Qualified Retirement Plan
ERISA Section 404(c) Employee Information Sheet
Lincoln American Legacy RetirementSM 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.)
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 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.
Investment
Alternatives
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.)
(Delete any investment options you do not allow your participants to
invest in. Attach the Investment Information Sheet for any investment
option that you allow participants to invest in.)
1/07
1
LFDXXXX-XXXX











































1/07
Guaranteed (certain restrictions apply)
SA1A American Funds AMCAP
SA1B American Funds American Balanced
SA1C American Funds American High-Income Trust
SA1D American Funds American Mutual
SA1E American Funds Bond Fund of America
SA1F American Funds Capital Income builder
SA1G American Funds Capital World Bond
SA1H American Funds Capital World Growth and Income
SA1I
American Funds EuroPacific Growth
SA1J
American Funds Fundamental Investors
SA1K American Funds Growth Fund of America
SA1L American Funds Income Fund of America
SA1M American Funds Intermediate Bond Fund of America
SA1N American Funds Investment Company of America
SA1P American Funds New Economy
SA1Q American Funds New Perspective
SA1R American Funds New World
SA1S American Funds SMALLCAP World
SA1T American Funds U.S. Government Securities
SA1U American Funds Washington Mutual Investors
SA1V AllianceBermstein International Value
SA1W AllianceBernstein VPS Small/Mid Cap Value
SA1X Baron Capital Asset
SA1Y Lincoln VIP Money Market
SA1Z Delaware Corporate Bond
SA2A Delaware Diversified Income
SA2B Delaware Limited-Term Government
SA2C Delaware Small Cap Core
SA2D FTVIPT Franklin Small Cap Value
SA2E Delaware U.S. Growth
SA2F Delaware Value
SA2G Fidelity VIP ContraFund
SA2H Fidelity VIP MidCap
SA2I
FTVIPT Franklin Income Securities
SA2J
FTVIPT Mutual Shares Securities
SA2K Lincoln VIP Aggressive Profile
SA2L Lincoln VIP Conservative Profile
SA2M Lincoln VIP Moderate Profile
SA2N Lincoln VIP Moderately Aggressive Profile
SA2P Lincoln VIP Social Awareness
SA2Q MFS VIT Research International
SA2R MFS VIT Total Return
2
LFDXXXX-XXXX



Investment
Instructions
SA2S
SA2T
SA2U
Neuberger Berman AMT Mid-Cap Growth
Neuberger Berman AMT Regency
FTVIPT Templeton Growth Securities
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 Fund 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 a 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
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.
A second way to submit changes in your investment instructions is
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.)
 Per participant account charge of $ _____ (enter the amount of this
fee). On the last day of each year, this charge is deducted from your
1/07
3
LFDXXXX-XXXX
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 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;
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.
1/07
4
LFDXXXX-XXXX
(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:
Name
Address
City,State, Zip
(000) 000-0000
(000) 000-0000
Phone:
Fax:
(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.)
Lincoln American Legacy RetirementSM is a group variable annuity contract issued on policy form
#19476 (and state variations thereof) by The Lincoln National Life Insurance Company, Fort Wayne,
IN, and is offered by broker/dealers who have selling agreements. The Lincoln National Life
Insurance Company is not licensed and does not solicit business in the State of New York.
Lincoln American Legacy Retirement group variable annuity contracts sold in New York are issued
by Lincoln Life & Annuity Company of New York, Syracuse, NY, on policy form #19476NY-A 7/04 and
offered by broker dealers who have selling agreements.
The Lincoln National Life Insurance Company and Lincoln Life & Annuity Company of New York
are separately responsible for their own contractual and financial obligations.
LFD0703-0692
1/07
5
LFDXXXX-XXXX