HomeMy WebLinkAboutLewis, Longman & Walker Summary Defined Benefit Plan & Trust - 2006 02 21
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SUMMARY PLAN DESCRIPTION
Defined Benefit Plan and Trust
for
Employees of the City of Winter Springs, Florida
February 21, 2006
Prepared by:
James Linn, Esq.
Glenn Thomas, Esq.
Lewis, Longman, & Walker, P.A.
125 S. Gadsden St. Suite 300
Tallahassee, Florida, 32301
(850) 222-5702
TABLE OF CONTENTS
(1) General...........................................................................................................................l
(2) Identification of Plan......................................................................................................l
(3) Type of Plan...................................................................................................................l
(4) Plan Administrator......................................................................................................... 1
(5) Trustee/Trust Fund.........................................................................................................l
(6) Hours of Service............................................................................................................2
(7) Eligibility to Participate.................................................................................................2
(8) Employer's Contribution...............................................................................................3
(10) Normal Retirement Pension ................... ........................ .......... ............ ... .................... ...3
(11) Accrued Benefit............................................................................................................. 5
( 12) Vesting........................................................................................................................ ...5
(13) When you Receive Your Accrued Benefit Under the Plan............................................5
(14) Optional Forms of Payment. .. ........................................................................................7
( 15) Forfeiture of Certain Benefits........................................................................................ 8
(16) Required Distributions ... ........... ......................................... ........ ...... ... ... ...... ... ....... ........8
(17) Special Options After You Reach Normal Retirement Age ..........................................8
(18) Death Benefits................................................................................................................8
(20) Claims Procedure........................................................................................................... 9
(21) Retired Participant, Separated Participant with Vested Benefit, Beneficiary
Receiving.................................................................................................................... .1 0
(22) Federal Income Taxation of Benefits Paid..... ..............................................................1 0
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SUMMARY PLAN DESCRIPTION
(1) General. The legal name, address and Federal employer identification number ("EIN")
of the Employer are:
City of Winter Springs
1126 East State Road 434
Winter Springs, FL 32708
EIN 59-1026364
The Employer has established this retirement plan ("Plan") to supplement your income upon
retirement. In addition to the retirement benefits, the Plan may provide benefits in the event of
your death or your termination of employment prior to Normal Retirement Age. If after reading
the summary you have any questions, please ask the Plan Administrator. We emphasize this
summary is a highlight of the more important provisions of the Plan. If there is a conflict
between a statement in the summary plan description and the Plan, the terms of the Plan control.
(2) Identification of Plan. The Plan is known as -
Defined Benefit Plan and Trust for Employees of the City of Winter Springs
The Employer has assigned 002 as the Plan identification number. The Plan year is the period on
which the Plan maintains its records: October 1 through September 30.
(3) Type of Plan. The Plan is a defined benefit pension plan. Under this type of plan, a
participant who retires after reaching the Normal Retirement Date will receive a monthly pension
based on a formula that reflects years of service, average compensation and a benefit multiplier.
Section (10) explains the benefit formula.
(4) Plan Administrator. The Employer is the Plan Administrator. The Employer's
telephone number is (407) 327-1800. You may contact the City Manager and the Human
Resource Coordinator at the Employer's address. The Plan Administrator is responsible for
providing you and other participants information regarding your rights and benefits under the
Plan.
The name of the person designated as agent for the service oflegal process upon the Plan is:
Ronald W. McLemore
City Manager
City of Winter Springs
1126 East State Road 434
Winter Springs, FL 32708
(5) Trustee/Trust Fund. The Employer has appointed a Retirement Committee to act as
Trustee and assist in the administration of the Plan. The Retirement Committee has the
responsibility for making certain discretionary determinations under the Plan, and approving all
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distribution and benefit payments from the trust fund to participants and beneficiaries. The
Retirement Committee consists of the members of the Board of Trustees. The members of the
Retirement Committee may change from time to time. The names of the current members of the
Retirement Committee are listed on an Appendix at the end of this summary plan description.
The Board of Trustees' address is:
The Board of Trustees of the City of Winter Springs
1126 East State Road 434
Winter Springs, FL 32708
(6) Hours of Service. The Plan and this summary plan description include references to
hours of service. For example, to advance on the vesting schedule, the Plan requires you to
complete a minimum number of hours of service during the plan year. The section covering
vesting explains this aspect of the Plan. However, hours of service has the same meaning for all
purposes of the Plan.
