Your Guide to GettinG Started
Retirement Savings Plan provided by The Directed Account Plan
Invest in your retirement—and yourself—today,
with help from the DAP and Fidelity.
Get started today.
Starting early can have an impact on your account.Your decision to start today could give you quite a bit more at retirement than starting five years from now.
Hypothetical example:
This hypothetical illustration is based on the following assumptions: (1) Hypothetical participant remains employed and contributes
as shown at the beginning of each month throughout the periods shown, (2) a hypothetical effective annual rate of return of 7%, (3)
reinvestment of all earnings, (4) no withdrawals or loans throughout the indicated periods, and (5) participant is 100% vested. Income taxes, inflation, fees and expenses are not taken into account. If they were, values would be lower. Earnings and pre-tax contributions in a tax-deferred plan are subject to income taxes when withdrawn, and if distributions are taken before age 59½, may also be subject to a 10% penalty. Individual results will vary. Systematic investing does not ensure a profit and does not protect against loss in a declin-ing market. This example is for illustrative purposes only and does not represent the performance of any investment. Contributions are subject to Plan and IRS limits and such limits are indexed and adjusted for cost of living increases. Plan limits may be less than IRS limits. For highly compensated employees, additional limits may apply.
This hypothetical illustration is for educational purposes. Actual benefits are provided solely according to the terms of the Plan.
A participant’s actual account balance at any point in the future will be determined by the contributions that have been made, any plan or account activity, and any investment gains or losses that may occur. The illustrations of future balances should in no way be construed to imply any guarantee of future employment.
* Increase your contributions to $200 a month, and your potential account value could be even more—$34,617 in 10 years and $104,185 in 20 years.
Potential growth if you contribute $100 of your paycheck monthly
Potential account Potential account
value in 10 years (2023) value in 20 years (2033)
Start today $17,308* $52,093*
Wait 5 years to start $7,159 $31,696
$10,149 difference $20,397 difference
0000100100001
FAQs
For more information visit www.401k.com or call 1-877-489-2327
Frequently asked questions about your plan.
Here are answers to questions you may have about the key features,
benefits, and rules of your plan.
When can I enroll in the plan?
There is no waiting period. You can enroll in the Plan at any time.
How do I enroll in the Plan?
Log on to Fidelity NetBenefits® at
www.401k.com or call the Directed Account Plan Benefits Center at Fidelity at
1-877-439-2327 to enroll in the Plan. If you
have not enrolled in the Plan within 45 days from your date of hire, you will be
automatically enrolled in the Plan at a contribution rate of 6% of your pretax eligible earnings. Your contributions will be
invested in the Moderate Portfolio. However, we encourage you to take an active role in the Plan and to choose a contribution rate and select the investment options that may be appropriate for you. If you do not wish to
contribute to the Plan, you must call Fidelity at 1-877-439-2327 or go to www.401k.com and change your contribution rate to 0% during the 45-day eligibility period. It’s
important to note that you can stop or change your contribution percentage at any time.
What is the Roth contribution option?
A Roth contribution to your retirement savings plan allows you to make after-tax contributions and take any associated earnings completely tax free at retirement - as long as the
distribution is a qualified one. A qualified distribution, in this case, is one that is taken at least five tax years after your first Roth 401(k) contribution and after you have attained age 59½, or become disabled or die. Through automatic payroll deduction, you can contribute between 1% and 75% of your
eligible pay as designated Roth contributions, up to the annual IRS dollar limits.
For more information please log on to
NetBenefits® at www.401k.com and select
"Tools & Learning" from the home page. Under "Learning" you will see a tab called "About 401(k)s;" select that tab and click on "Roth."
How much can I contribute?
Through automatic payroll deduction, you can contribute between 1% and 75% of your eligible pay on a pre-tax or Roth basis, up to the annual IRS dollar limits. The Internal Revenue Code provides that the combined annual limit for total plan contributions is 100% of your W2 compensation or $51,000,
whichever is less. You can request to change your contribution amount virtually any time by
logging on to Fidelity NetBenefits®
at www.401k.com.
When is my enrollment effective?
Your enrollment becomes effective once you elect a deferral percentage, which initiates deduction of your contributions from your pay. These salary deductions will generally begin with your next pay period after we receive your enrollment information, or as soon as
administratively possible.
If you have not made a deferral election after 45 days, you will be automatically enrolled in the Plan. Your enrollment will be effective, with deferrals of 6% of compensation, during the first pay period after the 45-day auto
enrollment window, unless you elect not to participate or change or stop
FAQs
In addition, your contribution to the Plan will be automatically increased by 1% of
compensation each year until a maximum of 9% of compensation is achieved, unless you make a subsequent contrary election.
Does the CommunityAmerica Credit Union contribute to my account?
The Plan helps your retirement savings grow by matching your contributions.
