

  	
  coincides with or next
  precedes

  
	
   

  	
   

  	
  c.

  	
  o

  	
  is nearest to

  

 

30

 

	
   

  	
   

  	
   

  	
  ... the date he/she
  satisfies the age and service requirements for such Component.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  J.6.

  	
  The Entry Dates for the
  Employer Regular Profit Sharing Component are the ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  first day of each Plan Year
  and the first day of the seventh month of each Plan Year.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  first day of each quarter
  of each Plan Year.

  
	
   

  	
   

  	
  c.

  	
  ý

  	
  first day of each month.

  
	
   

  	
   

  	
  d.

  	
  o

  	
  first day of each payroll
  period.

  
	
   

  	
   

  	
  e.

  	
  o

  	
  day on which the age and
  service requirements are satisfied.

  
	
   

  	
   

  	
  f.

  	
  o

  	
  first day of each Plan
  Year. [NOTE: This option is permitted only if (i) there is
  no age requirement or the age requirement specified in J.3.a. does not exceed
  201⁄2, and (ii) there is no service requirement or the service requirement
  specified in J.4.c. or d. does not exceed 6 months, or 18 months if full and
  immediate vesting.]

  
	
   

  	
   

  	
  g.

  	
  o

  	
  other [specify]:       .
  [NOTE: The Entry Dates specified must be at least as
  favorable as one of the choices in a. – f.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Requirements to Share in the Employer Regular Profit
  Sharing Contribution:

  [Plan Sec. 6.2(a) or (b)]

  	
   

  	
  J.7.

  	
  To share in the Employer
  Regular Profit Sharing Contribution for a Plan Year, a Participant must be an
  Active Participant in the Employer Regular Profit Sharing Component at some
  time during the Plan Year ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  ý

  	
  but need not be an Employee
  on the last day of the Plan Year or have completed any specified number of
  Hours of Service.

  
	
   

  	
  b.

  	
  o

  	
  and must either be
  an Employee on the last day of the Plan Year or must have completed at
  least        [1,000
  or less] Hours of Service during the Plan Year. However, these
  requirements do not apply if the Participant’s Termination of Service
  occurred during the Plan Year because he/she ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  died.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  became Disabled.

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  retired after ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Normal Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Early Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  age [specify]:       .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  and must both be an
  Employee on the last day of the Plan Year and must have completed at
  least        [1,000
  or less] Hours of Service during the Plan Year. However, ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  these requirements do not
  apply

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  the last day requirement
  does not apply

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ... if the Participant’s Termination of Service occurred during the
  Plan Year because he/she ... [check each
  that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  died.

  
	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  became Disabled.

  
	
   

  	
   

  	
   

  	
   

  	
  5.

  	
  o

  	
  retired after ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Normal Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Early Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  age [specify]:       .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  d.

  	
  o

  	
  and must be an Employee on
  the last day of the Plan Year. However, this requirement does not apply if
  the Participant’s Termination of Service occurred during the Plan Year
  because he/she ... [check each that
  applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  died.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  became Disabled.

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  retired after ... [check each that applies]:

  

 

31

 

	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Normal Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Early Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  age [specify]:       .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  e.

  	
  o

  	
  and must have completed at
  least        [1,000
  or less] Hours of Service during the Plan Year. However, this
  requirement does not apply if the Participant’s Termination of Service
  occurred during the Plan Year because he/she ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  died.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  became Disabled.

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  retired after ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Normal Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Early Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  age [specify]:       .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Contribution/Allocation Formula:

  [Plan Sec. 6.2(a) or (b)] 

  	
   

  	
  J.8.

  	
  The Employer Regular Profit
  Sharing Contribution for each Plan Year will ... [check one of a. through e., and check  f. if it applies.  Do not check b. or d. if any Controlled
  Group Member maintains any other plan that is integrated and that covers any
  of the same Participants]:  [NOTE: If
  the Plan is Top-Heavy, the contribution formula or allocation method for the
  Employer Regular Profit Sharing Contributions will be applied with the
  applicable modifications described in Plan Sec. 17.1(b) unless an additional
  contribution is elected in Q.2.]

  

 

32

 

	
  Non-Integrated Variable Formula – Discretionary or Non-Discretionary
  with Profits Contingency

  	
   

  	
  a.

  	
  ý

  	
  be allocated among the
  eligible Participants ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  ý

  	
  in proportion to Plan
  Compensation for the Plan Year

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  as an equal dollar amount
  (subject to the limits of Code § 415)

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ... using the nonintegrated allocation formula in Plan Sec. 6.2(a)(1).
  The amount of the contribution will be ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  ý

  	
  a discretionary amount
  determined by the Lead Employer (not contingent on Net Profits).

  
	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
       %
  of ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  current (for the fiscal
  year ending with or within the Plan Year)

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  accumulated

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... Net Profits of the Participating Employers, determined under ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  GAAP o before o after the payment of discretionary bonuses,

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  d.

  	
  o

  	
  other [specify]:       .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Integrated
  Variable Formula – Discretionary or Non-Discretionary with Profits
  Contingency

  	
   

  	
  b.

  	
  o

  	
  be allocated among the eligible Participants using an integrated
  allocation formula in Plan Sec. 6.2(a)(2). The amount of the contribution
  will be ... [check 1., 2. or 3., and
  complete 4. and 5. below]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  a discretionary amount determined by the Lead
  Employer (not contingent on Net Profits).

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
      % of ... [check one]:

  
	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  current (for the fiscal year ending with or within
  the Plan Year)

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  accumulated

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... Net Profits of the Participating Employers,
  determined under ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  GAAP o before o after the payment of discretionary bonuses,

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  d.

  	
  o

  	
  other [specify]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... but not to exceed the
  maximum amount deductible under the Code (or such other limits as may be
  imposed under the Plan).

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
     % [15% or less] of
  the aggregate Plan Compensation for the Plan Year of all eligible
  Participants.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  The Integration Level is ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  the Taxable Wage Base in
  effect at the beginning of the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  $    [not more than the Taxable Wage Base in effect at
  the beginning of the Plan Year in which this dollar amount is first
  effective].

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
      % [less than 100%] of the Taxable Wage
  Base in effect at the beginning of the Plan Year ... [check if desired]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  increased to the next
  highest whole dollar.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  5.

  	
  The integrated allocation formula used is the ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Two-step formula.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  Three-step formula.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  Four-step formula.

  

 

33

 

	
  Non-Integrated Fixed Formula – Non-Discretionary with
  Optional Profits Contingency

  	
   

  	
  c.

  	
  o

  	
  equal a fixed amount for
  each eligible Participant. The amount of the contribution will be ... [check one of 1., 2. or 3., and complete 4. and 5.
  below]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  $    for
  the Plan Year.

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  $    for
  each ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Hour of Service

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  day

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  week

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... as an Active
  Participant in the Employer Profit Sharing Component during the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
      % [not to exceed 15%] of Plan Compensation
  for the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  The Employer Regular Profit
  Sharing Contribution is ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  not contingent on Net
  Profits.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  contingent on ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  current (for the fiscal
  year ending with or within the Plan Year)

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  accumulated

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... Net Profits of the
  Participating Employers, determined under ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  GAAP o before o after the payment of discretionary bonuses.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  other [specify]:       .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  5.

  	
  The Lead Employer ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  does not

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  does

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... have the discretion to direct that an additional Employer Regular
  Profit Sharing Contribution be made for a Plan Year which, if made, will be
  allocated among the eligible Participants described in J.7. ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  who are Non-Highly
  Compensated Employees

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... in proportion to the Plan Compensation for the Plan Year of each
  eligible Participant.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Integrated

  Fixed Formula –

  Non-Discretionary with Optional Profits Contingency

  	
   

  	
  d.

  	
  o

  	
  equal a fixed amount for each eligible Participant.
  The amount of the contribution will be ... [complete
  1. through 5. below]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
       %
  of Plan Compensation for the Plan Year, plus

  
	
   

  	
   

  	
   

  	
  2.

  	
       %
  of Plan Compensation for the Plan Year in excess of the Integration Level [the percentage in 2. may not exceed the lesser of
  the percentage in 1. or the percentage in the table below]:

  

 

34

 

	
   

  	
   

  	
   

  	
   

  	
   

  	
  Table

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  If the Integration Level is:

  	
   

  	
  The maximum percentage is:

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  The Taxable Wage Base for
  the current year (“TWB”)

  	
   

  	
  5.7

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  More than 80% of the TWB
  but less than 100% of the TWB

  	
   

  	
  5.4

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  More than the greater of
  20% of the TWB or $10,000 but not more than

  80% of the TWB

  	
   

  	
  4.3

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Less than or equal to the
  greater of $10,000 or 20% of the TWB

  	
   

  	
  5.7

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  The Integration Level is ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  the Taxable Wage Base in
  effect at the beginning of the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
      % [less than 100%] of the Taxable Wage
  Base in effect at the beginning of the Plan Year ... [check if desired]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  increased to the next
  highest whole dollar.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  The Employer Regular Profit
  Sharing Contribution is ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  not contingent on Net
  Profits.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  contingent on ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  current (for the fiscal
  year ending with or within the Plan Year)

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  accumulated

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... Net Profits of the
  Participating Employers, determined under ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  GAAP o before o after the payment of discretionary bonuses.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  other [specify]:       .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  5.

  	
  The Lead Employer ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  does not

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  does

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... have the discretion to direct that an additional Employer Regular
  Profit Sharing Contribution be made for a Plan Year which, if made, will be
  allocated among the eligible Participants described in J.7. ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  who are Non-Highly
  Compensated Employees

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... in proportion to the Plan Compensation for the Plan Year of each
  eligible Participant.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Uniform
  Point Formula

  	
   

  	
  e.

  	
  o

  	
  be allocated among the
  eligible Participants in proportion to the “points” of each eligible Participant.
  An eligible Participant will be awarded ... [check
  one or both of 1. and 2., and check 3. if it applies]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
      
  [specify a whole number] points for each year of age he/she has attained by the last day of the
  Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
      
  [specify a whole number] points for each year of credited service he/she has completed by the
  last day of the Plan Year. ... [complete]

  
															

 

35

 

	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  The Participant’s years of
  credited service for this purpose means ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  the number of Plan Years in
  which the Participant had        [1,000 or less] or more Hours of
  Service.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  the number of years of
  elapsed time Service of the Participant as of the last day of the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  The Participant’s years of
  credited service taken into account will not exceed ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  N/A - there is no limit.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
      years.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  [check 3.
  if points are awarded based on compensation]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
     [specify
  a whole number] points
  for each $    [not
  more than $200] of Plan Compensation for the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Prevailing
  Wage Formula

  	
   

  	
  f.

  	
  o

  	
  equal a fixed amount for
  each hour working on a project and in a job category covered by the
  Prevailing Wage Laws. The amount of the contribution will be determined ... [check one of 1. or 2., and complete 3. and 4.]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  as specified on the
  Prevailing Wage Addendum. [NOTE: A contribution will be made
  only with respect to projects and job categories listed on the Prevailing
  Wage Addendum.]

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  as follows ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  For contracts classified as ...

  	
   

  	
  The
  contribution amount will be ...

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  o

  	
  $

  	
   

  	
  per hour

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  o

  	
   

  	
   

  	
  % of the prevailing wage.

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  o

  	
  $

  	
   

  	
  per hour

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  o

  	
   

  	
   

  	
  % of the prevailing wage.

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  o

  	
  $

  	
   

  	
  per hour

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  o

  	
   

  	
   

  	
  % of the prevailing wage.

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  The contribution will be
  made on behalf of each Active Participant in the Prevailing Wage Component ...
  [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  who is a Non-Highly
  Compensated Employee.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  If such a Participant also
  is eligible for an Employer Regular Profit Sharing Contribution for a Plan
  Year, such contribution ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  N/A – such Participants
  will not be eligible for Employer Regular Profit Sharing Contributions.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  will not

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  will

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... be offset by the Prevailing
  Wage Contribution.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  [NOTE: Employer Regular Profit Sharing Contributions should not be
  deposited or allocated until the end of the Plan Year (except under a
  Prevailing Wage Component).]

  
																		

 

36

 

	
  Vesting Schedule for Employer Regular Profit Sharing Component:
[Plan Sec.
  10.2(e)]

  	
   

  	
  J.9.

  	
  A Participant’s vested
  percentage in his/her Employer Regular Profit Sharing Contribution Account
  will be ... [check one]:

  

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  100% at all times.

  
	
   

  	
  b.

  	
  ý

  	
  determined under the
  following schedule ... [complete as desired]:

  
	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Years of

  Service

  	
   

  	
   

  	
   

  	
  Vested

  Percentage

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  0

  	
   

  	
   

  	
   

  	
  0

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  1

  	
   

  	
   

  	
   

  	
  25

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  2

  	
   

  	
   

  	
   

  	
  50

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  3

  	
   

  	
   

  	
   

  	
  75

  	
  %

  	
  [20% or more]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  4

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
  [40% or more]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  5

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
  [60% or more]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  6

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
  [80% or more]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  7
  or more

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  o

  	
  determined under the
  following schedule ... [complete as
  desired]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  Years of

  Service

  	
   

  	
   

  	
   

  	
  Vested

  Percentage

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  0

  	
   

  	
   

  	
   

  	
  0

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  1

  	
   

  	
   

  	
   

  	
   

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  2

  	
   

  	
   

  	
   

  	
   

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  3

  	
   

  	
   

  	
   

  	
   

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  4

  	
   

  	
   

  	
   

  	
   

  	
  %

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  5
  or more

  	
   

  	
   

  	
   

  	
  100

  	
  %

  	
   

  
	
   

  
	
   

  	
   

  	
   

  	
  [NOTE:  If the Plan is
  Top-Heavy, and if the vesting schedule specified above does not satisfy the
  vesting requirements appropriate for a Top-Heavy Plan under Plan Sec. 17.2,
  the vested percentage of the Participant will be the greater of the vested
  percentage determined under the vesting schedule specified above or the
  applicable vesting schedule specified in Plan Sec. 17.2.  If the Plan was, but has ceased to be
  Top-Heavy, the appropriate vesting schedule will be determined under Q.3.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  J.10.

  	
  The vesting schedule
  specified above applies to the Employer Regular Profit Sharing Contribution
  Accounts ... [check one]: [NOTE: If
  the vesting schedule is amended, special rules (including a participant
  election) may apply under Plan Sec. 10.2(k).]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  of all Participants.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  of Participants who become ...
  [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Employees

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  Active Participants in the
  Employer Regular Profit Sharing Component

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ... on or after        [month day, year] (and the vesting
  schedule in effect prior to such date will apply to all other Participants).

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  reflecting Employer Regular
  Profit Sharing Contributions made for periods on or after       
  [month day, year] (and the
  vesting schedule in effect prior to such date will apply to all Employer
  Regular Profit Sharing Contributions made for periods prior to such date).

  
																	

 

37

 

	
  Treatment of Forfeitures:

  [Plan Sec. 6.2(d)]

  	
   

  	
  J.11.

  	
  A Pending Allocation
  Account that reflects Forfeitures from Employer Regular Profit Sharing
  Contribution Accounts ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  [complete only if a vesting schedule
  applies with respect to any part or all of the Employer Regular Profit
  Sharing Contribution Account]

  	
   

  	
  a.

  	
  ý

  	
  can

  
	
   

  	
  b.

  	
  o

  	
  cannot

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ... be applied to pay
  administrative expenses of the Plan if so directed by the Plan Administrator.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  J.12.

  	
  A Pending Allocation
  Account that reflects Forfeitures from Employer Regular Profit Sharing
  Contribution Accounts (to the extent not applied to pay administrative
  expenses if permitted in J.11) will be ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  applied as a credit against
  ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  ý

  	
  Employer Safe-Harbor and/or
  Regular Matching Contributions

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  ý

  	
  Employer Safe-Harbor and/or
  Regular Profit Sharing Contributions

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ... that are made under the
  Plan, as and when directed by the Lead Employer.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  b.

  	
  o

  	
  allocated as of the last
  day of the Plan Year as an additional Employer Regular Profit Sharing
  Contribution. The allocation will be made in the same manner as (and as part
  of) any variable contribution, or in proportion to any fixed contribution
  (disregarding any contribution under a prevailing wage formula), under the
  Plan. [NOTE: If the Plan provides for a variable
  contribution (e.g., a discretionary contribution), and a contribution is not
  made for a Plan Year, the allocation will be made in the same manner as the
  variable contribution would have been allocated.] [NOTE: If the Plan provides
  for a fixed contribution under an integrated formula, the allocation will be
  made in proportion to Plan Compensation for the Plan Year.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  allocated as of the last
  day of the Plan Year in proportion to Plan Compensation for the Plan Year.
  The allocation will be among all eligible Participants described in J.7.

  

 

38

 

	
  In-Service Withdrawals:

  [Plan Sec. 11.2]

  	
   

  	
  J.13.

  	
  Withdrawals are allowed
  from Employer Regular Profit Sharing Contribution Accounts ... [check a., or check each of b. through d. that
  applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  N/A – in-service
  withdrawals are not allowed.

  
	
   

  	
   

  	
  b.

  	
  ý

  	
  for any reason after ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Normal Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  ý

  	
  age 591⁄2.

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  age
         ... [check
  each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  and completion of
         years of ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  vesting Service.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  participation in the Plan. [NOTE:
  Participation is measured on an elapsed time basis from the Entry Date.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  but only if at the time of
  the withdrawal the Participant is ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  fully vested

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  at least    %
  vested

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... in his/her Employer
  Regular Profit Sharing Contribution Account.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  completion of
         years of ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  vesting Service.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  participation in the Plan. [NOTE:
  Participation is measured on an elapsed time basis from the Entry Date.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  at any age on account of
  Hardship ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  but only if at the time of
  the withdrawal the Participant is ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  fully vested

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  at least
       % vested

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... in his/her Employer
  Regular Profit Sharing Contribution Account.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  d.

  	
  o

  	
  for any reason, but only if
  at the time of the withdrawal the Participant is fully vested in his/her
  Employer Regular Profit Sharing Contribution Account, and provided the
  withdrawal may not include amounts allocated to the Contribution Account
  within two years prior to the withdrawal ... [check
  if applicable]: [NOTE: The calculation of the
  maximum amount available for withdrawal is set forth in Plan Sec. 11.2(a).]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  unless the Participant has
  completed five years of participation in the Plan. [NOTE:
  Participation is measured on an elapsed time basis from the Entry Date.]

  

 

39

 

K.            Employer Qualified Matching and Profit Sharing Component

 

[NOTE:  Contributions elected
under this Section K. are in addition to any Employer Safe-Harbor Matching,
Regular Matching, Safe-Harbor Profit Sharing or Regular Profit Sharing
Contributions.]

 

	
  Employer Qualified Contributions:

  [Plan Secs. 5.3 and 6.3]

  	
   

  	
  K.1.

  	
  Employer Qualified Matching
  and/or Qualified Profit Sharing Contributions ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  ý

  	
  will

  
	
   

  	
  b.

  	
  o

  	
  will not [Skip to Section L.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... be made under the Plan.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  [NOTE:  Employer Qualified
  Matching and/or Qualified Profit Sharing Contributions must be made within
  twelve months following the close of the applicable Plan Year.  However, contributions made later than 30
  days after the employer’s tax filing deadline must be treated as Annual
  Additions in the Limitation Year made for purposes of Code § 415.]

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  [NOTE:  The “applicable” Plan
  Year is the current Plan Year if the current year testing method is used, or
  the prior Plan Year if the prior year testing method is used.]

  
	
   

  	
   

  	
   

  	
   

  
	
  Employer Qualified Matching Contributions (QMACs):

  [Plan Sec. 5.3]

  	
   

  	
  K.2.

  	
  Employer Qualified Matching
  Contributions (QMACs) will be allocated among the ... [check one of a. or b., and check one of c. – e.]:

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  ý

  	
  Non-Highly Compensated
  Employees

  
	
   

  	
  b.

  	
  o

  	
  Highly and Non-Highly
  Compensated Employees  [NOTE:  This option is not appropriate if the
  “prior year” testing method is used.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... who ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  are eligible Participants
  described in I.7 (relating to the Employer Regular Matching Component) with
  respect to the applicable Plan Year.  [NOTE:  This option is appropriate only if the Plan
  includes an Employer Regular Matching Component.]

  
	
   

  	
   

  	
  d.

  	
  ý

  	
  benefit under the
  applicable Component for the applicable Plan Year. [NOTE:  The “applicable” Component is the Employee
  Pre-Tax Component in the case of a contribution made to satisfy the Actual
  Deferral Percentage (ADP) Test of Code § 401(k); or the Employer Regular
  Matching Component in the case of a contribution made to satisfy the Actual
  Contribution Percentage (ACP) Test of Code § 401(m).] [NOTE:  If a Component is disaggregated into two or
  more separate Components for purposes of the coverage requirements of Code §
  410(b), any discretionary contribution will be determined separately for each
  disaggregated Component.]

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  [NOTE:  An Employee “benefits”
  under the Employee Pre-Tax Component if he/she is eligible to make
  Employee Pre-Tax Contributions during the applicable Plan Year.  An Employee “benefits” under the Employer
  Regular Matching Component if he/she satisfies the requirements in I.7. for
  the applicable Plan Year.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  e.

  	
  o

  	
  are Active Participants in
  the Employee Pre-Tax Component ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  at some time during

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  on the last day of

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  throughout

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ... the applicable Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  K.3.