The Plan utilizes the "actual" method for crediting hours of service. Under the actual method,
you will receive credit for each hour for which the Employer pays you, directly or indirectly, or
for which you are entitled to payment, for the performance of your employment duties. You also
will receive credit for certain hours during which you do not work if the Employer pays you for
those hours, such as paid vacation. You will further receive credit for certain unpaid leaves of
absence authorized by the Employer under a uniform, nondiscriminatory policy under which the
Employer specifically credits hours of service for such unpaid leaves of absence.
If an employee's absence from employment is due to maternity or paternity leave, the employee
will receive credit for unpaid hours of service related to his leave, not to exceed 501 hours. The
Plan administrator will credit these hours of service to the first period during which the employee
otherwise would incur a I-year break in service as a result of the unpaid absence.
(7) Eligibility to Participate. You do not have to complete any form for entry into the Plan.
Unless you are excluded, you will become a Participant on the first day of the month
immediately following the date 6 months after your first day of employment.
Excluded employees include those whose customary weekly employment is less than 29 hours.
A participant who becomes an excluded employee does not accrue benefits attributable to the
period he is excluded, but will receive credit for vesting. An excluded employee who is not a
plan participant but becomes eligible will become a participant immediately upon satisfaction of
eligibility conditions, and years of service during the period the employee was excluded will be
credited for vesting.
If you terminate employment after becoming a Participant in the Plan and later return to
employment, you will re-enter the Plan on your re-employment date. Also, if you terminate
employment after satisfying the Plan's eligibility conditions but before actually becoming a
participant in the Plan, you will become a participant in the Plan on the later of your scheduled
entry date or your reemployment date.
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(8) Employer's Contribution. For each plan year, the Employer must contribute to the
Trust an amount the Plan's actuary determines is necessary to fund retirement benefits under the
Plan.
(9) Employee's Contribution. Employees contribute 3% of compensation to the
retirement plan. Employee contributions are "picked up" by the City (i.e., they are deducted from
the employee's pay and paid to the retirement plan in pre-tax dollars).
(10) Normal Retirement Pension. The Plan defines the Normal Retirement Pension as an
amount payable every year in the normal form of annuity starting at your Normal Retirement
Date (age 65). The "normal form of annuity" is a life annuity, meaning an annuity that makes
payments during your lifetime.
The amount payable under the Normal Retirement Pension is 2% of the your Average
Compensation (as defined below) multiplied by your Years of Accrual Service for service before
October 1, 2000, and 3% of the your Average Compensation multiplied by your Years of
Accrual Service for service on and after October 1, 2000. However, effective October 1, 2008, a
Participant's Normal Retirement Pension shall equal 3% of the Participant's Average
Compensation multiplied by his Years of Accrual Service for service prior to October 1, 2000;
provided that such multiplier shall increase by one-fourth of one percent (.25%) each year
beginning October 1, 2005, as follows:
Effective Date
Multiplier for Service
Prior to October L 2000
October 1, 2005
October 1,2006
October 1, 2007
October I, 2008
2.25%
2.50%
2.75%
3.00%
Your Normal Retirement Pension shall be calculated by applying the multiplier for service prior
to October 1,2000 that is in effect on the date of the Participant's separation from service.
Your pension will be adjusted for any distribution in accordance with Section 8.05 of the Plan.
The maximum number of Years of Accrual Service taken into account in the normal retirement
pension is 30. See the illustration below for an example of the calculation of your Normal
Retirement Pension.
Your average compensation is the highest average over 3 consecutive compensation periods. A
compensation period is the 12-month period ending on the last day of the plan year. If you have
less than 3 years of employment with the Employer, your average compensation is the average
over your entire employment period. The Plan defines compensation to mean all the
compensation the Employer pays you for your services. Your regular salary or wages, any
overtime, any commissions or any bonuses are part of your compensation under the Plan.
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Your Normal Retirement Pension may be subject to a maximum limitation provided by the
Internal Revenue Code. The Revenue Service annually announces any adjustment to the
maximum limitation.
Example of calculation of Normal Retirement Pension.
