THE LINCOLN NATIONAL LIFE INSURANCE COMPANY
STANDARDIZED
PROFIT SHARING PROTOTYPE
PLAN AND TRUST
ADOPTION AGREEMENT
PLAN #005
IRS SERIAL #K273888a DATE May 14, 2002
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© Lincoln National Life Insurance Company 2002
Internal Revenue Service
Plan Description: Prototype Standardized Profit Sharing Plan
FFN: 50237590001-005 Case: 200100079 EIN: 35-0472300
Letter Serial No: K273888a
Department of the Treasury
Washington, DC 20224
Contact Person: Ms. Arrington 50-00197
LINCOLN NATIONAL LIFE INSURANCE CO
Telephone Number: (202) 283-8811
P 0 BOX 2248
In Reference to: T:EP:RA:T4
FORT WAYNE, IN 46801
Date: 05/14/2002
Dear Applicant:
In our opinion, the form of the plan identified above is acceptable under section 401 of the Internal Revenue Code for use by employers for the
benefit of their employees. This opinion relates only to the acceptability of the form of the plan under the Internal Revenue Code. It is not an opinion
of the effect of other Federal or local statutes.
You must furnish a copy of this letter to each employer who adopts this plan. You are also required to send a copy of the approved form of the plan,
any approved amendments and related documents to Employee Plans Determinations in Cincinnati at the address specified in section 9.11 of Rev.
Proc. 2000-20, 2000-6 I.R.B. 553.
This letter considers the changes in qualifications requirements made by the Uruguay Round Agreements Act (GATT), Pub. L. 103-465, the Small
Business Job Protection Act of 1996, Pub. L. 104-188, the Uniformed Services Employment and Reemployment Rights Act of 1994, Pub. L. 103353, the Taxpayer Relief Act of 1997, Pub. L. 105-34, the Internal Revenue Service Restructuring and Reform Act of 1998, Pub. L. 105-206 and the
Community Renewal Tax Relief Act of 2000, Pub. L. 106-554. These laws are referred to collectively as GUST.
Our opinion on the acceptability of the form of the plan is not a ruling or determination as to whether an employer's plan qualifies under Code section
401 (a). However, an employer that adopts this plan may rely on this letter with respect to the qualification of its plan under Code section 401 (a),
except as provided below, provided the eligibility requirements and contribution or benefit provisions are not more favorable for highly compensated
employees than for other employees. The terms of the plan must be followed in operation. Except as stated below, Employee Plans Determinations
will not issue a determination letter with respect to this plan.
Our opinion does not apply for purposes of Code section 401 (a) (10) (B) and section 401 (a) (16) if an employer ever maintained another qualified
plan for one or more employees who are covered by this plan, other than a specified paired plan within the meaning of section 4.13 of Rev. Proc.
2000-20, 2000-6 I.R.B. 553. For this purpose, the employer will not be considered to have maintained another plan merely because the employer has
maintained another defined contribution plan(s), provided such other plan(s) has been terminated prior to the effective date of this plan and no annual
additions have been credited to the account of any participant under such other plan(s) as of any date within the limitation year of this plan. Likewise,
if this plan is first effective on or after the effective date of the repeal of Code section 415 (e), the employer will not be considered to have maintained
another plan merely because the employer has maintained a defined benefit plan(s), provided the defined benefit plan(s) has been terminated prior to
the effective date of this plan. Our opinion also does not apply for purposes of Code section 401 (a) (16) if, after December 31, 1985, the employer
maintains a welfare benefit fund defined in Code section 419 (e), which provides postretirement medical benefits allocated to separate accounts for
key employees as defined in Code section 419A (d) (3).
An employer that adopts this plan may not rely on this opinion letter with respect to: (1) whether any amendment or series of amendments to the plan
satisfies the nondiscrimination requirements of section 1.401 (a) (4)-5 (a) of the regulations, except with respect to plan amendments granting past
service that meet the safe harbor described in section 1.401 (a) (4)-5 (a) (5) and are not part of a pattern of amendments that significantly
discriminates in favor of highly compensated employees; or (2) whether the plan satisfies the effective availability requirement of section 1.401 (a)
(4)-4 (c) of the regulations with respect to any benefit, right or feature.
