Qualified Retirement Plan ERISA Section 404(c) Employee Information Sheet Lincoln DirectorSM group variable annuity
(Instructions to help you customize this 404(c) Employee Information Sheet are included in red. This form can be modified to include your specific contract provisions, or you can create your own document. If you choose to modify this document, be sure to delete the instructions.) (To complete this document, you will need to know if you have an allocated or unallocated version of the contract. This information can be found at the bottom of the first page of your contract.) Plan Information Your employer has adopted a qualified retirement plan to help you with your plans to attain financial security during your retirement years. As a Participant in your Employer’s plan, you have the responsibility to decide how you want your retirement plan dollars invested. This Employee Information Sheet will outline some basic information about the investments available to you under your plan. Your Employer will give you Fund Information Sheets and a separate Enrollment and Investment Selection Form or other written instructions for selecting your investments. You should review this information carefully before making your investment choices. Keep this disclosure with your Summary Plan Description and other retirement plan documents.
PLAN NAME: (Insert the plan name as found in your adoption agreement, basic plan document, or first page of your DirectorSM contract) ERISA Section 404(c) Plan Your Employer intends that the retirement plan in which you participate satisfies the requirements of Section 404(c) of the Employee Retirement Income Security Act (ERISA) and Title 29, Code of Federal Regulations, Section 2550.404c-1. This means that your Employer is providing you with the opportunity to decide how your retirement plan dollars are invested, enabling you to choose investments that fit your personal needs. Your Employer, and other people in charge of the plan, will not be responsible for any investment loss of your retirement plan dollars which results from your investment instructions. You may invest your retirement plan dollars in any one or more of the following alternatives. (You are encouraged to refer to the other investment materials relating to these alternatives before you actually make your investment selections.)
Investment Alternatives
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(Delete any funds you do not allow your participants to invest in. Attach the Investment Information Sheet for any option that you allow participants to invest in.)
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Guaranteed (certain restrictions apply) SA11 Core Equity SA12 Government/Corporate Bond SA14 Short Term SA17 Medium Capitalization Equity SA19 AllianceBernstein VPS Growth and Income SA20 High Yield Bond SA21 Balanced SA22 International Equity SA23 Large Capitalization Equity SA24 Small Capitalization Equity SA27 DWS Equity 500 Index VIP SA28 Value Equity SA29 AllianceBernstein VPS Large Cap Growth SA30 Conservative Balanced SA31 AllianceBernstein VPS Global Technology SA32 Aggressive Balanced SA33 Social Awareness SA34 American Funds Insurance Series Global Growth SA35 Fidelity VIP ContraFund SA36 DWS Small Cap Index VIP SA37 Neuberger Berman AMT Mid-Cap Growth SA38 Neuberger Berman AMT Regency SA39 AllianceBernstein VPS Small/Mid Cap Value SA46 American Funds Insurance Series Global Small Capitalization SA48 American Funds Insurance Series Growth SA49 American Funds Insurance Series Growth-Income SA54 American Funds Insurance Series International SA55 Delaware VIP REIT Series SA56 Delaware VIP Small Cap Value Series SA57 Fidelity VIP Equity-Income SA58 Fidelity VIP Growth SA59 Fidelity VIP Overseas SA61 Delaware Value SA62 Templeton Growth Securities SA63 Franklin Small-Mid Cap Growth Securities SA64 Janus Aspen Series Mid-Cap Growth SA65 MFS VIT Emerging Growth Series SA66 MFS VIT Capital Opportunities Series
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SA67 SA70 SA75 SA76 SA77 SA80 SA81 SA83 SA84 SA86 SA87 SA92 SA93 SA94 SA95 SA96 SA97 SA98
MFS VIT Utilities Series Janus Aspen Series Large Cap Growth BlackRock Aurora BlackRock Small/Mid-Cap Growth BlackRock Global Resources BlackRock Large Cap Value BlackRock Legacy BlackRock Mid-Cap Value Equity Fidelity VIP Mid Cap Templeton Global Income Securities Delaware VIP Capital Reserves American Century VP Inflation Protection Delaware VIP Diversified Income Delaware VIP Emerging Markets Lincoln VIP Conservative Profile Lincoln VIP Moderate Profile Lincoln VIP Moderately Aggressive Profile Lincoln VIP Aggressive Profile
Investment Instructions