CommunityAmerica Credit Union ("the
Company") will match 100% of each pre-tax or Roth dollar you contribute on the first 6% of pay that you defer to your Plan. Your Company contributions may change depending on profitability. The Company matching contribution is made only on your pre-tax contributions.
The Company may also make profit-sharing contributions at its discretion which will be allocated among all eligible employees whether or not they make contributions. Employees may be eligible for discretionary contributions if they are actively employed on the last day of the Plan year and have worked 1,000 hours of service during the Plan year.
What "catch-up" contribution can I make?
If you have reached age 50 or will reach 50 during the calendar year January 1 –
December 31 and are making the maximum plan or IRS pretax contribution, you may make an additional “catch-up” contribution each pay period. Going forward, catch-up contribution limits will be subject to cost of living
adjustments (COLAs) in $500 increments.
When am I vested?
You are always 100% vested in your contributions to the DAP, as well as any earnings on them. The Company’s matching contributions and any earnings vest according to the following schedule:
years of service vested percentage
1 25%
2 50%
3 75%
4 100%
For the purpose of vesting, a year of service is defined as a calendar year in which you complete 1,000 hours of service.
Can I take a loan from my account?
Although your plan account is intended for the future, you may borrow from your account for any reason. Generally, the DAP allows you to borrow up to 50% of your vested account balance. The minimum loan amount is $1,000, and a loan must not exceed $50,000. You may have two loans outstanding at a time. You then pay the money back into your account, plus interest, through after-tax payroll deductions. The interest rate on your loan will be the Wall Street Journal Prime Rate plus 1%. Any
outstanding loan balances over the previous 12 months may reduce the amount you have available to borrow. The cost to initiate a loan is $35, and there is a quarterly maintenance fee of $3.75. The initiation and maintenance fees will be deducted directly from your individual plan account. If you fail to repay your loan (based on the original terms of the loan), it will be considered in "default" and treated as a distribution, making it subject to income tax and possibly to a 10% early withdrawal penalty. Defaulted loans may also impact your eligibility to request additional loans.
To learn more about or request a loan, log on to www.401k.com or call the The Directed Account Plan Service Center at 1-877-489-2327.
Can I make withdrawals from my account?
Withdrawals from the Plan are generally permitted when you terminate your employment, retire, become permanently disabled, or have severe financial hardship as defined by your Plan. Keep in mind that withdrawals are subject to income taxes and possibly to early withdrawal penalties.
FAQs
For more information visit www.401k.com or call 1-877-489-2327
The taxable portion of your withdrawal that is eligible for rollover into an individual
retirement account (IRA) or another employer’s retirement plan is subject to 20% mandatory federal income tax withholding, unless it is rolled directly over to an IRA or another employer plan. (You may owe more or less when you file your income taxes.) If you are under age 59½, the taxable portion of your withdrawal is also subject to a 10% early withdrawal penalty, unless you qualify for an exception to this rule. To learn more about and/or to request a withdrawal, log on to
Fidelity NetBenefits® at www.401k.com or call
The Directed Account Plan Service Center at 1-877-489-2327. The plan document and current tax laws and regulations will govern in case of a discrepancy. Be sure you understand the tax consequences and your plan’s rules for distributions before you initiate a distribution. You may want to consult your tax adviser about your situation.
When you leave the Company, you can withdraw contributions and any associated earnings or, if your vested account balance is greater than $5,000, you can leave
contributions and any associated earnings in the Plan. After you leave the Company, if your vested account balance is equal to or less than $1,000, it will automatically be distributed to you. If the balance is between $1,000 and $5,000, it must be distributed or it will be automatically rolled over to an Individual Retirement Account (IRA).
Can I move money from another retirement plan into my account in the DAP?
You are permitted to roll over eligible pre-tax or Roth contributions from another 401(k) plan, 403(b) plan or a governmental 457(b)
retirement plan account or eligible pre-tax contributions from conduit Individual
Retirement Accounts (rollover IRAs) and certain non-conduit individual retirement accounts (traditional IRAs, Simplified Employee Pension plans, and "SIMPLE" IRA distributions made more than two years from the date you first participated in the SIMPLE IRA). A conduit IRA
is one that contains only money rolled over from an employer-sponsored retirement plan that has not been mixed with regular
IRA contributions.
Contact your Fidelity Investments Benefits department for details.
You should consult your tax adviser and carefully consider the impact of making a rollover contribution to your employer’s plan because it could affect your eligibility for future special tax treatments.
You can also roll over eligible after-tax contributions from a 401(a), 401(k) or 403(a) account.
How do I access my account?
You can access your account online through
Fidelity NetBenefits® at www.401k.com or call
the The Directed Account Plan Service Center at 1-877-489-2327 to speak with a
representative or use the automated voice response system, virtually 24 hours, 7 days a week.
Where can I find information about exchanges and other plan features?
