EBSCO SAVINGS AND PROFIT SHARING TRUST
Request for Full Withdrawal
______________________________________________________________________________________________________ To: Administrative Committee, I certify that I have been furnished a Summary Plan Description (SPD) and meet the Trust eligibility requirement for a Full Withdrawal from the EBSCO Savings and Profit Sharing Trust (Trust) and I am at least age 59-1/2 and fully vested in the Trust. This is an annual election; once the election is made I will not be permitted to transfer my monies back into the investments of the Trust. This request must be received no later than October 31 st in the year in which I qualify for a Full Withdrawal and wish to make the election. Requests received after October 31st will be held until after the following year's October valuation. Elections will be processed and mailed out the end on November. This option allows me as an eligible participant to place my entire account balance with any financial institution and follow whatever arrangements they wish for investment and/or a combination of periodic withdrawal and investment. The funds are then completely under my personal control and, as with any withdrawal, would be taxable unless rolled over into an Individual Retirement Account (IRA). Under the Full Withdrawal option, I remain a Trust Participant for current savings and for receipt of any company contribution, if eligible, at fiscal year end. Succeeding years, following the annual audit of the Trust for a fiscal year ending June 30, that year's personal savings and applicable earnings, (if any) and that year's company contribution and applicable earnings, (if any) will automatically be disbursed per my instructions below. However, I do have the option to stop any future Full Withdrawal disbursements by submitting written instruction to the Administrative Committee prior to the processing of Full Withdrawals for that year. Should I elect to stop future Full Withdrawal disbursements the monies would remain in the Trust. A new Full Withdrawal form would need to be submitted with the stop option to be marked and returned to the Payroll /Trust Department. If I have savings prior to June 30, 1996 (employee after-tax savings) and elect a rollover the after-tax funds would be returned to me with no tax consequences. Should I elect a Lump Sum payment any personal savings contributed prior to June 30, 1996 would not be taxed again upon the disbursement. As the Trust Administrator is not in the position to advise on how funds should be disbursed, I am encouraged to consult with a financial advisor before making a Full Withdrawal election.
SUMMARY DIRECT ROLLOVER Payment will not be taxed in the current year and no income tax will be withheld Payment will be made directly to your IRA Payment will be taxed later when the IRA is disbursed
LUMP SUM PAYMENT Payment is considered taxable in the year of distribution. The Trust is required to withhold 20% of the payment for Federal Income Tax withholding to be credited against any taxes owed. It will be my responsibility to pay any related State Income Tax or any additional Federal Tax, if applicable. Within 60 days of receipt of lump sum payment I may still elect to roll the payment into an IRA. The amount rolled over will not be taxed until withdrawn from the IRA.
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Rollover into an Individual Retirement Acct. (IRA)
I have read and understand the entire document attached. I elect to have my funds transferred directly to my financial institution. I understand this will be done automatically each year following the completion of the annual audit( end of November). I further understand that in the future I may instruct The Trust in writing to: a) stop my automatic Full Withdrawal or b) change my rollover instructions below.
__________________________________________ Financial Institution __________________________________________ Contact Person __________________________________________ Address __________________________________________ City, State, Zip
___________________________________ IRA Account #
___________________________________ Employee’s Signature ___________________________________ Social Security # ___________________________________ Date
Lump Sum Payment
I have read and understand the entire document attached. I understand the Trust Administrator is required to withhold 20% of my disbursement for Federal Tax and it will be my responsibility to pay any applicable State Income Tax. I further understand that each succeeding year, following the completion of the annual audit (end of November), I will automatically receive another Lump Sum payment unless I instruct The Trust in writing to stop my Full Withdrawal payment.
__________________________________________ Employee's Signature
______________________ Date
Changes to Current Full Withdrawal Payments
□ Please stop my Full Withdrawal Payment. □ Please change my current Full Withdrawal setup. (Complete the section you want to change) Explain: ___________________________________________________________
Signed: ______________________________________ Date: _________________ ____________________________ ___________________ _________________ Print Name Social Security # EBSCO Location
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