PERALTA COMMUNITY COLLEGE DISTRICT
Oakland, California
Enrollment Procedures and Additional Information
FOR COMPLETING TSA/403(b) AND DCP/457(b) DOCUMENTS
The Peralta Community College District (“Employer”) has established and makes available Tax Sheltered Annuity (“TSA”) and Deferred
Compensation (“DCP”) voluntary retirement plans (“Plans”) for the benefit of its employees. It is intended that the Plans comply with the
requirements of and qualify under Section 403(b) and 457(b) of the Internal Revenue Code (“IRC”) of 1986, as amended, and Section
17501 of the California Revenue and Taxation Code. It is not the purpose of the Employer by providing these Plans to recommend its use
by any individual employee. The fact that a particular contract or custodial account may be available under the Employer’s Plans does not
constitute an endorsement, recommendation, or approval of any kind, and the Employer does not warrant any particular tax consequence to
the employees who elect to participate.
GENERAL INFORMATION:
1.
Eligibility: Each employee of the Employer is given an opportunity to participate in the Employer’s TSA/403(b) Plan, and
eligible employees/individuals as stated in the Plan Document of the Employer’s DCP/457(b) Plan (“the Plans”), by entering into
an amendment of employment contract through the use of a Salary Reduction Agreement (“SRA”).
2.
Plan Administration: Envoy Plan Services, Inc., the Third Party Administrator for the Plans (“Administrator”), is designated to
perform all of the administrative services of the Employer’s Plans. The Administrator provides all operational functions relating
to all aspects of the Plans for the Employer and for the employees participating in the Plans. Employees and participants should
contact the Administrator directly for processing SRAs, all DCP/457(b) distribution requests, and to obtain answers to questions
relating to all matters with regard to the Plans.
ENROLLMENT PROCEDURES:
To establish salary reductions to either the TSA/403(b) Plan and/or the DCP/457(b) Plan, or to make a change to an existing Salary
Reduction Agreement as a current participant, employees must follow the process outlined below and submit the properly completed
documents directly to the Administrator. Do not submit documents, including SRAs to the Employer.
1. Cut-off Date for Salary Reduction Agreements: Due to IRS regulations, the Administrator must receive
your thoroughly
completed Salary Reduction Agreement, affecting both TSA/403(b) and DCP/457(b) salary reductions, no later than the last
business day of the month. Properly completed SRAs timely received will be processed by the Administrator to affect future pay
periods as explained below. Your salary will not be affected in the month the SRA is received. The SRA will affect your
compensation for the next payroll period for Certificated and Classified employees.
2. CalSTRS Registry: Effective November 29, 2004, all 403(b) Company/Providers chosen MUST be a District approved provider
registered on the CalSTRS Registry. The current list of approved companies/providers can be viewed on the Administrator’s
website at EnvoyPlanServices.com or on the CalSTRS Registry at 403bCompare.com.
3. Submission of Salary Reductions Agreements: SRAs should only be submitted after choosing the provider(s) you wish to use,
and AFTER establishing a TSA/403(b) and/or DCP/457(b) account with the provider(s). A Salary Reduction Agreement and a list
of the TSA/403(b) and DCP/457(b) providers, may be obtained by directly contacting the Administrator and via the Internet at
EnvoyPlanServices.com .
4. Catch-up Contributions: If your SRA is requesting that your salary be reduced by an amount in excess of the basic Maximum
Allowable Contribution (“MAC”) limit, and the Age 50+ Catch-up limit (if applicable) for the affected tax year, you may be
required to submit a completed Participant Information Form (“PIF”) directly to the Administrator to have a personal MAC limit
established. Your personal MAC may increase your MAC limit due to other catch-up options that you may qualify for under IRC
Sections 402(g) and 457(b). A PIF may be obtained by directly contacting the Administrator, and via the Internet at
EnvoyPlanServices.com.
5. Terminate (Stop) Your Salary Reductions: To discontinue your TSA/403(b) and/or DCP/457(b) salary reductions, submit a new
Salary Reduction Agreement and complete the following: 1) Check the “Termination” box; and 2) Complete the TSA/403(b)
and/or DCP/457(b) sections by writing in the name of the provider, and indicate $0 for the amount, and provide the Effective
Date. Incomplete SRA forms cannot be processed, so please be sure that the SRA is properly completed and submitted directly to
the Administrator by the last business day of the month, to affect future income AND prior to termination of your TSA/403(b)
and/or DCP/457(b) account with your existing provider.