You can learn about loans, exchanges, and
more, online through Fidelity NetBenefits® at
www.401k.com. In particular, you can access loan modeling tools that illustrate the potential impact of a loan on the long-term growth of your account. You will also find a withdrawal modeling tool, which shows the amount of federal income taxes and early withdrawal penalties you might pay, along with the amount of earnings you could potentially lose by taking a withdrawal. You can also obtain more information about loans, withdrawals, and other plan features, by calling the The Directed Account Plan Service Center at 1-877-489-2327 to speak with a representative or use the automated voice response system, virtually 24 hours, 7 days a week.
FAQs
What are my rights with respect to mutual fund pass-through voting?
As a Plan participant, you have the ability to exercise voting, tender, and other similar rights for mutual funds in which you are invested through the Plan. Materials related to the exercise of these rights will be sent at the time of any proxy meeting, tender offer or similar rights relating to the particular mutual funds held in your account.
What are my investment options?
You give investment directions for your Plan account from a broad selection of investment choices. See your Investment Overview
booklet or log on to Fidelity NetBenefits®
at www.401k.com.
If you do not choose any investment options, your contributions will be invested in the Moderate Model Portfolio. You may change this selection at any time by logging on to
Fidelity NetBenefits®.
For those desiring the most investment flexibility and choice, the Plan offers a self-directed brokerage option, which gives you access to many mutual funds. A complete description of the Plan’s investment options and their performance, as well as planning tools to help you choose an appropriate mix,
are available online at Fidelity NetBenefits®.
How do I obtain additional investment option and account information?
The Employer has appointed Fidelity to provide additional information on the
investment options available through the Plan. Also, a statement of your account may be requested by phone at 1-877-489-2327 or reviewed online at www.401k.com.
Investment Options
For more information visit www.401k.com or call 1-877-489-2327
Roth Options
For more information visit www.401k.com or call 1-877-489-2327
A Roth contribution is available to employees who participate in the 401(k) plan. For payroll purposes Roth contributions are treated as after tax. This feature will allow participants to make Roth contributions to their plan while taking their earnings completely tax free at retirement — as long as the withdrawal is a qualified one. A qualified withdrawal is one that can be taken five tax years after the year of the first Roth contribution and after the participant has attained age 59½, has become disabled, or has died.
If you qualify to make traditional 401(k) contributions, you are eligible for a Roth 401(k) contribution.
How does a Roth 401(k) contribution option work?
You elect a percentage (or dollar amount) of your salary that you wish to contribute to the Roth source, just as you would for your traditional 401(k). The contribution is based on your eligible compensation, not on your net pay—for example, if your total annual eligible compensation is $40,000 per year and you elect a 6% deferral amount, then $2,400 per year would go into your Roth 401(k) account.
Unlike your traditional 401(k) pretax contribution, with a Roth 401(k) contribution, you pay the taxes now on the contributions you make—but later your earnings are all tax free, if you meet certain criteria. Example: Sally earns $40,000 and has elected to put 6% toward her Roth 401(k) contributions and 6% toward her traditional 401(k) pretax contributions on a monthly basis. ROTH 401(k)* TRADITIONAL 401(k)* Sally’s monthly contribution into each account $200 $200 Sally’s reduction in take-home pay $200 $150
* This hypothetical example is based solely on an assumed federal income tax rate of 25%. No other payroll deductions are taken into account. Your own results will be based on your individual tax situation.
Your combined Roth and traditional pretax 401(k) contributions cannot exceed the IRS limits for the year.
Would a Roth 401(k) contribution option benefit me?
The potential benefits of Roth 401(k) contributions really depend on your personal situation, but are mainly focused on your existing tax rate and your anticipated tax rate at the time of retirement. If you are contributing to a Roth, you are giving up a tax break today for a tax break in the future.
Therefore, a Roth contribution might benefit you if your tax rate in retirement were higher than it had been during the years you contributed.
If your tax rate were lower in retirement, then a traditional 401(k) might be more beneficial to you than the Roth option. Talk with a tax professional for more information on how to determine if Roth 401(k) contributions are right for you.
Is a traditional pretax 401(k) still beneficial?
Yes. For many participants a traditional pretax 401(k) will still be the most beneficial type of retirement savings plan. We do not know what the future holds regarding tax rates. Therefore, it is not possible to predict with certainty which type of 401(k) savings will be most beneficial to a participant.
Remember, because Roth 401(k) contributions are made after tax, you may take home less money in your paycheck than you would if you contributed to a traditional pretax 401(k).
What is the Roth 401(k) Contribution Option?
For more information, please log on to
www.401k.com and select “Tools & Learning”
from the homepage. Under “Learning” you will see a tab called “About 401(k)s.” Select that tab and click on “Roth 401k.”