Example 1: Assume you reach the Normal Retirement Date and retire on October 1, 2006,
your average compensation at retirement is $30,000 and you have 30 Years of Accrual Service at
your Normal Retirement Date credited as follows: 24 years of service prior to October 1, 2000
and 6 years of service on or after October 1, 2000. Under these circumstances, your annual
Normal Retirement Pension, payable in the form of a life annuity, would be $23,400, computed
as follows:
Credited Serviced Prior to October 1, 2000:
$30,000
x 2.5%
x 24
$18,000
(your average compensation)
(the Plan's annual accrual percentage)
(your Years of Accrual Service)
(your annual Normal Retirement Pension for service before
10/1/00)
Credited Serviced on or after October 1, 2000:
$30,000
x 3%
x 6
$ 5,400
(your average compensation)
(the Plan's annual accrual percentage)
(your Years of Accrual Service)
(your annual Normal Retirement Pension for service after 10/1/00)
Total annual Normal Retirement Pension under this Example: $23,400
Example 2: Assume you reach the Normal Retirement Date and retire on or after October 1,
2008, your average compensation at retirement is $30,000 and you have 30 Years of Accrual
Service at your Normal Retirement Date. Under these circumstances, your annual Normal
Retirement Pension, payable in the form of a life annuity, would be $27,000, computed as
follows:
$30,000
x 3.0%
x 30
$27,000
(your average compensation)
(the Plan's annual accrual percentage)
(your Years of Accrual Service)
(your annual Normal Retirement Pension)
As indicated above, the above examples assume you begin receiving benefit payments on your
Normal Retirement Date in the normal form of annuity (i.e., a life annuity). However, as
explained in Section (13), you may begin commencement of benefit payments after your Normal
Retirement Date and as explained in Section (14), you may elect to have your benefits paid in a
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form other than a life annuity. Under either of these circumstances, the amount of benefits
calculated in the above Examples will change.
(11) Accrued Benefit. If you qualify for a Pension from the Plan, the Plan Administrator will
calculate that Pension from your Accrued Benefit. Your Accrued Benefit is the portion of the
Normal Retirement Pension you have earned under the Plan. The portion of the Normal
Retirement Pension you have earned depends upon your period of service credited by the Plan.
The Plan refers to this period of service as your Years of Accrual Service. You will receive
credit for a Year of Accrual Service for each plan year (including plan years prior to the adoption
of the Plan) in which you receive credit for at least 1,000 hours of service.
(12) Vesting. When the Plan pays you your benefits, you will receive only your Vested
Accrued Benefit. Your Vested Accrued Benefit is the portion of your Accrued Benefit in which
you have earned a vested right (ownership) under the Plan's vesting schedule. The Plan will
determine your Vested Accrued Benefit according to the following schedule:
Years of Service Nonforfeitable Percentage
Less than 3 None
3 20%
4 40%
5 60%
6 80%
7 or more 100%
A year of vesting service means each plan year (including plan years prior to the adoption of the
Plan) in which you complete 1000 hours of service, except years of service prior to age 18.
However, if you incur a vesting break in service (as defined below), you will lose credit for your
prior years of vesting service, unless you complete a subsequent year of vesting service. Further,
if you are 0% vested and you incur 5 consecutive vesting breaks in service, you lose credit for
your prior years of vesting service. If your vesting percentage is less than 100% when you reach
Normal Retirement Age, and you are working for the Employer, the Plan automatically increases
your vesting percentage to 100%. Also, if your employment with the Employer terminates
because of death, disability or eligibility for an Early Retirement Pension, your vesting
percentage automatically increases to 100%.
(13) When you Receive Your Accrued Benefit Under the Plan. When you receive your
Accrued Benefit depends on when you terminate your employment with the Employer and the
circumstances of your termination. The following paragraphs explain the different types of
Pensions under the Plan. A reference to the "lump sum value" of your Pension means the single
sum determined by the Plan to equal the actuarial value of your Accrued Benefit payable at your
Normal Retirement Date (or at your current age, if later). The Plan specifies actuarial
assumptions for this purpose. The actuarial assumptions consider your life expectancy, the
number of years remaining to your Normal Retirement Date and a reasonable rate of return
expected on Plan investments.
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(a) Normal Retirement Pension. The Plan refers to your Pension as a Normal
Retirement Pension if you terminate employment with the Employer after reaching your
Normal Retirement Date. Payment of your Normal Retirement Pension begins as soon as
possible after you terminate employment with the Employer. If you begin payments after
your Normal Retirement Date, the Plan increases the amount of your Pension because at
an older age a person is expected to live for a shorter period. The increased payment will
equal the actuarial value of the Pension the Plan would have paid you at your Normal
Retirement Date. The Plan's actuary will calculate these adjustments to the Pension
based on the actuarial assumptions stated in the Plan.