LINCOLN NATIONAL LIFE INSURANCE CO
FFN: 50237590001-005
Page 2
An employer that adopts this plan as an amendment to a plan other than a standardized plan may not rely on this opinion letter with respect to
whether a benefit, right or other feature that is prospectively eliminated satisfies the current availability requirements of section 1.401 (a)-4 of the
regulations.
An employer that elects to continue to apply the pre-GUST family aggregation rules in years beginning after December 31, 1996, or the combined
plan limit of section 415 (e) in years beginning after December 31, 1999, will not be able to rely on the opinion letter without a determination letter.
The employer may request a determination (1) as to whether the plan, considered with all related qualified plans and, if appropriate, welfare benefit
funds, satisfies the requirements of Code section 401 (a) (16) as to limitations on benefits and contributions in Code section 415 and the requirements
of Code section 401 (a) (10) (B) as to the top-heavy plan requirements in Code section 416; (2) regarding the nondiscriminatory effect of grants of
past service; (3) with respect to whether a pro spectively eliminated benefit, right or feature satisfies the current availability requirements; and (4)
with respect to the continued application of the pre-GUST family aggregation rules in years beginning after December 31, 1996, or the combined
plan limit of section 415 (e) in years beginning after December 31, 1999. The employer may request a determination letter by filing an application
with Employee Plans Determinations on Form 5307, Application for Determination for Adopters of Master or Prototype or Volume Submitter Plans.
If you, the master or prototype sponsor, have any questions concerning the IRS processing of this case, please call the above telephone number. This
number is only for use of the sponsor. Individual participants and/or adopting employers with questions concerning the plan should contact the
master or prototype sponsor. The plan's adoption agreement must include the sponsor's address and telephone number for inquiries by adopting
employers.
If you write to the IRS regarding this plan, please provide your telephone number and the most convenient time for us to call in case we need more
information. Whether you call or write, please refer to the Letter Serial Number and File Folder Number shown in the heading of this letter.
You should keep this letter as a permanent record. Please notify us if you modify or discontinue sponsorship of this plan.
Sincerely yours,
Director
Employee Plans Rulings & Agreements
TABLE OF CONTENTS
AMENDMENT NO. 1
EGTRRA “GOOD FAITH” AMENDMENT
ARTICLE I
LIMITATIONS ON CONTRIBUTIONS
1.01
1.02
Effective Date Of Change In Annual Additions Limit ...............................................................
Maximum Permissible Amount ...................................................................................................
1
1
ARTICLE II
INCREASE IN COMPENSATION LIMIT
2.01
Annual Compensation Limit .......................................................................................................
1
ARTICLE III
MODIFICATION OF TOP HEAVY RULES
3.01
3.02
3.03
Effective Date Of Top Heavy Modifications ...............................................................................
Determination Of Top Heavy Status ...........................................................................................
Minimum Top Heavy Contributions ..........................................................................................
2
2
2
ARTICLE IV
DIRECT ROLLOVERS OF PLAN DISTRIBUTIONS
4.01
4.02
4.03
4.04
Effective Date ................................................................................................................................
Modification Of Definition Of Eligible Retirement Plan ...........................................................
Modification Of Definition Of Eligible Rollover Distribution To Exclude Hardship
Distribution ....................................................................................................................................
Modification Of Definition Of Eligible Rollover Distribution To Include After-Tax Employee
Contributions.................................................................................................................................
3
3
3
3
ARTICLE V
ROLLOVERS FROM OTHER PLANS
5.01
5.02
Rollover Contributions From Other Types Of Retirement Plans ............................................
Participant Rollover Contributions From IRAs .........................................................................
3
3
ARTICLE VI
ROLLOVERS INCLUDED IN INVOLUNTARY CASH-OUTS
6.01
Rollovers Included In Determining Value Of Account Balance For Involuntary
Distributions ..................................................................................................................................
4
ARTICLE VII
PLAN LOANS FOR OWNER-EMPLOYEES AND SHAREHOLDER-EMPLOYEES
7.01
Loans To Owner-Employees And Shareholder-Employees ......................................................
