Document:

exv4w2

 

EXHIBIT 4.2

FAEGRE & BENSON LLP

REGIONAL PROTOTYPE DEFINED CONTRIBUTION PLAN

ADOPTION AGREEMENT-001

(Non-Standardized)

PROFIT SHARING PLAN

(Including 401(k) Contribution Option)

THE FAEGRE & BENSON LLP REGIONAL PROTOTYPE DEFINED CONTRIBUTION PLAN CAN
BE USED TO CREATE A QUALIFIED PROFIT SHARING PLAN UNDER SECTION 401(A) OF THE INTERNAL REVENUE
CODE OF 1986, AS AMENDED (THE PLAN ALSO MAY INCLUDE A 401(K) FEATURE). WHETHER YOUR PLAN
IS QUALIFIED WILL DEPEND ON THE ELECTIONS (AND COMBINATION OF ELECTIONS) YOU MAKE ON THE ADOPTION
AGREEMENT, AND ALSO WILL DEPEND ON WHETHER THE PLAN IS ADMINISTERED PROPERLY. YOU SHOULD
CONSULT WITH LEGAL COUNSEL OR OTHER QUALIFIED PROFESSIONALS REGARDING YOUR ELECTIONS ON THE
ADOPTION AGREEMENT.

ONCE ESTABLISHED, YOUR PLAN CREATES LEGAL RIGHTS WITH RESPECT TO
PARTICIPANTS AND BENEFICIARIES UNDER THE PLAN. THESE RIGHTS GENERALLY ARE ENFORCEABLE UNDER THE EMPLOYEE
RETIREMENT INCOME SECURITY ACT OF 1974, AS AMENDED (“ERISA”). YOU SHOULD CONSULT WITH LEGAL
COUNSEL REGARDING ERISA AND OTHER FEDERAL AND STATE LAWS THAT MAY IMPACT YOUR PLAN.

Lead Employer Information

The following information relates to the “lead employer”. The lead employer is
the business entity that sponsors the plan on behalf of its employees and/or employees
of other controlled group members. Government filings with respect to the plan
(e.g., Form 5500) are made in the name of the lead employer.

You should notify the recordkeeper for your plan if any of the following
information changes with respect to the lead employer.

	 	 	 	 	 	 	 
	1.	 	
Name:
	 	Antennas America, Inc.
	 	 	 	 	 	 	 
	2.	 	
Employer

Identification

Number:
	 	87-0454148.	 	 
	 	 	 	 	 	 	 
	3.	 	
Address:
	 	Street:
	 	4860 Robb Street.
	 	 	 	 	 	 	Suite 101.
	 	 	 	 	City:
	 	Wheat Ridge.
	 	 	 	 	State:
	 	CO.
	 	 	 	 	Zip:
	 	80033.
	 	 	 	 	 	 	 
	4.	 	
Type of Business
	 	Corporation.	 	 
	 	 	
Organization:	 	 	 	 
	 	 	 	 	 	 	 
	5.	 	
Fiscal Year End:
	 	December 31.	 	 
	 	 	 	 	 	 	 
	6.	 	
SIC Code:
	 	       .	 	 
	 	 	 	 	 	 	 
	7.	 	
Contact:
	 	Name:
	 	Julie Grimm.
	 	 	 	 	Title:
	 	       .
	 	 	 	 	Phone:
	 	303-421-4063.

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Controlled Group Information

The following business entities are “controlled group members” with respect to
the lead employer. A controlled group member includes many of the businesses
that are commonly thought of as being related (parent companies, subsidiaries
and brother-sister companies). It also includes companies involved in more
complex relationships, such as “affiliated service groups” as defined in
Section 414(m) of the Internal Revenue Code. You should consult with a
professional advisor to determine the controlled group members.

For the lead employer or any controlled group member to be a “participating
employer” in the plan, it must be included as such on the Adoption Agreement.
If you change your business structure, or if you acquire a company, you should
remember that a new controlled group member does not automatically become a
participating employer under the plan. However, a participating employer will
automatically cease to be such as of the date it ceases to be a controlled
group member.

You should notify the recordkeeper for your plan if a new company becomes a
controlled group member or an existing controlled group member ceases to be
such for any reason.

	 	 	 
	1. Controlled Group Member 1:
	 	 	 
	 	 	Name:          .

	 	 	 
	2. Controlled Group Member 2:
	 	 	 
	 	 	Name:          .
	 	 	 
	3. Controlled Group Member 3:
	 	 	 
	 	 	Name:          .
	 	 	 
	4. Controlled Group Member 4:
	 	 	 
	 	 	Name:          .
	 	 	 
	5. Controlled Group Member 5:
	 	 	 
	 	 	Name:          .
	 	 	 
	6. Controlled Group Member 6:
	 	 	 
	 	 	Name:          .
	 	 	 
	7. Controlled Group Member 7:
	 	 	 
	 	 	Name:          .
	 	 	 
	8. Controlled Group Member 8:
	 	 	 
	 	 	Name:          .
	 	 	 
	9. Controlled Group Member 9:
	 	 	 
	 	 	Name:          .
	 	 	 
	10. Controlled Group Member 10:
	 	 	 
	 	 	Name:          .
	 	 	 
	11. Controlled Group Member 11:
	 	 	 
	 	 	Name:          .
	 	 	 
	12. Controlled Group Member 12:
	 	 	 
	 	 	Name:          .
	 	 	 
	13. Controlled Group Member 13:
	 	 	 
	 	 	Name:          .
	 	 	 
	14. Controlled Group Member 14:
	 	 	 
	 	 	Name:          .
	 	 	 
	15. Controlled Group Member 15:
	 	 	 
	 	 	Name:          .

 

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Supplemental Documentation

Your qualified plan will be governed by a set of documents, including the
following:

	 	•	 	Adoption Agreement:

		
	 	This document contains the elections that you have made to implement your
plan.

	 	•	 	Plan Document:

		
	 	This document contains many basic terms of your plan that may or may not
apply depending upon the elections you have made in the Adoption Agreement.

	 	•	 	Trust Agreement, Custodial Agreement and/or Group Annuity Contract:

		
	 	You may have one or a combination of these documents depending on how your
plan is funded. These documents generally control the relationship between the
participating employers and the trustee, custodian or insurance company, and define the rights and duties
of the funding agency with respect to the plan.

The operation of your qualified plan also may be affected by supplemental
documents, including the following:

	 	•	 	Participant Loan Policy Statement:

		
	 	If you allow loans to participants under your plan, the participant loan
program will be governed by this document. It sets forth the terms of your participant loan program.

	 	•	 	Investment Policy Statement:

		
	 	This document sets forth the investment policy you have established for
the plan. You may allow participants to direct the investment of their accounts under the plan.
If you do, the investment policy statement will describe what investment options are available and
will set forth your rules regarding how participants may exercise investment control.

	 	•	 	Claims Procedure:

		
	 	This document describes how participants can enforce their rights under
the plan. For example, it will describe the claim and appeal procedure you have established.

	 	•	 	Administrative Forms:

		
	 	To make it efficient for participants to interact with the administrator
of the plan, you may use a set of administrative forms. For example, you may have a form that will be
used to enroll in the plan, change investments, designate beneficiaries and request withdrawals or
distributions.

	 	•	 	Summary Plan Description:

		
	 	ERISA requires that you provide participants and beneficiaries with a
“summary plan description” for the plan, and keep it current. A summary plan description is an easy
to read description of the terms of the plan.

IT IS YOUR RESPONSIBILITY TO ADMINISTER THE PLAN IN ACCORDANCE WITH ALL
LAWS THAT APPLY, INCLUDING ERISA. FAEGRE & BENSON LLP MAKES AVAILABLE A SET OF SUPPLEMENTAL
DOCUMENTS TO PROVIDE YOU WITH AN EFFICIENT MEANS OF ESTABLISHING AND MAINTAINING YOUR PLAN – BUT, IT IS
YOUR RESPONSIBILITY TO DETERMINE WHETHER THE DOCUMENTS ARE APPROPRIATE FOR YOU AND YOUR PLAN.

IF YOU CONTRACT FOR RECORDKEEPING SERVICES, THE TERMS OF THE ARRANGEMENT
BETWEEN YOU AND YOUR RECORDKEEPER WILL BE SET FORTH IN AN AGREEMENT THAT YOU WILL ENTER INTO
WITH THE RECORDKEEPER.

AA1

 

 

FAEGRE & BENSON LLP

REGIONAL PROTOTYPE DEFINED CONTRIBUTION PLAN

ADOPTION AGREEMENT-001

(Non-Standardized)

PROFIT SHARING PLAN

(Including 401(k) Contribution Option)

Preamble

BY THIS AGREEMENT [check one]:

	 	 	 	 	 	 	 	 	 
	a.	 	x	 	New Plan. The Lead Employer hereby adopts a new profit sharing plan in the form of this Prototype
Defined Contribution Plan effective as of January 1, 2000 [month, day, year].
	 	 	 	 	 	 	 	 	 
	b.	 	o	 	Amended Plan. The Lead Employer hereby amends its profit sharing plan in the form of this Prototype
Defined Contribution Plan effective as of          [month, day, year].
Prior to the amendment [check one]:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	i.
	 	o
	 	The Plan was maintained in another form (an individually designed plan, volume submitter,
another prototype, etc.), and this amendment constitutes a restatement of the form of the
Plan.
	 	 	 	 	ii.
	 	o
	 	The Plan was maintained in the form of this Prototype
Defined Contribution Plan, and this amendment changes
the options previously elected in the Adoption
Agreement.

A. Participating Employer Information

	 	 	 	 	 	 	 	 	 
	1.	 	Lead Employer:

[Plan Sec. 2.34]	 	a.	 	Name: Antennas America, Inc..
	 	 	 	 	b.	 	Employer Identification Number: 87-0454148.
	 	 	 	 	 	 	 	 	 
	2.	 	Participating
Employers:

[Plan Sec. 16.1]	 	2.1	 	The following Controlled Group Members are Participating Employers in the
Plan [check each that applies]:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.	 	x	 The Lead Employer.
	 	 	 	 	b.	 	o	 The following Controlled Group Members:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	i.
	Participating Employer No. 1:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	          Name:     .
	 	 	 	 	 	 	 	 	 
	
NOTE: If there are more than 
	 	 	 	 	ii.
	Participating Employer No. 2:
	

three
Participating
Employers,

attach a
Participating

Employer Schedule.
	 	 	 	 	 	
          Name:     .
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	iii.
	Participating Employer No. 3:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	          Name:     .
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	[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.]

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B. Plan Information

	 	 	 	 	 	 	 	 	 	 	 	 	 
	1.	 	Plan Name:

[Plan Sec. 1.1]	 	a.	 	Antennas America, Inc. 401(k) Plan.	 	 
	 	 	 	 	b.	 	Former name, if any:      .	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 
	2.	 	
Plan Number:
	 	001.	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 
	3.	 	
Plan Year:
	 	3.1
	 	The Plan Year is [check one]:	 
	 	 	
[Plan Sec. 2.47]	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.	 	x	 	The
12-month period ending each December 31 [month,
day].
	 	 	 	 	b.	 	o	 	The 52/53 week fiscal year of the Lead Employer
[describe]:          .
	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	3.2	 	The first Plan Year is a short Plan
Year that began      [month, day, year]  and ended       [month, day, year].
	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	3.3	 	If the Plan Year has been amended,
the Plan Year before the amendment
was the 12-month period ending each      
[month, day], the short Plan Year
resulting from the amendment began      
[month, day, year] and ended      
[month, day, year], and the Plan Year after
the amendment is as specified above.
	 	 	 	 	 	 	 	 	 	 	 	 	 
	4.	 	Plan Administrator:

[Plan Sec. 15.1]	 	4.1	 	The Administrator of the Plan is [check one]:	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.	 	x	 	The Lead Employer.
	 	 	 	 	b.	 	o	 	The following individual or entity:
	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	Name:     .
	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	c.	 	o	 	The following committee of individuals:
	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	Name:     .
	 	 	 	 	 	 	 	 	Name:     .
	 	 	 	 	 	 	 	 	Name:     .
	 	 	 	 	 	 	 	 	Name:     .
	 	 	 	 	 	 	 	 	Name:     .
	 	 	 	 	 	 	 	 	Name:     .
	 	 	 	 	 	 	 	 	Name:     .
	 	 	 	 	 	 	 	 	 	 	 	 	 
	5.	 	Funding Vehicle:

[Plan Sec. 1.3]	 	5.1	 	The following Funding Vehicle(s) will be used for the Plan [check one or

more]:
	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.	 	x	 	Trust Fund under the Prototype Trust Agreement, with the Trustee

serving as [check one]:	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	i.
	o	A discretionary Trustee.	 	 
	 	 	 	 	 	 	 	 	ii.
	x	A non-discretionary Trustee.	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	b.	 	o	 	Custodial Account under the Prototype Custodial Agreement.
	 	 	 	 	c.	 	o	 	Annuity Funding Contract.
	 	 	 	 	 	 	 	 	 	 	 	 	 
	6.	 	Effective Date:

[Plan Sec. 1.2]	 	The Plan was originally established effective January 1, 2000 [month, day, year].	 	 

	 	 
	2	AA1

 

	 	 	 	 	 	 	 	 	 	 	 	 	 
	7.	 	Controlling Law
State:

[Plan Sec. 1.4]	 	The Plan shall be construed and administered in accordance with the laws of the
state or commonwealth of Colorado to the extent that such laws are not
preempted by federal law.	 	 

C. Eligibility and Service Requirements

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	1.	 	Excluded
Employment:

[Plan Sec. 2.14]	 	 	1.1	 	 	Covered Employment does not include service in any of the following
service categories [check as many as desired]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	a.	 	 	o	 	Highly Compensated Employees.	 	 
	 	 	 	 	 	b.	 	 	o	 	Self-Employed Individuals.	 	 
	NOTE: The Plan’s tax
qualification may
be affected if
certain classes are
excluded.	 	 	c.
d.
e.

f.	 	 	o
o
o
o	 	Salaried Employees.

Hourly Employees.

Employees paid primarily on a commission basis.

Employees whose services are performed outside the United States.

	 	 	 	 	 	g.	 	 	o	 	Non-resident aliens, except
non-resident aliens whose
services are performed in the
United States under the
following VISA or NAFTA
categories [check one]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	i.
	 	o
	 	All categories are excluded.	 	 
	 	 	 	 	 	 	 	 	 	 	ii.
	 	o
	 	The following
categories are included [specify]:          .	 	 
	 	 	 	 	 	h.	 	 	x	 	Non-resident aliens who
receive no earned income
(within the meaning of Code
section 911(d)(2)) from a
Participating Employer which
constitutes income from
sources within the United
States (within the meaning of
Code section 861(a)(3)), or
who receive such earned income
but it is all exempt from
income tax in the United
States under the terms of an
income tax convention.
	 	 	 	 	 	i.	 	 	o	 	Employees working in the following units or locations [specify]:           .
	 	 	 	 	 	j.	 	 	o	 	Other [specify]:           .
	 	 	Collective Bargaining

Only Plan	 	 	k.	 	 	o	 	This
Plan is being established exclusively as a collective bargaining
plan – thus the only Employees in Covered Employment are those who are
members of a unit covered by a
collective bargaining
agreement that provides for
participation in the Plan.
	 	 	Prevailing Wage

Only Plan	 	 	l.	 	 	o	 	This Plan is being established exclusively as a “prevailing wage”
plan – Plan thus, the only Employees
in Covered Employment are
those Non-Highly Compensated
Employees who are employed on
prevailing wage projects
specified on the Prevailing
Wage Schedule attached to this
Adoption Agreement.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	[NOTE: Covered Employment with respect to any Component of
the Plan does not include
service covered by a
collective bargaining
agreement unless such
agreement provides for
participation in such
Component.]
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	2.	 	Leased Employees:

[Plan Sec. 2.35]	 	 	2.1	 	 	Are Leased Employees eligible to participate in the Plan? [check one]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	a.	 	 	o
	 	Yes.	 	 	 	 	 	 
	 	 	 	 	 	b.	 	 	x
	 	No.	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	[NOTE: Leased Employees are excluded unless they are specifically designated as
eligible.]
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	3.	 	Method to Determine
Service for Eligibility Purposes:	 	 	3.1	 	 	Service will be determined as follows for eligibility purposes [check one]:
	 	 	[Plan Sec. 2.56]	 	 	a.	 	 	o	 	Based on whether the Employee has completed at least           [not
more than 1,000] Hours of Service during an eligibility computation
period.
	 	 	 	 	 	 	 	 	 	 	With respect to an Employee for whom a record of actual hours is not
maintained (e.g., salaried employees), Hours of Service will be
determined using the following equivalency for each period in which the

	 	 	 
	 	3	
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	 	 	[complete only if a	 	 	 	 	 	Employee has one or more Hours of Service [check one]:	 	 
	 	 	
Service requirement for	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	
eligibility is elected in
	 	 	 	 	 	i.
	 	o
	 	10 Hours of Service for each day.	 	 
	 	 	
Item E, Sec. 2.2, Item H,
 Sec. 2.2 or Item I, Sec 2.2]
	 	 	 	ii.

iii.
	 	o

o
	 	45 Hours of Service for each week.

95 Hours of Service for each semi-monthly payroll period.
	 	 	 	 	 	 	 	 	iv.
	 	o
	 	190 Hours of Service for each month.	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	With respect to an Employee for whom a record of actual hours is
maintained, Hours of Service will be
determined using [check one]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	v.
	 	o
	 	Actual hours.	 	 
	 	 	 	 	 	 	 	 	vi.
	 	o
	 	The same equivalency as specified above for an Employee for
whom a record of actual hours is not maintained.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	The eligibility computation period is [check one]:	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	vii.
	 	o
	 	The twelve consecutive month period beginning on the
Service Commencement Date and on each anniversary
thereof.
	 	 	 	 	 	 	 	 	viii.
	 	o
	 	The twelve consecutive
month period beginning on
the Service Commencement
Date, and each Plan Year beginning after the
Service Commencement Date.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	An Employee will be deemed to have satisfied the Service requirement [check one]:	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	ix.
	 	o
	 	As of the end of the eligibility computation period during which
he/she has completed the required Hours of Service.
	 	 	 	 	 	 	 	 	x.
	 	o
	 	As of the date during the eligibility computation period as of
which he/she has completed the required Hours of Service.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	b.	 	x	 	Based on elapsed time (365 days equals one year).	 	 
	 	 	 	 	c.	 	o	 	Different methods apply with respect to different service categories, as
specified in the Eligibility Service
Schedule attached to this Adoption
Agreement.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	4.	 	Method to Determine	 	4.1	 	Service will be determined as follows for vesting purposes [check one]:
	 	 	Service for Vesting
	 	 	 	 
	 	 	Purposes:
[Plan Sec. 2.56]	 	a.	 	x	 	Based on whether the Employee has completed at least 1000 [not
more than 1,000] Hours of Service during a vesting computation period.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	[complete only if a
vesting schedule other
than full and immediate
vesting is elected in
Item H, Sec. 10.1
or I, Sec. 7.1]	 	 	 	 	 	With respect to an Employee for whom a record of actual hours is not
maintained (e.g., salaried employees), Hours of Service will be
determined using the following equivalency for each period in which the
Employee has one or more Hours of Service [check one]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	i.
	 	o
	 	10 Hours of Service for each day.	 	 
	 	 	 	 	 	 	 	 	ii.
	 	x
	 	45 Hours of Service for each week.	 	 
	 	 	 	 	 	 	 	 	iii.
	 	o
	 	95 Hours of Service for each semi-monthly payroll period.	 	 
	 	 	 	 	 	 	 	 	iv.
	 	o
	 	190 Hours of Service for each month.	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	With respect to an Employee for whom a record of actual hours is
maintained, Hours of Service will be
determined using [check one]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	v.
	 	x
	 	Actual hours.	 	 
	 	 	 	 	 	 	 	 	vi.
	 	o
	 	The same equivalency as specified above for an Employee for
whom a record of actual hours is not maintained.
	 	 	 	 	 	 	 	 	The vesting computation period is [check one]:	 	 

	4	AA1

 

