403b Tax Sheltered Annuity Salary Reduction Agreement (SRA)
Instructions: This Agreement must be signed by the Employee and received by the Risk Management & Benefits th department by the 10 day of the month in which it is to be effective. Employees who participate in multiple 403(b)/403(b)(7) accounts must include all salary reductions for all accounts or providers on one SRA. In accordance with the regulations of the Internal Revenue Service, this Agreement is binding and irrevocable with respect to amounts not yet paid or made available until such time as the Agreement is terminated, or superseded with a new Agreement. Agreements to change or terminate this Agreement are subject to the same deadlines as listed in the preceding paragraph. Employee Name Check one: Classified Social Security Number Academic
Check appropriate box(s) for action needed: This is an initial Agreement to begin contributions. This is an Agreement to change my level of contribution: This is an Agreement to stop contributions to _______________________ Vendor #_________, and make no further salary reductions effective
(Month)
payroll period.
Compensation to be paid to the named Employee by the Grossmont-Cuyamaca Community College District shall be reduced by the sum indicated for each pay period beginning on the date stated or the next available pay period for which amounts are not currently available.
Amount $ ____ This deduction is for
beginning with money to be deducted______________, 200__. 10 months 11 months 12 months annually.
To allocate 403b funds to chosen vendor, you must establish an account with the vendor prior to submitting this form. You must provide your TSA account number in the section below.
The above amount shall be transmitted on behalf of the Grossmont-Cuyamaca Community College District in accordance with the GCCCD’s 403(b) plan in the following manner: Amount $ Amount $ Amount $ To:
(Vendor Name) (Vendor Number) (TSA Account #)
To:
(Vendor Name) (Vendor Number) (TSA Account #)
To:
(Vendor Name) (Vendor Number) (TSA Account #)
This is an Agreement to amend named Employee’s employment contract (whether written or verbal) to reduce compensation by the previously specified amount for the purposes of elective deferrals to the Grossmont-Cuyamaca Community College District’s 403(b) plan, in accordance with California Education Code Section 42649/86265, or the applicable Code in other states, and in conformance with Section 403(b) of the Internal Revenue Code of 1986, as amended, and Section 17501 of the California Revenue and Taxation Code or the relevant Code in other states.
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403b Tax Sheltered Annuity Salary Reduction Agreement (SRA) (cont.)
This Agreement supersedes and replaces all previous Agreement(s) regarding the named Employee’s salary reduction contributions to the Grossmont-Cuyamaca Community College District’s plan. The Grossmont-Cuyamaca Community College District shall have no more than one SRA in effect at any time, such SRA to include all annuity contracts and/or custodial accounts to which payments are to be made. Employee understands that this Agreement is binding and irrevocable with respect to amounts not paid or made available to Employee, and that Agreement can be terminated, or replaced with a new Agreement subject the Grossmont-Cuyamaca Community College District’s deadlines as explained in “Instructions”. 1. The Employee releases any and all rights to receive payment from the Grossmont-Cuyamaca Community College District of the sums resulting from this salary reduction agreement once those sums have been properly transmitted to the providers selected by Employee. This Agreement shall automatically apply to subsequent fiscal years unless terminated or replaced with a new Agreement that will affect only the amounts not currently paid or available to Employee. The Employee acknowledges that the Grossmont-Cuyamaca Community College District makes no representations about any 403(b)(1) annuity or 403(b)(7) custodial account available to Employee through the Grossmont-Cuyamaca Community College District’s plan, and further makes no recommendations as to the suitability or income tax consequences of Employee’s voluntary participation in the plan. Employee further understands that distributions from the 403(b) plan may be subject to IRC restrictions prior to age 59½, and additional surrender charges or back-end loads assessed by the Provider(s). The Employee acknowledges that the annuity contracts and/or custodial accounts were selected solely by Employee and that the Grossmont-Cuyamaca Community College District bears no responsibility for the results of those selections. Employee warrants that the amount of the requested salary reductions for purposes of contributions to the 403(b) plan do not exceed the maximum allowable contribution limits as set out in the IRC, and understands that those maximum allowable contribution limits apply in the aggregate to multiple Providers (if applicable). If it is determined that contributions have exceeded eligible IRC limits, Employee understands that corrective distributions and/or declaration of excess contributions as includible income may result, with Provider required to report those corrective distributions as taxable events.