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© Lincoln National Life Insurance Company 2002
AMENDMENT NO. 1
EGTRRA “GOOD FAITH” AMENDMENT
Pursuant to Article XV of the Plan Document, this Amendment No. 1 is hereby added to the Plan Document and
adopted in conjunction with the execution of the Adoption Agreement attached.
This Amendment No. 1 is adopted to reflect certain provisions of the Economic Growth and Tax Relief Reconciliation
Act of 2001 (“EGTRRA”). This Amendment is intended to be a good faith compliance with the requirements of
EGTRRA and is to be construed in accordance with EGTRRA and guidance issued thereunder. This Amendment
shall supersede the provisions of the Plan to the extent those provisions are inconsistent with the provisions of this
Amendment.
Elections below reflect the pre-selected choices made in the Lincoln National Life Insurance Company Amendment
No. VI; EGTRRA “Good Faith” Model Amendment; adopted in December, 2001 by Lincoln National Life Insurance
Company on behalf of employers who were using the Lincoln National Defined Contribution Prototype Basic Plan
Document #01 in effect on that date.
Except as otherwise provided, this Amendment shall be effective as of the first day of the first Plan Year
beginning after December 31, 2001.
ARTICLE I
LIMITATIONS ON CONTRIBUTIONS
1.01
EFFECTIVE DATE OF CHANGE IN ANNUAL ADDITIONS LIMIT
This Section shall be effective for Limitation Years beginning after December 31, 2001.
1.02
MAXIMUM PERMISSIBLE AMOUNT
Except to the extent permitted under Code Section 414(v), if applicable, the Maximum Permissible Amount
defined in Article VIII, Section 8.02 of the Plan Document that may be contributed or allocated to a
Participant’s Account under the Plan for any Limitation Year shall not exceed the lesser of:
(a)
$40,000, as adjusted for increases in the cost-of-living under Code Section 415(d), or
(b)
100 percent of the Participant’s Compensation, within the meaning of Code Section 415(c)(3), for
the Limitation Year. The Compensation limit referred to in this Subsection shall not apply to any
contribution for medical benefits after separation from service (within the meaning of Code Section
401(h) or Code Section 419A(f)(2)) which is otherwise treated as an Annual Addition.
ARTICLE II
INCREASE IN COMPENSATION LIMIT
2.01
ANNUAL COMPENSATION LIMIT
Article I, Section 1.13(f) of the Plan Document notwithstanding, the annual Compensation of each Participant
taken into account in determining allocations for any Plan Year beginning after December 31, 2001, shall not
exceed $200,000, as adjusted for cost-of-living increases in accordance with Code Section 401(a)(17)(B).
Annual Compensation means Compensation during the Plan Year or such other consecutive 12-month period
over which Compensation is otherwise determined under the Plan (the determination period). The cost-ofliving adjustment in effect for a calendar year applies to annual Compensation for the determination period
that begins with or within such calendar year.
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© Lincoln National Life Insurance Company 2002
ARTICLE III
MODIFICATION OF TOP HEAVY RULES
3.01
EFFECTIVE DATE OF TOP HEAVY MODIFICATIONS
This Section shall apply for purposes of determining whether the Plan is a Top Heavy Plan under Code
Section 416(g) for Plan Years beginning after December 31, 2001, and whether the Plan satisfies the
minimum benefit requirements of Code Section 416(c) for such years. This Section amends Article VII and
Article I, Section 1.47 of the Plan Document.
3.02
3.03
DETERMINATION OF TOP HEAVY STATUS
(a)
Key Employee. Key Employee means any Employee or former Employee (including any deceased
Employee) who at any time during the Plan Year that includes the Determination Date was an
officer of the Employer having annual 415 Compensation greater than $130,000 (as adjusted under
Code Section 416(i)(1) for Plan Years beginning after December 31, 2002), a 5-percent owner of the
Employer, or a 1-percent owner of the Employer having annual 415 Compensation of more than
$150,000. The determination of who is a Key Employee will be made in accordance with Code
Section 416(i)(1) and the applicable regulations and other guidance of general applicability issued
thereunder.