Fidelity BrokerageLink
®
Fidelity BrokerageLink
®
Fidelity BrokerageLink
®combines the convenience of your workplace
retirement plan with the additional flexibility of a brokerage account. It gives
you expanded investment choices and the opportunity to more actively
manage your retirement contributions. A self-directed brokerage account is
not for everyone. If you are an investor who is willing to take on the
poten-tial for more risk and you are prepared to assume the responsibility of more
closely monitoring this portion of your portfolio, it could be appropriate for
you. However, if you do not feel comfortable actively managing a portfolio
of options beyond those offered through your plan’s standard investment
options, then a self-directed brokerage account may not be appropriate for
you. Additional fees apply to a brokerage account; please refer to the fact
sheet and commission schedule for a complete listing of brokerage fees.
Remember, it is always your responsibility to ensure that the options you
select are consistent with your particular situation, including your goals,
time horizon, and risk tolerance.
Investment Options
For more information visit www.401k.com or call 1-877-489-2327
Incoming Rollover Instructions
Directed Account Plan #21622
If you are a current DirectedAccount Plan (DAP) participant or a former DAP participant, you may roll over assets
from other accounts into the DAP based on the following guidelines: 1) Traditional IRA assets can be rolled into the DAP. 2) Assets that were rolled out of the DAP into a Traditional IRA can be rolled back into the DAP. 3) Roth IRA assets cannot be rolled into the DAP. However, Roth 401(k)/403(b) assets can be rolled into the DAP. 4) Nondeductible IRA contributions cannot be rolled into the DAP. 5) The earnings attributable to nondeductible IRA contributions can be rolled into the DAP. If you have a balance in a former employer’s retirement plan or Individual Retirement Account (IRA), you may want to consider consolidating your assets in the Directed Account Plan. Keeping your retirement savings in a single plan can help simplify performance tracking, provide greater convenience in making investment changes, and minimize paperwork. Rolling money into the Directed Account Plan is a three-step process. Please follow these instructions to ensure that your rollover is completed in a timely and accurate manner.
Please note that failure to follow these instructions may result in a delay in the processing of your request and may jeopardize your ability to roll over your distribution.
1. Complete Your Rollover Application
Please complete the attached Incoming Rollover Contribution Application, and attach any supporting documents.
2. Mail the Information
Mail the Incoming Rollover Contribution Application along The Directed Account Plan with a copy of your latest statement from the financial 3221 McKelvey Road institution currently holding the funds to: Suite 105
Bridgeton, Missouri 63044
Please include all the information requested. Incomplete forms may be returned and may jeopardize your ability to roll over your distribution.
3. Request Your Distribution from Your Previous Employer-Sponsored Plan or Eligible IRA
There are two distribution check payment options:
1. Direct Rollover: The check can be made payable directly to Fidelity Investments Institutional Operations Company, Inc. (or FIIOC) for the benefit of [YOUR NAME]. The check must be from the distributing trustee or custodian. (Personal checks are not acceptable.) Do not endorse the check.
Important: This type of rollover avoids automatic federal income tax withholding. It also avoids the possible 10% early withdrawal penalty if you are under age 59½.
2. Indirect Rollover: If the distribution was originally made payable directly to you, you must send your rollover contribution via a certified check or money order only for the amount you are rolling over. (Personal checks are not acceptable.)
Important: If your distribution is initially received as a check made payable to you, your rollover must be completed within 60 days of the date of the distribution. Your previous administrator will be required to withhold federal income taxes and possibly state taxes. As a result, you will not be able to roll over 100% of your eligible distribution unless you have extra savings available to make up the amount withheld. You must also roll over that amount within 60 days of receipt of your distribution. If you do not make up the amount withheld, that amount will be considered a withdrawal from the previous program and will be subject to ordinary income taxes and possibly to a 10% early withdrawal penalty.
Once your application is received by the Directed Account Plan, and your rollover check is processed, you can log on to Fidelity NetBenefits® at www.401k.com to view your rollover contribution and investment elections. If you have any questions about
rollover contributions, call the Plan Office at 314-739-7373. Please allow time for your check to reach Fidelity.
Please be sure you have beneficiary information for the Plan on file. To select or change your beneficiary designation for the Directed Account Plan, you can log on to Fidelity NetBenefits at www.401k.com and click Beneficiaries in the My Profile section. If you do not have Internet access, call the Directed Account Plan Service Center toll free at 1-877-4TWADAP (1-877-489-2327) and request a Beneficiary Designation Form.
3.DI-C-740A.115 Page 1 of 6
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Incoming Rollover Contribution Application
Directed Account Plan #21622
Section 1 Participant Information Please Print
– – Participant’s Name (First, Middle Initial, Last) Social Security Number
( ) – Street Number Street Name Daytime Phone Number
City State ZIP Country
/ / / /
Birth Date Hire Date Email Address
000065593 DC
21622
658
020950001
1. Your Estimated Contribution Amount:
Pre-tax dollars $ ____________________ After-tax dollars $ ____________________ Roth 401(k)/403(b) dollars $ ____________________ Total $ ____________________
Section 2 Rollover Contribution Information
Please complete the boxes at the end of this section. If you are not sure of the plan type, please contact your prior Plan Sponsor for
verification. An incorrect plan type could invalidate your rollover.