(b) Deferred Vested Pension. The Plan refers to your Pension as a Deferred Vested
Pension if you terminate employment with the Employer before reaching your Normal
Retirement Date or before your eligibility for an Early Retirement Pension. See Section
(16) for further information on distributions. If you begin payments after your Normal
Retirement Date, the Plan increases the amount of your Pension because at an older age a
person is expected to live for a shorter period. The increased payment will equal the
actuarial value of the Pension the Plan would have paid you at your Normal Retirement
Date. The Plan's actuary will calculate these adjustments to the Pension based on the
actuarial assumptions stated in the Plan.
(c) Early Retirement Pension. The Plan refers to your Normal Retirement Pension as
an Early Retirement Pension instead of a Deferred Vested Pension if you have not
reached your Normal Retirement Date but you are at least age 55 and you have
completed at least 10 Years of Accrual Service or if you have completed at least 25 Years
of Accrual Service. The Plan commences payment of your Early Retirement Pension as
soon as possible after you become eligible for the Early Retirement Pension (and
subsequent to your termination of employment). You may elect to postpone payment of
your Early Retirement pension to the first day of any month subsequent to your
termination of employment. Any postponement of distributions is subject to the
distribution requirements of Section (16).
Your Early Retirement Pension is a subsidized benefit. If you begin payments after age
55, your Early Retirement Benefit is not reduced because of commencement of benefit
payments prior to your Normal Retirement Date. Thus, your benefit payment amounts
after age 55 would be the same as if you commenced benefit payments at your Normal
Retirement Date. However, if you commence your Early Retirement Pension payments
prior to age 55, the Plan reduces the amount of your Pension to the actuarial equivalent of
your Early Retirement Pension commencing at age 55. If you delay the commencement
of your Early Retirement Pension to after your Normal Retirement Date, the Plan will
increase the amount of your Pension. The Plan's actuary will calculate these adjustments
to the Pension based on the actuarial assumptions stated in the Plan.
If you have the right to elect when your Pension commences, the Plan Administrator will provide
you a form explaining your election rights. You will have at least 30 days to make your election.
Your Pension may not actually commence on the date you elect. The Plan has an
administratively reasonable period of time to make payment following your election. If you fail
6
to make an election, the Plan will commence payment under the "Required Distribution" rules
described in Section (16).
(14) Optional Forms of Payment. If you are married when your Pension commences, you
will receive a Qualified Joint and Survivor Annuity. This is an actuarially adjusted benefit that
provides a reduced monthly Pension for your lifetime plus a survivor Pension for your spouse (if
your spouse is living at your death) equal to 50% of your lifetime monthly Pension. If you are
not married when your Pension commences, the Qualified Joint and Survivor Annuity is a life
annuity, meaning a monthly Pension for your lifetime with no survivor Pension continuing after
your death.
Since the Qualified Joint and Survivor Annuity pays a benefit for two lifetimes if a participant is
married, the Plan reduces the amount of the monthly Pension payable to a married participant.
This reduction makes the actuarial value of the Qualified Joint and Survivor Annuity for a
married participant equal to the actuarial value of a life annuity for an unmarried participant.
Instead of the Qualified Joint and Survivor Annuity, you may elect any of the following payment
options.
(a) Life annuity. A life annuity is a monthly payment for your lifetime. If you are
unmarried, the Qualified Joint and Survivor Annuity already is a life annuity. If you are
married, the life annuity option would increase your monthly lifetime Pension since this
option makes payments only for your life and not also for your spouse's life.
(b) Joint and Survivor annuity. If you are married, you may use this option to elect a
survivor Pension equal to 100% instead of 50% of your lifetime Pension under the
Qualified Joint and Survivor Annuity. Since the 100% survivor Pension is more costly,
the Plan would reduce the amount of your monthly lifetime Pension to make the value of
this option equal to the value of your normal Qualified Joint and Survivor Annuity. If
you are unmarried, you may use this option to provide a survivor Pension to your
beneficiary equal to 75% or 100% of your lifetime Pension. The Plan would adjust the
amount of an unmarried participant's monthly lifetime Pension to make the actuarial
value of this option equal to the actuarial value of a life annuity.