COMPLETING THE SALARY REDUCTION AGREEMENT & PARTICIPANT INFORMATION FORM
Salary Reduction Agreements may be submitted to the Administrator using any of the following methods:
 Personally deliver to Administrator’s office at the address on Page 3.
 U.S. mail
 Overnight delivery service
Participant Information Forms may be faxed to the Administrator, if properly completed, signed and dated; or may be delivered in any
manner listed above.
Your salary reductions for all Plans will not be affected until all necessary forms are received properly completed and approved by the
Administrator. SRAs received after the deadline will take effect the next qualifying pay period. Incomplete, inaccurate, or non-legible
forms will be returned. Your SRA is irrevocable as to salary paid and reduced while the SRA is in effect.
Note: If you own a business and have a separate retirement plan, or if you participate in another employer’s retirement plan (such as a
TSA/403(b), DCP/457(b), SEP, SIMPLE IRA/401(k), or 401(k) Plan), your contributions to that plan must be taken into consideration
when calculating your MAC limit to this Employer’s Plans. (Please refer to the Definitions section item #5, “Ownership of a Business or
Working for Another Employer” for details.)
It is your responsibility to determine if you are affected by this rule, and if so, to notify the Administrator. You are strongly encouraged to
review and understand the Definitions to the Plans, which are provided to help you understand your responsibilities.
WHEN ADDITIONAL PARTICIPANT INFORMATION MAY BE REQUIRED


At any time, if required by the Administrator or Employer to substantiate employee contributions; or in the event of an IRS audit
of the Employer’s Plans.
If non-salary reduction contributions are being made by the Employer on behalf of the employee.
USE OF FINANCIAL ADVISOR/AGENT/PROVIDER ASSISTANCE
You may use the assistance of financial advisors, agents/brokers, or providers who may utilize their own custom forms or computer
programs to develop the data you will need to complete the SRA and/or the Participant Information Form (“PIF”). It is your responsibility
to provide accurate information in the process of completing all forms. Submit to the Administrator only the forms, worksheets, SRA, and
PIF that have been approved for use by the Employer and Administrator.
THE ADMINISTRATOR AND EMPLOYER DO NOT PROVIDE TAX OR INVESTMENT ADVICE TO ANY
EMPLOYEE – NOR REVIEW FOR ACCURACY THE INFORMATION PROVIDED BY YOU, YOUR
FINANCIAL REPRESENTATIVE, AGENT/ BROKER, OR PROVIDER
Below is the contact information for the Administrator. Please contact the administrator for all matters relating to the TSA/403(B) and
DCP/457(B) plans.
Salary Reduction Agreement Processing
1.
Complete all SRAs in BLACK INK ONLY.
2.
All completed Salary Reduction Agreements are to be submitted directly to the Administrator for processing. Contact the
Administrator below for ALL questions and inquiries relating to the Plans; including questions related to your paycheck affected
by your TSA/403(b) and DCP/457(b) salary reductions and the processing of your Salary Reduction Agreement
Envoy Plan Services, Inc.
901 Calle Amanecer
Suite 200
San Clemente, CA 92673
Local Ph 949-366-5070
Toll free: 800-248-8858
Fax:
877-513-2272
www.EnvoyPlanServices.com
Important Note:
Your Employer cannot process your Salary Reduction Agreement; if you or your financial advisor/agent inadvertently submit your SRA to
your Employer to initiate a new SRA, make changes, or to terminate your existing SRA, or else the processing of your SRA will be
delayed. To obtain faster service, please contact the Administrator directly. Please do not contact your Employer for questions relating to
the Plans.
.
PERALTA COMMUNITY COLLEGE DISTRICT
Oakland, California
Table of Salary Reduction Contribution Limits
Basic
Limits
and simultaneously
Additional
Information
You may make salary
reduction
contributions
to the
TSA/403(b) Plan and to the DCP/457(b) Plan of the Employer, equal to
100% of your includible
compensation,
not
to
exceed
the
basic
Maximum
Allowable Contribution
(“MAC”) limits identified in the table
FOR COMPLETING TSA/403(b) AND DCP/457(b)
DOCUMENTS
below:
For tax years beginning in:
The applicable dollar limit is:
2002
2003
2004
2005
2006
$11,000
$12,000
$13,000
$14,000
$15,000
Catch-up
Contributions
(Indexed in $500
increments
thereafter)
If you wish to make salary reduction contributions in excess of the basic MAC limits as stated above, you may qualify to elect the use of the
“Catch-up Options” made available by the Internal Revenue Code as described below.