ACCEPTABLE ROLLOVER FUNDS
The Plan will accept taxable and non-taxable money from the following types of employer-sponsored plans: • Qualified plans (such as 401(k), Roth 401(k)/403(b), profit-sharing, and money purchase pension plans) • Individual Retirement Accounts (IRAs)
UNACCEPTABLE ROLLOVER FUNDS
The Plan cannot accept distributions from the following types of plans or accounts: • Governmental 457(b) plans • Coverdell Education IRAs
• Roth IRAs • SIMPLE IRAs
• Simplified Employee Pension Plans (or SEP IRAs) • IRAs in which you have made non-deductible IRA contributions
In addition, distributions to a beneficiary (other than a spousal beneficiary), distributions to a former spouse under a qualified domestic relations order (QDRO), distributions made over life expectancy or a period of ten years or more, hardship distributions, and mandatory age 70½ distributions are not eligible for rollover into the Plan. Non-taxable (or after-tax) distributions other than from a qualified plan may not be rolled into the Plan. In-kind distributions of employer stock will not be accepted. If you hold employer stock in your prior employer’s plan, the stock must be sold and the proceeds rolled over in cash.
PLEASE COMPLETE BOTH BOXES BELOW:
2. Plan type of the origin of this rollover (please check one). If you are not sure of the plan type, please contact your prior
Plan Sponsor for verification. An incorrect plan type could invalidate your rollover.
____ Qualified plan (such as 401(k), Roth 401(k)/403(b), profit-sharing, and money purchase pension plan) ____ Individual Retirement Account (IRA)
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Section 3 Investment Elections
You may choose as many investment options as you wish from the options in the Plan. The quantity and selection of available investment options are determined by the Plan Sponsor.
Please indicate your investment elections in whole percentages among the investment options shown below (the total percentage must equal 100%). Your investment elections below will apply only to this rollover contribution. If your investment elections do not total 100%, your documentation and check will be returned to you.
Please be sure to read the mutual fund prospectuses before choosing your investment options. Prospectuses for the funds are available from the Directed Account Plan Service Center by calling 1-877-4TWADAP (1-877-489-2327).
Investment Option Fund CodeFund Percentage Investment Option Fund CodeFund Percentage
Level One: The Model Portfolios Level Three: Fidelity Mutual Funds cont’d
Retirement Model Portfolio OOLS % Fidelity® Equity-Income Fund — Class K 2085 %
Conservative Model Portfolio OJQT % Fidelity® Europe Capital Appreciation Fund* 0341 %
Moderate Model Portfolio OJQU % Fidelity® Europe Fund* 0301 %
Aggressive Model Portfolio OJQV % Fidelity® Export and Multinational Fund —
Class K*
2087 %
Level Two: The Core Options Fidelity Fifty® 0500 %
Stable Value Option OJQW % Fidelity® Focused Stock Fund 0333 %
Value Stock Option OJQX % Fidelity® Four-in-One Index Fund 0355 %
Equity Index Option OJQY % Fidelity® Fund — Class K 2088 %
Growth Stock Option OJQZ % Fidelity® Global Balanced Fund* 0334 %
International Stock Option* OJRA % Fidelity® Government Income Fund 0054 %
Diversified Small Company Stock Option OJRB % Fidelity® Growth & Income Portfolio —
Class K
2089 %
Level Three: Fidelity Mutual Funds Fidelity® Growth Company Fund — Class K 2090 %
Fidelity® Balanced Fund — Class K 2077 % Fidelity® Growth Discovery Fund — Class K 2091
Fidelity® Blue Chip Growth Fund — Class K 2078 % Fidelity® Growth Strategies Fund — Class K* 2076 %
Fidelity® Blue Chip Value Fund 1271 % Fidelity® High Income Fund* 0455 %
Fidelity® Canada Fund* 0309 % Fidelity® Independence Fund — Class K 2092 %
Fidelity® Capital & Income Fund* 0038 % Fidelity® Inflation-Protected Bond Fund 0794 %
Fidelity® Capital Appreciation Fund — Class K 2079 % Fidelity® International Capital Appreciation
Fund*
0335 %
Fidelity® China Region Fund* 0352 % Fidelity® International Discovery Fund —
Class K*
2093 %
Fidelity® Contrafund® — Class K 2080 % Fidelity® International Small Cap Fund* 0818 %
Fidelity® Convertible Securities Fund 0308 % Fidelity® Investment Grade Bond Fund 0026 %
Fidelity® Disciplined Equity Fund — Class K 2081 % Fidelity® Japan Fund* 0350 %
Fidelity® Diversified International Fund —
Class K*
2082 % Fidelity® Japan Smaller Companies Fund* 0360 %
Fidelity® Dividend Growth Fund — Class K 2083 % Fidelity® Large Cap Stock Fund 0338 %
Fidelity® Emerging Asia Fund* 0351 % Fidelity® Latin America Fund* 0349 %
Fidelity® Emerging Markets Fund — Class K* 2084 % Fidelity® Leveraged Company Stock Fund — Class K*
2094 %
Fidelity® Equity Dividend Income Fund —
Class K
2086 % Fidelity® Low-Priced Stock Fund — Class K* 2095 %
*Shareholders may be subject to certain short-term trading fees. Please consult the prospectus for further information.