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	vii.
	 	x
	 	The Plan Year.	 	 
	 	 	 	 	 	 	 	 	viii.
	 	o
	 	The twelve consecutive month period beginning on the
Service Commencement Date and on each anniversary of
thereof.
	 	 	 	 	 	 	 	 	ix.
	 	o
	 	The twelve consecutive month period ending each          .
[month,
day]
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	If the vesting computation period has been amended, the
vesting computation period before the amendment was the
twelve consecutive month period ending each
          [month,
day], the special vesting computation period resulting
from the amendment began       
    [month, day, year] and ended
on the following           
[month, day, year], and the vesting
computation period after the amendment is as specified
above beginning           
[month, day, year]. [NOTE: The special
vesting computation period must be twelve months in length.]
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	b.	 	o	 	Based on elapsed time, with years calculated as follows [check one]:	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	i.
	 	o
	 	365 days equals one year (with fractional years based on
completed days).
	 	 	 	 	 	 	 	 	ii.
	 	o
	 	12 months equals one year (with fractional years based on
completed months).
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	c.	 	o	 	Different methods apply with respect to different service categories, as
specified in the Vesting Service Schedule attached to this Adoption
Agreement.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	4.2	 	Service for vesting purposes will be calculated at Termination of Service
based on [check one]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.	 	x	 	Full years of Service.	 	 
	 	 	 	 	b.	 	o	 	Full and fractional years of Service.	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	5.	 	Break in Service
Rules For Both
Eligibility and
Vesting Purposes:

[Plan Sec. 2.9]	 	5.1	 	A Break in Service will occur under the hour count method of crediting
service if the Employee has fewer than 501 [not more than 501] Hours of
Service during an eligibility computation period or vesting computation
period.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	5.2	 	Service prior to a Break in Service of one year or more (unless otherwise
disregarded under Sec. 5.3) ... [check one]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.	 	x	 	will be taken into account immediately upon his/her subsequent return
to Service.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	b.	 	o	 	Will be taken into account under the Employee Pre-Tax Component of
the Plan immediately upon a subsequent
return to Service, but will not be taken into account
under the following Components until such time as the
Employee completes a year of Service after the Break in
Service (in which case Service will be retroactively restored
to the Employee) [check either or both]:
	 	 	 	 	 	 	 	 	i.
	 	o
	 	Employee Regular Matching Component.	 	 
	 	 	 	 	 	 	 	 	ii.
	 	o
	 	Employee Regular Profit Sharing Component.	 	 
	 	 	 	 	 	 	 	 	[NOTE: Use of option (b) may require that retroactive contributions be made
on behalf of the Participant.]
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	5.3	 	In the case of a Participant who had no vested interest in
his/her Account prior to a Break in Service (other than a
vested interest in an After-Tax or Rollover
Contribution Account), Service prior to the Break in Service
of one year or more ... [select one]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.
	 	o
	 	will	 	 	 	 	 	 

	 	 	 
	 	5	
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	 	 	 	 	b.	 	x	 	will not
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	... be taken into account after a subsequent return to Service if the Break in
Service exceeds five years (or, if greater, the number of years of Service
prior to the Break in Service). [NOTE: In all other cases and for all other
Participants, Service prior to a Break in Service will be taken into account after a
subsequent return to Service.]
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	6.	 	Predecessor

Employer Credit:	 	6.1	 	Does Service with a Predecessor Employer which did not maintain the Plan
count as Service under this Plan? [check one]:
	 	 	
[Plan Sec. 2.48]
	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.	 	x	 	No.	 	 	 	 	 	 	 
	 	 	 	 	b.	 	 ̈	 	Yes, for
the following purposes [check each that applies]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	i.	 	o	Eligibility, with Service with the Predecessor Employer

calculated based on [check one]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	A.	o	Elapsed
time from [check one]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	I.	o	Last date of hire.
	 	 	 	 	 	 	 	 	 	 	 	 	 	II.	o	Other
[specify date]:     .
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	B.	o	Hours of Service from:
	 	 	 	 	 	 	 	 	 	 	 	 	 	I.	o	Last date of hire.
	 	 	 	 	 	 	 	 	 	 	 	 	 	II.
	o	Other
[specify date]:     .
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	ii.	 	o	Vesting, with Service with the Predecessor Employer

calculated based on [check one]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	A.	o	Elapsed time from:
	 	 	 	 	 	 	 	 	 	 	 	 	 	I.
	o	Last date of hire.
	 	 	 	 	 	 	 	 	 	 	 	 	 	II.
	o	Other
[specify date]:     .
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	B.	o	Hours of
Service from [check one]:

	 	 	 	 	 	 	 	 	 	 	 	 	 	I.
	o	
Last date of hire.

	 	 	 	 	 	 	 	 	 	 	 	 	 	II.
	o	
 Other [specify date]:     .
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	iii.	o	Entitlement to share in the Employer Regular Profit Sharing
Contribution for the first year of participation (with Service with
the Predecessor Employer based on Hours of Service).
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	iv.	o	Recognized Earnings for purposes of determining the
Employer Regular Profit Sharing Contribution for the first year
of participation.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	[Note: Code section 414(a) requires that service with a predecessor employer be
taken into account if a plan of the predecessor employer is maintained by a
successor. The service credit under this Sec. 6.1 is in addition to that required
under Code section 414(a).]

	 	 	 
	 	6	
AA1

 

 

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	6.2	 	 	The following Predecessor Employers are covered by this provision:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	i.	 	Predecessor Employer No. 1:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Name:          .
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	NOTE: If there are more than	 	 	 	 	 	 	 	 	 	 	 	 
	three Predecessor Employers,

attach a Predecessor	 	 	 	 	 	 	 	ii.	 	Predecessor Employer No. 2:
	Employer Supplement.	 	 	 	 	 	 	 	 	 	 	 	Name:          .
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	iii.	 	Predecessor Employer No. 3:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	Name:          .
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	7.	 	Special Entry Rule

for New Plans:

[Plan Sec. 3.1(f)]	 	 	7.1	 	 	An Employee who is in Covered Employment on the initial effective date of
the Plan [check one]:
	 	 	 	 
	 	 	 	 	a.	 	 	x	 	Must satisfy the applicable age and/or service requirements to become
an Active Participant.
	 	 	[complete only if this
is a new plan]	 	 	b.	 	 	o	 	Will become an Active Participant on the initial effective date of the
Plan even if he/she has not satisfied ... [check either or
both]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	i.	 	o	 	the applicable age requirement.
	 	 	 	 	 	 	 	 	 	 	ii.	 	o	 	the applicable service requirement.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	This age and/or service waiver applies with respect to the following
Components of the Plan [check as many as apply]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	iii.	 	o	 	Employee Pre-Tax Component.
	 	 	 	 	 	 	 	 	 	 	iv.	 	o	 	Employer Regular Matching Component.
	 	 	 	 	 	 	 	 	 	 	v.	 	o	 	Employer Regular Profit Sharing Component.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	8.1	 	Election Not to
Participate:	 	 	8.1	 	 	May
Employees elect not to participate in the Plan? [check
one]:
 
	 	 	[Plan Sec. 3.4]	 	 	a.	 	 	o	 	Yes, but only for religious reasons.
	 	 	 	 	 	b.	 	 	x	 	Yes, for any reason.
	 	 	 	 	 	c.	 	 	o	 	No.
[If not allowed, skip to Item D.]
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	[NOTE: An election not to participate may be effective as of the initial Entry Date or
as of the first day of any subsequent Plan Year.]
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	8.2	 	 	An election not to participate may be revoked as of the following date
[check one]:
 
	 	 	 	 	 	a.	 	 	x	 	N/A – an election may not be revoked.
	 	 	 	 	 	b.	 	 	o	 	The first day of any Plan Year.
	 	 	 	 	 	c.	 	 	o	 	The
first day of any Plan Year after the election has been in effect for at least     Plan Years.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	8.3	 	 	Following the revocation of an election not to participate, the Participant
[check one]:
 
	 	 	 	 	 	a.	 	 	x	 	May not again elect not to participate.
	 	 	 	 	 	b.	 	 	o	 	May again elect not to participate effective as of the first day of any
subsequent Plan Year.
	 	 	 	 	 	c.	 	 	o	 	May again elect not to participate effective as of the first day of any
subsequent Plan Year after he/she has been a Participant for at least     
Plan Years.

	 	 	 
	 	7	
AA1

 

 

	 	 	 	 	 	 	 	 	 	 	 
	D.	 	
Recognized Earnings	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 
	1.	 	Recognized	 	1.1	 	The
Recognized Earnings of a Participant are [check one]:
	 	 	
Earnings:
	 	 
	 	 	 	 	 	 
	 	 	[Plan Sec. 2.53(a)]	 	a.	 	o	 	Earnings for purposes of Code section 415(c)(3).
	 	 	 	 	b.	 	o	 	Earnings for purposes of federal income tax withholding.
	 	 	 	 	c.	 	x	 	Earnings required to be reported in the Wages, Tips and Other
Compensation box of Form W-2.
	 	 	 	 	 	 	 	 	 	 	 
	2.	 	Determination

Period:	 	2.1	 	Recognized Earnings are amounts that are paid to the Participant within the
following determination period with respect to the Plan Year
[check one]:
	 	 	
[Plan Sec. 2.53(b)]	 	 	 	 	 	 	 	 
	 	 	 	 	a.	 	x	 	The Plan Year.
	 	 	 	 	b.	 	o	 	The calendar year that ends with or within the Plan Year. In the case
of a Participant hired during such calendar year, Recognized Earnings
are amounts that are paid to the Participant within ...
[check one]:
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	i.
	o	such calendar year.
	 	 	 	 	 	 	 	 	ii.
	o	the Plan Year.
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	c.	 	o	 	The
12-month period that ends each     [month, day] within the
Plan Year. In the case of a Participant hired during such 12-month
period, Recognized Earnings are amounts that are paid to the
Participant within ... [check one]:
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	i.
	o	such 12-month period.
	 	 	 	 	 	 	 	 	ii.
	o	the Plan Year.
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	2.2	 	Recognized Earnings includes only amounts paid while an Active
Participant in the case of Employee Pre-Tax and After-Tax Contributions,
Employer Safe-Harbor, Regular and Qualified Matching Contributions and
also the following contributions [check each that
applies]:
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.	 	o	 	Employer Safe-Harbor Profit Sharing Contributions.
	 	 	 	 	b.	 	o	 	Employer Regular Profit Sharing Contributions.
	 	 	 	 	c.	 	o	 	Employer Qualified Profit Sharing Contributions.
	 	 	 	 	 	 	 	 	 	 	 
	3.	 	Specific Exclusions:

[Plan Sec. 2.53(c) &

(d)]	 	3.1	 	Recognized
Earnings does not include the following amounts [check as
many as you wish to exclude]: [NOTE: If Employer Regular Profit Sharing
Contributions are made or allocated under an integrated formula the following
exclusions do not apply for purposes of determining or allocating the Employer
Regular Profit Sharing Contribution.]
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.	 	o	 	Amounts
in excess of $     . [NOTE: The amount that may be taken into
account for a Plan Year is already limited under Code section 401(a)(17).
Include an amount here only if a limit less than the otherwise applicable limit is
intended.]
	 	 	 	 	b.	 	o	 	Bonuses.
	 	 	 	 	c.	 	o	 	Commissions.
	 	 	 	 	d.	 	o	 	Overtime. [NOTE: Excluding overtime payments with respect to certain
contribution types may raise issues under the Wage and Hour
Laws.]
	 	 	 	 	e.	 	o	 	Compensation paid in a form other than cash.
	 	 	 	 	f.	 	o	 	Elective Deferrals and amounts that are excluded from income under
Code section 125, but such amounts are excluded only for purposes of
determining Employer Safe-Harbor, Regular and Qualified Profit
Sharing Contributions.
	 	 	 	 	g.	 	o	 	Other [specify]:    .
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	The
above exclusions shall apply ... [check one]:

	 	 	 
	 	8	
AA1

 

 

	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	i.	o	for any purpose under the Plan (except as expressly provided
otherwise above or elsewhere in the Plan).
	 	 	 	 	 	 	 	 	ii.	o	for purposes of determining Employer Safe-Harbor, Regular
and Qualified Profit Sharing Contributions.
	 	 	 	 	 	 	 	 	iii.	o	for purposes of
[specify]:          .
	 	 	 	 	 	 	 	 	 	 	 
	4.	 	Imputed Earnings

While Disabled:

[Plan Sec. 2.53(e)]
 	 	4.1	 	Recognized Earnings shall be imputed to a Participant during periods of
total disability (as defined in Code section 22(e)(3)) for purposes of the
following types of contributions [check as many as
apply]:
	 	 	 	 	a.	 	o	 	Employee Pre-Tax Contributions.
	 	 	 	 	b.	 	o	 	Employer Regular Matching Contributions.
	 	 	 	 	c.	 	o	 	Employer Regular Profit Sharing Contributions.
	 	 	 	 	 	 	 	 	 	 	 
	E.	 	
Employee Pre-Tax
Contributions	 	 
	 	 	 	 	 	 	 	 	 	 	 
	1.	 	Employee Pre-Tax

Contributions:
	 	1.1	 	Will
Employee Pre-Tax Contributions be allowed under the Plan? [check
one]:
	 	 	[Plan Sec. 4.1]	 	a.	 	x	 	Yes.
	 	 	 	 	b.	 	o	 	No.
[If not allowed, skip to Item F.]
	 	 	 	 	 	 	 	 	 	 	 
	2.	 	Age and Service

Requirements:

[Plan Sec. 3.1]	 	2.1	 	The following age requirement must be met for an Employee to become an
Active Participant in the Employee Pre-Tax Component of the Plan [check
one]:
	 	 	 	 	a.	 	o	 	There is no age requirement.
	 	 	 	 	b.	 	x	 	The
Employee must have attained age 18 [21 or less].
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	2.2	 	The following service requirement must be met for an Employee to become
an Active Participant in the Employee Pre-Tax Component of the Plan [check one]:
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.	 	o	 	There is no service requirement.
	 	 	 	 	b.	 	o	 	The Employee must have completed one year of Service.
	 	 	 	 	c.	 	x	 	The
Employee must have completed two [not more than 12] months of
elapsed time Service. [NOTE: If this option is selected, the elapsed time
option must be selected in Item C, Sec. 3.1.]
	 	 	 	 	 	 	 	 	 	 	 
	3.	 	Entry Dates:

[Plan Sec. 2.22]	 	3.1	 	The following are Entry Dates for the Employee Pre-Tax Component of the
Plan [check one]:
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.	 	o	 	The
first day of each Plan Year. [NOTE: This option is permitted only if the
service requirement does not exceed 6 months and the age requirement does
not exceed 201⁄2.]
	 	 	 	 	b.	 	o	 	The first day of each Plan Year and the first day of the seventh month
of each Plan Year (or, for a 52/53 week Plan Year, the first day of the
week nearest to the mid-point of such Plan Year).
	 	 	 	 	c.	 	o	 	The first day of each quarter of the Plan Year.
	 	 	 	 	d.	 	x	 	The first day of each calendar month.
	 	 	 	 	e.	 	o	 	The first day of each payroll period.
	 	 	 	 	f.	 	o	 	The Employee’s Service Commencement Date.
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	[NOTE: The applicable Entry Date is the date specified above after the Employee
has satisfied the age and service requirements.]
	 	 	 	 	 	 	 	 	 	 	 
	4.	 	Pay Reduction

Contributions -
	 	4.1	 	Employee Pre-Tax Contributions are permitted by means of pay reduction
[check (a) and/or (b), or (c)]:
	 	 	Minimums/
Maximums:	 	a.	 	x	 	In any whole percentage, subject to the following minimum and

	 	 	 
	 	9	
AA1

 

 

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	[Plan Sec. 4.1(a)]	 	 	 	 	 	maximum
[complete either or both]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	i.	 	x	 	Minimum: 1% of Recognized Earnings per payroll period.
	 	 	 	 	 	 	 	 	ii.	 	x	 	Maximum
[complete]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	A.
	 	15% of Recognized Earnings per payroll period with
respect to any Participant other than a Highly Compensated Employee.
	 	 	 	 	 	 	 	 	 	 	 	 	B.
	 	15% [not to
exceed the percentage in A] of
Recognized Earnings per payroll period with respect to
any Highly Compensated Employee.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	b.	 	o	 	In any whole dollar amount, subject to the following minimum and
maximum [complete either or both]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	i.	 	o	 	Minimum: $          per payroll period.
	 	 	 	 	 	 	 	 	ii.	 	o	 	Maximum: $          per payroll period.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	c.	 	o	 	In such percentage or amount as will be established by written action of
the Lead Employer taken prior to the first day of the Plan Year.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	[NOTE: If an Employer Safe-Harbor Matching Contribution is to be made, the
maximum under (a), (b) or (c) above, for a Participant who is not a Highly
Compensated Employee must be at least sufficient to allow the Participant to
receive the maximum Employer Safe-Harbor Matching
Contribution.]
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	Negative election	 	4.2	 	A Participant will be deemed to have elected the following pay reduction
upon initial entry into the Employee Pre-Tax Component of the Plan, unless
he/she affirmatively elects a different amount or percentage or elects not to
receive Employee Pre-Tax Contributions [check one]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.	 	x	 	N/A – the negative election provision does not apply.
	 	 	 	 	b.	 	o	 	          % of Recognized Earnings per payroll period.
	 	 	 	 	c.	 	o	 	$          per payroll period.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	This
negative election provision will be effective as of
          [month,
day, year] with respect to individuals who become Active Participants in
the Employee Pre-Tax Component on or after that date. The provision
.... [check one]
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	i.	 	o	 	will
	 	 	 	 	 	 	 	 	ii.	 	o	 	will not
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	...also apply effective as of that date to each then current Active
Participant in the Employee Pre-Tax Component.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	5.	 	Pay Reduction

Agreements:

[Plan Sec. 4.1(a)]	 	5.1	 	The initial pay reduction agreement filed by a Participant may be effective
as soon as administratively practicable after the initial Entry Date, and
thereafter may be modified (or a salary reduction agreement may be
effective for a Participant who has not previously filed one) effective as soon
as administratively practicable 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.	 	x	 	The first day of any Plan Year quarter.
	 	 	 	 	d.	 	o	 	The first day of any month.
	 	 	 	 	e.	 	o	 	The date the election is filed.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	5.2	 	A pay reduction agreement may be revoked effective as soon as

	 	 	 
	 	10	
AA1

 

 

	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	administratively
practicable 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 quarter.
	 	 	 	 	d.
	 	o
	 	The first day of any month.
	 	 	 	 	e.
	 	x
	 	The date the election is filed.
	 	 	 	 	 	 	 	 	 
	 	 	 	 	5.3	 	If revoked, a pay reduction agreement may be reinstated effective as soon
as administratively practicable 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.
	 	x
	 	The first day of any Plan Year quarter.
	 	 	 	 	e.
	 	o
	 	The first day of any month.
	 	 	 	 	f.
	 	o
	 	The date the election is filed.
	 	 	 	 	 	 	 	 	 
	6.	Cash or Deferred

Option:

[Plan Sec. 4.1(b)]	 	6.1	 	A general pay reduction agreement will not apply to the following amounts,
but a cash or deferred option is available with respect thereto
[check one]:
	 	 	 	 	a.
	 	x
	 	N/A.
	 	 	 	 	b.
	 	o
	 	Bonuses designated as eligible for this election by the Lead Employer.
	 	 	 	 	c.
	 	o
	 	Payments in lieu of accrued by unused vacation.
	 	 	 	 	d.
	 	o
	 	Other: [specify]      .
	 	 	 	 	 	 	 	 	 
	 	 	 	 	6.2	 	The contributions made pursuant to this cash or deferred option may not
exceed the following [check one]:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.
	 	o
	 	     % of Recognized Earnings for the Plan Year.
	 	 	 	 	b.
	 	o
	 	     % of the designated payments subject to the cash or
deferred option.
	 	 	 	 	c.
	 	o
	 	$     .
	 	 	 	 	d.
	 	o
	 	Other: [specify]     .
	 	 	 	 	 	 	 	 	 
	 	 	 	 	6.3	 	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 Employer
Safe-Harbor Matching Contributions are made, the contributions made pursuant to
this cash or deferred option are eligible for such Employer Safe-Harbor Matching
Contributions.]
	 	 	 	 	 	 	 	 	 
	7.	Catch-Up	 	7.1	 	An
Active Participant ... [check one]:
	 	
Contributions:	 	 	 	 	 	 
	 	
[Plan Sec. 4.1(h)]
	 	a.
	 	o
	 	may
	 	 	 	 	b.
	 	x
	 	may not
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	... enter into a special pay reduction agreement to make additional
Employee Pre-Tax Contributions in an amount equal to      % of
Recognized Earnings for any or all of the payroll periods ending in the final
month of the Plan Year.