  	
  Employer Qualified Matching
  Contributions (QMACs) will be a discretionary amount determined by the Lead
  Employer.  The contribution will be
  allocated ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  in proportion to the
  Employee Pre-Tax Contributions of each eligible Participant that do not
  exceed ... [check one]:

  

 

40

 

	
   

  	
   

  	
   

  	
   

  	
  1

  	
  ý

  	
  N/A – no limit.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
      %
  of his/her Plan Compensation for the Plan Year.  [NOTE:  If the Plan includes an Employer
  Safe-Harbor Component, include a percentage no greater than 6%.]

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  $     .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  b.

  	
  o

  	
  as an equal dollar amount
  to each eligible Participant who has Employee Pre-Tax Contributions.

  
	
   

  	
   

  	
  c.

  	
  o

  	
  in proportion to the
  Employer Regular Matching Contributions of each eligible Participant.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Employer Qualified Profit Sharing Contributions (QNECs):

  	
   

  	
  K.4.

  	
  Employer Qualified Profit
  Sharing Contributions (QNECs) will be allocated among the ... [check one of a. or b., and check one of c. – e.]:

  
	
  [Plan Sec.
  6.3]

  	
   

  	
  a.

  	
  ý

  	
  Non-Highly Compensated
  Employees

  
	
   

  	
   

  	
  b.

  	
  o

  	
  Highly and Non-Highly
  Compensated Employees  [NOTE:  This option is not appropriate if the
  “prior year” testing method is used.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... who ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  are eligible Participants
  described in J.7 (relating to the Employer Regular Profit Sharing Component)
  with respect to the applicable Plan Year. 
  [NOTE:  This
  option is appropriate only if the Plan includes an Employer Regular Profit
  Sharing Component.]

  
	
   

  	
   

  	
  d.

  	
  ý

  	
  benefit under the
  applicable Component for the applicable Plan Year.  [NOTE:  The “applicable” Component is the Employee
  Pre-Tax Component in the case of a contribution made to satisfy the Actual
  Deferral Percentage (ADP) Test of Code § 401(k); or the Employer
  Regular Matching Component in the case of a contribution made to satisfy the
  Actual Contribution Percentage (ACP) Test of Code § 401(m).]  [NOTE: 
  If a Component is disaggregated into two or more separate Components
  for purposes of the coverage requirements of Code § 410(b), any
  discretionary contribution will be determined separately for each
  disaggregated Component.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  [NOTE:  An Employee “benefits”
  under the Employee Pre-Tax Component if he/she is eligible to make
  Employee Pre-Tax Contributions during the applicable Plan Year.  An Employee “benefits” under the Employer
  Regular Matching Component if he/she satisfies the requirements in I.7. for
  the applicable Plan Year.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  e.

  	
  o

  	
  are Active Participants in
  the Employee Pre-Tax Component ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  at some time during

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  on the last day of

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  throughout

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ... the applicable Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  K.5.

  	
  Employer Qualified Profit
  Sharing Contributions (QNECs) will be a discretionary amount determined by
  the Lead Employer.  The contribution
  will be allocated ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  as a uniform percentage of
  Plan Compensation for the Plan Year... [check
  each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  ý

  	
  using testing compensation
  as the definition of Plan Compensation for the Plan Year instead of the
  definition in Item E.  [NOTE:
  For this purpose, “testing compensation” means the definition of compensation
  used for purposes of applying the Actual Deferral Percentage (ADP) Test or
  Actual Contribution Percentage (ACP) Test for the applicable Plan Year.]

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  disregarding Plan
  Compensation for the Plan Year in excess of $    [specify a dollar amount less than the compensation
  limit in effect under Code § 401(a)(17)].

  

 

41

 

	
   

  	
   

  	
  b.

  	
  o

  	
  as an equal dollar amount.

  
	
   

  	
   

  	
  c.

  	
  o

  	
  first to the eligible
  Participant with the lowest Plan Compensation for the Plan Year, then to the
  eligible Participant with the next lowest Plan Compensation for the Plan
  Year, etc. until the applicable test is met, with the allocation to each
  eligible Participant limited to the amount permitted under Code
  § 415.  [NOTE:  This option is not appropriate if the allocation
  will be made to Highly Compensated Employees.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  [NOTE:  If a Component is
  disaggregated into two or more separate Components for purposes of the
  coverage requirements of Code § 410(b), any discretionary contribution will
  be determined separately for each disaggregated Component.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  In-Service Withdrawals:

  [Plan Sec. 11.2]

  	
   

  	
  K.6.

  	
  Withdrawals are allowed
  from Employer Qualified Matching and/or Qualified Profit Sharing Contribution
  Accounts ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  N/A – in-service
  withdrawals are not allowed.

  
	
   

  	
   

  	
  b.

  	
  ý

  	
  for any reason after... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Normal Retirement Age (or
  age 591⁄2, if later).

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  ý

  	
  age 591⁄2.

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  age
         [60
  or more].

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  for Hardship after age 591⁄2.

  

 

L.            Employee
Rollover Component

 

	
  Employee Rollover Contributions:

  [Plan Sec. 4.5]

  	
   

  	
  L.1.

  	
  Employee Rollover
  Contributions are ... [check one]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  not allowed. [Skip to Section M.]

  
	
   

  	
  b.

  	
  ý

  	
  allowed if the Employee is ...
  [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  ý

  	
  in Covered Employment (but
  regardless of whether he/she is an Active Participant).

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  an Active Participant in
  any Component of the Plan.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  L.2.

  	
  Employee Rollover
  Contributions will be allowed in ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  cash only ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  except that an outstanding
  loan made under a prior employer’s plan will be accepted if the loan is not
  in default and the transfer satisfies such requirements as may be imposed
  under the participant loan program (if any) of the Plan.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  b.

  	
  o

  	
  cash or in kind (to the
  extent not prohibited by the Funding Agent), except that an outstanding loan
  made under a prior employer’s plan ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  will not be accepted.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  will be accepted only if
  the loan is not in default and the transfer satisfies such requirements as
  may be imposed under the participant loan program (if any) of the Plan.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  In-Service
  Withdrawals:

  	
   

  	
  L.3.

  	
  Withdrawals are allowed
  from Employee Rollover Contribution Accounts ... [check one]:

  
	
  [Plan Sec.
  11.2]

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  N/A – in-service
  withdrawals are not allowed.

  
	
   

  	
   

  	
  b.

  	
  ý

  	
  for any reason and at any
  time.

  
	
   

  	
   

  	
  c.

  	
  o

  	
  for any reason after ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Normal Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  age 591⁄2.

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  age      .

  

 

42

 

M.           Retirement, Disability and Hardship

 

	
  Retirement Age:

  [Plan Secs. 2.19 and 2.47]

  	
   

  	
  M.1.

  	
  The Normal Retirement Age
  is ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  age 59 1/2 [65 or less].

  
	
   

  	
   

  	
  b.

  	
  o

  	
  the later of age     
  [65 or less] or the     
  [5th or less] anniversary of
  the first day of the Plan Year in which the Participant commenced
  participation in the Plan.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  M.2.

  	
  The Early Retirement Age is
  ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  N/A – early retirement is
  not recognized under the Plan.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  age
         [less
  than Normal Retirement Age].

  
	
   

  	
   

  	
  c.

  	
  o

  	
  the later of age
         [less
  than Normal Retirement Age] or the date on which the Participant
  completes        years of vesting Service.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Disability:

  [Plan Sec. 2.18]

  	
   

  	
  M.3.

  	
  A Participant will be
  deemed to be Disabled for purposes of the Plan if he/she ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  has a physical or mental
  condition that makes him/her unable to engage in any substantial gainful
  activity and that can be expected to result in death or has lasted or can be
  expected to last for at least a twelve-consecutive-month period.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  meets the standard for
  long-term disability benefits under any disability plan maintained by a
  Controlled Group Member.

  
	
   

  	
   

  	
  c.

  	
  o

  	
  has been determined to be
  disabled for purposes of Social Security.

  
	
   

  	
   

  	
  d.

  	
  o

  	
  has a physical or mental
  condition that makes him/her permanently unable to perform the normal duties
  of his/her job with the Participating Employer.

  
	
   

  	
   

  	
  e.

  	
  o

  	
  has a physical or mental
  condition that makes him/her permanently unable to engage in any occupation
  for wage or profit for which he/she is reasonably fitted by training,
  education or experience.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Hardship:

  [Plan Sec. 2.33]

  	
   

  	
  M.4.

  	
  A Participant will be
  deemed to be under a Hardship for purposes of the Plan if he/she has a
  financial need resulting from ... [check
  each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  expenses for medical care described
  in Code § 213(d) incurred by the Participant, his/her spouse, or his/her
  dependents (as defined in Code § 152), or necessary for any of those
  persons to obtain such medical care.

  
	
   

  	
   

  	
  b.

  	
  ý

  	
  costs directly related to
  the purchase of the Participant’s principal residence (excluding mortgage
  payments).

  
	
   

  	
   

  	
  c.

  	
  ý

  	
  payment of tuition and
  related educational fees for the next 12 months of post-secondary education
  for the Participant, his/her spouse, children, or dependents.

  
	
   

  	
   

  	
  d.

  	
  ý

  	
  the need to prevent the eviction
  of the Participant from the Participant’s principal residence or foreclosure
  on the mortgage of the Participant’s principal residence.

  
	
   

  	
   

  	
  e.

  	
  o

  	
  other [specify in a manner that prevents employer
  discretion]:       .  [NOTE:  This hardship standard does not apply to
  hardship withdrawals from Employee Pre-Tax Contribution Accounts prior to age
  591⁄2.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  M.5.

  	
  The Hardship amount  ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  may

  
	
   

  	
   

  	
  b.

  	
  o

  	
  may not

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... include any amount
  necessary to pay any federal, state or local income taxes or penalties
  reasonably expected to result from the distribution.

  
	
   

  	
   

  	
   

  	
   

  
	
  N.            Special
  Vesting Rules

  
	
   

  
	
  [NOTE:  Do not complete if the
  Plan provides for full and immediate vesting of all Contribution
  Accounts.  Skip to Section O.]

  
	
   

  	
   

  	
   

  	
   

  
	
  Vesting:

  [Plan Sec. 10.2(e)]

  	
   

  	
  N.1.

  	
  A Participant’s vested
  percentage in his/her Employee Pre-Tax, After-Tax, Deductible, Forfeiture
  Restoration and Rollover Contribution Accounts, and in his/her Employer
  Safe-Harbor Matching, Qualified Matching, Safe-Harbor Profit Sharing and
  Qualified Profit Sharing Contribution Accounts, will be 100% at all times.

  

 

43

 

	
   

  	
   

  	
   

  	
  A Participant’s vested
  percentage in his/her Employer Regular Matching Contribution Account will be
  determined under I.11.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  A Participant’s vested
  percentage in his/her Employer Regular Profit Sharing Contribution Account
  will be determined under J.9.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Service Disregarded for Vesting:

  	
   

  	
  N.2.

  	
  To determine the vested percentage
  of a Participant in his/her Employer Regular Matching or Regular Profit
  Sharing Contribution Account, Service ... [check
  each that applies]:

  
	
  [Plan Sec.
  10.2(f)]

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  before the Participant
  attained the age of        [18 or less]

  
	
   

  	
   

  	
  b.

  	
  o

  	
  before any Controlled Group
  Member first maintained this Plan (or a predecessor plan)

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... will be disregarded. ...

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  Such Service also will be
  disregarded for purposes of determining ... [check
  each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Early Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  whether a Participant has
  satisfied the requirements to receive an in-service withdrawal that is
  conditioned on vesting Service.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Special Vesting Events:

  [Plan Sec. 10.2(b)]

  	
   

  	
  N.3.

  	
  A Participant will be fully
  vested in an Employer Regular Matching and/or Regular Profit Sharing
  Contribution Account if he/she ... [check
  each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  dies

  
	
   

  	
   

  	
  b.

  	
  ý

  	
  becomes Disabled

  
	
   

  	
   

  	
  c.

  	
  o

  	
  attains age
         [less
  than Normal Retirement Age]

  
	
   

  	
   

  	
  d.

  	
  o

  	
  attains Early Retirement
  Age

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... while employed with a
  Controlled Group Member.  [NOTE:  A Participant will in all events be fully
  vested upon attainment of Normal Retirement Age while employed with a
  Controlled Group Member.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Forfeitures:

  [Plan Sec. 10.2(g)]

  	
   

  	
  N.4.

  	
  The portion of an Employer
  Regular Matching or Regular Profit Sharing Contribution Account in which a
  Participant is not vested will become a Forfeiture on the earlier of the date
  the Participant incurs a period of five consecutive one year Breaks in
  Service or the ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  first day of the Plan Year
  after the Plan Year in which

  
	
   

  	
   

  	
  b.

  	
  o

  	
  last day of the Plan Year
  in which

  
	
   

  	
   

  	
  c.

  	
  ý

  	
  date on which

  
	
   

  	
   

  	
  d.

  	
  o

  	
  last day of the ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  first

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  second

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  third

  
	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  fourth

  
	
   

  	
   

  	
   

  	
   

  	
  5.

  	
  o

  	
  fifth

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ... Plan Year after the Plan
  Year in which

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... the Participant receives
  a full distribution of the vested portion of the Contribution Account (or
  immediately upon Termination of Service if the Participant is not vested in
  the Contribution Account).

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Vesting Formula for Partially Vested:

  [Plan Sec. 10.2(c) and (g)]

  	
   

  	
  N.5.

  	
  If a Participant receives a
  distribution after his/her Termination of Service of less than the full
  vested balance of a partially vested Employer Regular Matching or Regular
  Profit Sharing Account ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  the following formula will
  apply after the distribution to determine the vested portion of the
  Contribution Account ... [check one]:  [NOTE:  Under this option, a partial distribution
  will not result in an immediate Forfeiture.] 
  [NOTE:  This

  

 

44

 

	
   

  	
   

  	
   

  	
   

  	
  formula will also apply if a Participant is eligible to and does
  receive an in-service withdrawal (including those for Hardship) from a
  partially vested Employer Regular Matching and Regular Profit Sharing
  Account.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  P(AB+D)-D

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  ý

  	
  P[AB+(RxD)]-(RxD)

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  b.

  	
  o

  	
  a proportionate share of
  the remaining balance of the Contribution Account will immediately become a
  Forfeiture.  [NOTE:  Under this option, the Forfeiture will be
  immediately taken from the Contribution Account and credited to the Pending
  Allocation Account reflecting Forfeitures.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  If a Participant makes a
  withdrawal (including those for Hardship) before his/her Termination of
  Service from a partially vested Employer Regular Matching or Regular Profit
  Sharing Contribution Account, the formula that will apply to determine the
  vested portion of such Contribution Account after the in-service withdrawal
  is ... [check one]:  [NOTE:  The variables used in the following
  formulas are described in Plan Sec. 10.2(c).]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  N/A – In-service
  withdrawals are not permitted from partially vested Accounts.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  P(AB+D)-D

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  P[AB+(RxD)]-(RxD)

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Reinstatement upon Return to Service:

  [Plan Sec. 10.2(h)]

  	
   

  	
  N.6.

  	
  A Participant who has a
  Termination of Service, receives a distribution of the vested portion of an
  Employee Regular Matching or Regular Profit Sharing Contribution Account and
  returns to Covered Employment ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  will

  
	
   

  	
   

  	
  b.

  	
  o

  	
  will not

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... be required to repay the
  prior distribution in order to have the amount of a prior Forfeiture
  reinstated to such Contribution Account.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Special Vesting Rules for Life Insurance:

  	
   

  	
  N.7.

  	
  The value attributable to a
  life insurance policy held for the Contribution Account of the Participant
  will be ... [check one]:

  
	
  [Plan Sec.
  10.3]

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  N/A – life insurance is not
  available from a partially vested Contribution Account.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  fully vested
  notwithstanding the normal vesting rules applicable to the Contribution Account.

  
	
   

  	
   

  	
  c.

  	
  o

  	
  subject to the normal
  vesting rules applicable to the Contribution Account ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  and all premiums paid on a
  term life policy (other than unearned premiums returned by the insurance
  company to the Trustee or Custodian) and, in the case of a cash value policy
  ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  the excess of the premium
  paid over the cash surrender value of the policy

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  the PS-58 cost charged to
  the Participant as a result of the Trustee or Custodian holding the policy

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... will be treated as a
  withdrawal for purposes of applying the formula specified in N.5.

  

 

O.            Employer
Securities

 

	
  Employer Securities:

  [Plan Sec. 14.15 and 14.16] 

  	
   

  	
  O.1.

  	
  The Plan ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  may not [Skip to Section P.]

  
	
   

  	
   

  	
  b.

  	
  ý

  	
  may

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... hold Qualifying Employer
  Securities or Predecessor Employer Securities.

  

 

45

 

	
  Voting Provisions:

  [Plan Secs. 14.15(d) and 14.16]

  	
   

  	
  O.2.

  	
  A Participant will be
  allowed to direct the vote on Qualifying Employer Securities credited to
  his/her Account on ... [check one]:  [NOTE:  A Participant is not allowed to vote with
  respect to Predecessor Employer Securities.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  any matter put to the vote
  of shareholders.  Qualifying Employer
  Securities for which Participants fail to provide timely direction will be
  voted ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  in the same proportion as
  the votes cast on securities for which other Participants provide timely
  direction.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  at the discretion of the
  Lead Employer, or a Named Fiduciary or Investment Manager designated by the
  Lead Employer.

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  at the discretion of the
  Trustee.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  b.

  	
  o

  	
  any significant corporate
  event (as defined in Plan Sec. 14.15(e)). ... [complete
  1. and 2.]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  Qualifying Employer
  Securities for which Participants fail to provide timely direction will be
  voted ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  in the same proportion as
  the votes cast on securities for which other Participants provide timely
  direction.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  at the discretion of the
  Lead Employer, or a Named Fiduciary or Investment Manager designated by the
  Lead Employer.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
  at the discretion of the
  Trustee.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  With respect to any matter
  other than a significant corporate event, Qualifying Employer Securities will
  be voted ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  at the discretion of the
  Lead Employer, or a Named Fiduciary or Investment Manager designated by the
  Lead Employer.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  at the discretion of the
  Trustee.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  ý

  	
  N/A – not allowed to direct
  any vote.  Qualifying Employer
  Securities will be voted ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  ý

  	
  at the discretion of the
  Lead Employer, or a Named Fiduciary or Investment Manager designated by the
  Lead Employer.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  at the discretion of the
  Trustee.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Tender Provisions:

  [Plan Secs. 14.15(e)

  and 14.16]

  	
   

  	
  O.3.

  	
  A Participant will be
  allowed to direct the hold or sell/exchange decision on Qualifying Employer
  Securities or Predecessor Employer Securities credited to his/her Account in
  ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  any ... [check one or both]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  tender or exchange offer.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  cash or stock offer made in
  connection with a merger or other corporate transaction.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  Qualifying Employer
  Securities or Predecessor Employer Securities for which Participants fail to
  provide timely direction will be held or sold/exchanged  ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  in the same proportion as
  the securities for which other Participants provide timely direction.

  
	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  at the discretion of the
  Lead Employer, or a Named Fiduciary or Investment Manager designated by the
  Lead Employer.

  
	
   

  	
   

  	
   

  	
   

  	
  5.

  	
  o

  	
  at the discretion of the
  Trustee.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  b.

  	
  ý

  	
  N/A – not allowed to direct
  the hold or sell/exchange decision in any corporate transaction.   Qualifying Employer Securities or
  Predecessor Employer Securities will be held or sold/exchanged ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  ý

  	
  at the discretion of the
  Lead Employer, or a Named Fiduciary or Investment Manager designated by the
  Lead Employer.

  

 

46

 

	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  at the discretion of the
  Trustee.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  In-Kind
  Distribution Option:

  	
   

  	
  O.4.

  	
  A
  Participant ... [check one]:

  
	
  [Plan Sec.
  12.3(c)]

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  may not take an in-service
  withdrawal (including those for Hardship) or a distribution following
  Termination of Service in the form of Qualifying Employer Securities or
  Predecessor Employer Securities.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  may take ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  an in-service withdrawal
  (if otherwise available) ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  including

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  excluding

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... those for Hardship.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  a distribution following
  Termination of Service

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ... in the form of Qualifying
  Employer Securities or Predecessor Employer Securities (to the extent the
  applicable Contribution Account is then invested in such securities).

  

 

P.            Payment
of Benefits

 

	
  Balances Less Than Cash-Out Amount:

  	
   

  	
  P.1.

  	
  The Benefit subject to
  involuntary cash-out is ... [check one]:

  
	
  [Plan Sec. 12.4]

  	
   

  	
  a.

  	
  ý

  	
  $5000 [$5,000 or less].

  
	
   

  	
   

  	
  b.

  	
  o

  	
  N/A – involuntary cash-out
  distributions will not be made.  [Skip to P.3.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  P.2.