You must give instructions to the person(s) listed in the final section of this document as to how you want your retirement plan dollars invested. Your Employer will provide you with a Pension Investment Selection Worksheet to use for this purpose or will provide written instructions regarding other ways to select investments. There are two types of assets for which you may provide investment instructions: current contributions and accumulated balances. You may change investment instructions for your current contributions daily, quarterly, semi-annually or annually. (Select the frequency that your plan allows participants to change their current investment election/change future allocations. Be sure to delete the options that don't apply.) You may change investment balances daily, quarterly, semi-annually or annually which may be subject to market timing policies. (Select how often your participants are allowed to transfer accumulated balances. If you are using an allocated investment contract or daily valuation system, this most likely will be daily; otherwise it may coincide with the frequency selected in the previous sentence. Check your internal procedures to verify this information. Be sure to delete the options that don’t apply.) To make changes in your investment instructions you may use Lincoln Financial Group's toll-free access which is available from 8 a.m. to 8 p.m. ET Monday through Friday. If you call before 4:00 p.m. ET, on a business day, your transaction will be effective at the close of that day. If you call after 4:00 p.m. ET, your transaction will be effective at the
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close of the following business day. This toll-free line is for your convenience and privacy only. Please note that this line may be busy during times of unusually high transfer activity. (If you are using an unallocated contract, please delete this paragraph.) A second way to submit changes in your investment instructions is through Lincoln Financial Group’s participant Web site. The site will help you walk through the steps to make changes to your account. After making your changes, the screen will show you the effective date of your transaction. Transaction Fees/Expenses Your retirement account will be charged reasonable fees which consist of: (Please review your contract for the following items and delete any of the following fees that don't apply to your plan.) (allocated contracts only) Per participant account charge of $ _____ (enter the amount of this fee). On the last day of each year, this charge is deducted from your total account value. The charge is deducted on a pro-rata basis from each fund you are invested in. Market value adjustments. Periodic transfers to other investment options from the Guaranteed Account that exceed _____ percent (either 20% or 25%) in any 12-month period are subject to a market value adjustment. Lump-sum withdrawals from the Guaranteed Account are subject to both a market value adjustment and a possible withdrawal charge. Withdrawal charges. Withdrawals from the plan that are not due to termination of employment, retirement, death or disability are subject to these charges. (List all applicable withdrawal charges. Refer to your Director contract for the schedule of withdrawal charges.) Additional Information You may request the following additional investment information from the person(s) listed in the final section of this document: 1. A description of the annual operating expenses of each investment alternative which reduces your rate of return, with the overall amount of such expenses shown as a percentage of average net assets of the investment alternative; 2. Copies of any financial statements and reports, and any other materials relating to the investment alternatives available under the Plan if such information is provided to the Plan;
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3. A list of the actual investments held in each investment alternative and the value of each of these individual investments (or the proportion of the investment alternative that it comprises); 4. With respect to each individual investment which has a fixed rate of interest and is issued by a bank, savings and loan association or insurance company, the name of the issuer of the investment and its term and rate of return; 5. Information concerning the value of shares or units in investment alternatives available to you under the Plan, as well as the past and current investment performance of the investment alternatives; 6. Information concerning the value of shares or units in investment alternatives in which you have invested your retirement dollars.
(Insert the name or title, and the address, phone number and fax number of the Designated Plan Fiduciary. This may or may not be the same as the plan trustee. Check your plan documents for this information.) Designated Plan Fiduciary Name or Title of Fiduciary or designee of Fiduciary: Address: Phone: Fax:
Name Address City,State, Zip (000) 000-0000 (000) 000-0000
(A copy of your customized 404(c) Employee Information Sheet should be distributed to all plan participants. The original copy should be kept with your plan records.)
The Lincoln DirectorSM is a group variable annuity issued by The Lincoln National Life Insurance Company, Fort Wayne, IN, on policy form #19476 (and variations thereof) and is distributed by broker/dealers with selling agreements.
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