	 	 	 
	 	
11	AA1

 

 

F. Employee After-Tax Contributions

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	1.	Employee After-Tax

Contributions:

[Plan Sec. 4.2]	 	 	1.1	 	 	Will Employee After-Tax Contributions be allowed under the Plan? [check
one]:
	 	 	 	 	 	a.	 	 	o	 	Yes.
	 	 	 	 	 	b.	 	 	x	 	No. [If not allowed, skip to Item G.]
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	2.	Eligibility

Requirements/Entry

Date:

[Plan Sec. 3.1]	 	 	2.1	 	 	Covered Employment, the entry requirements, and the Entry Dates for the
Employee After-Tax Component of the Plan are the same as for
[check one]:
	 	 	 	 	 	a.	 	 	o	 	The Employee Pre-Tax Component.
	 	 	 	 	 	b.	 	 	o	 	The Employer Regular Matching Component.
	 	 	 	 	 	c.	 	 	o	 	The Employer Regular Profit Sharing Component.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	3.	After-Tax

Contributions -

Minimums/	 	 	3.1	 	 	An Active Participant will be permitted to make Employee After-Tax
Contributions [check (a) and/or (b), or (c)]:
	 	Maximums:

[Plan Sec. 4.2]	 	 	a.	 	 	o	 	In any
whole percentage, subject to the following minimum and maximum [check either or both]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	i.	 	o	 	Minimum:      % of Recognized Earnings per payroll period.
	 	 	 	 	 	 	 	 	 	 	ii.	 	o	 	Maximum
[complete]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	A.
	 	     % of Recognized Earnings per payroll period with
respect to any Participant other than a Highly
Compensated Employee.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	B.
	 	     % [not to exceed the percentage in A] of
Recognized Earnings per payroll period with respect to
any Highly Compensated Employee.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	b.	 	 	o	 	In any whole dollar amount, subject to the following minimum and
maximum [check either or both]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	i.	 	o	 	Minimum: $      per payroll period.
	 	 	 	 	 	 	 	 	 	 	ii.	 	o	 	Maximum: $      per payroll period.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	c.	 	 	o	 	In such percentage or amount as will be established by written action of
the Lead Employer taken prior to the first day of the Plan Year.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	Thrift-Plan option	 	 	3.2	 	 	An Active Participant will be required to make Employee After-Tax
Contributions equal to [check one, if applicable]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	a.	 	 	o	 	     % of Recognized Earnings per payroll period.
	 	 	 	 	 	b.	 	 	o	 	The percentage, not less than      %, of Recognized Earnings per
payroll period that is selected by the Participant upon his/her
enrollment in the Employee After-Tax Component.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	3.3	 	 	The Employee Pre-Tax and After-Tax Contributions of a Participant in
combination may not exceed [check one, if applicable]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	a.	 	 	o	 	     % of Recognized Earnings per payroll period.
	 	 	 	 	 	b.	 	 	o	 	$      per payroll period.

	 	 	 
	 	12	AA1

 

 

G. Employer Safe-Harbor Contributions

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	1.	Employer Safe-Harbor

Contributions:

[Plan Sec.     ]	 	 	1.1	 	 	Will
Employer Safe-Harbor Contributions be made under the Plan? [check one]:
	 	 	 	 	 	a.	 	 	o	 	Yes.
	 	 	 	 	 	b.	 	 	x	 	No, but Safe-Harbor Contributions will be made under the following plan
[select one and complete as appropriate]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	i.
	 	x
	 	N/A – such contributions will not be made under any other plan.
	 	 	 	 	 	 	 	 	 	 	ii.
	 	o
	 	Plan Name
[specify]:     .
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	[If not allowed, skip to Item H.]
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	2.	Employer Safe-

Harbor Matching

Contributions	 	 	2.1	 	 	Will Employer Safe-Harbor Matching Contributions be made under the Plan?
[check one]:
	 	
[Plan Sec. 5.2]	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 401(k)/401(m)

 Safe Harbor	 	 	a.	 	 	o	 	Yes, Employer Safe-Harbor Matching Contributions will be made on behalf
of each Employee who is eligible to make Employee Pre-Tax Contributions
under the Safe-Harbor Plan during the Plan Year in an amount equal to
[complete]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 

	 	 	 	 	 	 	 	 	 
	 	 	A	 	 	 	B
	 	 	
	 	 	 	

	 	 	 	 	 	 	 	 	Of the Employee Pre-Tax
	 	 	 	 	 	 	 	 	Contributions for payroll
	 	 	 	 	 	 	 	 	periods ending within the
	 	 	The Employer Safe-	 	 	 	Plan Year (expressed as a
	 	 	Harbor Matching	 	 	 	percentage of Recognized
	 	 	Contribution will be:	 	 	 	Earnings):
	 	 	
	 	 	 	

	1	 	
100%
	 	of the first:
	 	_______%
	 	 	 	 	 	 	 	 	[not less than 3%
	 	 	 	 	 	 	 	 	or more than 6%]
	 	 	 	 	 	 	 	 	 
	2	 	
_______%	 	of the next:
	 	_______%
	 	 	
[not less than 50% if B1	 	 	 	[not less than 5%, or more
	 	 	
is less than 4%]	 	 	 	than 6%, minus the percent in
	 	 	 	 	 	 	 	 	B1]
	 	 	 	 	 	 	 	 	 
	3	 	
_______%	 	of the next:
	 	_______%
	 	 	 	 	 	 	 	 	[not more than 6% minus the
	 	 	 	 	 	 	 	 	sum of the percents in B1 and
	 	 	 	 	 	 	 	 	B2]

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	[NOTE: If the 401(k)/401(m) Safe-Harbor is selected: (i) Employer Regular and
Qualified Matching Contributions are not permitted on Employee Pre-Tax or After-
Tax Contribution in excess of 6% of Recognized Earnings, and (ii) Employee After-
Tax Contributions nonetheless remain subject to the Average Contribution
Percentage Test of Code § 401(m).]
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 401(k)

 Safe-Harbor	 	 	b.	 	 	o	 	Yes, Employer Safe-Harbor Matching Contributions will be made on behalf
of each Employee who is eligible to make Employee Pre-Tax Contributions
under the Safe-Harbor Plan during the Plan Year in an amount equal to
[complete]:

	 	 	 
	 	
13	AA1

 

 

	 	 	 	 	 	 	 	 	 
	 	 	A	 	 	 	B
	 	 	
	 	 	 	

	 	 	 	 	 	 	 	 	Of the Employee Pre-Tax
	 	 	 	 	 	 	 	 	Contributions for payroll
	 	 	 	 	 	 	 	 	periods ending within the
	 	 	The Employer Safe-	 	 	 	Plan Year (expressed as a
	 	 	Harbor Matching	 	 	 	percentage of Recognized
	 	 	Contribution will be:	 	 	 	Earnings):
	 	 	
	 	 	 	

	1	 	
100%
	 	of the first:
	 	_______%
	 	 	 	 	 	 	 	 	[not less than 3%]
	 	 	 	 	 	 	 	 	 
	2	 	
_______%	 	of the next:
	 	_______%
	 	 	
[not less than 50% if	 	 	 	[not less than 5% minus the
	 	 	
B1 is less than 4%]	 	 	 	percent in B1]
	 	 	 	 	 	 	 	 	 
	3	 	
_______%	 	of the next:
	 	_______%
	 	 	 	 	 	 	 	 	 
	4	 	
_______%	 	of the next:
	 	_______%
	 	 	 	 	 	 	 	 	 
	5	 	
_______%	 	of the next:
	 	_______%

	 	 	 	 	 	 	 	 	 
	 	 	 	 	c.
	 	o
	 	No.
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	[NOTE: When expressing Employee Pre-Tax Contributions as a percentage of
Recognized Earnings for purposes of applying the formulas in (a) or (b), above, items
otherwise excluded from Recognized Earnings under Item D, Sec. 3.1, for purposes of
Employee Pre-Tax Contributions will be added back to Recognized Earnings.]
	 	 	 	 	 	 	 	 	 
	3.	Employer Safe-

Harbor Profit Sharing

Contributions:	 	3.1	 	Will Employer Safe-Harbor Profit Sharing Contributions be made under the Plan?
[check one]:
	 	
[Plan Sec.     ]
	 	a.
	 	o
	 	Yes. Employer Safe-Harbor Profit Sharing Contributions will be made on
behalf of each Employee who is eligible to make Employee Pre-Tax
Contributions under the Safe-Harbor Plan during the Plan Year in an amount
equal to     % [not less than 3%] of his/her Recognized Earnings for the
Plan Year.
	 	 	 	 	b.
	 	o
	 	No.
	 	 	 	 	 	 	 	 	 
	4.	Safe-Harbor Plan:

[Plan Sec.     ]	 	4.1	 	The
Safe-Harbor Plan is ... [check either or both]:
	 	 	 	 	a.
	 	o
	 	This Plan.
	 	 	 	 	b.
	 	o
	 	The following plan [specify]:     . Any Employee who is eligible to
make an Employee Pre-Tax Contribution under such plan will be
deemed to be in Covered Employment with respect to the Employer
Safe-Harbor Profit Sharing Component of this Plan. [NOTE: Such plan
must specifically (by name) reference this Plan as the plan under which safe-
harbor contributions will be made. Also, effective for plan years beginning on
or after January 1, 2000, the plan year of such plan must be the same as the
Plan Year of this Plan ]
	 	 	 	 	 	 	 	 	 

H. Employer Regular Matching Contributions

	 	 	 	 	 	 	 	 	 
	1.	Employer Regular

Matching

Contributions:	 	1.1	 	Will Employer Regular Matching Contributions be made under the Plan?
[check one]:
	 	
[Plan Sec. 5.1]
	 	a.
	 	x
	 	Yes.
	 	 	 	 	b.
	 	o
	 	No. [If not allowed, skip to Item I.]

	 	 	 
	 	
14	AA1

 

 

	 	 	 	 	 	 	 	 	 	 	 
	2.	Age and Service

Requirements:

[Plan Sec. 3.1]	 	 	2.1	 	 	The following age requirement must be met for an Employee to become an
Active Participant in the Employer Regular Matching Component of the Plan
[check one]:
	 	 	 	 	 	a.	 	 	o
	 	There is no age requirement.
	 	 	 	 	 	b.	 	 	x
	 	The Employee must
have attained age 18 [21 or less].
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	2.2	 	 	The following service requirement must be met for an Employee to become
an Active Participant in the Employer Regular Matching Component of the
Plan [check one]:
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	a.	 	 	o
	 	There is no service requirement.
	
NOTE: If more than one year

of Service is required for
	 	 	b.	 	 	o
	 	The Employee must
have completed o one year o two years of
Service.
	
eligibility, the Plan must

provide for full and immediate

vesting
	 	 	c.	 	 	x
	 	The Employee must have completed two [not more than 24] months of
elapsed time Service. [NOTE: If this option is elected, the elapsed time
option must be elected in Item C, Sec. 3.1.]
	 	 	 	 	 	 	 	 	 	 	 
	3.	Entry Dates:

[Plan Sec. 2.22]	 	 	3.1	 	 	The following are Entry Dates for the Employer Regular Matching
Component of the Plan [check one]:
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	a.	 	 	o
	 	The first day of each Plan Year. [NOTE: This option is permitted only if the
Service requirement does not exceed 6 months and the age requirement does
not exceed 201⁄2.]
	 	 	 	 	 	b.	 	 	o
	 	The first day of each Plan Year and the first day of the seventh month
of each Plan Year (or, for a 52/53 week, Plan Year, the first day of the
week nearest to the mid-point of such Plan Year).
	 	 	 	 	 	c.	 	 	o
	 	The first day of each quarter of the Plan Year.
	 	 	 	 	 	d.	 	 	x
	 	The first day of each calendar month.
	 	 	 	 	 	e.	 	 	o
	 	The first day of each payroll period.
	 	 	 	 	 	f.	 	 	o
	 	The Employee’s Service Commencement Date.
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	[NOTE: The applicable Entry Date is the date specified above after the Employee
has satisfied the age and Service requirements.]
	 	 	 	 	 	 	 	 	 	 	 
	4.	Excluded Employee

Classes:

[Plan Sec. 2.14]	 	 	4.1	 	 	Covered Employment with respect to the Employer Regular Matching
Component of the Plan does not include service in any of the following
service categories (in addition to the generally applicable exclusions) [check
as many as desired]:
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	a.	 	 	o
	 	Employees who are employed on prevailing wage projects specified on
the Prevailing Wage Schedule attached to this Adoption Agreement.
	 	 	 	 	 	b.	 	 	o
	 	Highly Compensated Employees.
	 	 	 	 	 	c.	 	 	o
	 	Other
[specify]:     .

	 	 	 
	 	
15	AA1

 

 

	 	 	 	 	 	 	 	 	 	 	 
	5.	 	Match Eligible
Contributions:
[Plan Sec. 2.36]	 	 	5.1	 	 	The Match Eligible Contributions under the Plan
are as follows [check as many as desired]:
	 	 	 	 	 	a.	 	 	x
	 	Employee Pre-Tax Contributions made under this Plan (except as provided in Item E, Sec. 6.3).
	 	 	 	 	 	b.	 	 	o
	 	Employee After-Tax Contributions made under this Plan.
	 	 	 	 	 	c.	 	 	o
	 	Employee Pre-Tax
Contributions made under the following plan
[specify]:        .
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	5.2	 	 	The Match Eligible Contributions under the Plan ... [check one]:
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	a.	 	 	o
	 	do
	 	 	 	 	 	b.	 	 	x
	 	do not
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	... include Employee Pre-Tax or After-Tax Contributions that are withdrawn by the Participant during the Matching Contribution Period.

	 	 	 	 	 	 	 	 	 	 	 
	6.	 	Matching Formula:
[Plan Sec. 5.1(a) &
(b)]	 	 	6.1	 	 	A Participant’s Match Eligible Contributions will be matched in
accordance with the following formula [check one]:
	 	 	 	 	 	a.	 	 	o
	 	The Employer Regular Matching Contributions will be based on the following schedule [complete as desired]:

	 	 	 	 	 	 	 	 	 
	 	 	 	 	A	 	 	 	B
	 	 	 	 	
	 	 	 	

	 	 	 	 	 	 	 	 	Of the Match Eligible
	 	 	 	 	 	 	 	 	Contributions for
	 	 	 	 	 	 	 	 	payroll periods ending
	 	 	 	 	 	 	 	 	within the Plan Year
	 	 	 	 	The Employer Regular	 	 	 	(expressed as a
	 	 	 	 	Matching	 	 	 	percentage of
	 	 	 	 	Contribution will be:	 	 	 	Recognized Earnings):
	 	 	 	 	
	 	 	 	

	 	 	
1
	 	____%
	 	of the first:
	 	____%
	 	 	
2
	 	____%
	 	of the next:
	 	____%
	 	 	
3
	 	____%
	 	of the next:
	 	____%
	 	 	
4
	 	____%
	 	of the next:
	 	____%
	 	 	
5
	 	____%
	 	of the next:
	 	____%

	 	 	 	 	 	 	 	 	 
	 	 	The
Employer Regular Matching Contribution ... [check one]:
	 	 
	 	 	 	 	 	 	 	 	 
	 	 	
i.
	 	o
	 	is not contingent on Net Profits.	 	 
	 	 	
ii.
	 	o
	 	is contingent on ... [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 the following standard [check one and complete]:
	 	 	 	 	 	 	 
	 	 	
C.
	 	o
	 	GAAP, determined   o   before   o   after the payment of discretionary bonuses.
	 	 	
D.
	 	o
	 	Other
[specify]:                    .

	 	 	 
	 	16	
AA1

 

 

	 	 	 	 	 	 	 
	 	 	The Lead Employer ... [check one]:
	 	 	 	 	 	 	 
	 	 	
iii.
	 	o
	 	does
	 	 	
iv.
	 	o
	 	does not
	 	 	 	 	 	 	 
	 	 	... have the discretion to direct that an additional Employer Regular
Matching Contribution be made for a Plan Year which, if made, will be
allocated in proportion to the Match Eligible Contributions of each
eligible Participant that do not exceed             % of his/her Recognized
Earnings for the Plan Year.

	 	 	 	 	 	 	 
	 	 	
b.
	 	o
	 	The Employer Regular Matching Contributions will be based on the
following schedule [complete as desired]:

	 	 	 	 	 	 	 	 	 
	 	 	 	 	A	 	 	 	B
	 	 	 	 	
	 	 	 	

	 	 	 	 	 	 	 	 	Of the Match Eligible
	 	 	 	 	The Employer Regular	 	 	 	Contributions for
	 	 	 	 	Matching	 	 	 	payroll periods ending
	 	 	 	 	Contribution will be:	 	 	 	within the Plan Year
	 	 	 	 	
	 	 	 	

	 	 	
1
	 	____%
	 	of the first:
	 	$____.
	 	 	
2
	 	____%
	 	of the next:
	 	$____.
	 	 	
3
	 	____%
	 	of the next:
	 	$____.
	 	 	
4
	 	____%
	 	of the next:
	 	$____.

	 	 	 	 	 	 	 	 	 
	 	 	The
Employer Regular Matching Contribution ... [check one]:
	 	 
	 	 	 	 	 	 	 	 	 
	 	 	
i.
	 	o
	 	is not contingent on Net Profits.	 	 
	 	 	
ii.
	 	o
	 	is contingent on ... [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 the following standard [check one and complete]:
	 	 	 	 	 	 	 
	 	 	
C.
	 	o
	 	GAAP, determined   o   before   o   after the payment of discretionary bonuses.
	 	 	
D.
	 	o
	 	Other [specify]:          .

	 	 	 	 	 	 	 
	 	 	The Lead Employer ... [check one]:
	 	 	 	 	 	 	 
	 	 	
iii.
	 	o
	 	does
	 	 	
iv.
	 	o
	 	does not
	 	 	 	 	 	 	 
	 	 	... have the discretion to direct that an additional Employer Regular
Matching Contribution be made for a Plan Year which, if made, will be
allocated in proportion to the Match Eligible Contributions of each
eligible Participant that do not exceed             % of his/her Recognized
Earnings for the Plan Year.

	 	 	 	 	 	 	 
	 	 	
c.
	 	o
	 	The Employer Regular
Matching Contribution will be based on the following schedule [complete as desired]:

	 	 	 
	 	17	
AA1

 

 

	 	 	 	 	 	 	 
	 	 	 	 	A	 	B
	 	 	 	 	
	 	

	 	 	 	 	The Employer Regular	 	For Participants with
	 	 	 	 	Matching	 	the following number
	 	 	 	 	Contribution will be:	 	of Years of Service.
	 	 	 	 	
	 	

	 	 	
1
	 	_________%
	 	_________yrs
	 	 	
2
	 	_________%
	 	_________yrs
	 	 	
3
	 	_________%
	 	_________yrs
	 	 	
4
	 	_________%
	 	_________yrs
	 	 	
5
	 	_________%
	 	_________yrs

	 	 	 	 	 	 	 	 	 
	 	 	The
Employer Regular Matching Contribution ... [check one]:
	 	 
	 	 	 	 	 	 	 	 	 
	 	 	
i.
	 	o
	 	is not contingent on Net Profits.	 	 
	 	 	
ii.
	 	o
	 	is contingent on ... [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 the following standard [check one and complete]:
	 	 	 	 	 	 	 
	 	 	
C.
	 	o
	 	GAAP, determined   o   before   o   after the payment of discretionary bonuses.
	 	 	
D.
	 	o
	 	Other [specify]:          .

	 	 	 	 	 	 	 
	 	 	The Lead Employer ... [check one]:
	 	 	 	 	 	 	 
	 	 	
iii.
	 	o
	 	does
	 	 	
iv.
	 	o
	 	does not
	 	 	 	 	 	 	 
	 	 	... have the discretion to direct that an additional Employer Regular
Matching Contribution be made for a Plan Year which, if made, will be
allocated in proportion to the Match Eligible Contributions of each
eligible Participant that do not exceed             % of his/her Recognized
Earnings for the Plan Year.

	 	 	 	 	 	 	 
	 	 	
d.
	 	x

	 	The Employer Regular Matching Contribution will be a discretionary amount.
	 	 	 	 	 	 	 