IRC 402(g)(7) Increased Elective Deferral Limit (15 Years of Service) – TSA/403(b) Plan Only
Employees who have 15 or more years of service with your current Employer by the end of the calendar year for which voluntary salary
reduction contributions are being made, may be eligible to increase their contributions by as much as $3,000 each year. The requirements
are:
Only employees whose total contributions averaged less than $5,000 for each year of service during their 15 or more total
years of service to a TSA/403(b) Plan or a DCP/457(b) Plan (or any other elective deferral plan sponsored by the Employer) are
eligible to use the limit. For example: If the affected employee has 15 years of service completed and contributed $75,000 or more
to the TSA/403(b) and DCP/457(b) Plans combined during the 15 years of service, this catch-up option cannot be used.
A $15,000 lifetime maximum limit can be utilized under this increased limit, not to exceed $3,000 per tax year. For example:
An employee contributing an extra $3,000 per year in excess of the basic MAC limit* could only contribute those extra amounts
for five years, compared to an employee contributing $1,000 per year in excess of the basic limit who could contribute the $1,000
extra amounts for 15 years.
The extra contributions made under this option do count against the Section 415(c) limit.
IRC 414(v) Age 50+ Catch-up
For employees that are age 50+ by the end of the calendar year, the additional amounts identified below can be contributed to the
TSA/403(b) and DCP/457(b)* Plans. The increased Age 50+ Catch-up Option is permitted based strictly on attained age by the end of the
calendar year. There are no other requirements or restrictions. The extra salary reduction contributions made under this option do not count
against any other limit.
*May contribute only the greater of the Age 50+ Catch-up Option, or if eligible, the Final 3-Year Catch-up Option.
For tax years beginning in:
The applicable dollar limit is:
2002
$ 1,000
2003
$ 2,000
2004
$ 3,000
2005
$ 4,000
2006
$ 5,000
(Indexed in $500 increments thereafter)
*The basic limits were: $9,500 from 1987 through 1997, $10,000 in 1998 and 1999, and $10,500 in 2000 and 2001.
PERALTA COMMUNITY COLLEGE DISTRICT
SRA – SALARY REDUCTION AGREEMENT
TSA/403(b) Plan and/or DCP/457(b) Plan
This Agreement must be signed by the Employee and received by the Plan Administrator. If you participate in multiple TSA/403(b) and/or
DCP/457(b) accounts, all salary reductions must be on one SRA form. This Agreement is not effective until approved. This Agreement is irrevocable
by the Employee as to any salary or amounts paid, but may be terminated or changed as to salary not yet paid. Compensation t o be paid to this
Employee shall be reduced by the sum indicated below per pay period starting with the compensation to be paid on the date requested below, or the
first available payroll period after all requirements are satisfied. Please note that any SRA initiating contributions to be directed to a non-register ed
403(b) provider must be rejected in conformance with California Education Code 25100 et. seq.
THIS AGREEMENT SUPERSEDES AND REPLACES ALL PRIOR TSA/403(b) and DCP/457(b) SALARY REDUCTION
AGREEMENTS - INCLUDING THE AMOUNT(S), PROVIDER(S), and EFFECTIVE DATE(S).
