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Self Employed 1099 Retirement Account - PDF

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					                                          ADOPTION AGREEMENT
B
                                         Self-Employed Minister



1 . Your C onta c t Inform ati on
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Name

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Address                                                                                 City                                          State       Zip

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S o ci a l S e c u r i t y N u m b e r                                                  Email

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Te l e p h o n e N u m b e r                                                            Fax Number



2 . Your Ac tive/Re tire e Status
I am ( c h e c k o n e ) :

       ® A n a c t i v e s e l f - e m p l o y e d l i c e n s e d o r o r d a i n ed minister of the Assemblies of God.
       ® A r e t i r e d s e l f - e m p l o y e d l i c e n s e d o r o r d a i n e d minister of the Assemblies of God.

4 A r e y o u s e l f - e m p l o y e d ? W-2 P a y v e r s u s 1 0 9 9 I ncome
Wh i l e a l l m i n i s t e r s a r e c o n s i d e r e d t o b e s e l f - e m p l oyed for F I C A purposes, whether you are self-employed for retirement plan
pur p o s e s d e p e n d s o n h o w y o u r c o m p e n s a t i o n i s b e ing reported—

       1099
       I f y o u r i n c o m e i s r e p o r t e d o n IRS F o r m 1 0 9 9 , y o u are self-employed. Please complete this form.

       W-2
       I f y o u r p a y i s r e p o r t e d t o y o u o n IRS F o r m W-2 , you are treated as an employee. D O N O T C O M P L E T E T H I S F O R M ! Contact the
       Plan Administrator for the correct form.

       1 0 9 9 a n d W-2
       I f y o u a r e r e c e i v i n g b o t h a 1 0 9 9 a n d a W-2 , p l e ase contact the Plan Administrator for more information.


3 . Pl an Insta l l ati on Inform ati on
A. P l a n A d o p t i o n
I am a d o p t i n g t h i s p l a n a s ( c h e c k o n e a n d c o m p l e te as necessary):

       ® A new plan.
       ® A n a m e n d m e n t a n d r e s t a t e m e n t o f m y c u r r e nt Section 403(b) plan which was originally
         e f f e c t i v e ( f i l l i n d a t e ) ___ / ___ / ___.
       ® A s a n a d d i t i o n a l 4 0 3 ( b ) p l a n t o t h e o n e ( s ) I already have (Note: the I R S limits on contributions apply on a
         c o m b i n e d p l a n b a s i s . Yo u d o n o t g e t a s e p a rate I R S limit for each 403(b) plan you have.)

B. E f f e c t i v e D a t e o f P l a n A d o p t i o n
I am a d o p t i n g t h i s P l a n e f f e c t i v e a s o f :

       ® F o r a n e w p l a n ___ / ___ / ___ ( c a n n o t b e earlier than January 1 of this year).
       ® F o r a n a m e n d m e n t / r e s t a t e m e n t ___ / ___ / ___ (retroactive effective date may be possible. Please contact the
         P l a n A d m i n is t r a t o r ) .

Con t i n u e d o n n e x t p a g e >
                                       ADOPTION AGREEMENT
B
                                  S e l f - E m p l o y e d M i n i s t e r p. 2



4 . E li g ibi lity an d Par ti cip ati on
A. D o y o u e m p l o y an y o n e a s a p a i d e m p l o y e e t o a s sist you in your ministry?

     ® No (Skip to Section 5)
     ® Ye s ( C o m p l e t e P a r t B o f S e c t i o n 4 )

B. W i l l y o u b e m a k i n g c o n t r i b u t i o n s f o r t h e s e e m p loyees and/or will they be making their own contributions to this Plan?

     ® No (Skip to Section 5)
     ® Ye s ( STOP! D o n o t c o m p l e t e t h e r e s t o f t h i s form. Please contact the Plan Administrator to obtain the
       correct Adoption Agreement.)


5 . C ontributi ons
A. S o u r c e o f C o n t r i b u t i o n s ( c h e c k o n e ) :

     ® I w i l l b e m ak i n g t h e c o n t r i b u t i o n p a y m e n t s myself.
     ® I w i l l b e m ak i n g o n l y r o l l o v e r c o n t r i b u t i o n s from an I R A or another 403(b) plan.
     ® M y c h u r c h or a n o t h e r o r g a n i z a t i o n I a m p r o viding ministry services to will be making the contributions
       f o r m e . ( STO P! D o n o t c o m p l e t e t h e r e s t o f t his form. Please contact the Plan Administrator to
       obtain the correct Adoption Agreement.)

B. A m o u n t o f C o n t r i b u t i o n s
I un d e r s t a n d t h a t :

     ( 1 ) F o r a n y c a l e n d a r y e a r, I c a n c o n t r i b u t e a n y amount up to the I R S limit for that year (see the Life Rewards Participant
           Handbook for details).
     ( 2 ) I c a n c h a n g e t h e a m o u n t I c o n t r i b u t e f r o m year to year.
     ( 3 ) I a m r e s p o n s i b l e f o r d e t e r m i n i n g w h e t h e r t he amount of my contribution for a particular year is within the I R S limit
           f o r t h a t y e a r.