	 	 	 	 	 	 	By written action taken prior to the first day of the Matching
Contribution Period, the Lead Employer may specify that Employer
Regular Matching Contributions will be made for such period in
accordance with a schedule that conforms with a schedule specified in
either (a) or (b), above. Otherwise, the Employer Regular Matching
Contribution made to the Plan will be allocated in accordance with the
following schedule [check one]:

	 	 	 	 	 	 	 
	 	 	
i.
	 	x

	 	The following schedule [complete]:

	 	 	 
	 	18	
AA1

 

 

	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	A	 	B
	 	 	 	 	
	 	

	 	 	 	 	 	 	 	 	Will be allocated in
	 	 	 	 	 	 	 	 	proportion to Match
	 	 	 	 	 	 	 	 	Eligible
	 	 	 	 	 	 	 	 	Contributions
	 	 	 	 	The following	 	that do not exceed
	 	 	 	 	percent of the	 	the following percent
	 	 	 	 	Employer Regular	 	of Recognized
	 	 	 	 	Matching Eligible	 	Earnings for payroll
	 	 	 	 	Contribution for the	 	periods ending
	 	 	 	 	Matching	 	within the Matching
	 	 	 	 	Contribution Period:	 	Contribution Period
	 	 	 	 	
	 	

	 	 	
1
	 	 	100	%	 	 	6	%
	 	 	
2
	 	 	____	%	 	 	____	%
	 	 	 	 	 	 	 	 	 	[less than (B1)]	 
	 	 	
3
	 	 	____	%	 	 	____	%
	 	 	 	 	 	 	 	 	 	[less than (B2)]	 
	 	 	 	 	 	Total = 100	%	 	 	 	 

	 	 	 	 	 	 	 
	 	 	 	 	 	 	[NOTE: The steps in the allocation formula provide cumulative contributions at lower deferral levels.]
	 	 	 	 	 	 	 
	 	 	
ii.
	 	o
	 	The following schedule [complete]:

	 	 	 	 	 	 	 
	 	 	 	 	A	 	B
	 	 	 	 	
	 	

	 	 	 	 	 	 	Will be allocated in
	 	 	 	 	 	 	proportion to Match
	 	 	 	 	 	 	Eligible
	 	 	 	 	 	 	Contributions
	 	 	 	 	The following	 	representing the
	 	 	 	 	portion of the	 	following percent
	 	 	 	 	Employer Regular	 	of Recognized
	 	 	 	 	Matching	 	Earnings for payroll
	 	 	 	 	Contributions for	 	periods ending
	 	 	 	 	the Matching	 	within the Matching
	 	 	 	 	Contribution Period:	 	Contribution Period:
	 	 	 	 	
	 	

	 	 	
1
	 	The
first:   $______.
	 	__________%
	 	 	
2
	 	The next:   $______.
	 	__________%
	 	 	 	 	 	 	[less than (B1)]
	 	 	
3
	 	The remainder
	 	__________%
	 	 	 	 	 	 	[less than (B2)]

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

	 	 	 	 	 	 	 	 	 
	 	 	
Multiple Formulas
	 	e.
	 	o
	 	Different formulas apply to different service categories or contribution
types, as specified in the Matching Contribution Schedule attached to
this Adoption Agreement.

	 	 	 
	 	19	
AA1

 

 

	 	 	 	 	 	 	 	 	 	 	 	 	 
	7.	 	 	Matching
Contribution Period:
[Plan Sec. 5.1(a) &
(b)]	 	 	7.1	 	 	Employer Regular Matching Contributions will be determined by reference
to the Match Eligible Contributions and Recognized Earnings of the
Participant with respect to each of the following Matching Contribution
Periods [check one]:
	 	 	 	 	 	 	 	a.	 	 	o      Each payroll period.	 	 
	 	 	 	 	 	 	 	b.	 	 	o      Each calendar month, based on payroll periods ending within the month.	 	 
	 	 	 	 	 	 	 	c.	 	 	o      Each Plan Year quarter, based on payroll periods ending within the quarter.	 	 
	 	 	 	 	 	 	 	d.	 	 	o      Each Plan Year half, based on payroll periods ending within the half.	 	 
	 	 	 	 	 	 	 	e.	 	 	x      Each Plan Year, based on payroll periods ending within the Plan Year.	 	 
	 	 	 	 	 	 	 	f.	 	 	o      Other [specify]:                    .	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	[NOTE: If Employer Regular Matching Contributions are contingent on Net Profits,
the Matching Contribution Period must be the Plan Year.]
	 	 	 	 	 	 	 	 	 	 	 	 	 

	 	 	 	 	 	 	 	 	 	 	 
	 	 	True-Up Match	 	 	7.2	 	 	If Employer Regular Matching Contributions are determined by reference to
a period less than a Plan Year, will such contributions be recalculated by
reference to the Match Eligible Contributions and Recognized Earnings for
the Plan Year and be “trued up” accordingly? [check one]: 
	 
	 	 	
 
	 	 	a.	 	 	o
	 	No.
	 	 	
 
	 	 	b.	 	 	o
	 	Yes, with respect to all Participants (regardless of whether they are
Employees on the last day of the Plan Year).
	 	 	
 
	 	 	c.	 	 	o
	 	Yes, but only with respect to Participants who are Employees on the
last day of the Plan Year or whose Termination of Service occurs
during the Plan Year for one of the following reasons [check as many
as desired]:

	 	 	 	 	 	 	 
	 	 	
i.
	 	o
	 	The Participant died
	 	 	
ii.
	 	o
	 	The Participant became disabled, which means that:

	 	 	 	 	 	 	 
	 	 	
A.
	 	o
	 	The Participant meets the standard for long-term
disability benefits under any disability plan
maintained by a Controlled Group Member.
	 	 	
B.
	 	o
	 	The Participant has been determined to be disabled
for purposes of Social Security.
	 	 	
C.
	 	o
	 	The Participant is permanently unable to perform the
normal duties of his/her job with the Participating Employer.
	 	 	
D.
	 	o
	 	The Participant is permanently unable to engage in
any occupation for wage or profit for which he/she is
reasonably fitted by training, education or experience.

	 	 	 	 	 	 	 
	 	 	
iii.
	 	o
	 	The Participant retired after reaching age             [Normal
Retirement Age or less].
	 	 	
iv.
	 	o
	 	Other [specify]:             .

	 	 	 	 	 	 	 	 	 	 	 
	8.	 	Requirements to

Receive Employer

Regular Matching	 	 	8.1	 	 	To receive Employer Regular Matching Contributions for a Matching
Contribution Period, must a Participant be an Employee on the last day of
the period? [check one]:
	 	 	
Contributions:
	 	 	a.	 	 	o
	 	No.
	 	 	
[Plan Sec. 5.1(a) &
	 	 	b.	 	 	o
	 	Yes, under all circumstances.
	 	 	
(b)]
	 	 	c.	 	 	x
	 	Yes, except in the case of a Participant whose Termination of Service
occurs during the period for one of the following reasons [check as
many as desired]:

	 	 	 	 	 	 	 
	 	 	
i.
	 	x
	 	The Participant died.
	 	 	
ii.
	 	x
	 	The Participant became disabled, which means that:

	 	 	 
	 	20	
AA1

 

 

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	A.
	 	o
	 	The Participant meets the standard
for long-term
disability benefits under any
disability plan
maintained by a Controlled Group
Member.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	B.
	 	o
	 	The Participant has been determined
to be disabled
for purposes of Social Security.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	C.
	 	o
	 	The Participant is permanently
unable to perform the
normal duties of his/her job with
the Participating
Employer.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	D.
	 	x
	 	The Participant is permanently
unable to engage in
any occupation for wage or profit
for which he/she is
reasonably fitted by training,
education or
experience.
	 
	 	 	 	 	 	 	 	 	iii.
	 	 	 	x
	 	The Participant retired after
reaching age 65 [Normal
Retirement Age or less].
	 	 	 	 	 	 	 	 	iv.
	 	 	 	o
	 	Other [specify]:       .
	 
	 	 	 	 	8.2
	 	To receive Employer Regular
Matching Contributions for a
Matching
Contribution Period, must a
Participant have completed a
minimum number
of Hours of Service during the
period? [check one]:
	 
	 	 	 	 	a.
	 	o
	 	No.	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	b.
	 	o
	 	Yes, the Participant must have at
least          [not more than 1,000]
Hours of Service under all
circumstances.
	 	 	 	 	c.
	 	x
	 	Yes, the Participant must have
completed at least 1000 [not more
than 1,000] Hours of Service except
in the case of a Participant whose
Termination of Service occurs
during the period for one of the
following
reasons [check as many as desired]:
	 
	 	 	 	 	 	 	 	 	i.
	 	 	 	x
	 	The Participant died.
	 	 	 	 	 	 	 	 	ii.
	 	 	 	x
	 	The Participant became disabled,
which means that:
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	A.
	 	o
	 	The Participant meets the standard
for long-term
disability benefits under any
disability plan
maintained by a Controlled Group
Member.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	B.
	 	o
	 	The Participant has been determined
to be disabled
for purposes of Social Security.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	C.
	 	o
	 	The Participant is permanently
unable to perform the
normal duties of his/her job with
the Participating
Employer.

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	D.
	 	
x
	 	
The Participant is permanently
unable to engage in
any occupation for wage or profit
for which he/she is
reasonably fitted by training,
education or
experience.
	 
	 	 	 	 	 	 	 	 	iii.
	 	 	 	x
	 	The Participant retired after
reaching age 65 [Normal
Retirement Age or less].
	 	 	 	 	 	 	 	 	iv.
	 	 	 	o
	 	Other
[specify]:        .
	 
	 	 	 	 	 	 	[NOTE: If the Matching Contribution
Period is less than a full Plan
Year, or in the
event of a short Plan Year, the
minimum number of Hours of Service
required above
shall be proportionately reduced.]
	 
	9.	 	
Minimums and
maximums:
[Plan Sec. 5.1(c)]
	 	9.1
	 	The minimum Employer Regular
Matching Contribution any
Participant who
has Match Eligible Contributions
can receive for any Plan Year is
[check
one]:
	 	 	 	 	a.
	 	x
	 	No minimum.	 	 	 	 	 	 	 	 
	 	 	 	 	b.
	 	o
	 	$        .	 	 	 	 	 	 	 	 

	 	 	 
	 	
21	AA1

 

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	c.
	 	o
	 	       % of Recognized Earnings for the Plan Year.
	 	 	 	 	d.
	 	o
	 	Other
[specify]:       .	 	 	 	 	 	 	 	 
	 
	 	 	 	 	9.2
	 	The maximum Employer Regular
Matching Contribution that any
Participant
can receive for any Plan Year is
[check one]:
	 
	 	 	 	 	a.
	 	x
	 	No maximum.	 	 	 	 	 	 	 	 
	 	 	 	 	b.      .
	 	o
	 	$
      .	 	 	 	 	 	 	 	 
	 	 	 	 	c.
	 	o
	 	      % of Recognized Earnings for the
Plan Year.
	 	 	 	 	d.
	 	o
	 	Other
[specify]:       .
	 	 	 	 	 	 	[NOTE: A separate maximum need be
specified only if it is less than
the maximum
otherwise resulting from the
applicable matching schedule.]
	 
	10.	 	
Vesting Schedule for
Employer Regular
Matching Contribution
Accounts: [Plan Sec. 11.2(c)]
	 	10.1
	 	The following vesting schedule applies to Employer
Regular Matching
Contribution Accounts [check one]:
	 	 	 	a.
	 	o
	 	A Participant’s vested
percentage will at all
times be 100%.
	 	 	 	b.
	 	o
	 	A Participant’s vested
percentage will be
determined under the
following schedule
[complete as desired]:

	 	 	 	 	 	 	 	 	 
	Years of	 	Vested	 	 	 	 
	Service	 	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.	 	 	x
	 	A Participant’s vested percentage will be
determined under the
following schedule [complete as desired]:

	 	 	 	 	 
	Years of	 	Vested
	Service	 	Percentage
	
	 	

	
0
	 	 	0	%
	
1
	 	 	20	%
	
2
	 	 	40	%
	
3
	 	 	60	%
	
4
	 	 	80	%
	
5 or more
	 	 	100	%

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	11.	 	Treatment of Forfeitures:	 	11.1	 	 	Forfeitures attributable to Employer Regular Matching
Contribution
Accounts will be [check one]:
	 	 	[Plan Sec. 5.1(f)]	 	a.	 	 	o	 	N/A – the Plan provides for full and immediate
vesting of Employer
Regular Matching Contribution Accounts.
	 	 	 	 	b.	 	 	o	 	Applied to pay administrative expenses of the
Plan. Any amounts
remaining after the payment of expenses will be
[check one]:
	 	 	 	 	 	 	 	 	 	i.	 	o	 	Applied as a credit against ...
[check either or both]:
	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	A.	 	o	 	Employer Safe-Harbor or
Regular Matching
Contributions
	 	 	 	 	 	 	 	 	 	 	 	 	 	B.	 	o	 	Employer Safe-Harbor or
Regular Profit
Sharing
Contributions

                       
                      
          
            ... made after the Forfeiture.

	 	 	 
	 	22	AA1

 

	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	ii.
	 	o
	 	Allocated in
the same
manner as the
Employer
Regular
Matching
Contribution
for the Plan
Year of the
Forfeiture.
	 	 	 	 	 	 	 	 	iii.
	 	o
	 	Allocated in
the same
manner as the
Employer
Safe-Harbor or
Regular
Profit
Sharing
Contribution
for the Plan
Year of the
Forfeiture.
	 
	 	 	 	 	c.
	 	x
	 	Applied
as a
credit
against
     ...
[check
either or
both]:
	 	 	 	 	 	 	 	 	i.
	 	x
	 	Employer
Safe-Harbor
or Regular
Matching
Contributions
	 	 	 	 	 	 	 	 	ii.
	 	o
	 	Employer
Safe-Harbor
or Regular
Profit
Sharing
Contributions
	 
	 	 	 	 	d.
	 	o
	 	Allocated in
the same
manner as
the Employer
Regular
Matching
Contribution
for the Plan
Year of the
Forfeiture.
	 	 	 	 	e.
	 	o
	 	Allocated in
the same
manner as
the Employer
Safe-Harbor
or Regular
Profit
Sharing
Contribution
for the Plan
Year of the
Forfeiture.
	 
	l.
Employer Regular Profit Sharing Contributions	 	 	 
	 
	1.	 	
Profit Sharing
Contributions:
[Plan Sec. 6.1]
	 	1.1
	 	Will Employer
Regular Profit
Sharing
Contributions be
made under the
Plan
[check one]:
	 	 	 	 	a.
	 	o
	 	Yes.
	 	 	 	 	b.
	 	x
	 	No. [If not
allowed, skip to Item J.]
	 
	2.	 	
Age and Service
Requirements:
[Plan Sec. 3.1]
	 	2.1
	 	The following
age
requirement
must be met
for an
Employee to
become an
Active
Participant in
the Employer
Regular Profit
Sharing
Component of
the
Plan [check
one]:
	 
	 	 	 	 	a.
	 	o
	 	There is no age
requirement.
	 	 	 	 	b.
	 	o
	 	The Employee
must have
attained age    [21
or less]          .
	 
	 	 	
NOTE: If more
than one year
of Service is
required for
eligibility, the
Plan must
provide for full
and immediate
vesting.
	 	2.2
	 	The following
service
requirement
must be met
for an
Employee to
become
an Active
Participant in
the Employer
Regular Profit
Sharing
Component of
the Plan
[check one]:
	 	 	 	a.
	 	o
	 	There is no
service
requirement.
	 	 	 	b.
	 	o
	 	The Employee
must have
completed o one
year o two years of
Service.
	 	 	 	c.
	 	o
	 	The Employee
must have
completed [not
more than 24]
months
of elapsed time
Service. [NOTE: If this option is elected, the
elapsed time
option must be
elected in Item
C.3.]
	 
	 
	3.	 	
Entry Dates:
[Plan Sec. 2.22]
	 	3.1
	 	The following
are Entry
Dates for the
Employer
Regular Profit
Sharing
Component of
the Plan
[check one]:
	 	 	 	 	a.
	 	o
	 	The first day of
each Plan Year.
[NOTE: This
option is
permitted only
if the
Service
requirement does
not exceed 6
months and the
age requirement
does
not exceed 201⁄2.]
	 	 	 	 	b.
	 	o
	 	The first day of
each Plan Year
and the first
day of the
seventh month
of each Plan
Year (or, for a
52/53 week Plan
Year, the first
day of the
week nearest to
the mid-point of
such Plan Year).
	 	 	 	 	c.
	 	o
	 	The first day of
each quarter of
the Plan Year.
	 	 	 	 	d.
	 	o
	 	The first day of
each calendar
month.
	 	 	 	 	e.
	 	o
	 	The first day of
each payroll
period.
	 	 	 	 	f.
	 	o
	 	The Employee’s
Service
Commencement
Date.
	 
	 	 	 	 	 	 	[NOTE: If one
of the above
boxes is
checked, the
applicable
Entry Date is
the date
specified
above after
the Employee
has satisfied
the age and
Service
requirements.

	 	 	 
	 	23	
AA1

 

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	If one of the following boxes is checked, the Entry Date is or may be
retroactive.]
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	g.	 	o	 	The first day of the Plan Year in which the Employee satisfies the
applicable age and service requirements.
	 	 	 	 	 	 	h.	 	o	 	The first day of the Plan Year nearest to the date on which the
Employee satisfies the applicable age and service requirements.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	4.	 	Excluded Employee

Classes:

[Plan Sec. 2.14]	 	4.1	 	Covered Employment with respect to the Employer Regular Profit Sharing
Component of the Plan does not include service in any of the following
service categories (in addition to the generally applicable exclusions)
[check as many as desired]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	a.	 	o	 	Employees who are employed on prevailing wage projects as specified
on the Prevailing Wage Schedule attached to this Adoption Agreement.
	 	 	 	 	 	 	b.	 	o	 	Highly Compensated Employees.
	 	 	 	 	 	 	c.	 	o	 	Other
[specify]:     .
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 5.	 	Contribution/

Allocation Formula:

[Plan Sec. 6.1(a) &
(b)]	 	5.1	 	Employer Regular Profit Sharing Contributions will be determined as follows
[check one of (a) through (e), and (f) if applicable, but do not use an
integrated formula if any Controlled Group Member maintains any other
plan that is integrated and that covers any of the same
Participants]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	Non-Integrated

Fixed Formula

(non-discretionary)	 	a.	 	o	 	The following amount will be contributed each Plan Year on behalf of
each eligible Participant [check one]:
	 	 	 	 	 	 	 	 	 	 	i.	o	$
           .
	 	 	 	 	 	 	 	 	 	 	ii	o	$
           for each Hour of Service during the Plan Year.
	 	 	 	 	 	 	 	 	 	 	iii.	o	
             % of Recognized Earnings for the Plan Year [not to
exceed 15%].
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	The
Employer Regular Profit Sharing Contribution ... [check one]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	iv.	o	is not contingent on Net Profits.
	 	 	 	 	 	 	 	 	 	 	v.	o	is
contingent on ... [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 the following standard [check one and complete]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	C.	o	GAAP, determined
o before o after the payment of
discretionary bonuses.
	 	 	 	 	 	 	 	 	 	 	 	 	D.	o	Other
[specify]:      .
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	The Lead
Employer ... [check one]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	vi.	o	does
	 	 	 	 	 	 	 	 	 	 	vii.	o	does not
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	... 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 in proportion to the Recognized Earnings of each eligible
Participant for the Plan Year.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	Non-Integrated

Variable Formula

(discretionary or

non-discretionary)	 	b.	 	o	 	The Employer Regular Profit Sharing Contribution for each Plan Year
will be determined as follows and will be allocated among the eligible
Participants based on their Recognized Earnings for the Plan Year
according to the nonintegrated formula in Plan Sec. 6(b)(1):

	24	AA1

 

	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	i.	o	The contribution amount is discretionary with the Lead
Employer.
	 	 	 	 	 	 	ii.	o	The
contribution amount is       % 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 the following standard [check one and complete]:
	 	 	 	 	 	 	 	 	C.
	o	GAAP,
determined o before o after the payment of
discretionary bonuses,
	 	 	 	 	 	 	 	 	D.
	o	Other [specify]:      .
	 	 	 	 	 	 	 	 	 	 	 
	 	 	Integrated

Fixed Formula

(non-discretionary)	 	c.	o	The following amount will be contributed each Plan Year on behalf of
each eligible Participant [complete]:
	 	 	 	 	 	 	i.	 	      % of Recognized Earnings for the Plan Year, plus
	 	 	 	 	 	 	ii.	 	      % of Recognized Earnings for the Plan Year in excess of the
Integration Level [the second percentage may not exceed the
lesser of the first percentage or the percentage in the table below]:

	 	 	 	 	 	 	 
	 	 	The maximum percentage is the percentage
	 	 	determined from the following 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 20% of the TWB but not

more than 80% of the TWB
	 	 	4.3	%
	 	 	 	 	 	 	 
	 	 	
Less than or equal to

20% of the TWB
	 	 	5.7	%

	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	The Integration Level is [check one]:
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	iii.	o	The Taxable Wage Base in effect at the beginning of the Plan
Year.
	 	 	 	 	 	 	iv.	o	$       but not to exceed the Taxable Wage Base in effect at
the beginning of the Plan Year.
	 	 	 	 	 	 	v.	o	      % [not more than 100%] of the Taxable Wage Base in
effect at the beginning of the Plan Year ... [select if desired]:
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	A.
	o	plus one dollar.
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	The Employer Regular Profit Sharing Contribution ... [check one]:
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	vi.	o	is not contingent on Net Profits.
	 	 	 	 	 	 	vii.	o	is contingent on ... [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 the following standard [check one and complete]:
	 	 	 	 	 	 	 	 	C.
	o	GAAP, determined
o before o after the payment of
discretionary bonuses.
	 	 	 	 	 	 	 	 	D.
	o	Other [specify]:          .