  	
  If a Benefit is subject to
  involuntary cash-out, the payment will be made to the Participant or
  Beneficiary as soon as administratively practicable after ... [check one]:  [NOTE:  The timing of distributions should be
  coordinated with the valuation date(s), which are the date(s) on which assets
  are valued under the Plan.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  Termination of Service.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  the first day of the... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  month

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  Plan Year quarter

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  Plan Year

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ... following Termination of
  Service.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  other [specify]:
        . [at
  least as soon as b.3]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Balances More Than Cash-Out Amount:

  [Plan Sec. 12.3(a)]

  	
   

  	
  P.3.

  	
  If a Benefit is not
  subject to involuntary cash-out, the earliest that the Participant or
  Beneficiary may elect to receive payment is as soon as administratively
  practicable after ... [check one]:  [NOTE:  The timing of distributions should be
  coordinated with the valuation dates, which are the date(s) on which assets
  are valued under the Plan.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  Termination of Service.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  the first day of the... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  month

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  Plan Year quarter

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  Plan Year

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ... following Termination of
  Service.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  the later of Termination of
  Service or attainment of ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Normal Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  age
         [less
  than Normal Retirement Age].

  

 

47

 

	
   

  	
   

  	
  d.

  	
  o

  	
  a Break in Service of
         years has occurred following Termination
  of Service.

  
	
   

  	
   

  	
  e.

  	
  o

  	
  other [specify]:
        . [no
  later than Normal Retirement Age]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  P.4.

  	
  A Benefit may be paid after
  Termination of Service and prior to the earliest payment date specified above
  if ... [check a., or each of b. through d.
  that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  N/A – earlier payment is
  not permitted.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  Termination of Service
  occurs because the Participant ... [check
  each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  died.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  became Disabled.

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  retired after ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  Early Retirement Age.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  age
         [less
  than Normal Retirement Age].

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  the Benefit does not exceed
  $    [specify dollar
  amount].

  
	
   

  	
   

  	
  d.

  	
  o

  	
  the Participant is under a
  Hardship.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  P.5.

  	
  A Benefit must be paid (or
  must commence) to a Participant or Beneficiary ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  by the date distributions
  are required to commence under Code § 401(a)(9).

  
	
   

  	
   

  	
  b.

  	
  o

  	
  on or as soon as
  administratively practicable after the Participant’s Normal Retirement Age
  (or age 62, if later) ... [check if
  applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  even if the Participant
  then remains employed with a Controlled Group Member.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  [NOTE:  If a Benefit is paid
  (or commences) and allocations are subsequently made to the Account, the
  additional Benefit resulting from such allocations will be paid in the same
  form as soon as administratively practicable following the close of each Plan
  Year or following Termination of Service.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Payment Forms:

  [Plan Secs. 12.3(b) and 12.6]

  	
   

  	
  P.6.

  	
  The methods of payment
  permitted under the Plan (for Benefits in excess of the cash-out amount)
  include ... [check each that applies]:
  [NOTE:  Minimum
  distributions will in all events be made in accordance with Code
  § 401(a)(9).]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  a lump sum payment ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  ý

  	
  including partial payments
  made at the request of the Participant or Beneficiary.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  b.

  	
  o

  	
  installments ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  over a fixed period that
  does not exceed ... [check each that
  applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  a number of years equal to
  the life expectancy of the Participant, as determined under Table V in Treas.
  Reg. § 1.72-9.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  a number of years equal to
  the joint life and last survivor expectancy of the Participant and his/her
  Beneficiary, as determined under Table VI in Treas. Reg. § 1.72-9.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  c.

  	
  o

  	
       years.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  d.

  	
  o

  	
  the shorter of
         months or the applicable life expectancy
  under Code § 401(a)(9).

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  e.

  	
  o

  	
  other [specify]:
        .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  of a fixed amount, as
  directed by the Participant or Beneficiary.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  purchase of a period-certain
  annuity contract.

  
	
   

  	
   

  	
  d.

  	
  o

  	
  purchase of any type of
  annuity contract (including a life annuity), in which case, the qualified
  annuity requirements of the Plan apply ... [check
  1. or 2., and complete 3. and 4.]:

  

 

48

 

	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  to all Participants

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  only to a Participant who
  elects a life annuity form of payment.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  The Qualified Joint and
  Survivor Annuity is a joint and survivor annuity with a survivor percentage
  of        [not
  less than 50% or more than 100%].

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  The Qualified Preretirement
  Survivor Annuity is the life annuity that can be purchased with ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  100%

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  50%

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... of the Participant’s
  Benefit.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  P.7.

  	
  The payment options
  specified above apply to ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  all Contribution Accounts.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  Contribution Accounts (or
  subaccounts thereunder) reflecting contributions made after
         [month
  day, year], and the payment options in effect under the Plan prior
  to such date will apply to all other Contribution Accounts (or subaccounts
  thereunder).

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  [NOTE:  Payment options that
  were available under the Plan prior to the later of the effective date or
  adoption date of an amendment to the Plan generally cannot be
  eliminated.  If the payment options are
  changed to be more restrictive, separate subaccounts must be maintained to
  reflect the portion of each Contribution Account subject to the prior payment
  options which cannot be eliminated.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Payment Medium:

  [Plan Sec. 12.3(c)]

  	
   

  	
  P.8.

  	
  The medium of payment
  permitted with respect to a non-annuity distribution under the Plan is ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  cash only.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  cash or in-kind.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  [NOTE:  Distribution of
  Qualifying Employer Securities or Predecessor Employer Securities is governed
  by O.4.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Beneficiary:

  [Plan Secs. 13.1 and 13.3]

  	
   

  	
  P.9.

  	
  If a designation of
  Beneficiary is not on file, or if all designated Beneficiaries predecease the
  Participant, the Beneficiary will be the ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  Participant’s Spouse, or if
  no Surviving Spouse, the Participant’s estate.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  person or persons surviving
  in the first of the following classes in which there is a survivor, share and
  share alike:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  Participant’s Spouse.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  Participant’s children,
  except that if any of those children predeceases the Participant but leaves
  issue surviving, such issue will take by right of representation the share
  their parent would have taken if living.

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  Participant’s parents.

  
	
   

  	
   

  	
   

  	
   

  	
  4.

  	
  Participant’s brothers and
  sisters.

  
	
   

  	
   

  	
   

  	
   

  	
  5.

  	
  Participant’s estate.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  other [specify]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  [NOTE:  The Participant’s
  Spouse must be the first primary Beneficiary.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  P.10.

  	
  The Spouse of a Participant
  must consent to a designation of another or different primary Beneficiary ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  under all circumstances.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  only if the Participant and
  Spouse have been married for one year. 
  [NOTE:  A 

  

 

49

 

	
   

  	
   

  	
   

  	
   

  	
  designation will cease to be effective after one year without
  consent.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  P.11.

  	
  A Beneficiary ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  may not

  
	
   

  	
   

  	
  b.

  	
  o

  	
  may

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... designate a successor
  beneficiary to take upon the death of the first Beneficiary.  [NOTE:  This designation will not operate to change
  any designation made by the Participant. 
  Thus, a Beneficiary may designate a successor only if such designation
  is not inconsistent with a designation made by the Participant.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Minimum
  Distributions:

  	
   

  	
  P.12.

  	
  The Required Beginning Date
  of a Participant will be ... [check one]:

  
	
  [Plan
  Secs. 2.62 and 12.7]

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  the April 1 of the calendar
  year after the later of the calendar year in which the Participant attains
  age 701⁄2, or (except in the case of a Participant who is a more than
  five-percent owner in the Plan Year ending in the calendar year in which
  he/she attains age 701⁄2), the calendar year of Termination of Service.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  Special Effective Date [complete
  only if this Adoption Agreement implements a change in the Required Beginning
  Date from b. to a. after the Plan has been amended for GUST]:

  
	
   

  	
   

  	
   

  	
   

  	
  The above date will be
  treated as the Required Beginning Date effective
         [month
  day, year].  A Participant
  who attained age 701⁄2 prior to this date and who has not had a Termination of
  Service ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  may not elect to stop
  minimum distributions.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  may elect to stop minimum
  distributions and recommence such distributions by the April 1 of the
  calendar year after the calendar year of his/her Termination of Service, and
  the new commencement date ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  will

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  will not

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ... be treated as a new
  Benefit Starting Date for purposes of the Plan.  [NOTE:  The option to stop minimum distributions
  does not apply to a Participant who is a more than five-percent owner in the
  Plan Year ending in the calendar year in which he/she attains age 701⁄2.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  b.

  	
  o

  	
  the April 1 of the calendar
  year after the Participant attains age 701⁄2. 
  [NOTE:  This
  option is not appropriate for a new plan with an Original Effective Date on
  or after January 1, 1997.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  P.13.

  	
  To determine the minimum
  distribution required to be made to a Participant prior to death, ... [check one]:  [NOTE:  Only the life expectancy of the Participant
  and his/her Spouse Beneficiary are eligible for recalculation.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  the Participant can elect
  the life expectancies to be recalculated. 
  In the absence of an election, ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  the life expectancy of the
  Participant will be recalculated annually, and the life expectancy of his/her
  Spouse Beneficiary ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  also will be recalculated
  annually.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  will not be
  recalculated.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  life expectancies will not
  be recalculated.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  b.

  	
  ý

  	
  the life expectancy of the
  Participant will be recalculated annually, and the life expectancy of his/her
  Spouse Beneficiary ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  ý

  	
  also will be recalculated
  annually.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  will not be
  recalculated.

  

 

50

 

	
   

  	
   

  	
  c.

  	
  o

  	
  life expectancies will not
  be recalculated.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  P.14.

  	
  To determine the minimum
  distribution required to be made to a Beneficiary when the Participant dies
  prior to the Required Beginning Date (and prior to commencement of an
  irrevocable annuity), the 5-year rule ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  applies in all cases.  [Skip to
  Section Q.]

  
	
   

  	
   

  	
  b.

  	
  o

  	
  applies, except that ... [check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  a Spouse Beneficiary

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  any Beneficiary

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ... may elect to have minimum
  distributions commence by December 31 of the year following the year of the
  Participant’s death, and such minimum distributions may continue beyond the
  5-year limit. ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  A Spouse Beneficiary may
  further elect to have minimum distributions commence at any time prior to
  December 31 of the calendar year in which the Participant would have reached
  age 701⁄2.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  P.15.

  	
  To determine the minimum
  distribution required to be made to a Spouse Beneficiary when the Participant
  dies prior to the Required Beginning Date (and prior to commencement of an
  irrevocable annuity), ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  the Spouse Beneficiary can
  elect whether his/her life expectancy is to be recalculated.  In the absence of an election, life
  expectancy ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  will be recalculated
  annually.

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  will not be
  recalculated.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  b.

  	
  o

  	
  the life expectancy of the
  Spouse Beneficiary will be recalculated annually.

  
	
   

  	
   

  	
  c.

  	
  o

  	
  the life expectancy of the
  Spouse Beneficiary will not be recalculated.

  

 

Q.            Top-Heavy
Provisions

 

	
  Top-Heavy Eligible Participant:

  [Plan Sec. 17.4(k)]

  	
   

  	
  Q.1.

  	
  A Top-Heavy Eligible
  Participant is an Active Participant at some time during the Plan Year who is
  an Employee on the last day of the Plan Year and who is a Non-Key Employee ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  or a Key Employee

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... with respect to the Plan
  Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Top-Heavy Contribution Requirement:

  	
   

  	
  Q.2.

  	
  If the Plan is Top-Heavy
  and a defined contribution minimum must be provided under this Plan, the
  minimum contribution requirement will be satisfied ... [check one]:

  
	
  [Plan Sec.
  17.1]

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  by means of an additional
  contribution made solely on behalf of the Top-Heavy Eligible
  Participants.  [NOTE:  Under this option, the Employer Safe-Harbor
  and/or Regular Profit Sharing Contribution will be determined or allocated as
  provided in Section H. and/or J, and additional contributions will be made as
  necessary to satisfy Plan Sec. 17.1(a).]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  b.

  	
  o

  	
  by modification of the
  otherwise applicable contribution formula or allocation method for the
  Employer Safe-Harbor or Regular Profit Sharing Contributions in accordance
  with Plan Sec. 17.1(b).  [NOTE:  This option is not appropriate if
  the Plan does not otherwise provide for an Employer Safe-Harbor or
  Regular Profit Sharing Contribution. 
  Under this option, the Employer Safe-Harbor and/or Regular Profit Sharing
  Contributions will not be determined or allocated as provided in Section H.
  and/or J., but will instead be determined or allocated as provided in Plan
  Sec. 17.1(b).]

  

 

51

 

	
  Top-Heavy
  Vesting Schedule:

  	
   

  	
  Q.3.

  	
  If the Plan was, but has
  ceased to be, Top-Heavy, the applicable vesting schedule specified in Plan
  Sec. 17.2 will ... [check one]:

  
	
  [Plan Sec.
  17.2]

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  cease to apply.  [NOTE:  This will be treated as an amendment to the
  vesting schedule that is subject to the participant election specified in
  Plan Sec. 10.2(k).]

  
	
   

  	
   

  	
  b.

  	
  ý

  	
  continue to apply to all
  Participants.

  
	
   

  	
   

  	
  c.

  	
  o

  	
  continue to apply to any
  Participant who has three or more years of vesting Service as of the last day
  the Plan is Top-Heavy (but not any other Participant).

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  [NOTE:  If the vesting schedule
  specified in Plan Sec. 17.2 continues to apply, a Participant’s vested
  percentage will be the greater of the vested percentage under such schedule
  or the vesting schedule that otherwise applies under the Plan.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Coordination
  With Other 

  	
   

  	
  Q.4.

  	
  Does any Controlled Group
  Member maintain another qualified plan? 
  [check one]:

  
	
  Qualified
  Plans:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  [Plan Sec.
  17.1]

  	
   

  	
  a.

  	
  ý

  	
  No.  [Skip to
  Section R.]

  
	
   

  	
   

  	
  b.

  	
  o

  	
  Yes.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Q.5.

  	
  If this Plan is Top-Heavy,
  and if a Participant also is covered under another qualified defined
  contribution plan, the defined contribution minimum will be provided under ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  N/A – no such plan exists.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  the following plan [specify name]:
        .

  
	
   

  	
   

  	
  c.

  	
  o

  	
  this Plan.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Q.6.

  	
  If this Plan is Top-Heavy,
  and if a Participant also is covered under a qualified defined benefit plan,
  ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  N/A – no such plan exists.  [Skip to
  Section R.]

  
	
   

  	
   

  	
  b.

  	
  o

  	
  a defined benefit minimum
  of 2% per year of service (up to 20%) will be provided under the defined
  benefit plan.

  
	
   

  	
   

  	
  c.

  	
  o

  	
  a defined contribution
  minimum of 5% will be provided under the defined contribution plan designated
  in Q.5. (or if there is no other defined contribution plan, or if another
  defined contribution plan is designated in Q.5. but the Participant is not
  covered under such plan, then under this Plan).

  
	
   

  	
   

  	
  d.

  	
  o

  	
  other [specify manner in which top-heavy benefit will be
  provided; attach addendum if necessary]:
        .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Q.7.

  	
  The Top-Heavy Ratio will be
  determined using the following interest rate and mortality assumptions to
  value accrued benefits under defined benefit plans [complete]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  Interest:

  	
  %

  
	
   

  	
   

  	
   

  	
   

  	
  Mortality:

  	
  .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  R.            Code
  § 415 Coordination

  
	
   

  	
   

  	
   

  	
   

  
	
  415 Compensation:

  [Plan Sec. 18.4(b)] 

  	
   

  	
  R.1.

  	
  The 415 Compensation of a
  Participant is his/her ... [check one]:

  
	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  Plan Compensation
  determined without regard to any exclusions elected in E.2. and without
  regard to the compensation limit imposed under Code § 401(a)(17).

  
	
   

  	
   

  	
  b.

  	
  o

  	
  earnings required to be
  reported in the Wages, Tips and other Compensation box of Form W-2.

  
	
   

  	
   

  	
  c.

  	
  ý

  	
  earnings for purposes of
  Code § 415(c)(3).

  
	
   

  	
   

  	
  d.

  	
  o

  	
  earnings for purposes of
  federal income for withholding.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  [NOTE:  For Limitation Years
  beginning on or after January 1, 1998, 415 Compensation includes Elective
  Deferrals and any contributions made at the election of the Participant to a
  cafeteria plan that is excluded from gross income under Code § 125.]

  
													

 

52

 

	
  Limitation Year:

  [Plan Sec. 18.4(h)]

  	
   

  	
  R.2.

  	
  The Limitation Year with
  respect to the Plan is the ... [check one of
  a. or b., and check c. if it applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  Plan Year.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  twelve-consecutive-month
  period ending each        [month day].

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  [check c.
  if the Limitation Year has been amended]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  The Limitation Year has
  been amended.  The last Limitation Year
  before the amendment ended        [month day, year], and the short Limitation Year resulting
  from the amendment began on the next day and ended
         [month
  day, year].

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Correction Method:

  [Plan Sec. 18.1(b)]

  	
   

  	
  R.3

  	
  If Excess Annual Additions
  have been made under the Plan, the correction will be made using the ... [check one]:  [NOTE:  The following correction method applies
  only after Employee Pre-Tax and After-Tax Contributions for the
  Limitation Year have been refunded to the Participant.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  individual reduction method
  – that is, the Excess Annual Additions will remain in the Participant’s
  Account (so long as he/she remains an Active Participant) and will reduce
  Employer Contributions made on behalf of such Participant in future
  Limitation Years.

  
	
   

  	
   

  	
  b.

  	
  ý

  	
  suspense account method –
  that is, the Excess Annual Additions will be placed in the Pending Allocation
  Account and will reduce Employer Contributions of all Participants in future
  Limitation Years.

  
	
   

  	
   

  	
  c.

  	
  o

  	
  current allocation method –
  that is, the Excess Annual Additions will be reallocated among other Active
  Participants as of the last day of the current Limitation Year in proportion
  to Plan Compensation.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  R.4.

  	
  If a Pending Allocation
  Account is ever maintained to hold Excess Annual Additions, such Account ... [check one]: [NOTE:  An election must be made even if the
  individual reduction method is used to correct Excess Annual Additions,
  because Excess Annual Additions that remain in a Participant’s Contribution
  Accounts at Termination of Service must then be credited to a Pending
  Allocation Account.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  will

  
	
   

  	
   

  	
  b.

  	
  o

  	
  will not

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... share in investment gains
  and losses under the Plan.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Coordination With Other Plans:

  [Plan Sec. 18.2 and 18.3]

  	
   

  	
  R.5.

  	
  Does any Controlled Group
  Member maintain (i) another qualified defined contribution plan (other than
  another master or prototype plan), (ii) a simplified employee pension as
  defined in Code § 408(a), (iii) a welfare benefit fund as defined in
  Code § 419(e), or (iv) an individual medical account as defined in Code
  § 415(l)(2), under which amounts are treated as Annual Additions with
  respect to any Participant in this Plan? 
  [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  No.  [Skip to
  Section S.]

  
	
   

  	
   

  	
  b.

  	
  o

  	
  Yes.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  R.6.

  	
  If a Participant is covered
  under another qualified defined contribution plan (other than a master or
  prototype plan) or under a simplified employee pension, welfare benefit fund
  or individual medical account of a Controlled Group Member, ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  the method used to
  coordinate the limit on Annual Additions will be the same method that would
  be used for a master or prototype plan under Plan Sec. 18.2(a).

  
	
   

  	
   

  	
  b.

  	
  o

  	
  the Excess Annual Additions
  will be attributed ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  last

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  first

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ... to this Plan.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  other [specify the method that will be used to coordinate
  the annual addition limits in a manner that precludes discretion; attach
  addendum if necessary]:       .

  

 

53

 

S.            Special
Testing Rules

 

[NOTE:  If this Adoption
Agreement amends the Plan to retroactively comply with the Small Business Job
Protection Act of 1996 and the Taxpayer Relief Act of 1997, complete and attach
the “Special Testing Rules Addendum”.]

 

	
  Highly Compensated Employees:

  [Plan Sec. 2.35]

  	
   

  	
  S.1.

  	
  An Employee will be a
  Highly Compensated Employee if he/she is a more than five-percent owner at
  any time during the current Plan Year or the twelve-consecutive-month period
  immediately preceding the current Plan Year. 
  [NOTE:  The
  constructive ownership rules under Code § 318 apply for determining who
  is a more than five-percent owner.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  An Employee also will be a
  Highly Compensated Employee if his/her Compensation during the look-back
  period exceeded the limit in effect under Code § 414(q)(1)(B) ... [check if applicable]:  [NOTE:  The following election can only be made if
  it is made in all plans of all Controlled Group Members.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  and the Employee was in the
  top-paid group for the look-back period.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  S.2.

  	
  The look-back period is the
  ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  twelve-consecutive-month
  period immediately preceding the current Plan Year.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  calendar year ending within
  the current Plan Year.  [NOTE:  This election is not appropriate if the
  Plan Year is the calendar year, and can only be made if it is made in all
  plans (other than calendar year plans) of all Controlled Group Members.]

  

 

[NOTE:  Complete S.3. through
S.10. only if the Plan has an Employee Pre-Tax or After-Tax Component.]

 

	
  ADP/ACP Testing Method:

  [Plan Sec. 19.2 and 19.3]

  	
   

  	
  S.3.

