o Establish how you want to receive communication, select one method Mail to your home to work address to another address






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How to Rollover Qualified Assets to

Baylor Health Care System Retirement Plans

Steps to Directly Rollover from another qualified 401(k) or 403(b)

Plan to Baylor’s 401(k) Plan: [not from an IRA or a Roth 401(k)]

See at the bottom for an IRA Rollover process. Baylor Health Care System can’t take a rollover form a Roth 401(k) Plan because Baylor doesn’t offer a Roth Plan.

Please always refer to the Plan’s Summary Plan Description for more specific information Step 1:

Enroll in the Baylor Health Care System Retirement Savings Plan and complete at least one payroll contribution to the Plan.

Step 2:

Contact your previous 401(k) Plan Administrator to request your assets to be rolled out of that Plan(s) and into one of the Baylor Health Care System Retirement Savings Plan.

Checks must be rolled directly over from the prior plan. Request that the check be made out as follows:

o If you work for the Baylor Heart and Vascular Hospital, the Baylor Heart Hospital at Plano, or Baylor Ambulatory Endoscopy Center you will have the check made out as follows;

Baylor Affiliated Services (BAS) Retirement Savings Plan

FBO: “Your Name

o If you work for any other location in the organization you will have the check made out as follows;

Baylor Health Care System (BHCS) Retirement Savings Plan

FBO: “Your Name”

The check is to be mailed to you directly.

At the time of the request for the check, you need to ask if the check will show what amount of the total check was contributed on a “Pre-Tax” basis and what, if any, was contributed on an “After-Tax” basis. No matter if this isn’t stated on the check, documentation must be provided from that Plan with this information. If “After-Tax” contributions are stated, this must also include all interest or earnings of the “After-Tax” contribution amount.


Allowable Forms:

o Distribution Statement / Letter

o IRS Form 1099-R Form

o Letter from prior plan administrator

o If rollover is from another Hewitt administered qualified plan then the Confirmation of Payment Notice would be acceptable as it would show any nontaxable contributions.

Required Information on Form:

o Type of distribution

o Amount of Check

o Show the entire amount and what amount is taxable and what amount is non-taxable.

With the check and explanation of your voluntary contributions you will need to provide evidence that the Plan you are rolling money from was a “Qualified Plan” under Internal Revenue Services (IRS) Guidelines. Written evidence must be provided from either the investment manager or the Plan


Acceptable Proof of Prior Plan Qualification:

o IRS Letter of Favorable Tax Status Determination of the Plan

o Statement from (prior) Plan Administrator on company stationery that states;

 The Plan is qualified under Section 401(a) of the IRS Code or;  The plan is a tax sheltered annuity under Section 403(b) or

Section 403(b) of the IRS Code or;  The Plan is a governmental 457 Plan or;

 Page from the Summary Plan description showing name of plan and that is qualified under Section 401(a) of the IRS Code.

o Contact the HR Benefits Center if none of the documents stated can be provided for possible other options.

Step 3:

Establish in “YBR” (Your Benefits Resource) in HR Work Ways the method you want to be notified. This is accomplished by going through the following steps;

o Go to HR Work Ways

o Go to Expressway (top right of screen page) and click on “Your Savings & Retirement”

o Go to “Your Profile” (at the top of the screen)

o Put your curser on “Your Profile”, a drop down screen will appear


o Establish how you want to receive communication, select one method Mail to your home

E-Mail to work e-mail address E-Mail to another e-mail address

E-mail communication takes a maximum of 48 hours upon submission for items are batch processed out each night in response.

After you have established on how you want to receive communication you need to go “Savings and Retirement”. Place your curser on the blue box titled “Savings and Retirement” and a drop down index of titles will appear. Go to contributions (on the right side of the screen) and place your curser on “Request a Rollover Contribution Form”

Click on the box “Rollover Contribution Form” and then click submit at the bottom of the page.

If you established e-mail as your method of communication you should receive your personalized rollover form the next day. The form has codes that are specific to you on the pages so that no information is lost when submitted and all information is entered to the correct person.

Step 4:

1. You have a maximum of 30 calendar days from the date the check is received at the HR Benefits Center for the complete transaction to occur. If all documents aren’t initially with the check or the document doesn’t meet the requirement, you have this maximum time period to provide the required documents before the check will be returned to you.

You also have a time limit on when the check becomes stale dated from the previous provider.

2. Rolling your money into the Baylor Retirement Savings Plan.

Request the rollover form from the Savings and Retirement screen in Your Benefits Resource (YBR) in HR Work Ways. Complete the rollover form. This form is personalized and contains coding on each page so that no documents are lost when you submit.

o This form should come to you within 48 hours if you established your e-mail as your place for notification. If you have elected to receive by mail it may take 5 to 7 calendar days.


You may send by regular mail or by overnight mail. If you send by overnight mail you will know when it was received and again you will be out of the market for a shorter period of time. There are different mailing addresses for regular and overnight mail. The addresses are stated below and on the rollover form.

Via United States Mail: Baylor HR Center P.O. Box 563938

Charlotte, North Carolina 28256-3938 Via Overnight Delivery:

Baylor HR Center

7201 Hewitt Associates Drive Charlotte, North Carolina 28262

877-446-9562 as a contact number for the carrier You need to include the statement that the rollover assets are from a

qualified plan.

You need to make sure either the check stub states or a separate document is included stating the amount of the assets being rolled over are Pre-Tax, After-Tax (including interest) or a combination of both.

The rollover addition to your account once your documents are

received should show in your Baylor 401(k) Account within 5 business days. If you send through the US Postal Service please allow an additional 5 business days. If you send via overnight or certified mail, please allow an additional business day. If you don’t see this rollover contribution in your account within the time frame stated, please call the HR Benefits Center at; 1-877-446-9562.

Non-Direct Rollover


If you received a distribution and cashed the distribution from your previous 401(k) provider and later desire to rollover your distribution, you only have a 60 calendar day window from the date of the check.

You have to make the contribution to the Baylor Health Care System Retirement Savings Plan out of your own assets and then declare on your IRS Tax Return that you have rolled over your money to receive the tax deferral benefit. Contact the HR Benefits Center on how to process 1-877-446-9562.



a. Check

b. Baylor Health Care System Rollover form

c. Previous plan’s qualified tax status documentation

d. Documentation of rollover money amount on how much is pre-tax and how much is post-tax

IRA Rollover Procedure:

Statement from the IRA showing the amount of distribution. The distribution has to state how much was taxable and how much is non-taxable.

AND one of the following:

o Statement of history form IRA showing all contributions made to the IRA

o Letter from IRA stating distribution contained no non-taxable amounts

o Letter from participant stating distribution contained no non-taxable amounts

Rollovers from IRAs can’t include after-tax money

If you have any questions you can always contact the Baylor Benefits Center at 1-877-446-9562.