	 	 	 
	 	25	
AA1

 

 

	 	 	 
	 	 	
The Lead Employer ... [check one]:
	 	 	 
	 	 	
viii. o does
	 	 	
ix.    o does not
	 	 	 
	 	 	
.... 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 in proportion to the Recognized Earnings of each eligible Participant for the Plan Year.

	 	 	 	 	 	 	 
	Integrated	 	
d.
	 	o
	 	The Employer Regular Profit Sharing Contribution each Plan Year will
	Variable Formula	 	 	 	 	 	be determined as follows and will be allocated among the eligible
	(discretionary or	 	 	 	 	 	Participants using the integrated allocation formula in Plan Sec. 6.1
	non-discretionary)	 	 	 	 	 	(b)(2) [check one]:
	 	 	 	 	 	 	 
	 	 	 	 	 	 	i.     o     The contribution amount is discretionary with the Lead Employer.
	 	 	 	 	 	 	ii.    o     The contribution amount is % 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 the following standard [check one and complete]:
	 	 	
C.     o     GAAP, determined 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).

	 	 	 
	 	 	
iii.    o    The contribution amount is      % [not to exceed 15%] of the aggregate
            
    Recognized Earnings of all eligible Participants
            
    for the Plan Year.
	 	 	 
	 	 	
The integrated allocation formula used will be [check one]:
	 	 	 
	 	 	
iv.    o    The two-step formula.
	 	 	
v.     o    The three-step formula.
	 	 	
vi.    o    The four-step formula.
	 	 	 
	 	 	
The Integration Level is [check one]:
	 	 	 
	 	 	
vii.     o    The Taxable Wage Base in effect at the beginning of the Plan Year.
	 	 	
viii.    o    $      but not to exceed the Taxable Wage Base in effect at the beginning of the
            
    Plan Year.
	 	 	
ix.       o         % [not more than 100%] of the Taxable Wage Base in effect at the
            
    beginning of the Plan Year ... [select if desired]:

	 	 
	 	A.    o    plus one dollar.

	 	 	 	 	 	 	 
	Multiple Formulas	 	
e.
	 	o
	 	Different formulas apply with respect different service categories, as
	 	 	 	 	 	 	specified in the Profit Sharing Contribution Schedule attached to this Adoption Agreement.

	 	 	 
	26	 	
AA1

 

 

	 	 	 	 	 	 	 
	Prevailing Wage	 	
f.
	 	o
	 	With respect to [check one]:
	Formula	 	 	 	 	 	 

	 	 	 
	 	 	
i.      o    any Active Participant
	 	 	
ii.     o    any Active Participant who is a Non-Highly Compensated Employee
	 	 	 
	 	 	
.... and who is employed on a prevailing wage project listed on the Prevailing Wage Schedule attached to this Adoption Agreement, the contribution is the amount per hour specified on the Prevailing Wage Schedule.
	 	 	 
	 	 	
If such a Participant also is eligible for an Employer Regular Profit
Sharing Contribution for a Plan Year, will the Employer Regular Profit Sharing Contribution be offset by the Prevailing Wage Contribution? [check one]:
	 	 	 

	 	 	 	 
	 	iii.	o	N/A – there are no Employer Regular Profit Sharing Contributions or Active
Participants who are employed on prevailing wage projects are not eligible for
Employer  Regular Profit Sharing  Contributions.
	 
	 	iv.	o	Yes.
	 
	 	v.	o	No.

	 	 	 	 	 	 	 	 	 	 
	6.	 	
Requirements to Share in Employer Regular Profit Sharing Contributions for a Plan Year: [Plan Sec. 6.1(a) & (b)]
	 	6.1	 	To share in the Employer Regular Profit Sharing Contribution for a Plan Year, must a Participant be an Employee on the last day of the Plan Year? [check one]:
	 	 	 	 	 
	 	 	 	a.	 	o	No.
	 	 	 	b.	 	o	Yes, under all circumstances.
	 	 	 	c.	 	o	Yes, except in the case of a Participant whose Termination of Service occurs during the Plan Year for one of the following reasons [check as many as desired]:

	 	 	 	 
	 	i.	o	The Participant died.
	 	ii.	o	
The Participant became disabled, which means that [check
one]:

	 	 	 
	A.	 	
    o     The Participant meets the standard for long-term disability
 
           
benefits under any disability plan
maintained by a Controlled
 
           Group Member.
	B.	 	
    o     The Participant has been determined to be disabled for purposes of
 
           Social Security.
	C.	 	
    o     The Participant is permanently unable to perform the normal duties
 
           of his/her job with the Participating Employer.
	D.	 	
    o     The Participant is permanently unable to engage in any occupation
 
           for wage or profit for which he/she is
reasonably fitted by training,
 
           education or experience.

	 	 	 	 
	 	iii.	o	The Participant
retired after reaching age [Normal Retirement Age or less].
	 	iv.	o	Other [specify]:     .

	 	 	 
	27	 	
AA1

 

 

	 	 	 
	 	6.2	
To share in the Employer Regular Profit Sharing Contribution for a Plan
Year, must a Participant have completed a minimum number of Hours of
Service during the Plan Year? [check one]:
	 
	 	a.	
o     No.
	 	b.	
o     Yes, the
Participant must under all circumstances have at least
     [not more than 1,000]
        Hours of Service.
	 	c.	
o     Yes, the
Participant must have completed at least
     [not more than 1,000] Hours of
        Service except in the case of a Participant whose Termination of Service occurs during
        the Plan Year for one of the following reasons [check as many as desired]:
	 	 	 
	 	 	       
i.          o    The Participant died.
	 	 	       
ii.         o    The
Participant became disabled, which means that
[check one]:

	 	 	 	 	 
	 	A.	
o
	 	The Participant meets the standard for long-term disability benefits under any disability plan
maintained by a Controlled Group Member.
	 	B.	
o
	 	The Participant has been determined to be disabled for purposes of Social Security.
	 	C.	
o
	 	The Participant is permanently unable to perform the normal duties of his/her job with the Participating
Employer.
	 	D.	
o
	 	The Participant is permanently unable to engage in any occupation for wage or profit for which he/she is
reasonably fitted by training, education or experience.

	 	 	 	 	 
	iii	 	
o
	 	The Participant retired after reaching age      [Normal
Retirement Age or less].
	iv	 	
o
	 	Other
[specify]:     .

	 	 
	 	[NOTE: In the event of a short Plan Year, the minimum number of Hours of
Service required above shall be proportionately reduced.]

	 	 	 	 	 
	7.	 	
Vesting Schedule for

Employer Profit
	 	7.1   The following vesting schedule applies to Employer Regular Profit Sharing
Contribution Accounts [check one]:
	 	 	
Sharing Accounts:	 	 
	 	 	
[Plan Sec. 11.2(c)]
	 	a.    o    A Participant’s vested percentage will at all times be 100%.
	 	 	 	 	b.    o    A Participant’s vested percentage will be determined under the following schedule 
              [complete as desired]:

	 	 	 	 	 
	NOTE: In
addition to the

“regular” vesting schedule,

an appropriate “top-heavy”

vesting schedule must be

selected in Item R, Sec. 5.1.
	 	
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
	A Participant’s vested percentage will be determined under the
following schedule [complete as desired]:

	 	 	 
	 	28	
AA1

 

	 	 	 	 	 
	Years of	 	Vested
	Service	 	Percentage
	
	 	

	0	 	 	
0	%
	1	 	 	
        	%
	2	 	 	
        	%
	3	 	 	
        	%
	4	 	 	
         	%
	5 or more	 	 	
100	%

	 	 	 	 	 	 	 	 
	8.	 	
Treatment of
	 	 	8.1	 	Forfeitures attributable to Employer Regular Profit Sharing Contribution
	 	 	
Forfeitures:
	 	 	 	 	Accounts will be
[check one]:
	 	 	
[Plan Sec. 6.1(c)]	 	 	 	 	 	 
	 	 	 	 	 	a.	 	o     N/A – the Plan provides for full and immediate vesting of Employer Regular Profit
    
    Sharing Contribution Accounts.
	 	 	 	 	 	b.	 	o     Applied to pay administrative expenses of the Plan. Any amounts remaining after
    
    payment of expense will be [check
one]:

	 	 	 	 	 
	i.	 	
o
	 	Applied as a credit against ... [check either or both]:
	 	 	 	 	 
	 	 	 	 	A.         o     Employer Safe-Harbor or Regular Matching Contributions
	 	 	 	 	B.         o     Employer Safe-Harbor or Regular Profit Sharing Contributions
	 	 	 	 	 
	 	 	 	 	... made for periods after the Forfeiture.
	 	 	 	 	 
	ii.	 	
o
	 	Allocated in the same manner as the Employer Safe-Harbor or Regular Profit Sharing Contribution for the Plan Year of the Forfeiture.

	 	 	 	 
	c.	 	
o
	Applied as a credit against ... [check either or both]:
	 	 	 	 	 
	 	 	 	i.     o     Employer Safe-Harbor or Regular Matching Contributions
	 	 	 	ii.    o     Employer Safe-Harbor or Regular Profit Sharing Contributions
	 	 	 	 	 
	 	 	 	... made after the Forfeiture.
	 	 	 	 	 
	d.	 	
o
	Allocated in the same manner as the Employer Safe-Harbor or Regular Profit Sharing Contribution for the Plan Year of the Forfeiture.

J. Employer Qualified Contributions

	 	 	 	 	 	 	 	 
	1.	 	
Employer Qualified
	 	 	1.1	 	Will Employer Qualified Matching Contributions be made under the Plan?
	 	 	
Matching
	 	 	 	 	[check one]:
	 	 	
Contributions:	 	 	 	 	 	 
	 	 	
[Plan Sec. 5.2]
	 	 	a.	 	o    Yes, Employer Qualified Matching Contributions will be made at the discretion of the
        Lead Employer, to be allocated among [check one]:

	 	 	 	 	 	 	 	 	 
	 	 	 	 	i.	 	o	 	Employees who are Active Participants on the last day of the applicable Plan Year and who have Employee Pre-Tax Contributions for such Plan Year.
	 	 	 	 	ii.	 	o	 	Non-Highly Compensated Employees who are Active Participants on the
last day of the applicable Plan Year and who have Employee
Pre-Tax Contributions for such Plan Year.
	 	 	 	 	 	 	 	 	 
	 	 	 	 	[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.]

	 	 	 
	29	 	
AA1

 

 

	 	 	 
	 	 	
Any Employer Qualified Matching Contributions that are made will be
allocated as follows [check one]:
	 	 	 
	 	 	
iii.     o     Allocated in proportion to the Employee Pre-Tax Contributions of each eligible
                
 Participant for the applicable Plan Year.
	 	 	
iv.     o    Allocated as a uniform dollar amount.
	 	 	
v.      o    Allocated first to the person with the lowest Recognized Earnings for the
                
 applicable Plan Year, then to the person with the next lowest Recognized
                
 Earnings for the applicable Plan Year, etc. until the applicable test is met, with the
                
 allocation to each person limited to the amount permitted under Code section 415.
	 	 	
vi.     o    Other [specify]:

	 	 	 	 	 
	 	b.	
x
	No.	 

	 	 	 	 	 	 	 	 
	2.	 	
Employer
	2.1	 	Will Employer Qualified Profit Sharing Contributions be made under the
	 	 	
Qualified
	 	 	Plan? [check one]:
	 	 	
Profit Sharing
	 	 	a.	 	o    Yes, Employer Qualified Profit Sharing Contributions will be made at
	 	 	
Contributions:
	 	 	 	 	   
    the discretion of the Lead Employer, to be allocated among [check one]:
	 	 	
[Plan Sec. 6.3]
	 	 	 	 	 	 

	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	i.       o    Employees who are Active Participants on the last day of the applicable Plan

             
   Year.
	 	 	 	 	 	 	 	 	ii.      o    Non-Highly Compensated Employees who are Active Participants on the last

             
   day of the applicable Plan Year.
	 
	 	 	 	 	 	 	 	 	iii.     o    First to former Employees whose Termination of Service occurred during the

             
   applicable Plan Year and who were Non-
Highly Compensated Employees
             
   prior to Termination of Service, and then, if required, to Non-Highly Compensated

             
   Employees who are Active Participants as of the last day of the applicable Plan Year.
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	[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.]
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	Any Employer Qualified Profit Sharing Contributions that are made will
	 	 	 	 	 	 	 	 	be allocated as follows [check one]:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	iv.    o     Allocated as a uniform percentage of Recognized Earnings for the applicable Plan Year.
	 	 	 	 	 	 	 	 	v.     o    Allocated as a uniform dollar amount.
	 	 	 	 	 	 	 	 	vi.    o     Allocated first to the person with the lowest Recognized
Earnings for the
             
   applicable Plan Year, then to the person with the next lowest Recognized Earnings for
             
   the applicable Plan
Year, etc. until the applicable test is met, with the allocation to each
             
   person limited to the amount permitted under Code section 415.

	 	 	 	 	 	 	 	 	vii.    o    Other: [specify]     .

	 	 	 	 	 
	 	b.	
x
	No.	 

K. Rollovers and Transfers

	 	 	 	 	 	 	 	 	 
	1.	 	
Employee Rollover
	1.1	 	 	Employee
Rollover Contributions will be permitted under the following
circumstances [check one]:
	 	 	
and Transfer
	 	 	 	 

	 	 	 
	30	 	
AA1

 

 

	 	 	 	 	 	 	 	 	 	 	 
	     Contributions:	 	
a.
	 	o
	 	Not permitted.
	     [Plan Sec. 4.4]	 	
b.
	 	o
	 	Permitted if the Employee is in Covered Employment (but
regardless of whether he/she is an Active Participant).
	 	 	
c.
	 	x
	 	Permitted if the Employee is an Active Participant in any Component of the Plan.
	 	 	 	 	 	 	 
	 	 	
1.2
	 	Account Transfers will be permitted
or made
to this Plan under the
following
circumstances [check one]:
	 	 	 	 	 	 	 
	 	 	
a.
	 	x
	 	Not permitted.
	 	 	
b.
	 	o
	 	Permitted if the Employee is in Covered Employment (regardless of
whether he/she is an Active Participant).
	 	 	
c.
	 	o
	 	Permitted if the Employee is an Active Participant in any Component of the Plan.
	 	 	
d.
	 	o
	 	Made at the direction of the Lead Employer from another plan
maintained by a Controlled Group Member upon transfer to
participation in this Plan. However, such transfer will be made ...
[select as desired]:

	 	i.	 o 	Only once the account is fully vested under the transferor plan.
	 	ii.	o 	Regardless of whether the account is fully vested under the
transferor plan; but the transfer account will become fully
vested upon transfer to this Plan.

	 	 	 	 	 	 	 	 	 	 	 	 	 
	2.	 	
Form of
	 	 	2.1	 	 	An Employee Rollover or Transfer Contribution will be allowed [check one]:	 	 
	 	 	Contribution:	 	 	 	 	 	 	 	 	 	 
	 	 	
[Plan Sec. 4.4 & 4.5]
	 	 	a.	 	 	x
	 	In cash only.	 	 
	 	 	
[complete only if

rollovers or transfers

	 	 	b.	 	 	o
	 	In cash only, 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.	 	 
	 	 	
allowed]
	 	 	c.	 	 	o
	 	In cash or in kind (to the extent not prohibited by the Funding Agent).	 	 
	 	 	
 	 	 	 	 	 	 	 	 	 	 
	L.	 	
Retirement Age	 	 	 	 	 	 	 	 	 	 
	 	 	
 	 	 	 	 	 	 	 	 	 	 
	1.	 	
Normal Retirement
	 	 	1.1	 	 	The
Normal Retirement Age under the Plan is [check one]:
	 	 
	 	 	Age:	 	 	 	 	 	 	 	 	 	 
	 	 	[Plan Sec. 2.40]
	 	 	a.	 	 	x
	 	Age 65 [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.	 	
Special Vesting Rules	 	 	 	 	 	 	 	 	 	 
	 	 	
 	 	 	 	 	 	 	 	 	 	 
	1.	 	
Vesting:

[Plan Sec. 11.2(c)]
	 	 	1.1	 	 	Does a vesting schedule apply to either Employer Regular Matching or
Regular Profit Sharing Contribution Accounts? [check
one]:	 	 
	 	 	
 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	a.	 	 	x
	 	Yes.	 	 
	 	 	 	 	 	b.	 	 	o
	 	No. [If full vesting, skip to Item N.]	 	 
	 	 	
 	 	 	 	 	 	 	 	 	 	 
	2.	 	
Service Disregarded

for Vesting: 

[Plan Sec. 11.2(f)]
	 	 	2.1	 	 	The following Service will be disregarded for the purpose of determining a
Participant’s vested percentage in an Employer Regular Matching or
Regular Profit Sharing Contribution Account [check as many as desired]:
	 	 
	 	 	
 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	a.	 	 	o
	 	Any Service before
the Participant attained the age of    [not more
than age 18].	 	 
	 	 	 	 	 	b.	 	 	o
	 	Any Service before any Controlled Group Member or a Predecessor
Employer first maintained this Plan (or a predecessor plan).	 	 
	 	 	
 	 	 	 	 	 	 	 	 	 	 
	3.	 	
Special Vesting
	 	 	3.1	 	 	A Participant will be fully vested in an Employer Regular Matching or	 	 

	 	 	 
	 	31	
AA1

 

 

	 	 	 	 	 	 	 
	Events:	 	 	 	Regular
Profit Sharing Contribution Account if [check as many as desired]:
	[Plan Sec. 11.2(a) & (b)]	 	 	 	 	 	 
	 	 	
a.
	 	o
	 	The Participant has
attained age    and completed    years of Service.

[NOTE: A Participant will in all events be fully vested upon attainment of
Normal Retirement Age while employed with a Controlled Group Member.]
	 	 	
b.
	 	x
	 	Termination of Service occurs as a result of death.
	 	 	
c.
	 	x
	 	Termination of Service occurs as a result of disability, which means that [check one]:

	 	i.	o	 The Participant meets the standard for long-term disability
benefits under any disability plan maintained by a Controlled Group Member.
	 	ii.	o	The Participant has been determined to be disabled for purposes of Social Security.
	 	iii.	o	The Participant is permanently unable to perform the normal duties of his/her job with the Participating Employer.
	 	iv.	x	The Participant is permanently unable to engage in any occupation for wage or profit for which he/she is reasonably
fitted by training, education or experience.

	 	 	 	 	 	 	 	 	 	 	 
	4.	 	
Forfeitures:

[Plan Sec. 11.2(g)]
	 	 	4.1	 	 	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 following date [check one]:
	 	 	
 	 	 	 	 	 	 	 	 
	 	 	 	 	 	a.	 	 	x
	 	On the earlier of the date the Participant incurs a five-year Break in
Service, or the date the Participant receives a full distribution of the
vested portion of the Contribution Account (or upon Termination of
Service if the Participant is not vested in the Contribution Account).
	 	 	 	 	 	b.	 	 	o
	 	On the earlier of the date the Participant incurs a five-year Break in
Service, or the last day of the ... [check one]:

	 	i.	o	 Plan Year in which
	 	ii.	o 	 first Plan Year after
	 	iii.	o 	 second Plan Year after
	 	iv.	 o 	 third Plan Year after
	 	v.	o 	fourth Plan Year after
	 	vi.	o 	fifth Plan Year after

	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	... the Participant receives a full distribution of the vested portion of the
Contribution Account (or upon Termination of Service if the Participant
is not vested in the Contribution Account).
	 	 	 	 	 	 	 	 	 
	5.	 	
Vesting Formula for

Partially Vested:

[Plan Sec. 11.2(c) & (g)]
	 	5.1
	 	The following formula shall apply to determine the vested portion of a
Contribution Account if a partially vested Participant receives a withdrawal
from such Contribution Account [check one]:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.
	 	o
	 	P(AB+D)-D
	 	 	 	 	b.
	 	x
	 	P[AB+(RxD)]-(RxD)
	 	 	 	 	 	 	 	 	 
	 	 	 	 	5.2
	 	If a partially vested Participant receives a distribution of less than the full
vested balance of a Contribution Account after his/her Termination of
Service [check one]:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.
	 	o
	 	A proportionate share of the remaining balance of the Contribution Account will become a Forfeiture.
	 	 	 	 	b.
	 	x
	 	The formula specified in Sec. 5.1, above, will apply after the distribution
to determine the vested portion of the Contribution Account.