(c) Life annuity with guaranteed payment. This option pays a monthly lifetime
Pension, but guarantees a minimum number of payments. The minimum number of
payments may not exceed your life expectancy or the joint life expectancy of you and
your beneficiary. If you die before the minimum payment period, your beneficiary
receives the remaining payments. The Plan would adjust the amount of the monthly
lifetime Pension to make the actuarial value of this option equal to the actuarial value of a
life annuity.
(d) Installments. This option makes payments over a fixed period of time equal to
your life expectancy or the joint life expectancy of you and your beneficiary. The Plan
would limit the annual amount of the fixed period payments so the actuarial value is the
same as the actuarial value of a life annuity.
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If you are married, you may not elect an optional form of payment instead of the Qualified Joint
and Survivor Annuity unless your spouse consents in writing. The Plan Administrator will
provide you a form-explaining the Qualified Joint and Survivor Annuity, your election rights for
optional forms of payment and your spouse's consent rights. You will have at least 30 days to
make your election.
(15) Forfeiture of Certain Benefits. If you are not 100% vested in your Accrued Benefit,
and you receive payment of your entire Vested Accrued Benefit, the Plan forfeits your Non-
vested Accrued Benefit. If you return to employment with the Employer, you may restore your
forfeited benefit by repaying the full amount of your distribution plus interest. You must make
the repayment no later than 5 years after your reemployment date or you lose your right to
restore the forfeited benefit. You also lose your right to restore the forfeited benefit if you incur
5 consecutive vesting breaks in service as a result of your termination of employment with the
Employer. The interest rate on your payment depends on an interest rate index published by the
Internal Revenue Service. Upon your reemployment with the Employer, you may request the
Plan Administrator to explain your repayment option.
(16) Required Distributions. The Plan must commence payment of your Pension no later
than 60 days after the close of the plan year in which you attain Normal Retirement Age, unless
you elect a later commencement date. If you have attained Normal Retirement Age when you
terminate employment with the Employer, the 60-day period runs from the close of the plan year
in which you terminate employment.
The law, with limited exceptions, also requires you to commence payment of your Normal
Retirement Pension, if you have not already done so, after you reach age 70 ~, unless you have
not retired at that time. You must start payment by April 1 of the calendar year following the
calendar year you reach age 70 ~ or in which you retire (whichever occurs later).
(17) Special Options After You Reach Normal Retirement Age. The Plan does not include
any special options merely because you continue working for the Employer after your Normal
Retirement Age.
(18) Death Benefits. Whether the Plan pays a benefit after your death depends on whether
your death occurs before or after your Pension commences.
If your death occurs after your Pension commences, your beneficiary will receive a death benefit
only if payments continue after your death under the form of distribution you are receiving. See
the explanation in Section (14) of the different forms of payment.
If your death occurs before your Pension commences, the Plan provides a death benefit to your
beneficiary equal to the value of your Accrued Benefit. If you are married, the Plan will pay
your death benefit to your surviving spouse in the form of a Preretirement Survivor Annuity,
which is a life annuity payable to your surviving spouse. However, unless you elected otherwise
(and your spouse consented to such election), your spouse may elect to receive payment in any
optional form of payment described in Section (14) (other than any type of joint and survivor
8
annuity). However, if the lump sum value of the Preretirement Survivor Annuity is $3,500 or
less, the Plan will pay your surviving spouse a single sum equal to that lump sum value. The
Preretirement Survivor Annuity benefit does not apply if you and your surviving spouse have not
been married during the one-year period ending on your date of death.
With the spouse's consent, you may elect not to have this death benefit payable under the Plan.
The Plan Administrator will provide you information explaining the Preretirement Survivor
Annuity and your election rights.
If the Preretirement Survivor Annuity does not apply, the Plan permits your designated
beneficiary to receive the death benefit under any optional form of payment described in Section
(14) (other than any type of joint and survivor annuity), unless the participant elected otherwise.
In general, death benefits under the Plan will commence as soon as administratively practicable
after the participant's death.
Generally, the Plan must distribute the death benefit by the end of the 5th calendar year following
your death. However, as indicated above, a designated beneficiary may receive distributions
over a period not exceeding his life expectancy, but only if benefit payments commence within
one year of the participant's death. A designated beneficiary is an individual designated by you
as your beneficiary. The Plan Administrator will provide you with the appropriate form for
naming a beneficiary.