000065593 DC
21622
658
020950001
Page 6 of 6 3.DI-C-740A.115 573886.6.2
Section 3 Investment Elections Continued
Investment Option Fund CodeFund Percentage Investment Option Fund CodeFund Percentage
Level Three: Fidelity Mutual Funds cont’d Fidelity® Stock Selector Large Cap Value Fund 0708 %
Fidelity® Magellan® Fund — Class K 2096 % Fidelity® Stock Selector Mid Cap Fund 2412 %
Fidelity® Mega Cap Stock Fund 0361 % Fidelity® Stock Selector Small Cap Fund* 0336
Fidelity® Mid-Cap Stock Fund — Class K* 2097 % Fidelity® Strategic Dividend & Income® Fund 1329 %
Fidelity® Mid Cap Value Fund* 0762 % Fidelity® Strategic Income Fund 0368 %
Fidelity® Money Market Trust Retirement
Government Money Market Portfolio
0631 % Fidelity® Telecom and Utilities Fund 0311 %
Fidelity® Nasdaq® Composite Index Fund* 1282 % Fidelity® Total Bond Fund 0820 %
Fidelity® New Markets Income Fund* 0331 % Fidelity® Trend Fund 0820 %
Fidelity® New Millennium Fund® 0300 % Fidelity® Value Discovery Fund — Class K 2103 %
Fidelity® Nordic Fund* 0342 % Fidelity® Value Fund — Class K 2102 %
Fidelity® OTC Portfolio — Class K 2098 % Fidelity® Value Strategies Fund — Class K 2104 %
Fidelity® Overseas Fund — Class K* 2099 % Fidelity® Worldwide Fund* 0318 %
Fidelity® Pacific Basin Fund* 0302 % Spartan® 500 Index Fund — Investor Class 0650
Fidelity® Puritan® Fund — Class K 2100 % Spartan® Extended Market Index Fund —
Investor Class*
0398 %
Fidelity® Real Estate Income Fund* 0833 % Spartan® International Index Fund —
Investor Class*
0399 %
Fidelity® Real Estate Investment Portfolio* 0303 % Spartan® Total Market Index Fund —
Investor Class*
0397 %
Fidelity® Small Cap Discovery Fund* 0384 % Spartan® U.S. Bond Index Fund —
Investor Class
0651 %
Fidelity® Small Cap Growth Fund* 1388 % Level Four: Fidelity BrokerageLink®
Fidelity® Small Cap Stock Fund* 0340 % Fidelity BrokerageLink® BLNK %
Fidelity® Small Cap Value Fund* 1389 % TOTAL 100%
Fidelity® Stock Selector All Cap Fund —
Class K
2101 %
Note: Any investment elections chosen on this form will take precedence over any other investment election that Fidelity Investments may have on its system for a rollover contribution.
*Shareholders may be subject to certain short-term trading fees. Please consult the prospectus for further information.
Section 4 Participant Certification
I authorize the investment elections for this rollover and acknowledge that I have received information detailing my available investment options.
I certify that this rollover amount is composed only of money from acceptable sources listed under Section 2 above, and I have completed the information regarding the source of this money to the best of my knowledge. Also, if the distribution check was made payable to me, I understand that this rollover must be received and deposited to my account within 60 days of my receipt of the distribution. I understand that once invested, these monies will be subject to the terms that govern the Directed Account Plan.
Signature of Participant Date
Use this envelope only for the rollover contribution application.
Please remove envelope from book here.
▲
BUSINESS REPL
Y MAIL
FIR S T -CLA SS MAIL PERMI T NO 1 9203 CINCINNA TI OH POS T A GE WILL BE P AID B Y ADDRESSEE FIDELITY INVES TMEN TS P.O . BO X 50 0 0 CINCINNA TI, OH 45273-80 11 NO POS T A GE NECESS AR Y IF MAILED IN THE UNI TED S T A TES RP-BREPlease do not return this page.
Fidelity Investments Institutional Operations Company, Inc.
Plan Name: Plan #:
Beneficiary Designation Instructions
Retirement Savings Plan provided by The Directed Account Plan
21622
A beneficiary is a person, institution, charitable organization, or Trust named by you, the participant, to receive payment of benefits provided under the DAP in the event of your death. You may designate more than one primary beneficiary who will share the benefit. You may also designate one or more contingent beneficiaries. A contingent beneficiary would receive payment only if the primary beneficiary or all the primary beneficiaries you named died before you or disclaimed the right to receive payment at the time that payment was to be made.