	 	 	 
	 	32	
AA1

 

 

	 	 	 	 	 	 	 	 	 	 	 
	6.	 	
Reinstatement upon
Return to Service:
[Plan Sec. 11.2(h)]
	 	 	6.1	 	 	A Participant who has a Termination of Service, receives a distribution of
the vested portion of a Contribution Account and returns to Covered
Employment ... [check one]:
	 	 	 	 	 	a.	 	 	x
	 	will
	 	 	 	 	 	b.	 	 	o
	 	will not
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	... be required to repay the prior distribution in order to have the non-vested
portion of the Contribution Account reinstated.

	 	 	 	 	 	 	 	 	 	 	 
	7.	 	
Special Vesting
Rules for Life
Insurance:
[Plan Sec. 10.4(a) & (c)]

[complete only if life
insurance is allowed as
an investment and if a
vesting schedule applies
to the Contribution
Account holding the life
insurance policy]

	 	 	7.1	 	 	Will a Participant be fully vested in any value held in the form of (or
attributable to) a life insurance policy acquired for his/her Contribution
Accounts, notwithstanding any other vesting provision of the Plan? [check
one]:
	 
	 	 	 	 	a.	 	 	o
	 	Yes.
	 	 	 	 	b.	 	 	o
	 	No – in which case, the following amounts will be treated as a
withdrawal or distribution for purposes of applying the formula specified
in Sec. 5.1, above (which calculates the vested interest following a
withdrawal or distribution from a partially vested Contribution Account)
[check one]:

	 	i.	o	 All premiums paid on term life policies (other than unearned
premiums returned by the insurance company to the Trustee
or Custodian) and, in the case of cash value policies ...

	 	A.	o	 the excess of the premium paid over the cash surrender value.
	 	B.	o	 the PS-58 cost charged to the Participant as a result
of the Trustee or Custodian holding such policies.

	 	ii.	o	 None – no amounts relative to any life insurance policy will be
treated as a withdrawal or distribution for such purpose.

	 	 	 	 	 	 	 	 	 
	N.	 	
Employer Securities	 	 	 	 	 	 
	 	 	
 	 	 	 	 	 	 
	1.	 	
Employer Securities:

[Plan Sec. 15.15]
	 	1.1
	 	Does the Plan hold Qualifying Employer Securities or Predecessor
Employer Securities? [check one]:
	 	 	 	 	a.
	 	x
	 	Yes.
	 	 	 	 	b.
	 	o
	 	No. [If not allowed, skip to Item O.]
	 	 	
 	 	 	 	 	 	 
	2.	 	
Voting Provisions:

[Plan Sec. 15.16]
	 	2.1
	 	A Participant will be allowed to direct the vote on Qualifying Employer
Securities credited to his/her Account on the following matters [check one]:
	 	 	
 	 	 	 	 	 	 
	 	 	
[complete only if the Plan holds Qualifying
Employer Securities]
	 	a.

b.

c.

d.
	 	x

o

o

o
	 	None – not allowed to direct any vote.

Any matter put to the vote of shareholders.

Any significant corporate event (as defined in Plan Sec. 15.16(c)).

Other [specify]:     .
	 	 	
 	 	 	 	 	 	 
	 	 	 	 	2.2
	 	Qualifying Employer Securities held in the Plan with respect to which the
Participant is not allowed to, or does not, direct the vote will be voted [check one]:
	 	 	
 	 	 	 	 	 	 
	 	 	 	 	a.
	 	x
	 	In the same proportion as the votes cast on Qualifying Employer
Securities for which the Participants provide timely direction.
	 	 	 	 	b.
	 	o
	 	At the discretion of the Trustee.
	 	 	 	 	c.
	 	o
	 	At the discretion of a Named Fiduciary or an Investment Manager
designated by the Lead Employer.
	 	 	
 	 	 	 	 	 	 
	3.	 	
Tender Provisions:

[Plan Sec. 15.17]
	 	3.1
	 	A Participant will be allowed to direct the hold or sell/exchange decision with
respect to Qualifying Employer Securities credited to his/her Account in the
following corporate transactions [check one]:
	 	 	
 	 	 	 	 	 	 
	 	 	
[complete only if the Plan
holds Qualifying
	 	a.
	 	x
	 	None – not allowed to direct the hold or sell/exchange decision in any

	 	 	 
	 	33	
AA1

 

 

\

	 	 	 	 	 	 	 
	 	 	
Employer Securities]
	 	 	 	corporate transaction.
	 	 	 	 	b.
	o 	Any tender or exchange offer.
	 	 	 	 	c.
	o 	 Any cash or stock offer made in connection with a merger or other corporate transaction.
	 	 	 	 	d.
	o 	Any tender or exchange offer, or any cash or stock offer made in
connection with a merger or other corporate transaction.
	 	 	 	 	 	 	 
	 	 	 	 	3.2
	Qualifying Employer Securities held in the Plan with respect to which the
Participant is not allowed to, or does not, direct the hold or sell/exchange
decision in a corporate transaction, will be held or sold/exchanged as
follows [check one]:
	 	 	 	 	 	 	 
	 	 	 	 	a.
	x	 In the same proportion as the Qualifying Employer Securities for which
the Participants do provide timely direction.
	 	 	 	 	b.
	o	 At the discretion of the Trustee.
	 	 	 	 	c.
	o	 At the discretion of a Named Fiduciary or an Investment Manager
designated by the Lead Employer.
	 	 	 	 	d.
	o	 Will not be sold/exchanged.
	 
	4.	 	
In-Kind Distribution
Option:

[Plan Sec. 13.3(c)]
	 	4.1
	The following distributions can be made in the form of Qualifying Employer
Securities (to the extent the applicable Contribution Account is then
invested in Qualifying Employer Securities) [check as many as
desired]:
	 	 	 	 	 	 	 
	 	 	 	 	a.

b.
	x
 o 	 None – distributions are not allowed in the form of Qualifying Employer
Securities.

In-service withdrawals o including o excluding hardship.
	 	 	 	 	c.
	o 	 Distributions following Termination of Service.
	 	 	 	 	 	 	 
	 	 	 	 	4.2
	The following distributions can be made in the form of Predecessor
Employer Securities (to the extent the applicable Contribution Account is
then invested in Predecessor Employer Securities) [check as many as desired]:
	 	 	 	 	 	 	 
	 	 	 	 	a.	x	 None – distributions are not allowed in the form of Predecessor
Employer Securities.
	 	 	 	 	b.
	o	 In-service withdrawals o including o excluding hardship.
	 	 	 	 	c.
	o	 Distributions following Termination of Service.
	 	 	
 	 	 	 	 
	O.	 	
Valuation Dates	 	 	 	 
	 	 	
 	 	 	 	 
	1.	 	
Common Valuation
	 	1.1	The
following dates are common Valuation Dates [check one]:
	 	 	Dates:
[Plan Sec. 2.63]	 	
a.	
o	
The last day of the last calendar month ending within the Plan Year.
	 	 	 	b.	o	The last day of each Plan Year.
	 	 	 	 	c.	o	The last day of each Plan Year and the last day of the seventh month of each Plan Year.
	 	 	 	 	d.	o	The last day of each quarter of the Plan Year.
	 	 	 	 	e.	o	The last day of each calendar month.
	 	 	 	 	f.	x	Each day on which trading occurs on the New York Stock Exchange.
	 	 	 	 	g.	o	 Other [specify]:        .
	 	 	 	 	[NOTE: A common Valuation Date is a date on which all assets of the Plan are valued.]
	 	 	 	 	 	 	 
	P.	 	Payment of Benefits	 	 	 	 
	 	 	 	 	 	 	 
	1.	 	Payment Date for

Balances Less Than

Cash-Out Amount:
	 	1.1	If a Participant’s benefit is subject to involuntary lump-sum payout after
Termination of Service, the payment will be made as soon as practicable
after [check one]:
	 	 	[Plan Sec. 13.4]	 	a.	o	Termination of Service.
	 	 	 	 	b.	o	The first day of the month following Termination of Service.

	 	 	 
	 	34	AA1

 

 

	 	 	 	 	 	 	 
	 	 	 	 	c.
	x	The first day of the Plan Year quarter following Termination of Service.
	 	 	 	 	d.
	o	The first day of the Plan Year following Termination of Service.
	 	 	 	 	e.
	o	Other
[specify]:        .
	 	 	 	 	 	 	 
	2.	 	
Payment Date for

Balances of Cash-

Out Amount or More:
	 	2.1
	If a Participant’s benefit is not subject to involuntary lump-sum payout after
Termination of Service, the earliest that the Participant may elect to receive
payment is as soon as practicable after [check one]:
	 	 	
[Plan Sec. 13.3(a)]
	 	a.
	x	
Termination of Service.
	 	 	 	 	b.
	o	 The first day of the month following Termination of Service.
	 	 	 	 	c.
	o	The first day of the Plan Year quarter following Termination of Service.
	 	 	 	 	d.
	o	The first day of the Plan Year following Termination of Service.
	 	 	 	 	e.
	o	Attainment of Normal Retirement Age.
	 	 	 	 	f.
	o	 Attainment of
age     [less than Normal Retirement Age].
	 	 	 	 	g.
	o	     
        following Termination of Service.
	 	 	 	 	h.
	o	Other
[specify]:        .
	 	 	 	 	 	 	Payment can be made after Termination of Service and prior to the
date specified above under the following circumstances [check either or
both]:

	 	i.	o	 If the Participant incurs a financial hardship (as defined in Item Q, Sec. 2.2).
	 	ii.	o	 If the Participant becomes disabled, which means that:

	 
	 	A.	o	 The Participant meets the standard for long-term disability benefits under any disability plan
maintained by a Controlled Group Member.
	 	B.	o	 The Participant has been determined to be disabled for purposes of Social Security.
	 	C.	o	 The Participant is permanently unable to perform the normal duties of his/her job with the Participating
Employer.
	 	D.	o	The Participant is permanently unable to engage in any occupation for wage or profit for which he/she is
reasonably fitted by training, education or experience.

	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	2.2	 	Even if a Participant then remains employed with a Controlled Group
Member, a Participant’s benefit will be paid (or payments will commence) as
soon as practicable after [check one]:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	a.	 	x	N/A  - no automatic pay-out.
	 	 	 	 	 	b.	 	o	Normal Retirement Age.
	 	 	 	 	 	c.	 	o	Attainment of age      [not less than the greater of 62 or Normal
Retirement Age].
	 	 	 	 	 	 	 	 	 
	3.	 	
Cash-Out Amount:
	 	 	3.1	 	The amount subject to involuntary cash-out is [check one]:
	 	 	
[Plan Sec. 13.4]
	 	 	
a.	 	
o 	

$3,500.
	 	 	 	 	 	b.	 	x	 $5,000 effective as of the later of [specify date] January 1, 2000 or the
first day of the first Plan Year beginning after August 5, 1997; and
$3,500 prior to such effective date.
	 	 	 	 	 	c.	 	o 	$      [not more than $5,000].
	 	 	 	 	 	 	 	 	 
	4.	 	
Payment Forms:

[Plan Sec. 13.3(b)]
	 	 	4.1	 	The methods of payment permitted under the Plan are [check as many as
desired]:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	a.	 	x 	Lump sum.
	
NOTE: You generally cannot

eliminate payment options
that were available under the

Plan prior to the effective date
	 	 	b.	 	o	 Installments, with the period over which installments may be taken
being limited to the following [check one]:

	 	 	 
	 	35	
AA1

 

 

	 	 	 	 	 	 	 
	of this Adoption
Agreement.	 	i.	 	o	 	N/A – no limit.
	 	ii.	 	o	 	         years.
	 	 	iii.	 	o	 	A number of years equal to ... [check one]:
	 	 	 	 	 	 	A.  o  The life expectancy of the Participant, as determined under Table V in Treas. Reg. Section 1.72-9.

	 	 	 	 	 	 	B.  o  The
joint life and last survivor expectancy of the Participant and his/her Beneficiary, as determined under Table VI in Treas. Reg. Section 1.72-9.

	 
	 	 	iv.	 	o	 	Other [specify]:      .

	 	 	 	 	 	 	 
	 	 	 	c.	o	 	Purchase of a period-certain annuity contract.
	 	 	 	d.	o	 	Purchase of any type of annuity contract.
	 
	5.	 Payment Medium:	 	5.1	The medium of payment permitted with respect to a non-annuity distribution under the Plan is 
	 	[Plan Sec. 13.3(c)]	 	 	[check one]:
	 
	 	 	 	a.	x	 	Cash only.
	 	 	 	b.	o	 	Cash or in-kind.
	 	 	 	c.	o	 	Cash only, except that any life insurance contract held on behalf of a Participant under the Plan may be distributed in-kind to the Participant.
	 	 	 	 	 	 	 
	 	 	 	 	[NOTE: Distribution of Qualifying Employer Securities or Predecessor Employer
	 	 	 	 	Securities is governed by Item N, Sec. 4.1.]

	 	 	 	 	 	 	 
	6.	Qualified Joint and	 	6.1	The annuity requirements of the Plan [check one]:
	 	Survivor Annuity	 	 	 	 	 	 	 
	 	Requirements:
[Plan Sec. 13.6]	 	a.	x	 	Do not apply. [NOTE: This option is not available if a life annuity is an available payment form under the Plan.]
	 	 	 	b.	o	 	Apply only to a Participant who elects a life annuity form of payment.
	 	 	 	c.	o	 	Apply to all Participants.

	 	 	 	 	 	 	 
	7.	
Beneficiary:
	 	7.1	The Beneficiary of a Participant shall be the following if a designation of Beneficiary is not
	 	
[Plan Sec. 14.3]	 	 	on file
[check one]:	 	 
	 
	 	 	 	a.	x	 	Participant’s Spouse, or if no Surviving Spouse, the Participant’s estate.
	 	 	 	b.	o	 	The person or persons surviving in the first of the following classes in which there is a survivor, share and share alike:

	 	 	 	 	 	 	 
	 	 	 	 	i.	 	
Participant’s Spouse.
	 	 	 	 	ii.	 	
Participant’s children, except that if any of those children
	 	 	 	 	 	 	
predeceases the participant but leaves issue surviving ,such issue
	 	 	 	 	 	 	
shall take by right of representation the share their parent would
	 	 	 	 	 	 	
have taken if living.
	 	 	 	 	iii.	 	
Participant’s parents.
	 	 	 	 	iv.	 	
Participant’s brothers and sisters.
	 	 	 	 	v.	 	
Participant’s estate.

	 	 	 	 	 	 	 
	 	 	 	c.	o	
 
	Other: Attach schedule.

	 	 	 	 	 	 	 
	 	 	 	7.2	
The Spouse of a Participant must consent to a designation of another or
	 	 	 	 	
different primary Beneficiary under the following circumstances
[check one]:

	 	 	 	 	 	 	 
	 	 	 	a.	x  Under all circumstances.
	 	 	 	b.	o  Only if the Participant and Spouse have been married for one year.
	 	 	 	 	     [NOTE: A designation will cease to be effective after one year without consent.]

	 	 	 	 	 	 	 
	8.	
Minimum
	 	8.1	The Required Beginning Date of a Participant after January 1, 1997 will

	 	 
	36	
AA1

 

 

	 	 	 	 	 	 	 
	 	Distributions:	 	 	be... [check one]:
	 	[Plan Sec. 13.7]	 	 	 	 	 
	 	 	 	
a.
	x
	 	The required beginning date determined under Code section 401(a)(9)
	 	 	 	 	 	 	(after amendment by the Small Business Protection Act of 1996).
	 	 	 	
b.
	o
	 	The April 1 of the
calendar year after the Participant attains age 701⁄2.
	 	 	 	
c.
	o
	 	Prior to
       [month, day, year], the April 1 of the calendar year after
	 	 	 	 	 	 	the Participant
attains age 701⁄2 thereafter, the required beginning date
	 	 	 	 	 	 	determined under Code section 401(a)(9) (after amendment by the
	 	 	 	 	 	 	Small Business Job Protection Act of 1996).

	 	 	 
	8.2	
To determine the minimum distribution required to be made to a Participant
	 	
prior to death, the following life expectancies will be recalculated annually
	 	
[check one]:

	 	 	 	 	 
	a.	
o
	None – life expectancies will not be recalculated.
	b.	
o
	The life expectancy of the Participant will be recalculated, but the life
	 	 	expectancy of a spouse Beneficiary will not be recalculated.
	c.	
o
	The life expectancy of both the Participant and a spouse Beneficiary
	 	 	will be recalculated.
	d.	
x
	The Participant can elect the life expectancies to be recalculated.
	 	 	[NOTE: Only the life expectancy of the Participant and his/her spouse are
	 	 	eligible for recalculation.]

	 	 	 
	8.3	
To determine the minimum distribution required to be made to a Beneficiary
	 	
when the Participant dies prior to the Required Beginning Date, the
	 	
following distribution rules will be used [check one]:

	 	 	 	 	 
	a.	
o
	The 5-year rule applies in all cases.
	b.	
x
	The following exceptions to the 5-year rule are available [check either
	 	 	one
or both]:

	 	 	 	 	 	 	 
	 	 	
i.
	 	x
	 	In the case of ... [check one]
	 	 	 	 	 	 	 
	 	 	 	 	 	 	A.  o  a spouse Beneficiary
	 	 	 	 	 	 	B.  x  any Beneficiary

	 	 	 	 	 	 	 
	 	 	 	 	 	 	... installments (if permitted and elected under the Plan) may
	 	 	 	 	 	 	continue beyond the 5-year limit.
	 	 	 	 	 	 	 
	 	 	
ii.
	 	x
	 	In the case of a spouse Beneficiary, payments may
	 	 	 	 	 	 	commence at any time prior to December 31 of the calendar
	 	 	 	 	 	 	year in which the
Participant would have reached age 701⁄2.

	 	 	 	 	 	 	 
	
8.4	 	 	 	If a
Participant who attained age 701⁄2 prior to 1997 (or such later date as
	 	 	 	 	may be specified in Sec. 8.1(c)) has elected 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, the new
	 	 	 	 	commencement date ... [check one]:
	
a.	 	 	 	x  will
	
b.	 	 	 	o  will not
	 	 	 	 	 	 	 
	 	 	 	 	    ... be treated as a new Benefit Starting Date for purposes of the Plan.

	 	 
	37	
AA1

 

 

Q. Withdrawals While Employed

	 	 	 	 	 	 	 	 	 
	1.	
Withdrawals:
	 	1.1	 	 	 	 	Are Participants permitted to make withdrawals from their Contribution
	 	
[Plan Sec. 12.1]
	 	 	 	 	 	 	Accounts prior to
Termination of Service? [check one]:
	 	 	 	 	 	 	 	 	 
	 	 	 	a.	 	 	 	 	x  Yes.
	 	 	 	b.	 	 	 	 	o  No [if not permitted, skip to Item R].
	 	 	 	 	 	 	 	 	 
	2.	
Withdrawal Events:[Plan Sec. 12.1(b), (c) & (d)]
	 	2.1	 	 	 	 	Withdrawals are permitted from the following Contribution Accounts when

the Participant has
reached the age specified, if any, and completed the

years of Service specified, if any [check as many as desired,
and complete]:

	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	Years of
	 	 	 	 	Account	 	Age	Service
	 	 	 	 	
	 	 	 	 
	a.	 	
o
	 	Employee Pre-Tax Contribution Account
	 	            yrs
	*	            yrs

	b.	 	
o
	 	Employee After-Tax Contribution Account
	 	            yrs
	 	            yrs

	c.	 	
o
	 	Employee Rollover Contribution Account
	 	            yrs
	 	            yrs

	d.	 	
o
	 	Employer Regular Matching Contribution
	 	            yrs
	 	            yrs

	 	 	 	 	Account	 	 	 	 
	e.	 	
o
	 	Employer Regular Profit Sharing
	 	            yrs
	 	            yrs

	 	 	 	 	Contribution Account	 	 	 	 
	f.	 	
o
	 	Employer Safe-Harbor Matching
	 	            yrs
	*	            yrs

	 	 	 	 	Contribution Account	 	 	 	 
	g.	 	
o
	 	Employer Safe-Harbor Profit Sharing
	 	            yrs
	*	            yrs

	 	 	 	 	Contribution Account	 	 	 	 
	h.	 	
o
	 	Employer Qualified Matching Contribution
	 	            yrs
	*	            yrs

	 	 	 	 	Account	 	 	 	 
	i.	 	
o
	 	Employer Qualified Profit Sharing
	 	            yrs
	*	            yrs

	 	 	 	 	Contribution Account	 	 	 	 
	j.	 	
o
	 	Qualified Replacement Plan Allocation
	 	            yrs
	 	            yrs

	 	 	 	 	Account	 	 	 	 
	 	 	 	 		 	 	 	 
	 	 	 	 	*[not
younger than 591⁄2]
	 	 	 	 

	 	 	 
	2.2	
Withdrawals are permitted from the following Contribution Accounts to meet
	 	
a financial hardship [check as many as desired]:

	 	 	 	 	 
	a.	
x
	Employee Pre-Tax Contribution Account
	b.	
o
	Employee After-Tax Contribution Account
	c.	
o
	Employee Rollover Contribution Account
	d.	
o
	Employer Regular Matching Contribution Account
	e.	
o
	Employer Regular Profit Sharing Contribution Account
	f.	
o
	Qualified Replacement Plan Allocation Account
	 	 	 
	 	 	The
following situations will be treated as constituting financial hardship [check
as many as desired]:

	 	 	 	 	 
	i.	 	
x
	 	Expenses for medical care described in Code section 213(d)
	 	 	 	 	incurred by the Participant, his/her spouse, or his/her
	 	 	 	 	dependents (as defined in Code section 152), or necessary for
	 	 	 	 	any of those persons to obtain such medical care.
	ii.	 	
x
	 	Costs directly related to the purchase of the Participant’s
	 	 	 	 	principal residence (excluding mortgage payments).
	iii.	 	
x
	 	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.
	iv.	 	
x
	 	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.
	v.	 	
o
	 	Funeral expenses relating to the death of a member of the
	 	 	 	 	Participant’s family.