(19) Amendment and Termination of the Plan. The Employer has the right to amend the
Plan in any manner, or terminate the Plan entirely. If the Employer terminates the Plan, you
would receive benefits under the Plan based on your Accrued Benefit as of the date of Plan
termination. Termination of the Plan could occur before you reach Normal Retirement Age. If
the Employer terminates the Plan, your Accrued Benefit becomes 100% vested.
The fact the Employer has established this Plan does not confer any right to future employment
with the Employer. You also may not assign your interest in the Plan to another person or use
your Plan interest as collateral for a loan from a commercial lender.
(20) Claims Procedure. You generally need not file a formal claim with the Plan
Administrator in order to receive your benefits under the Plan. When an event occurs which
entitles you to a payment of your benefits under the Plan, or if an election of a benefit is
required, the Plan Administrator will notify you. However, if you disagree with the Plan
Administrator's determination of the amount of your benefits under the Plan or with any other
decision the Plan Administrator may make regarding your interest in the Plan, the Plan contains
the appeal procedure you should follow. In brief, if the Plan Administrator determines it should
deny benefits to you or your beneficiary making a claim for benefits, the Plan Administrator will
give you or your beneficiary adequate notice in writing setting forth specific reasons for the
denial and referring you or your beneficiary to the pertinent provisions of the Plan supporting the
Plan Administrator's decision. If you or your beneficiary disagrees with the Plan Administrator,
you or your beneficiary, or a duly authorized representative, must appeal the adverse
determination in writing to the Retirement Committee within 75 days after the receipt of theP
9
notice of denial of benefits. If you or your beneficiary fails to appeal a denial within the 75-day
period, the Plan Administrator's determination will be final and binding.
If you or you beneficiary appeals to the Retirement Committee, you or your beneficiary, or a
duly authorized representative, must submit the issues and comments you or your beneficiary
feels are pertinent to permit the Retirement Committee to re-examine all facts and make a final
determination with respect to the denial. The Retirement Committee, in most cases, will make a
decision within 90 days of a request on appeal unless special circumstances would make
rendering a decision within the 90-day period unfeasible. In any event the Retirement
Committee must renter a decision within 120 days after its receipt of a request for review.
(21) Retired Participant, Separated Participant with Vested Benefit, Beneficiary
Receiving Benefits. If you are a retired participant or beneficiary receiving benefits, you are
entitled to the benefits that were in effect on the date your City employment terminated. The
benefits you presently are receiving will continue in the same amount and for the same period
provided in the form of payment selected at the time you retired. If you are a separated
participant with a Vested Accrued Benefit, you may obtain a statement of the dollar amount of
your Vested Accrued Benefit upon request of the Plan Administrator. There is no Plan provision
which reduces, changes, terminates, forfeits, or suspends the benefits of a retired participant or of
a beneficiary receiving benefits, or a separated participant's Vested Accrued Benefit, except as
explained in Section (19).
(22) Federal Income Taxation of Benefits Paid. Retirement benefits that you receive upon
reaching your Early or Normal Retirement Date are generally reported as taxable income. The
Federal tax laws permit you to defer Federal income taxation of certain distributions by making a
"rollover" contribution to your own individual retirement account. In general, the only type of
distribution available under the plan that qualifies for "rollover" treatment is a lump sum
distribution, which is only available under very limited circumstances. Income tax withholding
rules apply to some distribution you do not rollover directly to an individual retirement account
or to another plan. At the time you receive a distribution, you also will receive a notice
discussing withholding requirements and the options available to you. We emphasize you should
consult your own tax adviser with respect to the proper method of reporting any distribution you
receive from the Plan.
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APPENDIX
Retirement Committee / Board of Trustees
Robert Nippes, Chairman
Guy DeMaio
Byron Giltz
Veroon Rozelle
Mark Sardo
o
, '
ACKNOWLEDGMENT OF RECEIPT OF
SUMMARY PLAN DESCRIPTION OF THE
Defined Benefit Plan and Trust
For
Employees of the City of Winter Springs, Florida
I hereby acknowledge receipt of a copy of the Summary Plan Description ("SPD") on the
above plan. I received a copy of the SPD on the date indicated below.
Dated:
Participant's Name - Printed
Signature of Participant
o