  	
  The Actual Deferral
  Percentage Test and the Actual Contribution Percentage Test will be applied
  using the ... [select the method being used
  for the Plan Year for which this Adoption Agreement is effective]:  [NOTE:  If the Plan is designated as a Safe-Harbor
  Plan, it will be deemed to be using the current year testing method – thus, b.
  must be elected below.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  prior year testing
  method.  [NOTE:  If the Plan first is required to apply the
  Actual Deferral Percentage Test or Actual Contribution Percentage Test in a
  Plan Year beginning on or after January 1, 1997 (and the plan is not a
  successor plan), and the prior year testing method is used for such Plan
  Year, then the test will be applied for such Plan Year using the greater of
  (i) 3%, or (ii) the Actual Deferral Percentage or Actual
  Contribution Percentage, as appropriate, of the Non-Highly Compensated
  Employees for such Plan Year.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  b.

  	
  ý

  	
  current year testing
  method.  [NOTE:  The current year testing election can be
  changed only under circumstances prescribed by the IRS.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Other Elections Regarding ADP/ACP Testing:

  [Plan Sec. 19.2, 19.3 and 19.4]

  	
   

  	
  S.4.

  	
  In applying the Actual
  Deferral Percentage Test, ... [check each
  that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  ý

  	
  Employer Regular Matching
  Contributions (to the extent such contributions satisfy the requirements to
  be Employer Qualified Matching Contributions (QMACs))

  
	
   

  	
  b.

  	
  ý

  	
  Employer Regular Profit
  Sharing Contributions (to the extent such contributions satisfy the
  requirements to be Employer Qualified Profit Sharing Contributions (QNECs))

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... may be taken into account
  under such test at the discretion of the Plan Administrator.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  S.5.

  	
  In applying the Actual
  Contribution Percentage Test, ... [check
  each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  Employee Pre-Tax
  Contributions

  
	
   

  	
   

  	
  b.

  	
  ý

  	
  Employer Regular Profit
  Sharing Contributions (to the extent such contributions satisfy the
  requirements to be Employer Qualified Profit Sharing Contributions (QNECs))

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... may be taken into account
  under such test at the discretion of the Plan Administrator.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  [NOTE:  Employer Qualified
  Matching (QMACs) and Qualified Profit Sharing

  

 

54

 

	
   

  	
   

  	
   

  	
  (QNECs) Contributions (if permitted under the Plan) may in all cases
  be taken into account in applying the Actual Deferral Percentage Test and
  Actual Contribution Percentage Test. Also, Employer Safe-Harbor Profit
  Sharing Contributions may be taken into account in applying the Actual
  Contribution Percentage Test, but only to the extent they exceed the minimum
  contribution required to qualify as safe-harbor contributions under Code
  § 401(k).]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  S.6.

  	
  If Employee After-Tax
  Contributions are allowed under the Plan, Employee Pre-Tax Contributions ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  N/A – Employee After-Tax
  Contributions are not allowed under the Plan.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  may not

  
	
   

  	
   

  	
  c.

  	
  o

  	
  may at the discretion of
  the ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Plan Administrator

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  affected Participant

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... be recharacterized as
  Employee After-Tax Contributions to the extent necessary to satisfy the
  Actual Deferral Percentage Test.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  [NOTE:  Recharacterization is
  permissible only if the Plan uses the current year testing method and the
  Plan currently allows Employee After-Tax Contributions, and then only if the
  recharacterized amount, in combination with Employee After-Tax Contributions,
  does not exceed any limits otherwise imposed under the Plan on Employee
  After-Tax Contributions.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  S.7.

  	
  If Employer Regular
  Matching Contributions are forfeited as Excess Aggregate Contributions, such
  forfeited amounts will be ... [check a., or
  check one of b. through d.]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  N/A – the Plan provides for
  full and immediate vesting of Employer Regular Matching Contribution Accounts.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  applied in the same manner
  as any other Forfeiture from an Employer Regular Matching Contribution
  Account.

  
	
   

  	
   

  	
  c.

  	
  o

  	
  allocated as of the last
  day of the Plan Year to which such Employer Regular Matching Contributions
  relate among the Non-Highly Compensated Employees with respect to such Plan
  Year who are Active Participants in the ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Employee Pre-Tax Component

  
	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  Employer Regular Matching
  Component

  
	
   

  	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  Employer Regular Profit
  Sharing Component

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
  ... during such Plan Year and
  who have otherwise satisfied the requirements to receive a contribution under
  such Component for such Plan Year.  The
  allocation will be made in proportion to the Plan Compensation for the Plan
  Year of each eligible Participant.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  d.

  	
  ý

  	
  applied as a credit against
  Employer Safe-Harbor and/or Regular Matching Contributions that are made
  under the Plan, as and when directed by the Lead Employer.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  S.8.

  	
  If the multiple use test is
  failed for a Plan Year (after corrective contributions or distributions, if
  any), ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  the Actual Contribution
  Percentage

  
	
   

  	
   

  	
  b.

  	
  o

  	
  the Actual Deferral
  Percentage

  
	
   

  	
   

  	
  c.

  	
  o

  	
  the Actual Contribution
  Percentage and Actual Deferral Percentage (proportionately)

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... will be reduced as
  necessary to satisfy such test.  [NOTE:  If contributions of the same type are made
  under more than one plan, the correction will be made under the plan
  designated by the Plan Administrator.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Gain or Loss on Excess

  	
   

  	
  S.9.

  	
  The gain or loss allocable
  to Excess Elective Deferrals that are refunded to a Participant,

  

 

55

 

	
  Contributions:

  [Plan Sec. 19.1(d), 19.2(d) and 19.3(d)]

  	
   

  	
   

  	
  or allocable to Excess
  Contributions or Excess Aggregate Contributions distributed to satisfy the
  Actual Deferral Percentage Test, Actual Contribution Percentage Test, or
  multiple use test, will be determined using ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  the safe harbor method
  specified in the Plan.

  
	
   

  	
   

  	
  b.

  	
  o

  	
  a method established by the
  Plan Administrator that reasonably reflects the manner in which gain or loss
  is allocated under the Plan.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  S.10.

  	
  The gain or loss allocated
  ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  does not

  
	
   

  	
   

  	
  b.

  	
  o

  	
  does

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ... include gain or loss for
  the “gap period” – that is, the period from the end of the year to the date
  of distribution.

  

 

T.            Special
Effective Date Rules

 

	
   

  	
   

  	
  T.1.

  	
  The following Components
  are added and effective after the Original Effective Date or Amendment
  Effective Date specified in Section A ... [check
  each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
  Employee Pre-Tax Component

  
	
   

  	
   

  	
   

  	
   

  	
  Effective Date:
        .

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  b.

  	
  o

  	
  Employee After-Tax Component

  
	
   

  	
   

  	
   

  	
   

  	
  Effective Date:
        .

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
  Employer Regular Matching Component

  
	
   

  	
   

  	
   

  	
   

  	
  Effective Date:
         [must
  be the first day of a Matching Contribution Period].

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  d.

  	
  o

  	
  Employer Regular Profit Sharing Component

  
	
   

  	
   

  	
   

  	
   

  	
  Effective Date:
        .

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  e.

  	
  o

  	
  Employer Qualified Matching and Qualified Profit
  Sharing Component

  
	
   

  	
   

  	
   

  	
   

  	
  Effective Date:
        .

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  f.

  	
  o

  	
  Employer Prevailing Wage Component

  
	
   

  	
   

  	
   

  	
   

  	
  Effective Date:
        .

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  T.2.

  	
  The effective date for the
  following provisions is different than the Original Effective Date or
  Amendment Effective Date specified in Section A ... [complete as appropriate]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  o

  	
        .

  
	
   

  	
   

  	
   

  	
   

  	
  Effective Date:
        .

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  b.

  	
  o

  	
        .

  
	
   

  	
   

  	
   

  	
   

  	
  Effective Date:
        .

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  o

  	
        .

  
	
   

  	
   

  	
   

  	
   

  	
  Effective Date:
        .

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  d.

  	
  o

  	
        .

  
	
   

  	
   

  	
   

  	
   

  	
  Effective Date:
        .

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  U.            Frozen Contributions Accounts

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  U.1.

  	
  The following Components
  have been removed, but Contribution Accounts still exist under the Plan for
  contributions made under the Component (these are referred to as “Frozen”
  Contribution Accounts) ... [check each that
  applies]:  [NOTE:  Complete the Frozen Contribution Account
  Addendum.]

  

 

56

 

	
   

  	
   

  	
  a.

  	
  o

  	
  Employee Pre-Tax Component

  
	
   

  	
   

  	
  b.

  	
  ý

  	
  Employee After-Tax
  Component

  
	
   

  	
   

  	
  c.

  	
  o

  	
  Employee Deductible
  Component

  
	
   

  	
   

  	
  d.

  	
  o

  	
  Employee Safe-Harbor
  Matching and/or Safe-Harbor Profit Sharing Component

  
	
   

  	
   

  	
  e.

  	
  ý

  	
  Employer Regular Matching
  Component

  
	
   

  	
   

  	
  f.

  	
  o

  	
  Employer Regular Profit
  Sharing Component (including Prevailing Wage Component)

  
	
   

  	
   

  	
  g.

  	
  o

  	
  Employer Qualified Matching
  and/or Qualified Profit Sharing Component

  
	
   

  	
   

  	
  h.

  	
  o

  	
  Employer Pension Component

  

 

V.            Other Information for the Participating Employers

 

	
   

  	
   

  	
  Failure to fill out this
  Adoption Agreement completely and correctly may result in failure of the Plan
  to qualify under Code § 401(a).

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  The Plan Administrator is
  responsible for administration of the Plan, including the filing of the
  annual report on Form 5500 and the preparation and delivery of summary plan
  descriptions, summaries of material modifications and summary annual
  reports.  The Lead Employer and other
  fiduciaries agree to obtain bonds as required by law.  [ERISA § 412.]

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Inquiries regarding the
  adoption of the Plan, the meaning of its provisions or the effect of the
  opinion letter should be directed to the financial organization or other
  entity from which the Lead Employer obtained the Plan or to the Sponsor of
  the Prototype.

  

 

W.           Sponsor
of the Prototype

 

	
   

  	
   

  	
  The Sponsor of the
  Prototype is Scudder Trust Company

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Scudder Trust Company

  11 Northeastern Boulevard

  Salem, NH  03079-1953

  Phone Number:  (617) 295-1000

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  The Sponsor of the
  Prototype (or its authorized representative) will inform the Lead Employer if
  any amendments are made to the Prototype Defined Contribution Plan, or if the
  Prototype Defined Contribution Plan is discontinued or abandoned.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  [The
  remaining portion of the page is intentionally blank]

  

 

57

 

X.            Reliance
on IRS Opinion Letter

 

	
   

  	
   

  	
  The Participating Employers
  may rely on an opinion letter issued by the Internal Revenue Service (“IRS”)
  as evidence that the Plan is qualified under Code § 401(a) only to the
  extent provided in Announcement 2001-77, 2001-30 I.R.B.

   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  The Participating Employers
  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 have 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
  be used only in conjunction with Basic Plan Document #03.

  

 

Y.            Lead
Employer Signature

 

IN WITNESS
WHEREOF, the Lead
Employer has caused this Adoption Agreement to be adopted effective as of the
Original Effective Date or Amendment Effective Date (in Section A.  Preamble).

 

You should
consult with an attorney or other independent qualified advisor as to the legal
and tax effect of adopting the Plan.

 

 

	
  Date signed:

  	
   

  	
   

  	
  Lead Employer:

  	
  Clayton Williams Energy,
  Inc.

  	
   

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  By:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Name [print]:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Its [title]:

  	
   

  	
   

  
									

 

58

 

Z.            Trustee or Custodian Signature

 

FOR TRUST AGREEMENT

 

The Trustee(s) hereby accepts appointment as such in accordance with
the Prototype Trust Agreement.

 

	
  For
  Individual Trustee(s) serving pursuant to the “Trust

  Agreement for Individual Trustees”  (attach additional

  sheets if necessary)

  	
   

  	
  For a
  Financial Organization serving pursuant to the

  “Trust Agreement for Directed Trustee” or the “Trust

  Agreement with Discretionary Trustee Option”

  
	
   

  	
   

  	
   

  
	
  Date signed:

  	
   

  	
   

  	
   

  	
  Date signed:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  Effective:

  	
   

  	
   

  	
   

  	
  Effective:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  Trustee (1):

  	
   

  	
   

  	
   

  	
  Trustee:

  	
  Scudder Trust Company

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  By:

  	
   

  	
   

  
	
  Signature

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Name [print]:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Its [title]:

  	
   

  	
   

  
	
  Trustee (2):

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  [additional
  signature is optional]

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Signature

  	
   

  	
  And:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Name [print]:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  Trustee (3):

  	
   

  	
   

  	
   

  	
   

  	
  Its [title]:

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Signature

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  Trustee (4):

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Signature

  	
   

  	
   

  
																			

 

OR

 

FOR CUSTODIAL AGREEMENT

 

The Custodian hereby accepts its appointment as such in accordance with
the Custodial Agreement.

 

	
  Date signed:

  	
   

  	
   

  	
  Custodian:

  	
   

  	
   

  
	
   

  	
   

  
	
  Effective:

  	
   

  	
   

  	
   

  
	
   

  	
  By:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Name [print]:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Its [title]:

  	
   

  	
   

  
											

 

59

 

SCUDDER TRUST COMPANY

PROTOTYPE DEFINED CONTRIBUTION PLAN

 

SUPPLEMENT TO ADOPTION AGREEMENT

TO ALLOW FOR PARTICIPATING EMPLOYER ADOPTION

 

Effective as of August 1, 2004 the undersigned
Controlled Group Member adopts the Plan as established by the Lead Employer and
agrees to be a “Participating Employer” under the Plan.  The Section of the Adoption Agreement titled
“Reliance on IRS Opinion Letter” is incorporated herein by reference and
applies to the adoption of the Plan by the undersigned Participating Employer.

 

	
  Date signed:

  	
   

  	
   

  	
  Participating Employer:

  	
  Warrior Gas Company.

  	
   

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  By:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Name [print]:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Its [title]:

  	
   

  	
   

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  And:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Name [print]:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Its [title]:

  	
   

  	
   

  
										

 

Optional – Consent may be given in any manner
deemed appropriate by the Lead Employer.

 

The Lead Employer hereby consents to the
adoption of the Plan by the above Controlled Group Member.

 

	
  Date signed:

  	
   

  	
   

  	
  Lead Employer:

  	
  Clayton Williams Energy,
  Inc.

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  By:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Name [print]:

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Its [title]:

  	
   

  	
   

  
									

 

Attach additional sheet for each Participating Employer.

 

60

 

SCUDDER TRUST COMPANY

PROTOTYPE DEFINED CONTRIBUTION PLAN

 

PARTICIPATING EMPLOYER ADDENDUM

 

The
following Controlled Group Members are Participating Employers in the Plan (in
addition to those listed in Section B.3. of the Adoption Agreement):

 

Participating
Employer:

 

Name:          .

EIN:
     .

 

Participating
Employer:

 

Name:          .

EIN:
     .

 

Participating
Employer:

 

Name:          .

EIN:
     .

 

Participating
Employer:

 

Name:          .

EIN:
     .

 

Participating
Employer:

 

Name:          .

EIN:
     .

 

Participating
Employer:

 

Name:          .

EIN:
     .

 

Participating
Employer:

 

Name:          .

EIN:
     .

 

Participating
Employer:

 

Name:          .

EIN:
     .

 

Participating
Employer:

 

Name:          .

EIN:
     .

 

Participating
Employer:

 

Name:          .

EIN:
     .

 

Attach
additional sheets if necessary.

 

61

 

 

SCUDDER
TRUST COMPANY

PROTOTYPE
DEFINED CONTRIBUTION PLAN

 

SUPPLEMENTAL INFORMATION – Lead
Employer

 

Lead Employer Information

 

	
  Lead Employer:

  	
   

  	
   

  	
   

  
	
  [B.1]

  	
  B.1

  	
  a.

  	
  Lead
  Employer Name:  Clayton Williams
  Energy, Inc.

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  B.2.

  	
  Complete
  the following information about the Lead Employer... [complete]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  Address...
  [complete]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  1.

  	
  Lead
  Employer EIN: 75-2396863

  
	
   

  	
   

  	
  2.

  	
  SIC
  Code: 211110

  
	
   

  	
   

  	
  3.

  	
  Address:
  6 Desta Drive, Suite 6500

  
	
   

  	
   

  	
  4.

  	
  City:
  Midland

  
	
   

  	
   

  	
  5.

  	
  State:
  Texas

  
	
   

  	
   

  	
  6.

  	
  Zip
  Code: 79705

  
	
   

  	
   

  	
  7.

  	
  Phone
  Number: 915-688-3402

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  b.

  	
  Fiscal
  year end ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  1.

  	
  ý

  	
  December
  31                                       
  [month year]

  
	
   

  	
   

  	
  2.

  	
  o

  	
  52/53
  week year: [describe]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  Type
  of business entity ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  1.

  	
  ý

  	
  C
  Corporation

  
	
   

  	
   

  	
  2.

  	
  o

  	
  S
  Corporation

  
	
   

  	
   

  	
  3.

  	
  o

  	
  Limited
  Liability Corporation

  
	
   

  	
   

  	
  4.

  	
  o

  	
  Partnership

  
	
   

  	
   

  	
  5.

  	
  o

  	
  Limited
  Liability Partnership

  
	
   

  	
   

  	
  6.

  	
  o

  	
  Sole
  Proprietorship

  
	
   

  	
   

  	
  7.

  	
  o

  	
  other
  [specify]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  d.

  	
  Is
  the Lead Employer a Participating Employer in the Plan?

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  1.

  	
  ý

  	
  Yes

  
	
   

  	
   

  	
  2.

  	
  o

  	
  No

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  e.

  	
  Contact
  person for Lead Employer ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  1.

  	
  Name:   Lu Ann Bolding

  
	
   

  	
   

  	
  2.

  	
  Phone
  Number:    915-688-3402

  
	
   

  	
   

  	
  3.

  	
  E-mail:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  B.2.1.

  	
  Are
  there other business entities that are part of the controlled (or affiliated
  service) group of the Lead Employer? ...

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  ý

  	
  Yes
  [NOTE:  For each
  controlled (or affiliated service) group member, complete the sheet labeled
  Supplemental Information – Controlled Group Members]

  
	
   

  	
   

  	
  b.

  	
  o

  	
  No

  

 

62

 

SUPPLEMENTAL INFORMATION –
Controlled Group Member

 

Controlled Group Member
Information

 

	
  Controlled Group Member:

  	
  B.2.2

  	
  Complete
  the following information about each controlled (or affiliated service) group
  member ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  Employer
  information ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  1.

  	
  Name:
  Warrior Gas Company

  
	
   

  	
   

  	
  2.

  	
  EIN: 75-2470727

  
	
   

  	
   

  	
  3.

  	
  SIC Code: ......

  
	
   

  	
   

  	
  4.

  	
  Address:
  6 Desta Drive, Suite 6500

  
	
   

  	
   

  	
  5.

  	
  City:
  Midland

  
	
   

  	
   

  	
  6.

  	
  State:
  Texas

  
	
   

  	
   

  	
  7.

  	
  Zip
  Code: 79705

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  b.

  	
  Type
  of business entity ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  1.

  	
  ý

  	
  C
  Corporation

  
	
   

  	
   

  	
  2.

  	
  o

  	
  S
  Corporation

  
	
   

  	
   

  	
  3.

  	
  o

  	
  Limited
  Liability Corporation

  
	
   

  	
   

  	
  4.

  	
  o

  	
  Partnership

  
	
   

  	
   

  	
  5.

  	
  o

  	
  Limited
  Liability Partnership

  
	
   

  	
   

  	
  6.

  	
  o

  	
  Sole
  Proprietorship

  
	
   

  	
   

  	
  7.

  	
  o

  	
  other
  [specify]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  Is
  this member a Participating Employer in the Plan? ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  1.

  	
  ý

  	
  Yes

  
	
   

  	
   

  	
  2.

  	
  o

  	
  No

  

 

 

COMPLETE A SEPARATE SHEET FOR EACH

CONTROLLED GROUP MEMBER

 

63

 

SUPPLEMENTAL INFORMATION –
Funding Vehicle

 

Funding Information

 

[INSTRUCTION:  Complete
the following if an individual or a committee of individuals is a “Trustee” of
all or any portion of the Plan Assets.]

 

	
  Funding Vehicle:

  	
  C.5.

  	
  The
  Trustee is the following individual or committee of individuals ... [complete]:

  
	
  [C.5]

  	
   

  	
   

  	
   

  
	
   

  	
  1.

  	
  individual
  trustee(s) ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  List
  the trustee(s)

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  1.

  	
  Name:

  
	
   

  	
   

  	
  2.

  	
  Name:

  
	
   

  	
   

  	
  3.

  	
  Name:

  
	
   

  	
   

  	
  4.

  	
  Name:

  
	
   

  	
   

  	
  5.

  	
  Name:

  
	
   

  	
   

  	
  6.

  	
  Name:

  
	
   

  	
   

  	
  7.

  	
  Name:

  
	
   

  	
   

  	
  8.

  	
  Name:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  b.

  	
  Trustee
  contact ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  1.