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Termination of Payroll Deduction: There are circumstances whereby an employee’s TSA contribution will be automatically stopped by the District. If the annual contribution limit is exceeded, the District will automatically terminate the payroll deduction and notify the Employee. If the TSA company notifies the District that it has no record of your TSA contract, the deduction will be stopped immediately in the payroll system and no further deductions will be made until the problem is resolved by the Employee, and the company notifies the District (in writing) that the TSA contract is valid. Resolution is the Employee’s responsibility. Employee bears the sole responsibility of providing the data necessary for the calculation of the Section 403(b)(2) exclusion allowance, the Section 415 Limits, and the Section 402(g) elective deferral limits, including both the basic limit under 402(g)(1), and the increased limit under 402(g)(8). Employee agrees that the Grossmont-Cuyamaca Community College District, the governing board, and any officer’s or other employees of the Grossmont-Cuyamaca Community College District are not responsible for Employee’s selection of a specific product or investment option from those authorized for the 403(b) plan. Employee bears sole responsibility for the selection and the result for that selection. Employee further agrees to reimburse the Grossmont-Cuyamaca Community College District for any federal or state income taxes, penalties or interest that the Grossmont-Cuyamaca Community College District may be required by the Internal Revenue Service to pay on behalf of Employee as a result of contributions which are in excess of eligible contribution limits under the applicable Code Sections either through payroll deduction or through direct payment by Employee, at the Grossmont-Cuyamaca Community College District’s discretion. The Grossmont-Cuyamaca Community College District reserves the right to terminate this Agreement at any time, after written notice to Employee, should the selected Provider(s) fail to comply with the 403(b) plan procedures, including the solicitation rules of the GrossmontCuyamaca Community College District, or with respect to the Internal Revenue Code, or the relevant Code of the State of California.
This Agreement represents the entire Agreement, and is executed with the signatures of both Employee and Employer’s designated representative: EMPLOYEE: Signature: Date: DISTRICT REPRESENTATIVE: Name/Title: Wendy Corbin, Benefits Technician Signature: Date:
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403b Tax Sheltered Annuity SRA Approved Vendors
You may elect to tax shelter a portion of your monthly income (based on IRS 403b regulations). The money in your account is intended to remain until you reach age 59½. If you withdraw early, with the exception of roll-overs, loans, or emergencies, the IRS will impose a 10% penalty. Below is a list of Tax Sheltered Annuity and Mutual Fund companies that are the District’s current vendors. Other companies may be added with Board approval. You will need to contact the vendor of your choice and request an application to start an account. A majority of these companies have an 800/888 number which may be found by calling 800 information at 1 (800) 555-1212 or by searching on the internet. Once you have made the decision on the tax shelter of your choice, please contact Risk Management/Benefits for the required District forms. Make sure you return the forms to Risk Management/Benefits by the 10th of the month in which you would like the deduction to be effective. Please note that District involvement is limited to payroll deductions only. Any other questions must be directed to your selected vendor. Plan participants are able to enter into more than one salary reduction agreement in a tax year. Only 2 changes per year are allowed. Contact a financial consultant or listed vendor for more details.
District Authorized Companies: GCCCD DISTRICT 403b APPROVED VENDOR LIST
VENDOR NAME VNDR #
AIG VALIC AIG American General Annuity Aviva Life Insurance Company AXA Equitable Life Insurance Company Conseco Annuity Assurance Co/Conseco Ins. Co. Fidelity Investments Institutional Services Co. First Investors Corporation Franklin Templeton FTJ FundChoice LLC Great American Life Insurance Company The Legend Group Inc. Life Insurance Company of the Southwest Lincoln National Life (took over Jefferson Pilot) Metropolitan Life Insurance Co. New York Life North American Co. For Life (NACOLAH) Northwestern Mutual Oppenheimer Funds Security Benefit Group State Farm VP Mgmt Corp/State Farm Insurance Thrivent Financial for Lutherans TIAA-CREF Transamerica Life and Annuity Company Travelers Life & Annuity USAA Life Insurance Company
20510 20920 22050 20380 20980 21770 21580 22220 22980 21220 22480 22210 20420 20100 23540 24700 24700 21620 20270 20650 20360 23130 21300 20320 21440
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