	 	 
	38	
AA1

 

 

	 	 	 
	vi.	
o
	Other
[specify]:     

	 	 	 
	The amount of a hardship withdrawal ... [check one]:
	vii.	x	may
	viii.	o	may not
	 	 	 
	... include any
amounts necessary to pay any federal, state or local income taxes or
penalties reasonably expected to result from the distribution.

	 	 	 
	2.3	
Withdrawals are permitted from the following Contribution Accounts at
any time [check either or both]:
	 	
 
	a.	
o   Employee After-Tax Contribution Account.
	b.	
o   Employee Rollover Contribution Account.

R. Top-Heavy Provisions

	 	 	 	 	 	 	 	 	 
	1.	
Top-Heavy Status
	1.1	 	 	 	 	The
Plan’s Top-Heavy status is determined as follows [check one]:
	 	
Determination:	a.	 	 	 	 	x   Whether the Plan is or is not Top-Heavy depends on its actual status for each Plan Year.
	 	
[Plan Sec. 18.1]

	 	 	b.	 	 	 	 	o   The Plan will be deemed to be Top-Heavy regardless of its actual status.
	 	
 

	2.	
Coordination with
	2.1	 	 	 	 	If the
Participant also participates in another qualified defined
contribution Plan of a Controlled Group Member, the minimum Top-Heavy
allocation will be made under [check one]:
	 	
Other Defined
	 	 	 	 	 	 
	 	
Contribution Plan:
	a.	 	 	 	 	x   This Plan.
	 	
[Plan Sec. 18.2

	 	
(a)]
	b.	 	 	 	 	o   The following plan [complete]:
	 
	 	 	 	 	 	 	 	       Plan Name:     
	 
	3.	
Coordination with
	3.1	 	 	 	 	If a
Participant participates in both a Top-Heavy defined contribution
plan and Top-Heavy defined benefit plan of a Controlled Group Member
[check one]:
	 	
Defined Benefit Plan:
	a.	 	 	 	 	o   A minimum benefit of 2% per year of service (up to 20%) will be provided under the defined benefit plan.
	 	
[Plan Sec. 18.2(a)]

	 	
[complete only if a Controlled	 	 	 	 	 	 	 
	 	
Group Member
	b.	 	 	 	 	o   A minimum contribution of 5% will be provided under the defined contribution plan.
	 	
maintains a	 	 	 	 	 	 	 
	 	
defined benefit plan]
	3.2	 	 	 	 	Prior to
the first day of the first Plan Year beginning in 2000, if a
Participant participates in both a Top-Heavy defined contribution
plan and Top-Heavy defined benefit plan of a Controlled Group Member [check one]:

	 	 	 	 	 
	a.	
o
	The denominator of the defined contribution and defined benefit
	 	 	fractions will in all cases be computed by substituting a factor of 1.0 for
	 	 	1.25.
	b.	
o
	The denominator of the defined contribution and defined benefit
	 	 	fractions will be computed by using a factor of 1.25 if the Top-Heavy
	 	 	ratio does not exceed 90% and [check one]:

	 	 	 	 	 
	i.	 	
o
	 	A minimum benefit of
3% per year of service (up to 30%) will be provided under the defined benefit plan.
	ii.	 	
o
	 	A minimum
contribution of 71⁄2% will be provided under the defined contribution plan.

	 	 	 
	3.3	
To determine the Top-Heavy ratio, the following interest rate and
mortality assumptions will be used to value accrued benefits under
defined benefit plans [complete]:
	 	

	 	 
	39	
AA1

 

 

	 
	Interest:          %
	Mortality:          .

	 	 	 	 	 	 	 	 	 
	4.	
Special Top-
Heavy
	4.1	 	 	 	 	If the
Plan is Top-Heavy for a Plan Year and the Plan provides for a variable Employer
Regular Profit Sharing Contribution, the minimum contribution requirement will be satisfied [check one]:
	 	
Contribution:
	 	 	 	 	 	 
	 	
[Plan Sec. 18.2
	a.	 	 	 	 	
o
	By means
of an additional Employer Regular Profit Sharing Contribution.
	 	
(b)]
	b.	 	 	 	 	
x
	By modification of the allocation method that would otherwise apply.

	 	 	 	 	 	 	 	 	 
	5.	Special Top-Heavy
	5.1	 	 	 	 	If the
Plan is Top-Heavy for a Plan Year, the following vesting schedule will be
substituted for any vesting schedule that otherwise would apply for that year
[check one]:
	 	
Vesting:
	 	 	 	 	 	 
	 	
[Plan Sec. 18.3]
	 	 	 	 	 	 

	a.	
o
	A
Participant’s vested percentage will at all times be 100%.
	b.	
x
	A
Participant’s vested percentage will be determined under the following schedule [complete as desired]:

	 	 	 	 	 
	Years of	 	Vested	 	 
	Service	 	Percentage	 	 
	
	 	
	 	 
	0	 	
0 %	 	 
	1	 	
20 %	 	 
	2	 	
40 %	 	[20% or more]
	3	 	
60 %	 	[40% or more]
	4	 	
80 %	 	[60% or more]
	5	 	
100 %	 	[80% or more]
	6 or more	 	
100 %	 	 

	 	 	 	 	 
	c.	
o
	A
Participant’s vested percentage will be determined under the following schedule [complete as desired]:

	 	 	 	 	 
	Years of	 	Vested
	Service	 	Percentage
	
	 	

	0	 	 	
0	%
	1	 	 	
___	%
	2	 	 	
___	%
	3 or more	 	 	
100	%

	 	 	 
	5.2	
If the Plan was, but has ceased to be, Top-Heavy, the above vesting schedule ... [check one]:

	 	 	 	 	 
	a.	x
	Will nonetheless continue to apply to all Participants.
	b.	
o
	Will
nonetheless continue to apply to any Participant who has three or
more years of Service as of the last day the Plan is Top-Heavy (but not any other Participant).
	c.	
o
	Will
cease to apply. [NOTE: This will be treated as an amendment to the vesting schedule that is subject to the election specified in the Plan.]

S. Code Section 415 Provisions

	 	 	 	 	 	 	 	 	 
	1.	
Compensation:
	1.1	 	 	The
Compensation of a Participant is [check one]:
	 	
[Plan Sec. 19.4(b)]	 	 	 	 	 	 	 
	 	 	a.	 	 	o   Earnings for purposes of Code section 415(c)(3).
	 	 	b.	 	 	o   Earnings for purposes of federal income tax withholding.

	 	 
	40	 	
AA1

 

 

	 	 	 	 	 	 	 	 	 
	 	 	 	 	c.
	 	x
	 	Earnings required to be reported in the Wages, Tips and Other
Compensation box of Form W-2.
	 	 	 	 	 	 	 	 	 
	2.	 	
Limitation Year:
	 	2.1
	 	The
Limitation Year with respect to the Plan is [check one]:
	 	 	
[Plan Sec. 19.4(g)]	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.
	 	x
	 	The Plan Year.
	 	 	 	 	b.
	 	o
	 	The 12-month period ending each
       
[month, day].
	 	 	 	 	 	 	 	 	 
	 	 	 	 	2.2
	 	If the Limitation Year is being or has been amended, the limitation year
before the amendment was the 12-month period ending each        
[month, day] , the short Limitation Year resulting from the amendment
began
       
[month, day, year] and ended      [month, day, year], and
the Limitation Year after the amendment is as specified above.
	 	 	 	 	 	 	 	 	 
	3.	 	
Correction Method:

[Plan Sec. 19.1(c)]
	 	3.1
	 	If Excess Annual Additions have been made under the Plan, the following
correction method will be used [check one]:
	 
	 	 	 	 	a.
	 	x
	 	Individual reduction method – 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.
	 	o
	 	Suspense account method – the Excess Annual Additions will be
placed in a Pending Allocation Account and will reduce Employer
Contributions of all Participants in future Limitation Years.
	 	 	 	 	c.
	 	o
	 	Current allocation method – the Excess Annual Additions will be
reallocated among other Active Participants as of the last day of the
current Limitation Year in proportion to Recognized Earnings.
	 	 	 	 	 	 	[NOTE: The above correction method applies only after Employee Pre-Tax and
After-Tax Contributions for the Limitation Year have been refunded to the
Participant.]
	 	 	 	 	 	 	 	 	 
	 	 	 	 	3.2
	 	If a Pending Allocation Account is ever maintained to hold Excess Annual
Additions, the Pending Allocation Account ... [check
one]:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.
	 	x
	 	will
	 	 	 	 	b.
	 	o
	 	will not
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	... share in investment income and losses under the Plan.
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	[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.]
	 	 	 	 	 	 	 	 	 
	4.	 	
Other Qualified

Plans:

[Plan Sec. 19.2]
	 	4.1
	 	Does a Controlled Group Member maintain or has a Controlled  Group
Member ever maintained another qualified plan in which any participant in
this Plan is (or was) a participant or could possibly become a participant
(other than another master or prototype defined contribution plan), a welfare
benefit fund as defined in Code section 419(e), or an individual medical
account as defined in Code section 415(l)(2), under which amounts are
treated as annual additions with respect to any Participant in this Plan?
[check one]:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.
	 	o
	 	Yes.
	 	 	 	 	b.
	 	x
	 	No. [If no other plan, skip to Item T.]

	 	 	 	 
	 	
41	 	AA1

 

	 	 	 	 	 	 	 	 	 	 	 
	5.	 	
Defined Contribution
Plan:

[Plan Sec. 19.2(b)]
	 	 	5.1	 	 	If the Participant is covered under another qualified defined contribution
plan maintained by a Controlled Group Member, other than a master or
prototype plan [check one]:
	 	 	 	 	 	a.	 	 	o
	 	The method used to coordinate the annual addition limit will be the
same method that would be used for a master or prototype plan.
	 	 	 	 	 	b.	 	 	o
	 	Other [specify the method that will be used to coordinate the annual
addition limits in a manner that precludes
discretion]:     .
	6.	 	
Defined Benefit Plan:

[Plan Sec. 19.3]
	 	 	6.1	 	 	If the Participant is or has ever been a participant in a defined benefit plan
maintained by the Controlled Group Member, allocations and benefits will
be limited as follows [check one]:
	 	 	 	 	 	a.	 	 	o
	 	By limiting the projected benefit under the defined benefit plan.
	 	 	 	 	 	b.	 	 	o
	 	Other
[specify, in a manner that precludes discretion]:     .

	T.	 	Special Non-Discrimination Testing Rules

	 	 	 	 	 	 	 	 	 	 	 
	1.	 	
Highly Compensated

Employees:

[Plan Sec. 2.29]
	 	 	1.1	 	 	An Employee will be a Highly Compensated Employee if he/she
is a five-percent owner at any time during the current Plan Year or the twelve-month
period immediately preceding the current Plan Year, or if the Employee’s
compensation during the look-back period exceeded the limit in effect under
Code section 414(q)(1)(B) ... [check if applicable]:
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	a.	 	 	o
	and the Employee was in the top-paid group for the look-back period.
This top-paid group election applies with respect to Plan Years
beginning on or after January 1, 1997, unless otherwise specified
below [check if applicable]:
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	i.
	o	The top-paid group election applies with respect to Plan Years
beginning on or after [specify date]:     .
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	1.2	 	 	The
look-back period is [check one]:
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	a.	 	 	x
	The twelve-month period immediately preceding the current Plan Year.
	 	 	 	 	 	b.	 	 	o
	The calendar year ending within the current Plan Year. [NOTE: This
election is not available if the Plan Year is the calendar year, and can only be
made if it is made in all of the Controlled Group Members’ plans other than
calendar year plans.]

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	2.	 	
ADP/ACP Testing

Method:

[Plan Sec. 20.2 &
	 	 	2.1	 	 	The Average Deferral Percentage Test and the Average Contribution
Percentage Test will be applied using the following testing method [select
one]:
	 	 	
20.3]
	 	 	a.	 	 	x
	The prior year testing method, modified as follows [check as
applicable]:
	 
	 	 	 	 	 	 	 	 	 
	i.	x
	 	The Employee Pre-Tax Contribution Component of the Plan
first became effective on or after January 1, 1997, and the
Average Deferral Percentage of the Non-Highly Compensated
Employees for the first Plan Year of such Component will be
deemed to be [check one]:
	 
	 	 	 	 	 	 	 	 	 	 	 	 	A.
	 	o
	 	3%
	 	 	 	 	 	 	 	 	 	 	 	 	B.
	 	x
	 	The Average Deferral Percentage of the Non-Highly
Compensated Employees for the first Plan Year of
such Component.
	 	 	 	 	 	 	 	 	 
	ii.	x
	 	The Employee After-Tax Contribution and/or Employer
Regular Matching Contribution Component of the Plan first
became effective on or after January 1, 1997, and the Average

	 	 	 	 
	 	
42	 	AA1

 

	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	Contribution Percentage of the Non-Highly Compensated
Employees for the first Plan Year of such Component will be
[check one]:
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	 	 	 	 	A.
	 	o
	 	3%.
	 	 	 	 	 	 	 	 	 	 	 	 	B.
	 	x
	 	The Average Contribution Percentage of the Non-Highly Compensated Employees for the first Plan
Year of such Component.
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 

	 	 	 	 	b.
	 	o
	The current year testing method. [NOTE: The current year testing election
can be changed only under circumstances prescribed by the IRS.]
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	[NOTE: If the Plan uses an Employer Safe-Harbor Contribution to satisfy the
Average Deferral Percentage Test or Average Contribution Percentage Test, it
will be deemed to be using the current year testing method.]
	 	 	 	 	 	 	 	 	 
	 	 	 	 	2.2
	 	Notwithstanding the above election, the Average Deferral Percentage Test
and the Average Contribution Percentage Test for Plan Years beginning
before [specify date]     , will be applied using the following testing
method [check one]:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.
	 	o
	 	The prior year testing method.
	 	 	 	 	b.
	 	o
	 	The current year testing method.
	 	 	 	 	 	 	 	 	 
	3.	 	
Other Elections

Regarding ADP/ACP
	 	3.1
	 	The following contributions may be taken into account in applying the
Average Deferral Percentage Test [check as desired]:

	 	 	
Testing:

[Plan Sec. 20.2, 20.3

& 20.4]
	 	a.
	 	x
	 	Employer Regular Matching Contributions to the extent such
contributions satisfy the requirements to be Employer Qualified
Matching Contributions.
	 	 	 	 	b.
	 	o
	 	Employer Regular Profit Sharing Contributions to the extent such
contributions satisfy the requirements to be Employer Qualified Profit
Sharing Contributions.
	 	 	 	 	 	 	 	 	 
	 	 	 	 	3.2
	 	The
following contributions may be taken into account in applying the Average Contribution Percentage Test [check as desired]:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.
	 	x
	 	Employee Pre-Tax Contributions.
	 	 	 	 	b.
	 	o
	 	Employer Regular Profit Sharing Contributions to the extent such
contributions satisfy the requirements to be Employer Qualified Profit
Sharing Contributions.
	 	 	 	 	 	 	[Note: Employer Qualified Matching and Qualified Profit Sharing Contributions (if
permitted under the Plan) may in all cases be taken into account in applying the
Average Deferral Percentage Test and Average Contribution Percentage Test. Also,
Employer Safe-Harbor Matching and Safe-Harbor Profit Sharing Contributions may
be taken into account in applying the Average Contribution Percentage Test, but
only to the extent they exceed the minimum contribution required to qualify as safe-
harbor contributions.]
	 	 	 	 	 	 	 	 	 
	 	 	 	 	3.3
	 	Is it permissible to recharacterize Employee Pre-Tax Contributions as
Employer After-Tax Contributions to the extent necessary to satisfy the
Average Deferral Percentage Test? [check one]:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.
	 	x
	 	No.
	 	 	 	 	b.
	 	o
	 	Yes, recharacterization will be allowed at the discretion of the Lead
Employer.
	 	 	 	 	c.
	 	o
	 	Yes, recharacterization will be allowed at the election of the affected
Participant.
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	[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, do not exceed any limits otherwise imposed under the Plan on
Employee After-Tax Contributions.]
	 	 	 	 	 	 	 	 	 

	 	 	 	 
	 	
43	 	AA1

 

	 	 	 	 	 	 	 	 	 
	 	 	 	 	3.4
	 	If the multiple use test is failed for a Plan Year, the following percentages
for the Highly Compensated Employees shall be reduced to satisfy such
test [check one]:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.
	 	o
	 	Average Deferral Percentage.
	 	 	 	 	b.
	 	x
	 	Average Contribution Percentage.
	 	 	 	 	 	 	 	 	 
	4.	 	
Income on Excess

Contributions:

[Plan Sec. 20.1(c),

20.2(d) & 20.3(d)]
	 	4.1
	 	The income or loss allocable to Excess Elective Deferrals that are refunded
to a Participant, or allocable to Excess Contributions or Excess Aggregate
Contributions distributed to satisfy the Average Deferral Percentage Test or
Average Contribution Percentage Test, will be determined as follows [check
one]:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.
	 	o
	 	Determined using a method established by the Lead Employer that
reasonably reflects the manner in which income or loss is allocated
under the Plan.
	 	 	 	 	b.
	 	x
	 	Determined under the safe harbor method specified in the Plan.
	 	 	 	 	 	 	 	 	 
	 	 	 	 	4.2
	 	The
income or loss allocated ... [check one]:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	a.
	 	o
	 	does
	 	 	 	 	b.
	 	x
	 	does not
	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	 	 	... include income or loss for the gap period.

	U.	 	Transfers from Terminating Defined Benefit Plan

	 	 	 	 	 	 	 	 	 	 	 
	1.	 	
Transferor Plan:

[Plan Sec. 17.6]
	 	 	1.1	 	 	The Plan has accepted a transfer of assets from the following terminating
defined benefit plan:
	 	 	 	 	 	a.	 	 	o	 	     .
	 	 	 	 	 	b.	 	 	o	 	     .
	 	 	 	 	 	c.	 	 	o	 	     .
	 	 	 	 	 	 	 	 	 	 	 
	2.	 	
Allocations:

[Plan Sec. 17.6]
	 	 	2.1	 	 	The assets transferred from the defined benefit plan will be initially credited
to a Pending Allocation Account, with the amount released each year from
the Pending Allocation Account being determined at the discretion of the
Lead Employer. This amount will be allocated among:
	 	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	a.	 	 	o
	 	Participants who are Non-Highly Compensated Employees for the Plan
Year and who satisfy the requirements to share in the Employer
Regular Profit Sharing Contribution for the Plan Year.
	 	 	 	 	 	b.	 	 	o
	 	Participants who satisfy the requirements to share in the Employer
Regular Profit Sharing Contributions for the Plan Year.

	V.	 	Special Effective Date Rules

	 	 	 	 	 
	1.1	 	The following Components of the Plan have an effective date after the
effective date of the Adoption Agreement [check each that
applies]:
	 	 	 	 	 
	a.  	 	
o
	Employer Pre-Tax Component
	 	 	 	Effective Date:         .

	 	 	 	 
	 	
44	 	AA1

 

	 	 	 	 	 
	b.	 	
o
	 	Employer After-Tax Component
	 	 	 	 	Effective Date:
           .
	 
	c.	 	
o
	 	Employer Safe-Harbor Matching Component
	 	 	 	 	Effective Date:
           .
	 
	d.	 	
o
	 	Employer Regular Matching Component
	 	 	 	 	Effective Date:
           .
	 
	e.	 	
o
	 	Employer Safe-Harbor Profit Sharing Component
	 	 	 	 	Effective Date:
           .
	 
	f.	 	
o
	 	Employer Regular Profit Sharing Component
	 	 	 	 	Effective Date:
           .
	 
	g.	 	
o
	 	Employer Prevailing Wage Component
	 	 	 	 	Effective Date:
           .
	 