  	
  Name:

  
	
   

  	
   

  	
  2.

  	
  Address:

  
	
   

  	
   

  	
  3.

  	
  City:

  
	
   

  	
   

  	
  4.

  	
  State:

  
	
   

  	
   

  	
  5.

  	
  Zip
  Code:

  
	
   

  	
   

  	
  6.

  	
  Phone
  Number:

  
	
   

  	
   

  	
  7.

  	
  E-mail:

  
					

 

[INSTRUCTION:  Complete
the following if a financial organization is a “Trustee” of all or any portion
of the Plan Assets.]

 

	
  Funding Vehicle:

  	
  C.5.

  	
  The
  Trustee is the following financial organization ... [complete]:

  
	
  [C.5]

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  2.

  	
  a
  financial organization serving pursuant to the Trust Agreement ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  c.

  	
  ý

  	
  Scudder
  Trust Company

  
	
   

  	
   

  	
   

  	
   

  	
  11
  Northeastern Boulevard

  
	
   

  	
   

  	
   

  	
   

  	
  Salem,
  N.H. 03079

  
	
   

  	
   

  	
   

  	
   

  	
  EIN:  02-0443137

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  d.

  	
  o

  	
  Trustee
  information ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  Name:

  
	
   

  	
   

  	
   

  	
  2.

  	
  EIN:

  
	
   

  	
   

  	
   

  	
  3.

  	
  Address:

  
	
   

  	
   

  	
   

  	
  4.

  	
  City:

  
	
   

  	
   

  	
   

  	
  5.

  	
  State:

  
	
   

  	
   

  	
   

  	
  6.

  	
  Zip
  Code:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  Trustee
  contact ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  7.

  	
  Name:

  
	
   

  	
   

  	
   

  	
  8.

  	
  Phone
  Number:

  
	
   

  	
   

  	
   

  	
  9.

  	
  E-mail:

  
							

 

64

 

[INSTRUCTION:  Complete
the following if a financial organization is a “Custodian” of all or any
portion of the Plan Assets.]

 

	
  Funding Vehicle:

  	
  C.5.

  	
  The
  Custodian is the following financial organization ... [complete]:

  
	
  [C.5]

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  1.

  	
  Custodian
  information ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  Name:

  
	
   

  	
   

  	
  b.

  	
  EIN:

  
	
   

  	
   

  	
  c.

  	
  Address:

  
	
   

  	
   

  	
  d.

  	
  City:

  
	
   

  	
   

  	
  e.

  	
  State:

  
	
   

  	
   

  	
  f.

  	
  Zip Code:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  2.

  	
  Custodian
  contact ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  Name:

  
	
   

  	
   

  	
  b.

  	
  Phone
  Number:

  
	
   

  	
   

  	
  c.

  	
  E-mail:

  

 

[INSTRUCTION:  Complete
the following if the Plan is funded in whole or in part through a group annuity
contract with an insurance company (other than a group annuity contract held as
an asset of a trust).]

 

	
  Funding Vehicle:

  	
  C.5.

  	
  The
  Annuity Funding Contract is with the following insurance company ... [complete]:

  
	
  [C.5]

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  1.

  	
  Insurance
  company information ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  Name:

  
	
   

  	
   

  	
  b.

  	
  EIN:

  
	
   

  	
   

  	
  c.

  	
  Address:

  
	
   

  	
   

  	
  d.

  	
  City:

  
	
   

  	
   

  	
  e.

  	
  State:

  
	
   

  	
   

  	
  f.

  	
  Zip Code:

  
	
   

  	
   

  	
  g.

  	
  Phone
  Number:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  2.

  	
  The
  contact person is ... [complete]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  a.

  	
  Name:

  
	
   

  	
   

  	
  b.

  	
  Phone
  Number:

  
	
   

  	
   

  	
  c.

  	
  E-mail:

  

 

65

 

FROZEN ACCOUNT ADDENDUM

 

The
following vesting and withdrawal rules apply to frozen accounts under this
Plan.

 

A.            Frozen Employee Pre-Tax Component

 

	
  Vesting:

  [Plan Sec. 10.2(e)]

  	
  A.1.

  	
  A
  Participant’s vested percentage in his/her Frozen Employee Pre-Tax
  Contribution Account will be 100% at all times.

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
  In-Service Withdrawals:

  [Plan Sec. 11.2]

  	
  A.2.

  	
  Withdrawals
  are allowed from Frozen Employee Pre-Tax Contribution Accounts... [check a., or check each of b. and c. that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  N/A
  – in-service withdrawals are not allowed.

  
	
   

  	
  b.

  	
  o

  	
  for
  any reason after... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Normal
  Retirement Age (or age 591⁄2, if later).

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  age
  591⁄2.

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  age
         [60
  or more].

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  o

  	
  at
  any age on account of Hardship.

  

 

B.            Frozen Employee After-Tax Component

 

	
  Vesting:

  [Plan Sec. 10.2(e)]

  	
  B.1.

  	
  A
  Participant’s vested percentage in his/her Frozen Employee After-Tax Contribution
  Account will be 100% at all times.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  In-Service Withdrawals:

  [Plan Sec. 11.2]

  	
  B.2.

  	
  Withdrawals
  are allowed from Frozen Employee After-Tax Contribution Accounts... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  N/A
  – in-service withdrawals are not allowed.

  
	
   

  	
  b.

  	
  ý

  	
  for
  any reason and at any time.

  
	
   

  	
  c.

  	
  o

  	
  for
  any reason after ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Normal
  Retirement Age.

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  age
  591⁄2.

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  age
        .

  

 

C.            Frozen Employee Deductible Component

 

	
  Vesting:

  [Plan Sec. 10.2(e)]

  	
  C.1.

  	
  A
  Participant’s vested percentage in his/her Frozen Employee Deductible
  Contribution Account will be 100% at all times.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  In-Service Withdrawals:

  [Plan Sec. 11.2]

  	
  C.2.

  	
  Withdrawals
  are allowed from Frozen Employee Deductible Contribution Accounts... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  N/A
  – in-service withdrawals are not allowed.

  
	
   

  	
  b.

  	
  o

  	
  for
  any reason and at any time.

  
	
   

  	
  c.

  	
  o

  	
  for
  any reason after ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Normal
  Retirement Age.

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  age
  591⁄2.

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  age
        .

  

 

66

 

D.            Frozen Employer Safe-Harbor Component

 

	
  Vesting:

  [Plan Sec. 10.2(e)]

  	
  D.1.

  	
  A
  Participant’s vested percentage in his/her Frozen Employer Safe-Harbor
  Matching and/or Safe-Harbor Profit Sharing Contribution Account will be 100%
  at all times.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  In-Service Withdrawals:

  [Plan Sec. 11.2]

  	
  D.2.

  	
  Withdrawals
  are allowed from Frozen Employer Safe-Harbor Matching and/or Safe-Harbor
  Profit Sharing Contribution Accounts ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  N/A
  – in-service withdrawals are not allowed.

  
	
   

  	
  b.

  	
  o

  	
  for
  any reason after ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Normal
  Retirement Age (or age 591⁄2 if later).

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  age
  591⁄2.

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  age
         [60
  or more].

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  o

  	
  for
  Hardship after age 591⁄2.

  

 

E.               Frozen Employer Regular Matching Component

 

	
  Vesting:

  [Plan Sec. 10.2(e)]

  	
  E.1.

  	
  A
  Participant’s vested percentage in his/her Frozen Employer Regular Matching
  Contribution Account will be ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  ý

  	
  100%
  at all times.

  
	
   

  	
  b.

  	
  o

  	
  determined
  under the following schedule ... [complete
  as desired]:

  

 

	
  Years
  of

  Service

  	
   

  	
  Vested

  Percentage

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  0

  	
   

  	
  0

  	
  %

  	
   

  	
   

  
	
  1

  	
   

  	
  0

  	
  %

  	
   

  	
   

  
	
  2

  	
   

  	
  0

  	
  %

  	
   

  	
   

  
	
  3

  	
   

  	
  0

  	
  %

  	
  [20% or
  more]

  	
   

  
	
  4

  	
   

  	
  0

  	
  %

  	
  [40% or
  more]

  	
   

  
	
  5

  	
   

  	
   

  	
  %

  	
  [60% or
  more]

  	
   

  
	
  6

  	
   

  	
   

  	
  %

  	
  [80% or
  more]

  	
   

  
	
  7 or more

  	
   

  	
  100

  	
  %

  	
   

  	
   

  

 

	
   

  	
  c.

  	
  o

  	
  determined
  under the following schedule ... [complete
  as desired]:

  

 

	
  Years
  of

  Service

  	
   

  	
  Vested

  Percentage

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  0

  	
   

  	
  0

  	
  %

  	
   

  	
   

  
	
  1

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
  2

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
  3

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
  4

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
  5 or more

  	
   

  	
  100

  	
  %

  	
   

  	
   

  

 

	
   

  	
   

  	
  [NOTE: 
  If the Plan is Top-Heavy, and if the vesting schedule specified above
  does not satisfy the vesting requirements appropriate for a Top-Heavy Plan
  under Plan Sec. 17.2, the vested percentage of the Participant will be the
  greater of the vested percentage determined under the vesting schedule
  specified above or the applicable vesting schedule specified in Plan Sec.
  17.2.]

  

 

67

 

	
  Treatment of Forfeitures: [Plan Sec. 5.2(g)]

  	
  E.2.

  	
  A
  Pending Allocation Account that reflects Forfeitures from Frozen Employer
  Regular Matching Contribution Accounts ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  ý

  	
  can
  

  	
   

  	
   

  
	
   

  	
  b.

  	
  o

  	
  cannot

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ...
  be applied to pay administrative expenses of the Plan if so directed by the
  Plan Administrator.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  E.3.

  	
  A
  Pending Allocation Account that reflects Forfeitures from Frozen Employer
  Regular Matching Contribution Accounts (to the extent not applied to pay
  administrative expenses if permitted in E.2) will be ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  ý

  	
  applied
  as a credit against ... [check each that
  applies]:  

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  ý

  	
  Employer
  Safe-Harbor Matching Contributions

  
	
   

  	
   

  	
   

  	
  2.

  	
  ý

  	
  Employer
  Safe-Harbor and/or Regular Profit Sharing Contributions

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ...
  that are made under the Plan, as and when directed by the Lead Employer.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  b.

  	
  o

  	
  allocated
  as of the last day of the Plan Year as an additional Employer Profit Sharing
  Contribution.  The allocation will be
  made in the same manner (and as part of) any variable contribution, or in
  proportion to any fixed contribution, under the Plan.  [NOTE:  If the Plan provides for a fixed Employer
  Regular Profit Sharing Contribution determined under an integrated formula,
  the Pending Allocation Account will be allocated in proportion to Plan
  Compensation for the Plan Year.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  o

  	
  allocated
  as of the last day of the Plan Year in proportion to Plan Compensation for
  the Plan Year.  The allocation will be
  among all eligible Participants who are eligible to receive any Employer
  Contribution for the Plan Year or, if there are no such Participants, among
  all eligible Participants who are eligible to make an Employee Contribution
  for the Plan Year.

  

 

68

 

	
  In-Service Withdrawals:

  [Plan Sec. 11.2]

  	
  E.4.

  	
  Withdrawals
  are allowed from Frozen Employer Regular Matching Contribution Accounts ... [check a., or check each of b. through d. that
  applies]: 

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  N/A
  – in-service withdrawals are not allowed.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  b.

  	
  ý

  	
  for
  any reason after ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Normal
  Retirement Age.

  
	
   

  	
   

  	
   

  	
  2.

  	
  ý

  	
  age
  591⁄2.

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  age[check each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  and
  completion of            years
  of ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  vesting
  Service.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  participation
  in the Plan.  [NOTE:  Participation is measured on an elapsed
  time basis from the Entry Date.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  but
  only if at the time of the withdrawal the Participant is ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  fully
  vested

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  at
  least
              %
  vested

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ...
  in his/her Frozen Employer Regular Matching Contribution Account.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  completion
  of          years of ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  vesting
  Service.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  participation
  in the Plan. [NOTE: 
  Participation is measured on an elapsed time basis from the Entry
  Date.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  o

  	
  at
  any age on account of Hardship ... [check if
  applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  but
  only if at the time of the withdrawal the Participant is ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  fully
  vested

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  at
  least
                   
  % vested

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  ...
  in his/her Frozen Employer Regular Matching Contribution Account.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  d.

  	
  o

  	
  for
  any reason, but only if at the time of the withdrawal the Participant is
  fully vested in his/her Frozen Employer Regular Matching Contribution
  Account, and provided the withdrawal may not include amounts allocated to the
  Contribution Account within two years prior to the withdrawal ... [check if applicable]:  [NOTE: The calculation of the
  maximum amount available for withdrawal is set forth in Plan Sec. 11.2(a).]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  unless
  the Participant has completed five years of participation in the Plan. [NOTE:  Participation is measured on an elapsed
  time basis from the Entry Date.]

  

 

F.             Frozen Employer Regular Profit Sharing Component

 

	
  Vesting:

  [Plan Sec. 10.2(e)]

  	
  F.1.

  	
  A
  Participant’s vested percentage in his/her Frozen Employer Regular Profit
  Sharing Contribution Account will be ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  100%
  at all times. [Skip to F.4.]

  
	
   

  	
  b.

  	
  o

  	
  determined
  under the following schedule ... [complete
  as desired]:

  

 

69

 

	
  Years
  of

  Service

  	
   

  	
  Vested

  Percentage

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  0

  	
   

  	
  0

  	
  %

  	
   

  	
   

  
	
  1

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
  2

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
  3

  	
   

  	
   

  	
  %

  	
  [20% or more]

  	
   

  
	
  4

  	
   

  	
   

  	
  %

  	
  [40% or more]

  	
   

  
	
  5

  	
   

  	
   

  	
  %

  	
  [60% or more]

  	
   

  
	
  6

  	
   

  	
   

  	
  %

  	
  [80% or more]

  	
   

  
	
  7 or more

  	
   

  	
  100

  	
  %

  	
   

  	
   

  

 

	
   

  	
  c.

  	
  o

  	
  determined
  under the following schedule ... [complete
  as desired]:

  

 

	
  Years
  of

  Service

  	
   

  	
  Vested

  Percentage

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  0

  	
   

  	
  0

  	
  %

  	
   

  	
   

  
	
  1

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
  2

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
  3

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
  4

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
  5 or more

  	
   

  	
  100

  	
  %

  	
   

  	
   

  

 

	
   

  	
   

  	
  [NOTE: 
  If the Plan is Top-Heavy, and if the vesting schedule specified above
  does not satisfy the vesting requirements appropriate for a Top-Heavy Plan
  under Plan Sec. 17.2, the vested percentage of the Participant will be the
  greater of the vested percentage determined under the vesting schedule
  specified above or the applicable vesting schedule specified in Plan Sec.
  17.2.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Treatment of Forfeitures:

  [Plan Sec. 6.2(c)]

  	
  F.2.

  	
  A
  Pending Allocation Account that reflects Forfeitures from Frozen Employer
  Regular Profit Sharing Contribution Accounts ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  can

  
	
   

  	
  b.

  	
  o

  	
  cannot

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ...
  be applied to pay administrative expenses of the Plan if so directed by the
  Plan Administrator.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  F.3.

  	
  A
  Pending Allocation Account that reflects Forfeitures from Frozen Employer
  Regular Profit Sharing Contribution Accounts (to the extent not applied to
  pay administrative expenses if permitted in F.2) will be ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  applied
  as a credit against ... [check each that
  applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Employer
  Safe-Harbor and/or Regular Matching Contributions

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  Employer
  Safe-Harbor Profit Sharing Contributions

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ...
  that are made under the Plan, as and when directed by the Lead Employer.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  b.

  	
  o

  	
  allocated
  as of the last day of the Plan Year in proportion to Plan Compensation for
  the Plan Year.  The allocation will be
  among all eligible Participants who are eligible to receive any Employer
  Contribution for the Plan Year or, if there are no such Participants, among
  all eligible Participants who are eligible to make an Employee Contribution
  for the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  In-Service Withdrawals:

  [Plan Sec. 11.2]

  	
  F.4.

  	
  Withdrawals
  are allowed from Frozen Employer Regular Profit Sharing Contribution Accounts
  ... [check a., or check each of b. through
  d. that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  N/A
  – in-service withdrawals are not allowed.

  
	
   

  	
  b.

  	
  o

  	
  for
  any reason after... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Normal
  Retirement Age.

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  age
  591⁄2.

  

 

70

 

	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  age
         ... [check
  each that applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  and
  completion of        years of ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  vesting
  Service.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  participation
  in the Plan. [NOTE: 
  Participation is measured on an elapsed time basis from the Entry
  Date.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  but
  only if at the time of the withdrawal the Participant is ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  fully
  vested

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  at
  least        % vested

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
  ...
  in his/her Frozen Employer Regular Profit Sharing Contribution Account.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  4.

  	
  o

  	
  completion
  of        years of  ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  vesting
  Service.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  participation
  in the Plan. [NOTE: 
  Participation is measured on an elapsed time basis from the Entry
  Date.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  o

  	
  at
  any age on account of Hardship  ... [check if applicable]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  but
  only if at the time of the withdrawal the Participant is ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  a.

  	
  o

  	
  fully
  vested

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  b.

  	
  o

  	
  at
  least         % vested

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
  ...
  in his/her Frozen Employer Regular Profit Sharing Contribution Account.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  d.

  	
  o

  	
  for
  any reason, but only if at the time of the withdrawal the Participant is
  fully vested in his/her Frozen Employer Regular Profit Sharing Contribution
  Account, and provided the withdrawal may not include amounts allocated to the
  Contribution Account within two years prior to the withdrawal ... [check if applicable]:  [NOTE: The calculation of the
  maximum amount available for withdrawal is set forth in Plan Sec. 11.2(a).]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  unless
  the Participant has completed five years of participation in the Plan. [NOTE:  Participation is measured on an elapsed
  time basis from the Entry Date.]

  

 

G.            Frozen Employer Qualified Matching and Profit Sharing Component

 

	
  Vesting:

  [Plan Sec. 10.2(e)]

  	
  G.1.

  	
  A
  Participant’s vested percentage in his/her Frozen Employer Qualified Matching
  and/or Qualified Profit Sharing Contribution Account will be 100% at all
  times.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  In-Service Withdrawals:

  [Plan Sec. 11.2]

  	
  G.2.

  	
  Withdrawals
  are allowed from Frozen Employer Qualified Matching and/or Qualified Profit
  Sharing Contribution Accounts ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  N/A
  – in-service withdrawals are not allowed.

  
	
   

  	
  b.

  	
  o

  	
  for
  any reason after... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Normal
  Retirement Age (or age 591⁄2, if later).

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  age
  591⁄2.

  
	
   

  	
   

  	
   

  	
  3.

  	
  o

  	
  age
         [60
  or more].

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  o

  	
  for
  Hardship after age 591⁄2.

  

 

71

 

H.            Frozen Employer Pension Component

 

	
  Vesting:

  [Plan Sec. 10.2(e)]

  	
  H.1.

  	
  A
  Participant’s vested percentage in his/her Frozen Employer Pension
  Contribution Account will be ... [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  100%
  at all times. [Skip to H.4.]

  
	
   

  	
  b.

  	
  o

  	
  determined
  under the following schedule ... [complete
  as desired]:

  

 

	
  Years
  of

  Service

  	
   

  	
  Vested

  Percentage

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  0

  	
   

  	
  0

  	
  %

  	
   

  	
   

  
	
  1

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
  2

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
  3

  	
   

  	
   

  	
  %

  	
  [20% or more]

  	
   

  
	
  4

  	
   

  	
   

  	
  %

  	
  [40% or more]

  	
   

  
	
  5

  	
   

  	
   

  	
  %

  	
  [60% or more]

  	
   

  
	
  6

  	
   

  	
   

  	
  %

  	
  [80% or more]

  	
   

  
	
  7 or more

  	
   

  	
  100

  	
  %

  	
   

  	
   

  

 

	
   

  	
  c.

  	
  o

  	
  determined
  under the following schedule ... [complete
  as desired]:

  

 

	
  Years
  of

  Service

  	
   

  	
  Vested

  Percentage

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  0

  	
   

  	
  0

  	
  %

  	
   

  	
   

  
	
  1

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
  2

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
  3

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
  4

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
  5 or more

  	
   

  	
  100

  	
  %

  	
   

  	
   

  

 

	
   

  	
   

  	
  [NOTE: 
  If the Plan is Top-Heavy, and if the vesting schedule specified above
  does not satisfy the vesting requirements appropriate for a Top-Heavy Plan
  under Plan Sec. 17.2, the vested percentage of the Participant will be the
  greater of the vested percentage determined under the vesting schedule
  specified above or the applicable vesting schedule specified in Plan Sec.
  17.2.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Treatment of Forfeitures:

  [Plan Sec. 7.2]

  	
  H.2.

  	
  A
  Pending Allocation Account that reflects Forfeitures from Frozen Employer Pension
  Contribution Accounts ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  can

  
	
   

  	
  b.

  	
  o

  	
  cannot

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  ...
  be applied to pay administrative expenses of the Plan if so directed by the
  Plan Administrator.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  H.3.