C. Ti m e f o r P a y m e n t
I un d e r s t a n d t h a t :

     ( 1 ) I n o r d e r f o r m y c o n t r i b u t i o n ( s ) t o b e c r e d i t ed to a particular year, they must be postmarked no later than June 15 of
           t h e f o l l o w i ng y e a r.
     ( 2 ) I c a n m a k e p a y m e n t s a t a n y t i m e d u r i n g t h e year, and I do not have to send in my payments under any fixed
           payment schedule.

D. R e t i r e e C o n t r i bu t i o n s
I un d e r s t a n d t h a t :

     ( 1 ) I m a y m a k e c o n t r i b u t i o n s i n t o t h i s P l a n f o r up to five (5) years after I retire from the ministry.
     ( 2 ) F o r p u r p o s e s o f d e t e r m i n i n g t h e IRS l i m i t a pplicable to my retiree contributions, I must use my taxable
           s e l f - e m p l o y m e n t i n c o m e f o r t h e y e a r i n w h i ch I retired.

E. N o W a i t i n g P e r i o d / M i n i m u m H o u r s R e q u i r e m e n ts
I un d e r s t a n d t h a t f o r p u r p o s e s o f p a r t i c i p a t i n g i n Life Rewards:

     ( 1 ) T h e r e i s n o w a i t i n g p e r i o d f o r m a k i n g c o n t r ibutions. I may begin making contributions as soon as this
           A d o p t i o n A gr e e m e n t i s a c c e p t e d b y t h e P l a n Administrator.
     ( 2 ) I d o n o t n e ed t o h a v e a m i n i m u m n u m b e r o f Hours of Service credited during a Plan Year in order to
           make contributions.

Con t i n u e d o n n e x t p a g e >
                                                  ADOPTION AGREEMENT
B
                                             S e l f - E m p l o y e d M i n i s t e r p. 3



6 . Terms an d C on diti ons of Par ti cip ati on
By s i g n i n g t h i s A d o p t i o n A g r e e m e n t , I c e r t i f y t h a t I understand and agree to the following terms and conditions:

A. P l a n A d o p t i o n
I ag r e e t o b e b o u n d b y a l l o f t h e p r o v i s i o n s , c o n d i tions and limitations of the Plan, as stated in the official Plan document,
as a m e n d e d f r o m t i m e t o t i m e , a s i f I w e r e a s i g n atory to the Plan.

B. R e q u i r e m e n t s f o r P a r t i c i p a t i o n
I ag r e e t h a t I w i l l :

           ( 1 ) P r o v i d e t h e P l a n A d m i n i s t r a t o r o r i t s a p p o i ntee with any information or documentation necessary or desirable for Plan
                 administration or legal compliance.

           ( 2 ) P a y m y p r o po r t i o n a t e s h a r e o f P l a n e x p e n s e s as assessed by the Plan Administrator.

C. W i t h d r a w a l f r o m P a r t i c i p a t i o n

           ( 1 ) I m a y w i t h d r a w f r o m p a r t i c i p a t i o n i n t h e P l an at any time by giving written notice to the Plan Administrator.
           ( 2 ) A n y d i s t r i b u t i o n o r t r a n s f e r o f m y a c c o u n t balance in the Plan, whether to me or to another retirement plan or to an
                 IRA , w i l l b e n e t o f m y p r o p o r t i o n a t e s h a r e o f any Plan administrative, maintenance and investment management
                 e x p e n s e s t h a t a r e p r o p e r l y c h a r g e a b l e t o m e and are unpaid as of the withdrawal date.

D. P l a n A m e n d m e n t a n d Te r m i n a t i o n
I ac k n o w l e d g e t h a t C h u r c h E x t e n s i o n P l a n i s u n d e r no obligation to continue to maintain the Plan, and C E P may amend or
ter m i n a t e i t , i n w h o l e o r i n p a r t , a t a n y t i m e .

E. D i s c l a i m e r
I un d e r s t a n d t h a t :

           ( 1 ) CEP m a k e s n o r e p r e s e n t a t i o n o r w a r r a n t y t h at the Plan document or the selections I have made in this
                 A d o p t i o n A gr e e m e n t a r e s u i t a b l e f o r m y p a r ticular circumstances.
           ( 2 ) CEP c a n n o t g i v e m e t a x , l e g a l o r f i n a n c i a l planning advice, and I should consult with my own advisors.


Par ti cip ant’s Si g n ature

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P a r t i c i p a n t ’s S i g n a t u r e                                                                                         Date



Ac c e ptan c e (to be completed by Plan Admini strator)

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Authorized Signature

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Ti t l e                                                                                                                           Date

				
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Description: Self Employed 1099 Retirement Account document sample