All information must be typed or printed neatly, using upper-case letters and black ink. If it is necessary to make
corrections to the beneficiary section, you must place your initials next to the corrected or crossed-out words. Do not use Wite-Out® or other correction fluid to make a correction. The form is not acceptable if correction fluid is used, and the form will be returned to you. If you have any questions about making a beneficiary designation, call Fidelity Investments toll-free at 1-877-489-2327 and speak with a Participant Services Representative. You can obtain additional Designation of Beneficiary Forms by logging on to Fidelity NetBenefits® at www.401k.com or by calling Fidelity Investments at 1-877-489-2327.
Please make a copy of it for your files, and return the original in the enclosed envelope or mail to:
Fidelity Investments P.O. Box 5000
Cincinnati, OH 45273-8012
A. Participant Information
Complete all applicable information. You must check either
single or married. If you are married at the time of your death,
the provision of your retirement plan generally requires that all benefits from the retirement plans be paid to your spouse, unless your spouse consents in writing to another beneficiary designation and a Plan Representative or Notary Public witnesses this consent.
B. and C.
Primary and Contingent Beneficiary(ies) Information
Complete all applicable information for those whom you are naming as beneficiary(ies).
Please note: Some retirement plans restrict whom you can
elect as a beneficiary for specific benefits and when you can change your election. If you designate one beneficiary for all plans in which you are enrolled, you will be subject to these restrictions across all plans. If section B is not filled out completely, the form will be returned to you.
1. The beneficiary designation should not include wording such as “either/or” or “and/or.” You cannot designate unborn children as beneficiaries. You can designate charitable organizations.
2. Use only whole-number percentages equaling 100%. For example, designations such as 33 1/3 or 33.3 are not acceptable.
3. Naming an estate: Letters of appointment issued by the court following your death, naming the executor or administrator of the estate must be provided when a claim is filed. Please consult your attorney for advice on the effect of this designation. No additional legal documentation is required at this time.
4. Naming a Trust: Provide the Trust‘s name and address, name of one Trustee, the date of the Trust and the Trust‘s tax ID number. Do not send a copy of the trust agreement.
If you would like to name more than two primary and two contingent beneficiaries, you may attach a separate sheet of paper to the Designation of Beneficiary Form with the applicable information.
D. Signature and Date
By signing and dating this section, you officially designate the person(s) listed on the form as your primary
beneficiary(ies) and, if applicable, your contingent beneficiary(ies) for this Plan. Your beneficiary
designation(s) will not be valid unless this form is on file with the record keeper for this Plan.
E. Spousal Consent
For the DAP, if you name someone other than, or in addition to, your spouse as your primary beneficiary(ies), your
spouse must sign and date the form and have his/her signature witnessed by a Plan Representative or Notary Public. A bank, law office or local government office usually
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Note:The instructions for this form are an integral part of the form. You should use them to assist you. Also, if it is necessary to make corrections to any part of this form, please do not use whiteout; you must place your initials next to the corrected or crossed-out words.
Participant Name (First, MI, Last): ___________________________________________ Social Security #:
Participant Address: ______________________________________________________________________________________________________ City: _______________________________________________________ State: _____________ ZIP: _________________________________ Phone (day): Marital Status: (select one) Single Married
I understand that if I am married, my spouse shall automatically be my designated beneficiary unless I elect otherwise and my spouse consents to such election as well as to the designation of the other beneficiary(ies). I hereby designate the following person or persons as primary beneficiary(ies) of my account under the Plan(s) payable by reason of my death. If any primary beneficiary does not survive me, the share of that beneficiary shall be divided between the remaining beneficiaries in proportion with their stated percentage of interest. If no primary beneficiary survives me, then my account shall go to my contingent beneficiary(ies). (If additional space is needed for beneficiary information, attach a separate sheet of paper to the Designation of Beneficiary F orm with the information noted below.)
1. Beneficiary’s Name: (First, MI, Last) _____________________________________________________________________ Share %: Date of Birth: _____/_____/_____ Sex (M/F) _____
Relationship to Participant: Spouse Trust Other: __________________________________
Address: ____________________________________________________________________________________________________________ City: __________________________________________________ State: _____________ ZIP: __________________________________
2. Beneficiary’s Name: (First, MI, Last) _____________________________________________________________________ Share %: Date of Birth: _____/_____/_____ Sex (M/F) _____
Relationship to Participant: Spouse Trust Other: __________________________________
Address: ____________________________________________________________________________________________________________ City: __________________________________________________ State: _____________ ZIP: __________________________________
In the event that no primary beneficiary survives me, I hereby designate the following person or persons as contingent beneficiary(ies) of my account. If any contingent beneficiary does not survive me, then the share of that beneficiary shall be divided between the remaining contingent beneficiaries in proportion with their stated percentage of interest.