BLACK INK ONLY
Employee
Name: _______________________________________
Social Security
Date of
Number: ___________________________ Birth: _________________
Phone (Day) ____________________(Home)_________________E-mail: ______________________________________________
Mailing Address: ____________________________________________________________________________________________
Employee:
Salary Reductions
-
-
-month
TSA/403(b) PLAN
Check Box:
Initiate a New 403(b) Salary Reduction Agreement (Check only if not currently participating)
Change the Amount of my currently existing 403(b) Salary Reduction Agreement
Change my Company/Provider
Terminate my 403(b) Salary Reduction Agreement (Indicate below the Effective Date & Company/Provider Name)
NO Change to my currently existing 403(b) Salary Reduction Agreement
Monthly Amount $ __________________
Effective with payroll date (mm/dd/yyyy): ____________________, 20___
The Employer in accordance with the Employer’s 403(b) Plan shall transmit the above in the following manner:
Company/Provider Name
FOR INTERNAL USE ONLY
CalSTRS Registry ID #
$_____________ To: _______________________________
_________________
$_____________ To: _______________________________
__________________
$_____________ To: _______________________________
__________________
FOR INTERNAL USE ONLY
Deduction Code: ______________
Deduction Code: ______________
Deduction Code: ______________
DCP/457(b) PLAN
Check Box:
Initiate a New 457(b) Salary Reduction Agreement (Check only if not currently participating)
Change the Amount of my currently existing 457(b) Salary Reduction Agreement
Change my Company/Provider
Terminate my 457(b) Salary Reduction Agreement (Indicate below the Effective Date & Company/Provider Name)
NO Change to my currently existing 457(b) Salary Reduction Agreement
Monthly Amount $ ___________________
Effective with payroll date (mm/dd/yyyy): __________________, 20_____
The Employer in accordance with the Employer’s 457(b) Plan shall transmit the above in the following manner:
FOR INTERNAL USE ONLY
Company/Provider Name:
$__________________
To:
Deduction Code: ______________
RSG Securities
EMPLOYEE ACKNOWLEDGES that Employee has read, understands, and agrees to the terms and conditions set forth on the reverse
side of this form. Employee further understands that a termination of salary reduction contributions to a provider that has not complied
INITIALS with or maintained registration in conformance with California law relating to those registration requirements will mean that Employee
may not resume contributions later to that non-conforming provider
_________
IN WITNESS WHEREOF, this Agreement has been executed by and on behalf of the parties hereto and the Employee has read and
understands the terms and conditions listed on the reverse side of this form.
_______________________________________________
_________________________________________
Employee Signature
Date
_________________________________________
Print Name of Agent/Broker
PROCESSING INSTRUCTIONS ON REVERSE
ADVISOR / AGENT INFORMATION
(_____)_____________________ _______________________________________________
Telephone
E-mail address
403/457 SRA Rev. 03/30/05
It is Hereby Agreed by the Employer and the Employee that the certain valid existing employment contract (written or otherwise) made and entered into by and
between the Employer and Employee be amended by salary reduction in the manner described above, and this Salary Reduction Agreement be incorporated therein
by reference and made a part thereof as if set out therein in full, as of the date of this Salary Reduction Agreement (“agreement”).
This Agreement supersedes and replaces all previous Agreement(s) naming the providers designated above. Employee agrees that no more than one Salary
Reduction Agreement may be in effect at any time, listing all DCP/457(b) and/or TSA/403(b) accounts to which payments are made by the Employer, and that this
Agreement can only be effective with respect to compensation not yet received by or made available to the Employee.
1.
Employee releases any rights, present and future, to receive payment from the Employer of sums resulting from such Agreement in any form except
(a) the right of the Employee’s estate to receipt of sums so paid at death, or (b) the right to the Employee upon termination of employment by reason
other than death, to personally receive all or any part of the amount specified for which service has been rendered but which has not been
transmitted to the designated provider(s).
2. This Agreement shall automatically apply to the employment contract entered into between the Employer and Employee for each succeeding calendar
year unless amended or terminated by a thirty (30) day written notice to the Administrator of the Plans.
3.
Employee acknowledges that:
a.
For purposes of this Agreement, the “Accommodating Parties” are the Employer, its governing board, the County Superintendent of
Schools, and officers and employees respectively. The Accommodating Parties do not recommend to any individual employee
participation in the DCP/457(b) and/or TSA/403(b) Plan. The fact that a particular investment option may be available under the
Employer’s DCP/457(b) and /or TSA/403(b) Plan does not constitute an endorsement, recommendation, or approval of any kind by any
of the Accommodating Parties, and they do not warrant any particular tax consequence to the employees who elect to participate.
b.
Any amounts held under the DCP/457(b) Plan shall be subject to the terms of the Plan Document, and amounts held in either the 457(b)
Plan or TSA/403(b) Plan for Employee shall be subject to federal and state statutes, and to any terms, conditions and restrictions imposed
by any investment option in which Employee’s deferrals are invested. Any amounts contributed to the 457(b) Plan, and the earnings
thereon, shall be held in Trust as defined in Section 401(f) of the Code for the exclusive benefit of Employee and Employee’s beneficiary
or in an annuity contract or custodial account as defined in IRC 401(f). Amounts contributed to the 403(b) Plan and earnings thereon
shall be held in IRC 403(b)(1) Annuity Contracts, or IRC 403(b)(7) custodial accounts.
c.