	1.2	 	The effective date for the following provisions is different than the effective
date of the Adoption Agreement [complete as appropriate]:
	 
	a.	 	
o	 	
            .
	 	 	 	 	Effective Date:
           .
	 
	b.	 	
o	 	 
           .
	 	 	 	 	Effective Date:
           .
	 
	c.	 	
o	 	 
           .
	 	 	 	 	Effective Date:
           .

	W.	 	Other Information for the Lead Employer

	 	 	 
	 	 	
Failure to fill out this Adoption Agreement completely and correctly may result in
disqualification of the Plan.
	 	 	 
	 	 	
The Lead Employer and other fiduciaries agree to obtain bonds as required by
law. [ERISA section 412.]
	 	 	 
	 	 	
The Lead Employer or Administrator designated in Item B.4 is responsible for
administration, 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.

	 	 	 	 
	 	
45	 	AA1

 

	 
	The Sponsoring Organization will inform you if any amendments are made to
the Faegre & Benson LLP Prototype Defined Contribution Plan, or if the Faegre
& Benson LLP Prototype Defined Contribution Plan is discontinued or
abandoned.
	 
	Inquiries regarding the adoption of the Faegre & Benson
LLP Prototype Retirement Plan, the intended meaning of any provisions of the Plan, or
the effect of the IRS Opinion Letter should be directed to:

	 	 	 	 	 
	Faegre & Benson LLP

2200 Norwest Center

90 South Seventh Street

Minneapolis, Minnesota 55402	 	 	
 	 

X.     Reliance on IRS Notification Letter

	 
	The Lead Employer may not rely on a notification letter issued by the
National Office of the Internal Revenue Service as evidence that the Plan is
qualified under Code section 401. In order to obtain reliance with respect to Plan
qualification, the Lead Employer must apply to the appropriate Key
District Office for a determination letter.

Y.     Sponsoring Organization

	 
	The Sponsoring Organization of
the Plan is Faegre & Benson LLP.

	 	 	 
	 	46	
AA1

 

 

IN WITNESS WHEREOF, the Lead Employer has caused this Adoption Agreement to be
executed effective as of the date written on page 1.

This Adoption Agreement may be used only in conjunction with Basic Plan
Document #01.

	 	 	 	 	 	 	 
	Date signed:	 	
 
	 	Lead Employer:	 	 
	 	
	
 
	 	 	 	 
	 	 	 	 	 	 	 
	 	 	 	 	Antennas America, Inc.
	 	.
	 	 	 	 	

	
	 	 	 	 	[Name of Lead Employer]
	 

	 	 	 	 	 	 	 
	(Corporate Seal,
	 	
By
	 
	if applicable)
	 	 	

	 	 	 	 	 	 	 
	 	 	 	Its
	 	.	 
	 	 	 	 	
	 	 
	 	 	 	 	 	 	 
	 	 	And	 
	 	 	 	

	 	 	 	 	 	 	 
	 	 	 	Its
	 	.	 
	 	 	 	 	
	 	 

	 	 	 
	 	47	
AA1

 

 

PROTOTYPE TRUST AGREEMENT

The Trustee hereby accepts its appointment as such in accordance with the
Prototype Trust Agreement.

	 	 	 
	Date signed:	 	 
	 	

	 

	 	 	 	 	 
	Individual Trustees:	 	
Corporate Trustee:
	 	 	 	 	 
	 	 	
Marquette Trust Company, N.A.
	 	 	 	 	 
	 	 	
By
	 
	
	 	 	

	Signature	 	
 
	 	 
	 	 	 	Its	 
	

	 	 	 	

	
Printed Name	 	 	 	 
	 	 	And	 	 
	

	 	 	

	Business Address	 	 	 	 
	 	 	 	Its	 
	

	 	 	 	

	Business Address	 	 	 	 

	 
	

	Signature

	 
	

	Printed Name

	 
	

	Business Address

	 
	

	Business Address

	 
	

	Signature

	 
	

	Printed Name

	 
	

	Business Address

	 
	

	Business Address

	 	 	 
	 	48	
AA1

 

 

OR

PROTOTYPE CUSTODIAL AGREEMENT

The Custodian hereby accepts its appointment as such in accordance with the
Prototype Custodial Agreement.

	 	 	 	 	 
	Date signed:	 	
Custodian:
	 	
	 
	 	 	 	 	 
	 	 	
By	 	 
	 	 	 	

	 	 	 	 	 

	 	 	 	Its	 
	 	 	 	 	

	 	 	 
	 	49	
AA1

 

 

FAEGRE & BENSON LLP

REGIONAL PROTOTYPE DEFINED CONTRIBUTION PLAN

SUPPLEMENT TO ADOPTION AGREEMENT-001

Effective as of       the undersigned Controlled Group Member adopts the Faegre
& Benson LLP Regional
Prototype Defined Contribution Plan as established by the Lead Employer and
agrees to be a “Participating
Employer” under the Plan. The sections of the Adoption Agreement titled
“Reliance on IRS Opinion Letter” are
incorporated herein by reference and apply to the adoption of the Plan by the
undersigned Participating
Employer.

	 	 	 	 	 	 	 	 	 
	Date signed:	

	 	Participating Employer:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	
	 	 	 
	 	 	 	 	 	 	[Name of Participating Employer]
	 	 	 	 	 	 	 	 	 
	(Corporate Seal,

if applicable)	 	By	

	 	 	 	 	 	 	Its  	

	 	 	 	 	 	 	 	 	 
	 	 	 	 	And	

	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	Its  	

The Lead Employer hereby consents to the adoption of the Plan by the above
Controlled Group Member.

	 	 	 	 	 	 	 	 	 
	 	
 	 	Lead
Employer:
	 	 	 	 	 	 	 	 	 
	 	 	 	 	
	 	 	 
	 	 	 	 	 	 	 	 	 
	 	 	By	

	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	Its  	

	 	 	 	 	 	 	 	 	 

AA1

 

 

FAEGRE & BENSON LLP

REGIONAL PROTOTYPE DEFINED CONTRIBUTION PLAN

PARTICIPATING EMPLOYER SCHEDULE

The following Controlled Group Members are Participating Employers in the Plan
(in addition to those listed in
Item A, Sec. 2.1 of the Adoption Agreement):

iv. Participating Employer 4:

	 	 	 	Name:      .

v. Participating Employer 5:

	 	 	 	Name:       .

vi. Participating Employer 6:

	 	 	 	Name:       .

vii. Participating Employer 7:

	 	 	 	Name:       .

viii. Participating Employer 8:

	 	 	 	Name:       .

ix. Participating Employer 9:

	 	 	 	Name:       .

x. Participating Employer 10:

	 	 	 	Name:       .

xi. Participating Employer 11:

	 	 	 	Name:       .

xii. Participating Employer 12:

	 	 	 	Name:       .

xiii. Participating Employer 13:

	 	 	 	Name:       .

xiv. Participating Employer 14:

	 	 	 	Name:       .

xv. Participating Employer 15:

	 	 	 	Name:       .

Attach additional sheets if necessary.

AA1

 

FAEGRE & BENSON LLP

REGIONAL PROTOTYPE DEFINED CONTRIBUTION PLAN

PREDECESSOR EMPLOYER SCHEDULE

The following Predecessor Employers are covered by Item C, Sec. 6.2 of the
Adoption Agreement (in addition to those listed in Item C, Sec. 6.2 of the
Adoption Agreement):

iv. Predecessor Employer 4:

	 	 	 	Name:      .

v. Predecessor Employer 5:

	 	 	 	Name:      .

vi. Predecessor Employer 6:

	 	 	 	Name:      .

vii. Predecessor Employer 7:

	 	 	 	Name:      .

viii. Predecessor Employer 8:

	 	 	 	Name:      .

ix. Predecessor Employer 9:

	 	 	 	Name:      .

x. Predecessor Employer 10:

	 	 	 	Name:      .

xi. Predecessor Employer 11:

	 	 	 	Name:      .

xii. Predecessor Employer 12:

	 	 	 	Name:      .

xiii. Predecessor Employer 13:

	 	 	 	Name:      .

xiv. Predecessor Employer 14:

	 	 	 	Name:      .

AA1<PAGE>
                                                                     EXHIBIT 4.4

                         DISTRIBUTION REINVESTMENT PLAN
                                       OF
                             VESTIN FUND III, LLC
                       A NEVADA LIMITED LIABILITY COMPANY

      This Distribution Reinvestment Plan (this "Plan") is being offered to all
Persons who may become members of Vestin Fund III, LLC, a Nevada limited
liability company (the "Company") from time to time in accordance with that
certain Operating Agreement (the "Operating Agreement"), dated May 2, 2003,
entered into by and among Vestin Mortgage, Inc., a Nevada corporation (the
"Manager" and, in its capacity as a member of the Company, the "Initial Member"
and collectively with all Persons who may become members of the Company from
time to time in accordance herewith, the "Members"), and the Company.

                                   ARTICLE 1

                                   DEFINITIONS

      Unless stated otherwise, the terms set forth in this section shall, for
purposes of this Plan, have the following meanings:

      1.1 Affiliate means, (a) any person directly or indirectly controlling,
controlled by or under common control with the Person, (b) any other Person
owning or controlling ten percent (10%) or more of the outstanding voting
securities of the Person, (c) any officer, director or Member of the Person, or
(d) if the other Person is an officer, director or Manager, any company for
which the Person acts in any similar capacity.

      1.2 Company means Vestin Fund III, LLC, the Nevada limited liability
company to which this Plan pertains.

      1.3 Code means the Internal Revenue Code of 1986, as amended from time to
time, and corresponding provisions of subsequent revenue laws.

      1.4 Manager means Vestin Mortgage, Inc., a Nevada corporation, in that
capacity, or any Person replacing Vestin Mortgage under the Operating Agreement.
For greater certainty, Vestin Mortgage, in its capacity as the Initial Member,
is a distinct entity from the Manager for purposes of this Plan unless the
context should indicate to the contrary.

      1.5 Member means an owner of Units in the Company, unless the instruments
through which the Units were transferred to the owner did not also convey the
transferor's status as a Member.

      1.6 NASAA Guidelines means the Mortgage Program Guidelines of the North
American Securities Administrators Association, Inc. adopted on September 10,
1996, as amended from time to time unless indicated to the contrary by the
context and the Real Estate Program Guidelines of the North American Securities
Administration Association, Inc. adopted on September 29, 1993, as amended from
time to time.

      1.7 Offering means the offer and sale of Units of the Company made under
the Prospectus.
<PAGE>
      1.8 Operating Agreement means the Operating Agreement, dated May 2, 2003,
entered into by and between the Manager, in its capacity as an Initial Member
and collectively with all Persons who may become members of the Company from
time to time in accordance with the Operating Agreement, and the Company.

      1.9 Plan means this Distribution Reinvestment Plan.

      1.10 Person means any natural person, partnership, corporation,
unincorporated association or other legal entity.

      1.11 Prospectus means the prospectus that forms a part of the Registration
Statement on Form S-11 to be filed under the Securities Act of 1933, as amended,
with the Securities and Exchange Commission and any supplement or amended
prospectus or new prospectus that forms a part of a supplement to the
Registration Statement filed by the Company, unless the context should indicate
to the contrary.

      1.12 Reinvested Distributions mean Units purchased under the Company's
Plan.

      1.13 Subscription Agreement means the document that is an exhibit to and
part of the Prospectus that every Person who buys Units of the Company must
execute and deliver with full payments for the Units and which, among other
provisions, contains the written consent of each Member to the adoption of the
Operating Agreement and an election allowing each Member to indicate his
participation in the Plan.

      1.14 Units mean the Units of equity in the Company that are (a) issued to
Members upon their admission to the Company under the Subscription Agreement and
the Prospectus or (b) transferred to those who become substituted Members under
Article 10.2 of the Operating Agreement.

                                   ARTICLE 2

                                     PURPOSE

      This Plan provides Members with an optional and convenient method to
acquire additional Units of the Company by automatic reinvestment of
distributions on such Units under the terms and conditions set forth in this
Plan. If a Member chooses to participate in the Plan, distributions the Member
would otherwise receive are used to acquire additional Units in the Company. The
Company will use proceeds derived from the Reinvested Distributions for general
working capital purposes, as further described in the Prospectus.

                                   ARTICLE 3

                                 ADMINISTRATION

         The Plan shall be administered by the Manager in accordance with the
terms and conditions set forth herein. The Manager shall be indemnified for any
liability or loss resulting from its administration of the Plan, subject to the
limitations set forth in Article 3.5 of the Operating Agreement.

                                       2
<PAGE>
                                   ARTICLE 4

                              ELIGIBLE PARTICIPANTS

      4.1 Members Must Continue to Satisfy Investor Suitability Standards. All
Members are eligible to participate in the Plan. Each Member who is a
participant in the Plan, however, must continue to meet the investor suitability
standards set forth in Article 4.2 below (subject to minimum requirements of
applicable securities laws) to continue to participate in reinvestments. It is
the responsibility of each Member to notify the Manager promptly if he no longer
meets the suitability standards set forth in the Prospectus for a purchase of
Units in the offering. The Members acknowledge that the Company is relying on
this notice in issuing the Units, and each Member shall indemnify the Company if
he fails to so notify the Company and the Company suffers any damages, losses or
expenses, or any action or proceeding is brought against the Company due to the
issuance of Units to the Member.

      4.2 Investor Suitability Standards.

      As a result of the risks inherent in an investment in Units, the Units are
suitable only for Persons who meet the financial suitability standards adopted
by the states in which they live, as set forth below. The Company's Units are
only suitable for those who desire a relatively long term investment for which
they do not need liquidity for at least five years, in light of the other
limitations on redemption and transfer described in the Prospectus.

      Prospective investors must meet one of the investor suitability standards
contained in the second and third columns in the table below and the suitability
standard contained in the fourth column, if applicable, to purchase Units and to
participate in the Plan. Fiduciaries must also meet one of these conditions. If
the investment is a gift to a minor, the custodian or the donor must meet these
conditions. For purposes of the net worth calculations below, net worth is the
amount by which a prospective investor's assets exceed his liabilities, but
excluding his house, home furnishings or automobile(s) among his assets. In the
Subscription Agreement, investors must confirm that he has met these minimum
standards. The inclusion of a state in the chart below is for informational
purposes only and is not intended to imply that the Offering of Units has been
qualified in the particular state at this time. The Company will not sell in a
state in which it has not qualified the Offering.

<TABLE>
<CAPTION>
                                              1. MINIMUM NET
                                             WORTH AND MINIMUM                                                 2. ADDITIONAL
              STATE(S)                         GROSS INCOME             MINIMUM NET WORTH                        STANDARDS
              --------                         ------------             -----------------                        ---------
<S>                                          <S>                        <C>                        <C>
Alabama, Arkansas, Colorado, Delaware,
Florida, Hawaii, Idaho, Indiana,                                                                   Minimum investment in New York is
Kentucky, Minnesota, New York, North                                                               $2,500
Dakota, Oklahoma, Oregon, South Dakota,

Utah, Vermont, Virginia, Washington,         $45,000/$45,000                $150,000               ($1,000 for IRAs)
West Virginia, Wisconsin
</TABLE>

                                       3
<PAGE>
<TABLE>
<CAPTION>
                                              1. MINIMUM NET
                                             WORTH AND MINIMUM                                                2. ADDITIONAL
              STATE(S)                         GROSS INCOME             MINIMUM NET WORTH                       STANDARDS
              --------                         ------------             -----------------                       ---------
<S>                                          <S>                        <C>                       <C>
                                                                 OR                        AND

Alaska, Arizona, California, Iowa,                                                                 Minimum investment in Iowa for
Massachusetts, Michigan, Mississippi,                                                              IRAs is $3,000.
Missouri, New Jersey, North Carolina,        $60,000/$60,000               $225,000
Texas                                                                                              Minimum investment in North
                                                                                                   Carolina is $2,500

Maine                                        $50,000/$50,000               $200,000                               N/A

New Hampshire, New Mexico                    $125,000/$50,000              $250,000                               N/A

Tennessee                                    $250,000/$65,000              $500,000                               N/A

Nevada                                       $45,000/$45,000    OR         $150,000        AND     Minimum investment is $5,000
                                                                                                   ($2,000 for IRAs)

Kansas, Ohio, Pennsylvania                   $45,000/$45,000               $150,000                Investment is less than 10% of
                                                                                                   Net Worth. The Company will make
                                                                                                   no sales in these states until it
                                                                                                   receive proceeds of at least
                                                                                                   $5,000,000.

District of Columbia, Georgia,              These jurisdictions do not have quantified suitability requirements. The Company
Louisiana, Montana,                         believes that it is reasonable for it to rely upon the suitability standards set forth
Rhode Island                                above for Alabama et al. when selling Units to residents of these jurisdictions.

Connecticut, Illinois, Maryland,            No minimum requirements. Disclosure state only.  The Company will follow the guidelines
Wyoming                                     for the preponderance of the states above in selling Units in these states.
</TABLE>

NOTE: The Company is not qualified in, and it is not seeking qualification in,
South Carolina and Nebraska.

      In addition to the foregoing suitability standards, the Company cannot
accept subscriptions from anyone if the representations required are either not
provided or are provided but are inconsistent with its determination that the
investment is suitable for the subscriber.

                                   ARTICLE 5

                      MEMBER PARTICIPATION AND TERMINATION

      A Member may elect to participate in the Plan at the time of his purchase
of Units, by electing to do so in the Subscription Agreement executed by the
Member. The Member's participation in the Plan commences after the Company has
accepted the Member's Subscription Agreement. Subsequently, a Member may revoke
any previous election or make a new election to participate in the Plan by
sending written notice to the Company. The notice shall be effective for the
month in which the notice is received, if received at least ten (10) days before
the end of the calendar month. Otherwise the notice is effective the following
month. The Company will not reinvest proceeds from a capital transaction unless
the Company has sufficient funds to pay any state or federal income tax due to
the disposition or refinancing of mortgages.

                                       4
<PAGE>
                                   ARTICLE 6

                          PURCHASE OF ADDITIONAL UNITS

      Under the Plan, participating Members use distributions to purchase
additional Units at ten dollars ($10.00) per Unit. The Manager will credit Units
purchased under the Plan to the Member's Capital Account as of the first day of
the month following the month in which the Reinvested Distribution is made. If a
Member revokes a previous election to participate in the Plan, subsequent to the
month in which the Company receives the revocation notice, the Company shall
make distributions in cash to the Member instead of reinvesting the
distributions in additional in Units.

                                   ARTICLE 7

                              STATEMENT OF ACCOUNT

         Within 30 days after the Reinvested Distributions have been credited to
Members participating in the Plan, the Manager will mail to participating
Members a statement of account describing the Reinvested Distributions received,
the number of incremental Units purchased, the purchase price per Unit (if other
than ten dollars ($10.00) per Unit), and the total number of Units held by the
Member. Before the Members' reinvestment of distributions in the Company, the
Manager will also mail an updated Prospectus or other updated disclosure
document to each Member that fully describes the Plan, including the minimum
investment amount, the type or source of proceeds which may be reinvested and
the tax consequences of the reinvestment to the Members.

                                   ARTICLE 8

                       CHANGES OR TERMINATION OF THE PLAN

         The terms and conditions of the Plan may be amended, supplemented,
suspended or terminated for any reason by the Manager at any time by mailing
notice thereof at least thirty (30) days before the effective date of the action
to each participating Member at his last address of record.

                                   ARTICLE 9

                                 EFFECTIVE DATE

      The commencement of the Plan is conditional upon the Company receiving all
necessary federal and state governmental and regulatory approvals. Subject to
the foregoing, the Plan shall be deemed effective for any distributions made
after ___________, 2003.

                                       5
<PAGE>
                                   ARTICLE 10

                                  MISCELLANEOUS

      11.1 Notices. All notices which any Member may desire or may be required
to give any other Members shall be in writing and shall be deemed duly given
when delivered personally or when deposited in the United States mail,
first-class postage pre-paid. Notices to Members shall be addressed to the
Members at the last address shown on the Company records. Notices to the Manager
or to the Company shall be delivered to the Company's principal place of
business, located at 2901 El Camino Avenue, Las Vegas, Nevada 89102, until the
Manger changes it after giving the Members notice.

      11.2 Application of Nevada law. This Plan and the application or
interpretation thereof shall be governed, construed, and enforced exclusively by
its terms and by the law of the State of Nevada.

      11.3 Captions. Section titles or captions contained in this Plan are
inserted only as a matter of convenience and for reference and in no way define,
limit, extend or describe the scope of this Plan.

      11.4 Number and Gender. Whenever the singular form is used in this Plan it
includes the plural when required by the context, and the masculine gender shall
include the feminine and neuter genders.

                                       6

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