  	
  A
  Pending Allocation Account that reflects Forfeitures from Frozen Employer
  Pension Contribution Accounts (to the extent not applied to pay
  administrative expenses if permitted in H.2) will be  [check
  one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  a.

  	
  o

  	
  applied
  as a credit against ... [check each that
  applies]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Employer
  Safe-Harbor and/or Regular Matching Contributions

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  Employer
  Safe-Harbor and/or Regular Profit Sharing Contributions

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  ...
  that are made under the Plan, as and when directed by the Lead Employer.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  b.

  	
  o

  	
  allocated
  as of the last day of the Plan Year as an additional ... [check one]:

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  1.

  	
  o

  	
  Employer
  Regular Matching Contribution.

  
	
   

  	
   

  	
   

  	
  2.

  	
  o

  	
  Employer
  Regular Profit Sharing Contribution. [NOTE: If
  the Plan provides for a fixed contribution determined under an integrated
  formula, the allocation will be made in proportion to Plan

  

 

72

 

	
   

  	
   

  	
   

  	
   

  	
   

  	
  Compensation for the Plan Year.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  The
  allocation will be made in the same manner as (and as part of) any variable
  contribution, or in proportion to any fixed contribution, under the Plan. [NOTE: If
  the Plan provides for a variable contribution (e.g., a discretionary
  contribution), and a contribution is not made for a Plan Year, the allocation
  will be made in the same manner as the variable contribution would have been
  allocated.]

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
  c.

  	
  o

  	
  allocated
  as of the last day of the Plan Year in proportion to Plan Compensation for
  the Plan Year. The allocation will be among all eligible Participants who are
  eligible to receive any Employer Contribution for the Plan Year or, if there
  are no such Participants, among all eligible Participants who are eligible to
  make an Employee Contribution for the Plan Year.

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  In-Service Withdrawals:

  [Plan Sec. 11.2]

  	
  H.4.

  	
  Withdrawals
  are allowed from Frozen Employer Pension Contribution Accounts ... [check one]:

  
	
   

  	
  a.

  	
  o

  	
  N/A
  – in-service withdrawals are not allowed.

  
	
   

  	
  b.

  	
  o

  	
  for
  any reason after Normal Retirement Age.

  

 

73

 

SPECIAL TESTING RULES ADDENDUM

 

 

This Special Testing Rules Addendum must be completed if this
amendment to the Plan is being made in order to retroactively document the
administrative choices made in response to changes in the law resulting from
the Uruguay Round Agreements Act (“GATT”), the Uniform Services Employment and
Reemployment Rights Act (“USERRA”), the Small Business Job Protection Act of
1996 (“SBJPA”), the Taxpayer Relief Act of 1997 (“TRA ‘97”), the Internal
Revenue Service Restructuring and Reform Act of 1998 or the Community Renewal
Tax Relief Act of 2000 (collectively referred to as “GUST”).

 

The elections set forth in the Adoption Agreement will
control for Plan Years beginning on and after the Amendment Effective Date of
the Adoption Agreement that implements the changes required by GUST.  The following elections relate only to Plan
Years beginning prior to such Amendment Effective Date.

 

Highly Compensated Employees

 

Explanation:  Code § 414(q) allows two
elections for purposes of determining the Highly Compensated Employees.  First, a “top-paid group” election generally
allows the Highly Compensated Employees (other than more than five-percent
owners) to be limited to the top 20% of employees when ranked by
compensation.  Second, if the plan year
is other than the calendar year, a “calendar year” election generally allows
the Highly Compensated Employees to be determined based on calendar year
compensation instead of plan year compensation. 
These elections are first available for plan years beginning on or after
January 1, 1997.

 

Election (1):  Specify whether the “top-paid
group” election did or did not apply for the specified Plan Year ... [complete]:

 

	
  For the Plan
  Year

  beginning on or after

  January 1 of the following year:

  	
   

  	
  Did the top-paid

  group election

  apply?

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1997

  	
   

  	
  o  did

  	
  ý  did not

  	
   

  	
  ... apply

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1998

  	
   

  	
  o  did

  	
  ý  did not

  	
   

  	
  ... apply

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1999

  	
   

  	
  o  did

  	
  ý  did not

  	
   

  	
  ... apply

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  2000

  	
   

  	
  o  did

  	
  ý  did not

  	
   

  	
  ... apply

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  2001

  	
   

  	
  o  did

  	
  ý  did not

  	
   

  	
  ... apply

  	
   

  

 

Election (2):  Specify whether the “calendar
year” election did or did not apply for the specified Plan Year ... [complete]: [NOTE:  Do not complete for any year for which the
calendar year was the Plan Year.]

 

	
  For the Plan
  Year

  beginning on or after

  January 1 of the following year:

  	
   

  	
  Did the calendar

  year election

  apply?

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1997

  	
   

  	
  o  did

  	
  o  did not

  	
   

  	
  ... apply

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1998

  	
   

  	
  o  did

  	
  o  did not

  	
   

  	
  ... apply

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1999

  	
   

  	
  o  did

  	
  o  did not

  	
   

  	
  ... apply

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  2000

  	
   

  	
  o  did

  	
  o  did not

  	
   

  	
  ... apply

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  2001

  	
   

  	
  o  did

  	
  o  did not

  	
   

  	
  ... apply

  	
   

  

 

[NOTE:  Depending on your Adoption Agreement, the
“calendar year” election may not be available for Plan Years beginning on or
after the Amendment Effective Date of your new Adoption Agreement.]

 

74

 

Actual Deferral/Contribution Percentage Test

 

Explanation:  Code § 401(k) requires that
elective deferrals annually satisfy an Actual Deferral Percentage (ADP)
Test.  Further, Code § 401(m) requires
that after-tax contributions and matching contributions annually satisfy an
Actual Contribution Percentage (ACP) Test. 
Starting for the first plan year beginning on or after January 1, 1997,
the ADP and ACP Tests must either be applied using a “prior year” or “current
year” testing methodology.

 

Election (1):  For each specified Plan Year in
which the Plan was subject to the ADP Test, specify whether the “prior year” or
“current year” testing methodology applied for purposes of the ADP Test ... [complete]: [NOTE:  If the Plan was a safe-harbor plan under Code
§ 401(k)(12) for any Plan Year beginning on or after January 1, 1999, the
“current year” method must be specified for that Plan Year.]

 

	
  For the Plan Year

  beginning on or after

  January 1 of the following year:

  	
   

  	
  Which testing method

  was used to apply

  the ADP Test?

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1997

  	
   

  	
  o  current year

  	
  ý  prior year

  	
   

  	
  ... method

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1998

  	
   

  	
  ý  current year

  	
  o  prior year

  	
   

  	
  ... method

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1999

  	
   

  	
  ý  current year

  	
  o  prior year

  	
   

  	
  ... method

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  2000

  	
   

  	
  ý  current year

  	
  o  prior year

  	
   

  	
  ... method

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  2001

  	
   

  	
  ý  current year

  	
  o  prior year

  	
   

  	
  ... method

  	
   

  

 

Election (2):  For each specified Plan Year in
which the Plan was subject to the ACP Test, specify whether the “prior year” or
“current year” testing methodology applied for purposes of the ACP Test ... [complete]:  [NOTE:  If the Plan was a safe-harbor plan under Code
§ 401(m)(11) for any Plan Year beginning on or after January 1, 1999, the
“current year” method must be specified for that Plan Year.]

 

	
  For the Plan Year

  beginning on or after

  January 1 of the following year:

  	
   

  	
  Which testing method

  was used to apply

  the ACP Test?

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1997

  	
   

  	
  o  current year

  	
  ý  prior year

  	
   

  	
  ... method

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1998

  	
   

  	
  ý  current year

  	
  o  prior year

  	
   

  	
  ... method

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  1999

  	
   

  	
  ý  current year

  	
  o  prior year

  	
   

  	
  ... method

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  2000

  	
   

  	
  ý  current year

  	
  o  prior year

  	
   

  	
  ... method

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  2001

  	
   

  	
  ý  current year

  	
  o  prior year

  	
   

  	
  ... method

  	
   

  

 

Family Aggregation Rules

 

Explanation:  Code § 401(a)(17) previously
applied certain “family aggregation rules” to determine the annual compensation
limit of a participant.  Those family
aggregation rules were repealed effective as of the first plan year beginning
on or after January 1, 1997.   However,
the Plan voluntarily may have continued to apply the family aggregation rules
for this purpose until it is amended for GUST.

 

Election:  The Plan discontinued the family
aggregation rules as of the Plan Year beginning on or after ... [check one]:

 

	
  a.

  	
  ý  January 1,
  1997.

  
	
  b.

  	
  o  the
  Amendment Effective Date of the Adoption Agreement that implements the
  changes required by GUST.

  
	
  c.

  	
  o       
      [a date between the dates specified in a. and b.]

  

 

Cash-Out Amount

 

Explanation:  Code § 411(a)(11)
previously allowed involuntary “cash-out” of amounts not in excess of
$3,500.  This limit was raised to $5,000
effective as of the first plan year beginning after August 5, 1997.  However, the Plan voluntarily may have
continued the $3,500 (or a lower) cash-out amount.

 

75

 

Election:  The Plan implemented the higher
cash-out amount now specified in the Adoption Agreement as of... [check one]:

 

	
  a.

  	
  ý  the
  first day of the first Plan Year beginning after August 5, 1997.

  
	
  b.

  	
  o  the
  Amendment Effective Date of the Adoption Agreement that implements the
  changes required by GUST.

  
	
  c.

  	
  o            
  [a date between the dates specified in a.
  and b.]

  
	
  d.

  	
  o  N/A
  – the cash-out amount has not been increased by the Amendment Effective Date
  of the Adoption Agreement that implements the changes required by GUST.

  

 

Required Beginning Date

 

Explanation:  Code § 401(a)(9) previously
required that minimum distributions commence to any participant as of the April
1 of the calendar year after the calendar year in which he/she attained age 701⁄2
(even if he/she remained employed with the employer sponsoring the plan).  This “required beginning date” was changed
for participants who are still employed after age 701⁄2 (but not for more than
five percent owners) effective January 1, 1997. 
However, the Plan voluntarily may have continued to determine the
required beginning date based on the definition in effect prior to January 1,
1997.

 

Election (1):  The Plan implemented the new
required beginning date as of ... [check one]:

 

	
  a.

  	
  ý  January
  1, 1997.

  
	
  b.

  	
  o  the
  Amendment Effective Date of the Adoption Agreement that implements the
  changes required by GUST.

  
	
  c.

  	
  o              [a date
  between the dates specified in a. and b.]

  
	
  d.

  	
  o  N/A
  – the new required beginning date has not been implemented by the Amendment
  Effective Date of the Adoption Agreement that implements the changes required
  by GUST.  [NOTE:
  This option is not appropriate for Plans adopted or originally effective on
  or after January 1, 1997.]

  

 

Election (2):  A Participant who attained age
701⁄2 prior to the date specified above and who has not had a Termination of
Service ... [check one]:  [NOTE:  Do not complete if d. is selected above.]

 

	
  a.

  	
  o may not elect to stop minimum
  distributions.

  
	
  b.

  	
  ý may elect to stop minimum distributions and
  recommence such distributions by the April 1 of the calendar year after the
  calendar year of his/her Termination of Service, and the new commencement
  date ... [check one]:

  

 

1.   ý      will

2.   o      will not

 

... be treated as a new Benefit Starting Date for purposes of the
Plan.  [NOTE:  The option to stop minimum distributions does
not apply to a Participant who is a more than five-percent owner in the Plan
Year ending in the calendar year in which he/she attains age 701⁄2.]

 

Combined Plan Limit

 

Explanation:  Code § 415(e) previously imposed
a “combined plan limit” if an employer maintained both a defined contribution
plan and a defined benefit plan.  This
limit was repealed effective for Limitation Years beginning on or after January
1, 2000.  However, the Plan voluntarily
may have continued to apply the limit until it is amended for GUST.

 

Election:  The Plan eliminated the combined
plan limit effective as of the first Limitation Year beginning on or after ... [check one]:

 

	
  a.

  	
  o  January
  1, 2000.

  
	
  b.

  	
  o  the
  Amendment Effective Date of the Adoption Agreement that implements the
  changes required by GUST.

  
	
  c.

  	
  o              [a date
  between the dates specified in a. and b.]

  
	
  d.

  	
  ý  N/A –
  no Controlled Group Member has maintained a defined benefit plan after
  January 1, 2000, covering any Participant in this Plan.

  

 

76

 

ECONOMIC GROWTH AND TAX RELIEF RECONCILIATION ACT OF
2001

PLAN ADDENDUM

 

The Economic Growth and Tax Relief
Reconciliation Act of 2001 (“EGTRRA”) made a number of changes to the Plan –
some mandatory and some optional.  This
EGTRRA Addendum includes both the required changes to the Plan and the elective
provisions.

 

Use of this Addendum:  For a
Plan with an Original Effective Date prior to January 1, 2002, use this
Addendum to amend the Plan for the provisions of EGTRRA.  This Addendum must be adopted by the Lead
Employer by the end of the Plan Year beginning in 2002.  For a Plan with an Original Effective Date on
or after January 1, 2002, use this Addendum to supplement the Adoption
Agreement for plan options which are not reflected on the Adoption
Agreement.  This Addendum should be
adopted with the Adoption Agreement.

 

Preamble

 

1.     Adoption and effective date of
amendment.  Except as otherwise provided,
this Addendum shall be effective as of the first day of the first Plan Year
beginning after December 31, 2001 (or
the Plan’s Original Effective Date, if later). 
This Addendum is intended as good faith compliance with the requirements
of EGTRRA and is to be construed in accordance with EGTRRA and guidance issued
thereunder.

 

2.     Inconsistent provisions.  This Addendum shall supersede the provisions of
the Basic Plan Document and the Adoption Agreement to the extent those
provisions are inconsistent with the provisions of this Addendum.

 

Lead Employer Options

 

The following amendments reflect provisions of EGTRRA on
which choices are available to Lead Employers. 
Lead Employers must complete the following elections and sign this
Addendum on the final page.  If you do
not complete this Addendum, the default provisions of the Basic Plan Document
will continue to apply.

 

Plan Compensation

 

Explanation:  Tax law limits the amount of a Participant’s
earnings that can be considered for purposes of Plan contributions.  For the 2001 Plan Year, the limit was
$170,000.  Under EGTRRA, this limit was
increased to $200,000 in 2002, and will be adjusted for inflation in future
years.  This increase is not mandatory
and a Plan on a non-standardized adoption agreement may elect to remain at the
$170,000 limit indefinitely, with no adjustments for inflation.  However,
a Plan must use $200,000 (or the applicable yearly limit) for the purposes of
calculating Employer Safe-Harbor Matching or Safe-Harbor Profit Sharing
Contributions for Plan Years beginning on or after January 1, 2002.  Please
note that if the Lead Employer has otherwise limited Plan Compensation to a
specific dollar amount under Section E.2. of the Adoption Agreement, it may be
unnecessary to complete this election.

 

Election:  Plan Compensation.  Will the Plan limit Plan Compensation to
$170,000 for Plan Years beginning on or after January 1, 2002? ... [check if applicable]:

 

a.       o  Yes. [Note:  Not a valid
option for a Plan on a standardized adoption agreement.  This limit will not apply for the purposes of
Employer Safe-Harbor Matching or Safe-Harbor Profit Sharing Contributions.]

 

[NOTE:  Unless a. is checked above, the Plan
Compensation Limit will be $200,000 for the 2002 Plan Year and will continue to
be adjusted for cost of living increases in future years.  However, if the Lead Employer has limited
Plan Compensation under Section E.2.d. of the Adoption Agreement, that
limitation will continue to apply, regardless of the election made above.]

 

Rollovers Disregarded in Cash-Outs

 

Explanation:  Effective January 1, 2002, a Plan may opt to calculate an involuntary
cash-out amount by disregarding the balance of the Participant’s Employee
Rollover Account.  If this election is
made, the balance of the Participant’s Employee Rollover Account will not be
considered when determining if the Participant is subject to the cash-out.  For example, a Participant with an Employee
Rollover Account balance of $10,000 may be cashed-out of the Plan, provided the
balance of his/her other Plan Accounts is under the cash-out amount then in
effect for the Plan.

 

Election:  Treatment of Employee Rollover Contributions
in the Application of the Cash-Out Provision. 
Does the Plan exclude Employee Rollover Contributions (and earnings
allocable thereto) in determining whether the Participant’s Benefit is

 

 

subject to involuntary cash-out? ...[check if applicable]:

 

a.     ý      Yes.  This rule applies to all ... [complete if applicable]:

1.   ý      distributions made after
December 31, 2001 [enter a date
no earlier than December 31, 2001]

2.   o      Participants who separated from service after            [enter a
date; date may be earlier than December 31, 2001]

 

[NOTE:  Employee Rollover Account balances will be
considered in determining cash-outs unless a. is checked above.  If a. is checked, but neither 1. nor 2. is
completed, the new rule will apply as of the first day of the Plan Year in
which this Addendum is signed.]

 

Rollovers

 

Explanation:  A Plan that accepts rollover contributions will
accept rollovers from qualified plans and conduit IRAs.  Starting
with the first Plan Year beginning after December 31, 2001, a Plan may accept rollover contributions and direct
rollovers from additional retirement savings vehicles – 403(b) plans, certain
457 plans, non-conduit IRAs (but only those amounts attributable to pre-tax or
deductible contributions to the IRA), and rollovers of after-tax contributions
to a retirement plan.  If the Plan elects
to receive after-tax contributions, the Plan must separately account for such
amounts in order to track basis.  In
addition, the basis rules are different for certain after-tax contributions,
depending when made.

 

Election:  Additional Rollover Sources.  Specify the additional sources from which the
Plan will accept rollovers ... [check each of
a. through d. that applies]:

 

a.                    ý            Annuity contracts described
in Code § 403(b).

b.                   ý            Code § 457(b) plans
maintained by a state, political subdivision of a state, or any agency or
instrumentality of a state or political subdivision of a state.

c.                    ý            IRAs described in Code §
408(a) or (b) (to the extent the distribution that is eligible to be rolled
over is otherwise includible in gross income).

d.                   o            After-tax contributions
to Code § 401(a) or 403(a) plan (excluding after-tax IRA and Roth IRA
contributions).

 

[NOTE: 
Plans that elected to accept rollover contributions in the Adoption
Agreement will automatically accept rollover contributions from qualified plans
and conduit IRAs.  If you do not complete
this election, rollover contributions will not be accepted from the new sources
described in a. through d. above.]

 

Special
Effective Date [complete if any of
a. through d. above are checked]:

This provision will be effective as of January 1, 2002 [month, day, year].  [NOTE:  If the effective date is not specified, this
provision will be effective on the first day of the Plan Year in which this
Addendum is signed.]

 

Suspension Period Following Hardship Distribution

 

Explanation:  Effective January 1, 2002, Plans may impose a 6 month pre-tax and
after-tax deferral suspension period following a hardship withdrawal made after
December 31, 2001.  (Prior to January 1,
2002, the Plan imposed a twelve month suspension period following a
hardship.)  This change is mandatory for
safe-harbor plans within the meaning of Code § 401(k)(12) and 401(m)(11) (plans
that avoid ADP and ACP testing by making 100% vested matching or profit sharing
contributions to the Plan under Article H. of the Adoption Agreement).

 

Election 1:  Will the Plan impose a 6 month suspension
period following a hardship withdrawal made after December 31, 2001? ... [check if applicable]:

 

a.       ý    Yes.

 

[NOTE: 
The suspension period will be 12 months unless a. is checked above.  However, if this Plan is a safe-harbor plan
under Article H. of the Adoption Agreement, the suspension period will be 6
months regardless of your election above.]

 

Explanation:  Plans may also limit the suspension period for a hardship withdrawal
taken in 2001 to the later of 6 months after receipt of the distribution or
January 1, 2002.  A Plan with an Original
Effective Date on or after January 1, 2002, should not complete this election.

 

Election 2:  Will the Plan shorten the suspension period
imposed following a hardship withdrawal made in 2001 to the later of 6 months
after the receipt of the hardship distribution or January 1, 2002? ...[check if applicable]:

 

a.       o    Yes.

 

[NOTE: 
The suspension period following hardship withdrawals made in 2001 will
be 12 months unless a. is checked above.]

 

 

Vesting Schedule

 

Explanation:  For Plan Years beginning on or after January 1,
2002, Plans are required to vest Participants in their Matching Contributions
at least as quickly as a six-year graded schedule or a three-year cliff
schedule.  This change is required for
all Matching Contributions on Elective Deferrals made after January 1,
2002.  For a Plan in existence prior to
2002, the vesting schedule elected below (if different) replaces the vesting
schedule elected in Section I.11. of the Adoption Agreement for all Matching
Contributions made for Plan Years beginning on or after January 1, 2002.  For a Plan with an Original Effective Date on
or after January 1, 2002, the vesting schedule elected below applies to all
Matching Contributions made to the Plan and Section I.11. of the Adoption
Agreement does not apply.