1. Contingent Beneficiary’s Name: (First, MI, Last) _____________________________________________________________ Share %: Date of Birth: _____/_____/_____ Sex (M/F) _____
Relationship to Participant: Spouse Trust Other: _____________
Address: ____________________________________________________________________________________________________________ City: __________________________________________________ State: _____________ ZIP: __________________________________
2. Contingent Beneficiary’s Name: (First, MI, Last) _____________________________________________________________ Share %: Date of Birth: _____/_____/_____ Sex (M/F) _____
Relationship to Participant: Spouse Trust Other: _____________
Address: ____________________________________________________________________________________________________________ City: __________________________________________________ State: _____________ ZIP: __________________________________
— —
A. Participant Information
B. Primary Beneficiary(ies)
C. Contingent Beneficiary(ies)
— —
Social Security Number/Tax ID: — —
Social Security Number/Tax ID: — —
Social Security Number/Tax ID: — —
Social Security Number/Tax ID: — —
Designation of Beneficiary Form
Total 100%
Total 100%
Plan Name: Plan #:
IBS
DC 002560001
Retirement Savings Plan provided by The Directed Account Plan
21622
(Must be witnessed by a Plan Representative or Notary Public)
Signature of spouse witnessed this on this date, ___________________ in the presence of:
Plan Representative Signature: _________________________________________________________________________________ Plan Representative Print Name (Last, First, MI): _____________________________________________________________________
OR
STATE OF ______________ (ss.) COUNTY OF _____________________
On this date, ____________ before me appeared __________________________________ Print Name: (Last, First, MI) who acknowledged herself or himself to be the person who executed the consent set forth above and acknowledged the consent to be his or her free act and deed.
Notary Public Signature: ______________________________________
I am the spouse of the Participant named above. By signing below, I hereby acknowledge that I understand: (1) that the effect of my consent may result in the forfeiture of benefits I would otherwise be entitled to receive upon my spouse’s death; (2) that my waiver is not valid unless I consent to it; (3) that my consent is voluntary, (4) that my consent is irrevocable unless my spouse completes a new Beneficiary Designation and (5) that my consent (signature) must be witnessed by a notary public [or a plan representative].
I understand that if this beneficiary designation is executed prior to the first day of the plan year in which the participant attains age 35, then my rights to receive the death benefit as determined by the retirement plan provisions will be restored to me on the earlier of (1) the first day of the plan year in which the participant attains age 35, or (2) the date the participant separates from service with the employer sponsoring the retirement plan.
SIGNATURE OF SPOUSE DATE
X
D. Signature and Date
I reserve the right to revoke or change my beneficiary designation in the future. I hereby revoke all my previous designations (if any) of primary and contingent beneficiar-ies. Note: If you are married, see the next section for applicable spousal consent requirements.
I understand that if this beneficiary designation is executed prior to the first day of the plan year in which I attain age 35 that my spouse will become the beneficiary on the earlier of (1) the first day of the plan year in which I attain age 35, or (2) the date that I separate from service with the employer sponsoring the retirement plan. I understand that if I do not wish for my spouse to be my beneficiary at that time I need to complete a new Beneficiary Designation Form.
SIGNATURE OF EMPLOYEE DATE
X
Note: If your spouse is not your designated primary beneficiary, this Designation of Beneficiary Form is invalid without the consent of your spouse. If you are currently single
[and marry] or re-marry you will need to complete a new Beneficiary Designation Form if you do not wish for your new spouse to be your primary beneficiary.
E. Spousal Consent
(Signature must be witnessed by a Plan Representative or Notary Public)
If you, the Participant, are married and your spouse is not designated as your primary beneficiary, your beneficiary designation is invalid without the consent of your spouse. Your spouse's consent must be witnessed by a Plan Representative or Notary Public.
Fidelity Investments Institutional Operations Company, Inc. 409573.5
(c)201 FMR Corp. All rights reserved.
;
1
Please make a copy of it for your files, and return the original in the enclosed envelope or mail to:
Fidelity Investments P.O. Box 5000
00001001_E_000001_ABC123
This document provides only a summary of the main features of the DAP and the Plan Document will govern in the event of discrepancies.
The Plan is intended to be a participant-directed plan as described in Section 404(c) of ERISA, which means that fiduciaries of the Plan are ordinarily relieved of liability for any losses that are the direct and necessary result of investment instructions given by a participant or beneficiary.
© 2010 - 2013 FMR LLC
1.909381.100
Fidelity Investments P. O. Box 145429 Cincinnati, OH 45250-5429 Fidelity Brokerage Services LLC, Member NYSE, SIPC, 900 Salem Street, Smithfield, RI 02917 583554.2.2
4.NVCP2162230100_C