Employee Retirement Plan Summary

EMPLOYEE RETIREMENT PLAN SUMMARY

Plan Identification

Plan Year begins:    Plan Effective Date:

Participant Personal Information

Position Information

Employment Start Date:    Current Annual Salary: $

Employment History (most recent)

Education

Graduation Date:

Professional References

Plan Overview & Participation

Plan Type: 401(k) 403(b) Roth Option Other:

Eligibility: Employees are eligible to participate upon satisfying the plan's eligibility requirements as set forth in the plan document. Standard eligibility criteria (check all that apply):
Completion of in a plan year.
Completion of of service.

Contributions, Matching and Vesting

Employee Elective Deferral Options: Participants may elect pre-tax deferrals and, where available, Roth after-tax deferrals. Default elective deferral percentage: .

Employer Matching Formula (if applicable): Employer will match of employee deferrals up to of pay.

Check applicable vesting schedule:
Cliff vesting: 100% vested after years.
Graded vesting:

Investments, Loans & Distributions

Loans: Permitted Not Permitted    If permitted, maximum loan amount: $

Hardship Distributions and In-Service Withdrawals: Subject to plan terms and federal tax rules. Early distribution penalties and ordinary income tax may apply. Required Minimum Distributions follow federal rules applicable to plan type.

Beneficiaries

Primary Beneficiary (name and relationship):

Contingent Beneficiary (name and relationship):

Beneficiary designations are effective only when submitted on the plan's designated beneficiary form and accepted by the plan administrator. The plan document governs designation and distribution rules.

Claims, Appeals & Participant Rights

This summary provides key features only. The plan document and trust agreement control all rights and obligations. Under applicable law, participants have the right to examine plan documents and to file claims and administrative appeals as provided by the plan's claims procedure.

Legal Notices & Disclosures

ERISA Statement: The Plan is a benefit plan maintained by the employer and governed by the Employee Retirement Income Security Act (ERISA) where applicable. Plan fiduciaries must act solely in the interest of participants and beneficiaries for the exclusive purpose of providing plan benefits and defraying reasonable administration expenses.

Governing Document: This summary is not the plan document. If there is any discrepancy between this summary and the plan document, the plan document shall control in all cases.

Tax Consequences: Contributions and distributions under the plan may have federal and state tax consequences. Participants are encouraged to consult a tax advisor prior to making elections or accepting distributions. The plan administrator does not provide tax advice.

Acknowledgements & Authorizations

I acknowledge receipt of this Employee Retirement Plan Summary and understand that it summarizes certain material provisions of the plan but is not a complete statement of all plan terms.

I authorize the Plan Administrator and its delegates to obtain and verify employment and compensation information necessary to administer plan benefits, and to request records from prior employers as required by plan provisions.

I consent to any background checks or verifications required to establish eligibility or enrollment under the plan, to the extent permitted by law.

By signing below, I acknowledge that I have read and understand the summary information provided. I authorize participation and applicable payroll deferrals as elected by me and acknowledge that I may change my deferral elections in accordance with plan procedures.

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