 

Election 1: Vesting Schedule for Employer
Matching Contributions.  A Participant’s
vested percentage in his/her Employer Regular Matching Contributions made for
Plan Years beginning on or after January 1, 2002 will be ... [check one]:

 

a.                    o            100% at all times.

b.                   o            determined under the following schedule ... [complete as desired]:

 

	
  Years
  of Service

  	
   

  	
  Vested Percentage

  	
   

  	
   

  	
   

  
	
  0

  	
   

  	
  0

  	
  %

  	
   

  	
   

  
	
  1

  	
   

  	
   

  	
  %

  	
   

  	
   

  
	
  2

  	
   

  	
   

  	
  %

  	
  [20% or more]

  	
   

  
	
  3

  	
   

  	
   

  	
  %

  	
  [40% or more]

  	
   

  
	
  4

  	
   

  	
   

  	
  %

  	
  [60% or more]

  	
   

  
	
  5

  	
   

  	
   

  	
  %

  	
  [80% or more]

  	
   

  
	
  6 or more

  	
   

  	
  100

  	
  %

  	
   

  	
   

  

 

c.       o    determined under the following schedule ... [complete as desired]:

 

	
  Years
  of Service

  	
   

  	
  Vested Percentage

  	
   

  
	
  0

  	
   

  	
  0

  	
  %

  
	
  1

  	
   

  	
   

  	
  %

  
	
  2

  	
   

  	
   

  	
  %

  
	
  3

  	
   

  	
  100

  	
  %

  

 

d.      o    vesting schedule in Section I.11. of the
Adoption Agreement complies with (a), (b) or (c). [Note:  Not a
valid option for a Plan with an Original Effective Date on or after January 1,
2002.]

 

[NOTE: 
If the Plan matches Employee Catch-up Contributions, those matching
contributions will also vest on the schedule listed above.  If the Lead Employer does not complete this
election and the Plan’s vesting schedule does not satisfy the new requirements,
a graded vesting schedule will be deemed to be a six year graded schedule (20%
per year, starting at two years of Service) and a cliff vesting schedule will
be deemed to be a three year cliff schedule (with full vesting at 3 years of
Service).]

 

Explanation:  Plans may also apply the vesting schedule
elected above to past Employer Regular Matching Contributions and to Employer
Regular Profit Sharing Contributions for all Active Participants.  Plans with an Original Effective Date on or
after January 1, 2002, should not complete Election 2.  For a Plan with an Original Effective Date
prior to January 1, 2002, the Elections below will replace the applicable
elections in the Adoption Agreement, if different, including Sections I.11. and
J.9. of the Adoption Agreement.  If the
revised schedule is not applied to past matching contributions, a separate
source will be required to track the vested percentage of the pre-2002 and
post-2001 Matching Contributions.

 

Election 2:  Other Contributions.  Specify the other contributions (which are currently subject to a vesting
schedule), if any, to which the revised
vesting schedule will apply ... [check a., or
each of b. and c. that applies]:

 

a.                    o            N/A - the revised vesting schedule only applies
to Employer Regular Matching Contributions made for Plan Years beginning on or
after January 1, 2002.

b.                   o            all Employer Regular Matching Contributions,
whenever made.

c.                    o            also to Employer Regular Profit Sharing
Contributions ... [check one]:

 

1.   o                 whenever made.

2.   o                 made for Plan Years beginning on or after
January 1, 2002.

 

[NOTE: 
Unless b. or c. is checked above, the revised vesting schedule will only
apply to Matching Contributions made for Plan Years beginning on or after
January 1, 2002.  If b. or c. is checked
above, the revised vesting schedule will only apply to the specified accounts
of Participants who are Active Participants at some time during the 2002 Plan
Year.  If vesting occurs at a slower rate
under the revised schedule, the election provisions of Plan section 10.2(k)
will apply.]

 

 

Employee Catch-up Contributions

 

Explanation:  Effective January 1, 2002, a Plan may now
allow Participants age 50 or over (plus those projected to attain age 50) in
the applicable year to make additional pre-tax contributions (“Employee
Catch-up Contributions”) to the Plan when the Participant’s pre-tax
contributions are otherwise limited under the Plan or by law.  However, if a Plan allows for Employee
Catch-up Contributions, all plans in the Controlled Group that allow for
pre-tax contributions must generally provide Participants with the same
“effective opportunity” to make Employee Catch-up Contributions.

 

Election 1:  Employee Catch-up Contributions.  Will Employee Catch-up Contributions be
allowed under this Plan? ... [check one]:

 

a.                    o  No.

b.                   ý  Yes.  This provision will be effective as of ... [check one]:

 

1.   o      January 1, 2002.

2.   o      The first day of the Plan Year beginning            [specify
date no earlier than January 1, 2002].

3.
  ý      Other December 1, 2002 [specify date no earlier than January 1, 2002].

 

[NOTE:  The Plan will not accept Employee Catch-up
Contributions unless b. is checked above.  Employee Catch-up Contributions will
generally be subject to the same administrative options and requirements that
apply to Employee Pre-Tax Contributions under the Plan (e.g., the dates as of
which a pay reduction agreement may be modified, etc.).]

 

Election 2:  Maximum Contributions.  Employee Catch-up Contributions will be limited to
...[complete if applicable]:

 

a.       o  A maximum of
      % of Plan Compensation each payroll period.

 

[NOTE:  In addition to any percentage limit on
contributions elected above, Employee Catch-up Contributions will be limited to
the dollar amount for the applicable year under the tax laws.]

 

Employer Catch-up Matching Contributions

 

Explanation:  Plans that allow Employee Catch-up
Contributions may decide to match those contributions.  While Employee Catch-up Contributions are
generally exempt from the Plan’s testing requirements, including the Actual
Deferral Percentage Test, any matching contributions made on these Employee
Catch-up Contributions will be considered in the Plan’s testing.  Employer Catch-up Matching Contributions will
be allocated in the same manner and under the same formula as other Employer
Regular Matching Contributions (or Employer Safe-Harbor Matching Contributions)
made under the Plan.

 

Election:  Employer Catch-up Matching Contributions.  Will the Plan match Employee Catch-up
Contributions? ... [check one]:

 

a.                    o       No.

b.                   ý       Yes.  This provision will be effective as of ... [check one]:

 

1.   o      January 1, 2002.

2.   o      The first day of the Plan Year beginning            [specify
date no earlier than January 1, 2002].

3.
  ý      Other December 1 2002 [specify date no earlier than January 1, 2002].

 

[NOTE: Employer
Catch-up Matching Contributions will not be made unless b. is checked above.
Employer Catch-up Matching Contributions will be determined under the same
formula used for Employer Regular Matching Contributions (or Employer Safe-Harbor
Matching Contributions) .]

 

Mandatory Plan Amendments

 

The following amendments are mandatory changes to your Basic
Plan Document as a result of EGTRRA. 
Although you do not have to make any choices on these provisions, you
should read through the changes to see how they affect your Plan.

 

Section 2.56(f) – Plan Compensation

 

Effective January 1, 2002, Plan Section 2.56(f) is
amended to add the following sentence at the end of the subsection:

 

If
so specified in the Adoption Agreement (or addendum thereto), for Plan Years
beginning on or after January 1, 2002, Plan Compensation will be limited to
$170,000, the Code § 401(a)(17) limit in effect for 2001.

 

 

Section 2.70 - Termination of Service

 

Effective for distributions made after December 31,
2001, Plan Section 2.70 is amended to replace the words “separation from
service” with the words “severance from employment”.  In addition, the following sentence is added
to the end of the section:

 

The
“severance from employment” standard applies to all distributions made after
December 31, 2001, regardless of when the severance from employment occurred.

 

Section 4.1 – Pre-Tax
Contributions

 

Effective January 1, 2002, Plan Section 4.1(e) is
amended to add the following to the end of the subsection:

 

However, the limit in this subsection does not apply to
any contributions permitted by the Plan and specified in the Adoption Agreement
(or addendum thereto) which are subject to Code § 414(v).

 

Effective January 1, 2002, Plan Section 4.1 is amended
to add a new subsection (i) to read as follows:

 

(i)    Employee Catch-up
Contributions.  If so specified in the Adoption
Agreement (or addendum thereto), an eligible Active Participant may elect to
have his/her Plan Compensation further reduced to make additional pre-tax
contributions to the Plan, as provided in Code § 414(v) and regulations
thereunder.  Such additional
contributions are Employee Catch-up Contributions.  To be eligible to make Employee Catch-up
Contributions, the Active Participant must be otherwise eligible to make
Employee Pre-Tax Contributions and must be age 50 or older.  For purposes of this rule, a Participant who
is projected to attain age 50 before the end of a calendar year is deemed to be
age 50 as of January 1 of that year.

 

Except to the extent required by applicable regulations,
such Employee Catch-up Contributions shall not be taken into account for
purposes of the provisions of the Plan implementing the required limitations of
Code § 401(a)(30) and 415(c).  The
Plan shall not be treated as failing to satisfy the provisions of the Plan
implementing Code § 401(k)(3), 401(a)(4), 401(k)(3), 401(k)(11), 410(b) or
416, as applicable, by reason of allowing such Employee Catch-up Contributions.

 

Employee
Catch-up Contributions may not exceed the limit in effect under Code § 414(v)
for such taxable year.  All Catch-up
Contributions made by the Participant to any qualified plan or Code § 403(b),
408(k) or 408(p) plan sponsored by a Controlled Group Member will be aggregated
for purposes of this limit.

 

Employee Catch-up Contributions under the Plan will be
administered in accordance with Code § 414(v) and any applicable
regulations or other IRS guidance thereunder.

 

Employee
Catch-up Contributions will be subject to the same administrative options and requirements
that apply to Employee Pre-Tax Contributions, as specified in the Adoption
Agreement or other Plan procedures.

 

Section 4.5 – Rollover Contributions

 

Effective January 1, 2002, Plan Section 4.5 is amended
to replace the second paragraph with the following:

 

An “Employee Rollover Contribution” means a rollover
contribution or rollover amount from another qualified plan or “conduit”
individual retirement account described in Code § 401(a)(31), 402(c), 403(a)(4)
or 408(d)(3), or an elective transfer described in Treas. Reg. §
1.411(d)-4(Q&A-3), as allowed under the Code as in effect on December 31,
2001.  As of the first day of the Plan
Year beginning in 2002, or any later date that may be indicated in the Adoption
Agreement (or addendum hereto), “Employee Rollover Contribution” also includes
rollover contributions from the sources, if any, specified in the Adoption
Agreement (or addendum thereto).

 

Section 5.2 – Regular Matching Contributions

 

Effective January 1, 2002, Plan Section 5.2 is amended to
add a new subsection (h) to read as follows:

 

(h)   Matching Employee Catch-up Contributions.  If so specified in the Adoption Agreement (or
addendum thereto), the Employer will make Employer Catch-up Matching
Contributions on the Employee Catch-up Contributions made under the Plan.  Employer Catch-up Matching Contributions will
be allocated in the same manner as Employer Regular Matching Contributions (or
Employer Safe-Harbor Matching Contributions). 
Any such Employer Catch-up Matching Contributions under the Plan will be
administered in accordance with Code § 414(v) and any applicable
regulations or other IRS guidance thereunder.

 

 

Section 10.2 – Vesting Schedule for Employer Regular
Matching Contributions

 

Effective January 1, 2002, Plan Section 10.2 is amended
to add a new subsection (n) to read as follows:

 

(n)         Vesting of Employer
Matching Contributions.  Notwithstanding
any provision of the Plan to the contrary, all Employer Regular and Catch-up
Matching Contributions made for Plan Years beginning on or after January 1,
2002, shall vest as specified in the Adoption Agreement (or addendum thereto),
provided such vesting schedule satisfies the requirements of Code
§ 411(a).  If the specified vesting
schedule does not satisfy the requirements of Code § 411(a), a graded
vesting schedule will be deemed to be a six year graded schedule (20% per year,
starting at 2 years of Service) and a cliff vesting schedule will be deemed to
be a three year cliff schedule (with full vesting at 3 years of Service).

 

If and to the extent so specified in the Adoption
Agreement (or addendum thereto), the vesting schedule required by Code
§ 411(a) will be applied to other Contribution Accounts, including
Employer Regular Matching Contributions made for Plan Years beginning prior to
January 1, 2002, and Employer Regular Profit Sharing Contributions.

 

Section 11.2(b) – Suspension Period following Hardship
Distribution

 

Effective January 1, 2002, Plan Section
11.2(b)(3)(B)(iii) is amended to add the following paragraph:

 

If so specified in the Adoption Agreement (or addendum
thereto), for withdrawals made on or after January 1, 2002, the Participant’s
Pre-Tax and After-Tax Contributions, Elective Deferrals and other voluntary
contributions will be suspended for a period of six months after such
withdrawal.  For Plans that are
safe-harbor plans within the meaning of Code § 401(k)(12) or 401(m)(11), the
suspension period is six months after such withdrawal.  For withdrawals made in 2001, the suspension
period will be the later of 6 months after the receipt of the distribution or
January 1, 2002, if so specified in the Adoption Agreement (or addendum
thereto).

 

Effective January 1, 2002, Plan Section
11.2(b)(3)(B)(iv) is amended to add the following paragraph:

 

Effective January 1, 2002, this paragraph (iv) shall
cease to apply to this Plan.

 

Section 11.3(g) - Plan Loans for Owner-Employees and
Shareholder Employees

 

Plan Section 11.3(g), prohibiting Plan loans to any
owner-employee or shareholder-employee, shall cease to apply effective for Plan
loans made after December 31, 2001.

 

Section 12.4 – Cash-Out of Small Benefits

 

Effective January 1, 2002, Plan Section 12.4 is amended
to add the following paragraph:

 

If so specified in the Adoption Agreement (or addendum
thereto), Benefits attributable to Employee Rollover Contributions, and
earnings thereon, shall be disregarded in determining the cash-out amount.

 

Section 12.8 – Direct Rollovers

 

Effective for distributions made after December 31,
2001, Plan Section 12.8(c)(1) is amended to replace subsections (C) and (D) as
follows:

 

(C)        Any distribution to the extent such a distribution
is attributable to a Hardship.

 

(D)       Any portion of a distribution shall not fail to be
an Eligible Rollover Distribution merely because the portion consists of
after-tax employee contributions which are not includible in gross income.  However, such portion may be transferred only
to an individual retirement account or annuity described in Code § 408(a) or
(b), or to a qualified defined contribution plan described in Code § 401(a) or
403(a) that agrees to separately account for amounts so transferred, including
separately accounting for the portion of such distribution which is includible
in gross income and the portion of such distribution which is not so
includible.

 

Effective for distributions made after December 31,
2001, Plan Section 12.8(c)(3) is amended to read as follows:

 

(3)          “Eligible Retirement Plan” – means an individual
retirement account described in Code § 408(a), an individual retirement annuity
described in Code § 408(b), an annuity plan described in Code § 403(a), a
qualified trust described in Code § 401(a), an annuity contract described in
Code § 403(b), an eligible plan under Code § 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 and which agrees to separately
account for amounts transferred into such plan from this Plan, or any other
plan

 

 

or account allowed under future legislation or
regulation that accepts the Eligible Rollover Distribution.  The definition of Eligible Retirement Plan
also applies in the case of a distribution to a surviving spouse, or to a
spouse or former spouse who is the alternate payee under a qualified domestic
relations order, as defined in Code § 414(p).

 

Section 12.17 – Special Distribution Provisions

 

Effective January 1, 2002, Plan Section 12.17 is amended
to add the following sentence to the end of the section:

 

Effective January 1, 2002, subsections (b) and (c) shall
cease to apply to this Plan.

 

Article XVII – Top-Heavy Rules

 

For Plan Years beginning after December 31, 2001, Plan
Section 17.1(a) is amended to add the following paragraph:

 

As of the first day of the Plan Year beginning on or
after January 1, 2002, Employer Regular and Catch-up Matching Contributions
under this Plan (and employer matching contributions under any other plan whose
contributions are to be used to satisfy the requirements of this section) may
be used to satisfy the minimum amount of employer contributions which must be
allocated under this section.  Matching
Contributions that are used to satisfy the requirements of this section shall
be treated as Employer Regular and Catch-up Matching Contributions for purposes
of the Actual Contribution Percentage Test and other requirements of Code
§ 401(m).

 

For Plan Years beginning after December 31, 2001, Plan
Section 17.1(b) is amended to add a new paragraph (7) to read as follows:

 

(7)          As of the first day of
the Plan Year beginning on or after January 1, 2002, this Article XVII shall
not apply in any year in which the Plan consists solely of a cash or deferred
arrangement which meets the requirements of Code § 401(k)(12) and Safe-Harbor
Matching Contributions with respect to which the requirements of Code
§ 401(m)(11) are met.

 

For Plan Years beginning after December 31, 2001, Plan
Section 17.4(b) is amended to read as follows:

 

(b)         Key Employee – means any individual
defined as such in Code § 416(i); generally, any Employee or former Employee
(including the Beneficiary of a deceased Employee or former Employee) who at
any time during the Plan Year that includes the Determination Date was:

 

(1)          An officer having Top-Heavy Compensation greater
than $130,000 (as adjusted under Code § 416(i)(1) for Plan Years beginning
after December 31, 2002).

 

(2)          A five-percent owner.

 

(3)          A one-percent owner who has Top-Heavy Compensation
of more than $150,000.

 

The determination of who is a Key Employee will be
made in accordance with Code § 416(i)(1) and the applicable regulations and
other guidance of general applicability issued thereunder.

 

For Plan Years beginning after December 31, 2001, Plan
Section 17.4(l) is amended to add a new paragraph (5) to read as follows:

 

(5)          As of the first day of the Plan Year beginning on
or after January 1, 2002, any distribution due to severance from employment,
death or disability which was made prior to the one-year period ending on the
Determination Date shall be disregarded for purposes of applying the top-heavy
rules.  Paragraphs (1) and (2) of this
subsection shall also apply to distributions under a terminated plan which, had
it not been terminated, would have been aggregated with this Plan under Code §
416(a)(2)(A)(i).  If an individual has
not performed services for the employer at any time during the one-year period
ending on the Determination Date, any account balance or accrued benefit for such
individual shall not be taken into account.

 

Section 18.4(a) – Annual Additions

 

Effective January 1, 2002, Plan Section 18.4(a) is
amended to add the following paragraph:

 

Annual Additions do not include any Employee Rollover
Contribution made to this Plan.  For Plan
Years commencing in 2002 or later, any contributions to the Plan determined to
be Employee Catch-up Contributions under Code § 414(v) are not Annual
Additions.

 

 

Section 18.4(j) – Maximum Permissible Amount

 

For Limitation Years beginning after December 31, 2001,
Plan Section 18.4(j) is amended to read as follows:

 

(j)             Maximum Permissible
Amount –
means the maximum Annual Addition that may be contributed or allocated to a
Participant’s Contribution Accounts under the Plan for any Limitation Year,
which (except to the extent permitted under Code § 414(v), if applicable)
will not exceed the lesser of:

 

(1)          $40,000, (as adjusted for increases in the
cost-of-living under Code § 415(d)).

 

If a short Limitation Year is created because of
an amendment changing the Limitation Year to a different
twelve-consecutive-month period, the dollar limit above will be multiplied by
the number of months (full months) in the short Limitation Year and divided by
12.

 

(2)          100% of the Participant’s 415 Compensation for the
Limitation Year.

 

The limitation referred to in paragraph (2) will
not apply to any contribution for medical benefits (within the meaning of Code
§ 401(h) or 419A(f)(2)) which is otherwise treated as an Annual Addition under
Code § 415(l)(1) or 419A(d)(2).

 

Section 19.4 – Multiple Use Test

 

Effective January 1, 2002, Plan Section 19.4 is amended
to add a new subsection (c) to read as follows:

 

(c)          This section will not
apply to any Plan Years beginning on or after January 1, 2002.

 

Section 19.6(h) – Excess Deferrals

 

Effective January 1, 2002, Plan Section 19.6(h) is
amended to add the following sentence to the end of the subsection:

 

However, in determining Excess Deferrals, any
contributions to the Plan subject to Code § 414(v) shall be disregarded.

 

Lead Employer Signature

 

IN WITNESS WHEREOF, the Lead Employer has caused this EGTRRA Addendum to be adopted
effective as of the date specified below.

 

You should consult with an attorney or other independent
qualified advisor as to the legal and tax effect of adopting this Addendum.

 

 

	
  Date
  signed:

  	
   

  	
   

  	
  Lead
  Employer:  Clayton Williams Energy, Inc.

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  By:

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
    Name [print]:

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
    Its [title]:

  	
   

  
							

 

 

REQUIRED MINIMUM DISTRIBUTIONS ADDENDUM

 

Model Amendments for the 2001 Proposed Regulations and
the 2002 Final Regulations Under Code Section 401(a)(9)

 

 

This Required Minimum Distributions Addendum amends the
required minimum distribution provisions of the Basic Plan Document as provided
for by the 2001 Proposed Regulations and as required by the 2002 Final
Regulations under Code § 401(a)(9). 
In addition, the Addendum documents the choices made by a Plan while
transitioning to the 2002 Final Regulations.

 

Read the instructions in Sections I. – IV. of this
Addendum to determine which sections you need to complete.  Even if you do not complete Sections I. –
IV., read the 2002 Final Regulations Plan Amendment which appears at the end of
this Addendum and sign the Addendum, where indicated, to adopt this amendment.