Employee has elected to participate, and has determined the amounts of salary reduction and the investment options into which such
amounts shall be invested, and has not relied in any manner on the Accommodating Parties. Employee acknowledges that TSA/403(b)
investment choices are limited only to those that are vendors properly registered with the California State Teachers’ Retirement System,
in accordance with California law. Employee further understands that comparative data regarding the available products is available to
employee on web site www.403bcompare.com.
d.
In selecting among the available investment options, Employee understands that equity-based options may result in loss of all or a
portion of the contributions, and other types of accounts may include surrender or withdrawal charges for a specific period of time.
e.
The Salary Reduction Contribution Amounts (“SRCA”) selected by Employee do not exceed the maximum allowable contribution
(“MAC”) limits that may be excluded from gross income under the applicable provisions of the Tax Code regardless of the number of
accounts to which contributions are being made; and Employee further agrees that Employer or designee may amend the SRCA and/or
suspend any portion thereof, so as to not permit the Employee to exceed his/her MAC limits, and authorizes Employer or designee to
then resume the previous SRCA effective with the first payroll period of the following tax year; and Employee further acknowledges that
Administrator and/or Employer may require corrective distributions if Employee’s MAC limits are exceeded.
f.
Employee acknowledges that the Administrator and/or Employer may terminate this Agreement at any time in the event the employee, or
the provider of the investment options under the Plans, fails to comply with the 457(b) and/or 403(b) Plan federal and state regulations
and/or the procedures and/or rules established by the Administrator and/or Employer. This will include violation of any other applicable
Agreements with the Employer.
g.
Employee certifies that he or she has received a prospectus (in the case of an equity investment option) or similar disclosure document,
including, if applicable, a copy of the annuity contract and understands any applicable sales and/or management fees or other charges.
4.
Employee agrees that the Accommodating Parties shall have no liability whatsoever for any loss suffered by the Employee with regard to the
selection of a provider and its investment options; or the solvency, operation of, or benefits provided by said provider; nor liability for any loss
suffered by Employee by reason of the transmittal of any funds pursuant to this or any other Agreement.
5.
Employee acknowledges that there are rules set forth in IRC Sections 457(b), 402(g), 415 (c), and 414(v) of the Code that limit the maximum
amount of salary reduction that can be made in any calendar year; that Employee, Employer, and/or Administrator may require knowledge of the
Employee’s current and past participation in salary reduction programs of the Employer and/or any other employer to determine the MAC limits.
6.
Employee agrees that all computations in connection with the determination of the amount of the salary reduction hereby authorized shall be made
based on the accuracy of information provided by Employee. Employee agrees to provide signed certification of the correctness of the information
and/or computations as the Employer and/or Administrator may require; Employee agrees to provide accurate information on which to base those
computations. In no event will the Accommodating Parties, its officers, or employees be responsible for the computations.
7.
The Employee agrees to hold harmless and indemnify the Accommodating Parties from any and all damages that may result from Employee’s
participation in the Employer’s DCP/457(b) and/or TSA/403(b) Plans, and further agrees to hold harmless and indemnify the Accommodating
Parties and the Administrator from any and all damages that may result including any incorrect calculation of Employee’s MAC limits due to
incorrect information provided by Employee. Indemnification from damages shall include any tax, interest, penalties or assessments or related costs
that may be incurred by or imposed upon the Accommodating Parties and/or Administrator. The Employee agrees and authorizes the Employer to
recover indemnification through payroll deduction or, at the option of the Employer, through any other legal process.
PROCESSING INSTRUCTIONS
The Administrator must receive this Agreement no later than the
LAST BUSINESS DAY OF THE MONTH.
Mail or deliver SRA to: Envoy Plan Services, Inc.  901 Calle Amanecer  Suite 200  San Clemente CA 92673
MUST ALLOW 3 DAYS FOR U.S. MAIL ● FAXED SRAs CANNOT BE PROCESSED
Processing questions contact Envoy Plan Services, Inc. at:
 949-366-5070  800-248-8858  Fax: 877-513-2272
www.envoyplanservices.com
457/403 SRA