 

Preamble

 

1.              Adoption
of amendment.  The provisions in
Section I. of this Addendum, if applicable to the Plan, must be adopted by the
later of December 31, 2002, or the end of the Plan’s GUST remedial amendment
period.  The provisions in the remainder
of the Addendum must be adopted no later than the last day of the first Plan
Year beginning on or after January 1, 2003.

 

2.              Inconsistent
provisions.  This Addendum shall
supersede the provisions of the Basic Plan Document and the Adoption Agreement
to the extent those provisions are inconsistent with the provisions of this
Addendum.

 

Section I. – The 2001 Proposed Regulations

 

Complete this Section I. if any required minimum
distributions for the 2001 calendar year were determined by the Plan based on
the 2001 Proposed Regulations.  Do not
complete Section I. if the Plan used the 1987 Proposed Regulations to determine
all minimum distributions for 2001.  In
addition, do not complete Section I. if your Plan’s Original Effective
Date is on or after January 1, 2002, or if the Plan has already been amended
for GUST.

 

Explanation:  In 2001, the IRS issued revised
proposed regulations under Code § 401(a)(9), relating to required minimum
distributions from retirement plans (the “2001 Proposed Regulations”).  Under the terms of this Plan, required minimum
distributions for calendar year 2002 will be determined in accordance with the
2001 Proposed Regulations.  The following
model amendment shall apply:

 

With respect to distributions under the Plan made for calendar years
beginning on or after January 1, 2002, the Plan will apply the minimum
distribution requirements of Code § 401(a)(9) in accordance with the
regulations under Code § 401(a)(9) that were proposed on January 17, 2001,
notwithstanding any provision of the Plan to the contrary.  This amendment shall continue in effect until
the end of the last calendar year beginning before the effective date of final
regulations under Code § 401(a)(9) or such other date as may be specified
in guidance published by the Internal Revenue Service.

 

However, in determining required minimum distributions for the 2001
calendar year, a Plan may have relied on either the regulations under Code
§ 401(a)(9) that were proposed in 1987 (the “1987 Proposed Regulations”)
or the 2001 Proposed Regulations.  If the
Plan determined minimum distributions based on the 2001 Proposed Regulations
for the 2001 calendar year, specify whether it did so ... [check one if applicable]:  [NOTE:  Do not
complete this Section I. if you are completing this Addendum following the
close of the Plan’s GUST remedial amendment period, if the Plan’s Original
Effective Date is on or after January 1, 2002, or if the Plan determined all
2001 minimum distributions under the 1987 Proposed Regulations.]

 

a.               o            For the entire 2001 calendar year (in which
case January 1, 2001 is substituted for January 1, 2002 in the model amendment
above, as it applies to your Plan); or

 

b.              o            For only part of the 2001 calendar year.  Specify the date during the 2001 calendar
year as of which you began to apply the 2001 Proposed Regulations:
              
[month, day, year].

 

If you selected this option, the following model amendment applies to
your Plan:

 

 With respect to distributions under the Plan made on or after
              
for calendar years beginning on or after January 1, 2001, the Plan will apply
the minimum distribution requirements of Code § 401(a)(9) in accordance
with the regulations under Code § 401(a)(9) that were proposed on January
17, 2001 (the 2001 Proposed Regulations), notwithstanding any provision of the Plan
to the contrary.  If the total amount of
required minimum distributions made to a Participant for 2001 prior to
              

 

 

are equal to or greater than the amount of required minimum
distributions determined under the 2001 Proposed Regulations, then no
additional distributions are required for such Participant for 2001 on or after
such date.  If the total amount of
required minimum distributions made to a Participant for 2001 prior to
              
are less than the amount determined under the 2001 Proposed Regulations, then
the amount of required minimum distributions for 2001 on or after such date
will be determined so that the total amount of required minimum distributions
for 2001 is the amount determined under the 2001 Proposed Regulations.  This amendment shall continue in effect until
the last calendar year beginning before the effective date of the final
regulations under Code § 401(a)(9) or such other date as may be published
by the Internal Revenue Service.

 

Section II. – The 2002 Final Regulations

 

Complete this Section II. if the Plan began calculating
required minimum distributions under the 2002 Final Regulations for the 2002
calendar year.

 

Explanation:  In accordance with Section I. of this
Addendum, required minimum distributions for the 2002 calendar year are
determined based on the 2001 Proposed Regulations.  However, in 2002, the IRS issued final
regulations under Code § 401(a)(9) (the “2002 Final Regulations”) which
will be effective for the Plan on January 1, 2003, or the Plan’s Original
Effective Date, if later.  In addition, a
Plan may elect to apply the 2002 Final Regulations to required minimum
distributions it made for 2002.  If the
Plan determined distributions for 2002 under the 2002 Final Regulations, you
must complete the following election and contact Scudder Trust Company
immediately to insure that payments for 2002 are processed correctly.

 

Election 1:  If the Plan determined minimum
distributions for all or part of the 2002 calendar year based on the 2002 Final
Regulations, check the box below and specify the date as of which the Plan
began operating under the 2002 Final Regulations ... [check if applicable]:

 

a.               o            The Plan determined required minimum
distributions for the 2002 calendar year based on the 2002 Final Regulations, beginning
with minimum distributions made on or after
              
[month, day, year], and the 2001
Proposed Regulations applied to any minimum distributions for the 2002 calendar
year made prior to that date.

 

Section III. – Elections Under the 2002 Final
Regulations

 

Complete this Section III. if the Plan will modify the
default rules for calculating required minimum distributions which apply under
the 2002 Final Regulations.

 

Explanation:  The following elections must be
completed if the Plan wishes to modify the default requirements in sections 2.2
and 4.2 of the 2002 Final Regulations Plan Amendment at the end of this
Addendum.  The default rules under the
2002 Final Regulations require that if the Participant has a designated
Beneficiary, distributions will be made in accordance with the life expectancy
rules in Code § 401(a)(9)(B)(iii) and (iv) and if the Participant does not
have a designated Beneficiary, distributions will be made in accordance with
the 5-year rule in Code § 401(a)(9)(B)(ii).

 

Election 2:  A Plan may elect to modify the
default requirements to apply the 5-year rule in Code § 401(a)(9)(B)(ii)
to all distributions, even if the Participant has a designated Beneficiary.  Alternatively, the Plan may elect to apply
the 5-year rule only to certain distributions to a designated Beneficiary, as
described below.

 

Election to Apply 5-Year Rule to Distributions to
Designated Beneficiaries
... [check if applicable]:

 

a.               o            If the Participant dies before distributions
begin and there is a designated Beneficiary, distribution to the designated
Beneficiary is not required to begin by the date specified in section 2.2 of
the following amendment, but the Participant’s entire interest will be
distributed to the designated Beneficiary by December 31 of the calendar year
containing the fifth anniversary of the Participant’s death. If the
Participant’s surviving Spouse is the Participant’s sole designated Beneficiary
and the surviving Spouse dies after the Participant but before distributions to
either the Participant or the surviving Spouse begin, this election will apply
as if the surviving Spouse were the Participant.  This election will apply to ... [check one]:

 

1.               o            All distributions.

 

2.               o            The following distributions:
              
[complete].

 

Election 3:  Alternatively, a Plan may permit
Participants or Beneficiaries to elect, on an individual basis, whether the
5-year rule in Code § 401(a)(9)(B)(ii) or the life expectancy rule in Code
§ 401(a)(9)(B)(iii) and (iv) applies to distributions after the death of a
Participant who has a designated Beneficiary.

 

 

Election to Allow Participants or Beneficiaries to
Elect 5-Year Rule ... [check if applicable]:

 

a.               o            Participants or Beneficiaries may elect on an
individual basis whether the 5-year rule or the life expectancy rule in
sections 2.2 and 4.2 of the following amendment applies to distributions after
the death of a Participant who has a designated Beneficiary. The election must
be made no later than the earlier of September 30 of the calendar year in which
distribution would be required to begin under section 2.2 of the following
amendment, or by September 30 of the calendar year which contains the fifth
anniversary of the Participant’s (or, if applicable, surviving Spouse’s) death.
If neither the Participant nor Beneficiary makes an election under this
paragraph, distributions will be made in accordance with sections 2.2 and 4.2
of the following amendment and, if applicable, the elections in Election 2
above.

 

Election 4:  As a result of the default rules
under the 1987 Proposed Regulations, some beneficiaries did not commence
distributions under the life expectancy rules. 
A Plan may allow a designated Beneficiary who is subject to the 5-year
rule under the 1987 Proposed Regulations to switch to the life expectancy rule.

 

Election to Allow Designated Beneficiary Receiving
Distributions Under 5-Year Rule to Elect Life Expectancy Distributions ... [check
if applicable]:

 

a.               o            A designated Beneficiary who is receiving
payments under the 5-year rule may make a new election to receive payments
under the life expectancy rule until December 31, 2003, provided that all
amounts that would have been required to be distributed under the life
expectancy rule for all distribution calendar years before 2004 are distributed
by the earlier of December 31, 2003 or the end of the 5-year period.

 

Section IV. – Installment Payments under the 2002 Final
Regulations

 

Complete this Section IV. if the Plan allows for
distributions in the form of installment payments and wishes to continue
determining installments based on the life expectancy tables contained in
Treas. Reg. § 1.72-9, instead of moving to the life expectancy tables in the
2002 Final Regulations.

 

Explanation:  Under the terms of this Plan, a Plan that
allows for distributions in the form of installments will determine future
installment payments by using the life expectancy tables contained in the 2002
Final Regulations instead of the tables contained in Treas. Reg. § 1.72-9.  The new tables will be applied to both former
employees currently receiving installment payments and to employees who begin
installment payments in the future. 
However, a Plan may elect to continue using the life expectancy tables
in Treas. Reg. § 1.72-9 for all such installments.

 

Election 5:  Will the Plan continue to use
the life expectancy tables contained in Treas. Reg. § 1.72-9 to determine
installment payments?  ... [check if applicable]:

 

a.               o            Yes.

 

[NOTE:  Unless a. is checked above, the Plan will
begin determining installments under the 2002 Final Regulation life expectancy
tables as of the date that the Plan otherwise begins determining minimum
distributions under the 2002 Final Regulations.]

 

2002 Final Regulations Plan Amendment

 

Section 1 –
General Rules.

 

1.1.                  Effective Date.  Unless
an earlier effective date is specified above, the provisions of this amendment
will apply for purposes of determining required minimum distributions for
calendar years beginning with the 2003 calendar year.

 

1.2.                  Coordination with Minimum Distribution
Requirements Previously in Effect. If the provisions above specify an effective date of this amendment
that is earlier than calendar years beginning with the 2003 calendar year,
required minimum distributions for 2002 under this amendment will be determined
as follows:  If the total amount of 2002
required minimum distributions under the Plan made to the distributee prior to
the effective date of this amendment equals or exceeds the required minimum
distributions determined under this amendment, then no additional distributions
will be required to be made for 2002 on or after such date to the distributee.
If the total amount of 2002 required minimum distributions under the Plan made
to the distributee prior to the effective date of this amendment is less than
the amount determined under this amendment, then required minimum distributions
for 2002 on and after such date will be determined so that the total amount of
required minimum distributions for 2002 made to the distributee will be the
amount determined under this amendment.

 

1.3.                  Precedence. The requirements of this amendment will take precedence over any
inconsistent provisions of the Basic Plan Document and the Adoption Agreement.

 

 

1.4.                  Requirements of Treasury Regulations
Incorporated. All distributions
required under this amendment will be determined and made in accordance with
the Treasury regulations under Code § 401(a)(9).

 

1.5.                  TEFRA Section 242(b)(2) Elections. Notwithstanding the other provisions of this
amendment, distributions may be made under a designation made before January 1,
1984, in accordance with section 242(b)(2) of the Tax Equity and Fiscal
Responsibility Act (TEFRA) and the provisions of the Plan that relate to
section 242(b)(2) of TEFRA.

 

Section 2 – Time and Manner of Distribution.

 

2.1.                  Required Beginning Date. The Participant’s entire interest will be
distributed, or begin to be distributed, to the Participant no later than the
Participant’s Required Beginning Date.

 

2.2.                  Death of Participant Before Distributions
Begin. If the Participant
dies before distributions begin, the Participant’s entire interest will be
distributed, or begin to be distributed, no later than as follows:

 

(a)                      If the Participant’s surviving Spouse is the
Participant’s sole designated Beneficiary, then, except as provided in Election
2 or 3 above, distributions to the surviving Spouse will begin by December 31
of the calendar year immediately following the calendar year in which the
Participant died, or by December 31 of the calendar year in which the Participant
would have attained age 70 1/2, if later.

 

(b)                     If the Participant’s surviving Spouse is not
the Participant’s sole designated Beneficiary, then, except as provided in
Election 2 or 3 above, distributions to the designated Beneficiary will begin
by December 31 of the calendar year immediately following the calendar year in
which the Participant died.

 

(c)                      If there is no designated Beneficiary as of
September 30 of the year following the year of the Participant’s death, the
Participant’s entire interest will be distributed by December 31 of the
calendar year containing the fifth anniversary of the Participant’s death.

 

(d)                     If the Participant’s surviving Spouse is the
Participant’s sole designated Beneficiary and the surviving Spouse dies after
the Participant but before distributions to the surviving Spouse begin, this
section 2.2, other than section 2.2(a), will apply as if the surviving Spouse
were the Participant.

 

For purposes of this section 2.2 and section
4, unless section 2.2(d) applies, distributions are considered to begin on the
Participant’s Required Beginning Date. If section 2.2(d) applies, distributions
are considered to begin on the date distributions are required to begin to the
surviving Spouse under section 2.2(a). If distributions under an annuity
purchased from an insurance company irrevocably commence to the Participant
before the Participant’s Required Beginning Date (or to the Participant’s
surviving Spouse before the date distributions are required to begin to the
surviving Spouse under section 2.2(a)), the date distributions are considered
to begin is the date distributions actually commence.

 

2.3.                  Forms of Distribution. Unless the Participant’s interest is
distributed in the form of an annuity purchased from an insurance company or in
a single sum on or before the Required Beginning Date, as of the first
distribution calendar year distributions will be made in accordance with
sections 3 and 4 of this amendment. If the Participant’s interest is
distributed in the form of an annuity purchased from an insurance company,
distributions thereunder will be made in accordance with the requirements of
Code § 401(a)(9) and the Treasury regulations.

 

Section 3 – Required Minimum Distributions During
Participant’s Lifetime.

 

3.1.                  Amount of Required Minimum Distribution For
Each Distribution Calendar Year.  During the Participant’s lifetime, the
minimum amount that will be distributed for each distribution calendar year is
the lesser of:

 

(a)                      the quotient obtained by dividing the
Participant’s Account balance by the distribution period in the Uniform
Lifetime Table set forth in Treas. Reg. § 1.401(a)(9)-9, using the
Participant’s age as of the Participant’s birthday in the distribution calendar
year; or

 

(b)                     if the Participant’s sole designated Beneficiary
for the distribution calendar year is the Participant’s Spouse, the quotient
obtained by dividing the Participant’s Account balance by the number in the
Joint and Last Survivor Table set forth in Treas. Reg. § 1.401(a)(9)-9, using
the Participant’s and Spouse’s attained ages as of the Participant’s and
Spouse’s birthdays in the distribution calendar year.

 

3.2.                  Lifetime Required Minimum Distributions
Continue Through Year of Participant’s Death.  Required minimum distributions
will be determined under this section 3 beginning with the first distribution
calendar year and up to and including the distribution calendar year that
includes the Participant’s date of death.

 

 

Section 4 – Required Minimum Distributions After
Participant’s Death.

 

4.1.                  Death On or After Date Distributions Begin.

 

(a)                      Participant Survived by Designated Beneficiary.  If
the Participant dies on or after the date distributions begin and there is a
designated Beneficiary, the minimum amount that will be distributed for each
distribution calendar year after the year of the Participant’s death is the
quotient obtained by dividing the Participant’s Account balance by the longer
of the remaining life expectancy of the Participant or the remaining life
expectancy of the Participant’s designated Beneficiary, determined as follows:

 

(1)                                  The Participant’s remaining life expectancy is
calculated using the age of the Participant in the year of death, reduced by
one for each subsequent year.

 

(2)                                  If the Participant’s surviving Spouse is the
Participant’s sole designated Beneficiary, the remaining life expectancy of the
surviving Spouse is calculated for each distribution calendar year after the
year of the Participant’s death using the surviving Spouse’s age as of the
Spouse’s birthday in that year. For distribution calendar years after the year
of the surviving Spouse’s death, the remaining life expectancy of the surviving
Spouse is calculated using the age of the surviving Spouse as of the Spouse’s
birthday in the calendar year of the Spouse’s death, reduced by one for each
subsequent calendar year.

 

(3)                                  If the Participant’s surviving Spouse is not
the Participant’s sole designated Beneficiary, the designated Beneficiary’s
remaining life expectancy is calculated using the age of the Beneficiary in the
year following the year of the Participant’s death, reduced by one for each
subsequent year.

 

(b)                     No Designated Beneficiary. If the Participant dies on or after the date
distributions begin and there is no designated Beneficiary as of September 30
of the year after the year of the Participant’s death, the minimum amount that
will be distributed for each distribution calendar year after the year of the
Participant’s death is the quotient obtained by dividing the Participant’s
Account balance by the Participant’s remaining life expectancy calculated using
the age of the Participant in the year of death, reduced by one for each
subsequent year.

 

4.2.                  Death Before Date Distributions Begin.

 

(a)                      Participant Survived by Designated Beneficiary. Except as provided in Election 2 or 3 above,
if the Participant dies before the date distributions begin and there is a
designated Beneficiary, the minimum amount that will be distributed for each
distribution calendar year after the year of the Participant’s death is the
quotient obtained by dividing the Participant’s Account balance by the
remaining life expectancy of the Participant’s designated Beneficiary,
determined as provided in section 4.1.

 

(b)                     No Designated Beneficiary. If the Participant dies before the date
distributions begin and there is no designated Beneficiary as of September 30
of the year following the year of the Participant’s death, distribution of the
Participant’s entire interest will be completed by December 31 of the calendar
year containing the fifth anniversary of the Participant’s death.

 

(c)                      Death of Surviving Spouse Before Distributions
to Surviving Spouse Are Required to Begin. If the Participant dies before the date distributions begin, the
Participant’s surviving Spouse is the Participant’s sole designated
Beneficiary, and the surviving Spouse dies before distributions are required to
begin to the surviving Spouse under section 2.2(a), this section 4.2 will apply
as if the surviving Spouse were the Participant.

 

Section 5 –
Definitions.  As used in this Addendum, the following terms
shall have the following meanings:

 

5.1.                  Designated Beneficiary.  The
individual who is designated as the Beneficiary under Plan Article XIII and is
the designated Beneficiary under Code § 401(a)(9) and Treas. Reg.
§ 1.401(a)(9)-1, Q&A-4.

 

5.2.                  Distribution calendar year.  A
calendar year for which a minimum distribution is required. For distributions
beginning before the Participant’s death, the first distribution calendar year
is the calendar year immediately preceding the calendar year which contains the
Participant’s Required Beginning Date. For distributions beginning after the
Participant’s death, the first distribution calendar year is the calendar year
in which distributions are required to begin under section 2.2. The required
minimum distribution for the Participant’s first distribution calendar year
will be made on or before the Participant’s Required Beginning Date. The
required minimum distribution for other distribution calendar years, including
the required minimum distribution for the distribution calendar year in which
the Participant’s Required Beginning Date occurs, will be made on or before
December 31 of that distribution calendar year.

 

5.3.                  Life expectancy.  Life
expectancy as computed by use of the Single Life Table in Treas. Reg. §
1.401(a)(9)-9.

 

 

5.4.                  Participant’s Account balance.  The
Account balance as of the last valuation date in the calendar year immediately
preceding the distribution calendar year (valuation calendar year) increased by
the amount of any contributions made and allocated or forfeitures allocated to
the Account balance as of dates in the valuation calendar year after the
valuation date and decreased by distributions made in the valuation calendar
year after the valuation date. The Account balance for the valuation calendar
year includes any amounts rolled over or transferred to the Plan either in the
valuation calendar year or in the distribution calendar year if distributed or
transferred in the valuation calendar year.

 

5.5.                  Required Beginning Date.  The
date specified in Plan section 2.62.

 

Section 6 – Use of New Life Expectancy Tables to Determine
Periodic Payments.

 

6.1.                  Life expectancy.  Unless available and selected in Election 5,
installment payments under the Plan will be determined using the life
expectancy tables in Treas. Reg. § 1.401(a)(9)-9 and not the life
expectancy tables under Treas. Reg. § 1.72-9, notwithstanding any
provisions of the Basic Plan Document or the Adoption Agreement to the
contrary.  This provision will be
effective as of the date that the Plan began operating in accordance with the
2002 Final Regulations under Code § 401(a)(9).

 

Lead Employer Signature

 

IN WITNESS WHEREOF, the Lead Employer has caused this Required Minimum Distributions
Addendum to be adopted effective as of the date specified below.

 

You should consult with an attorney or other independent
qualified advisor as to the legal and tax effect of adopting this Addendum.

 

	
  Date
  signed:

  	
   

  	
   

  	
  Lead
  Employer:  Clayton Williams Energy, Inc.

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  By:

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
    Name [print]:

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
    Its [title]:

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