(b)
Determination Of Present Values And Account Balances. This Subsection (b) shall apply for
purposes of determining the present values of accrued benefits, and the amounts of Account balances
of Employees as of the Determination Date.
(1)
Distributions During Year Ending On The Determination Date. The present values of
accrued benefits and the amounts of Account balances of an Employee as of the
Determination Date shall be increased by the distributions made with respect to the
Employee under the Plan and any plan aggregated with the Plan under Code Section
416(g)(2) during the 1-year period ending on the Determination Date. The preceding
sentence shall also apply to distributions under a terminated plan which, had it not been
terminated, would have been aggregated with the Plan under Code Section 416(g)(2)(A)(i).
In the case of a distribution made for a reason other than severance from employment,
death, or Disability, this provision shall be applied by substituting “5-year period” for “1year period.”
(2)
Employees Not Performing Services During Year Ending On The Determination Date. The
accrued benefits and Account balances of any individual who has not performed services
for the Employer during the 1-year period ending on the Determination Date shall not be
taken into account.
MINIMUM TOP HEAVY CONTRIBUTIONS
(a)
Matching Contributions. Matching Contributions shall be taken into account for purposes of
satisfying the minimum contribution requirements of Code Section 416(c)(2) and the Plan, if the
Plan provides that the minimum contribution requirement shall be met in another plan.
(b)
Contributions Under Other Plans. The Employer may provide in the Adoption Agreement that the
minimum benefit requirement shall be met in another plan (including another plan that consists
solely of a cash or deferred arrangement which meets the requirements of Code Section 401(k)(12)
and Matching Contributions with respect to which the requirements of Code Section 401(m)(11) are
met).
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© Lincoln National Life Insurance Company 2002
ARTICLE IV
DIRECT ROLLOVERS OF PLAN DISTRIBUTIONS
4.01
EFFECTIVE DATE
This Section shall apply to distributions made after December 31, 2001.
4.02
MODIFICATION OF DEFINITION OF ELIGIBLE RETIREMENT PLAN
For purposes of the Direct Rollover provisions in Section 11.06 of Article XI and Section 1.24 of Article I of
the Plan Document, an Eligible Retirement Plan shall also mean an annuity Contract described in Code
Section 403(b) and an eligible plan under Code Section 457(b) which is maintained by a state, political
subdivision of a state, or any agency or instrumentality of a state or political subdivision of a state and which
agrees to separately account for amounts transferred into such plan from this Plan. The definition of Eligible
Retirement Plan shall also apply in the case of a distribution to a surviving spouse, or to a spouse or former
spouse who is the alternate payee under a qualified domestic relation order, as defined in Code Section
414(p).
4.03
MODIFICATION OF DEFINITION OF ELIGIBLE ROLLOVER DISTRIBUTION TO EXCLUDE
HARDSHIP DISTRIBUTION
For purposes of the Direct Rollover provisions in Article I, Section 1.24 of the Plan Document, any amount
that is distributed as a Hardship Distribution as defined in Article X, Sections 10.08 or 10.09 of the Plan
Document shall not be an Eligible Rollover Distribution and the Distributee may not elect to have any portion
of such a distribution paid directly to an Eligible Retirement Plan.
4.04
MODIFICATION OF DEFINITION OF ELIGIBLE ROLLOVER DISTRIBUTION TO INCLUDE
AFTER-TAX EMPLOYEE CONTRIBUTIONS
For purposes of the Direct Rollover provisions in Article I, Section 1.24 of the Plan Document, a portion of a
distribution shall not fail to be an Eligible Rollover Distribution merely because the portion consists of
Employee after-tax contributions which are not includible in gross income. However, such portion may be
transferred only to an individual retirement account or annuity described in Code Section 408(a) or (b), or to a
qualified defined contribution plan described in Code Sections 401(a) or 403(a) that agrees to separately
account for amounts so transferred, including separately accounting for the portion of such distribution which
is includible in gross income and the portion of such distribution which is not so includible.
ARTICLE V
ROLLOVERS FROM OTHER PLANS
5.01
ROLLOVER CONTRIBUTIONS FROM OTHER TYPES OF RETIREMENT PLANS
If Rollover Contributions are permitted by the Employer in Part 14, Section 14-4 of the Adoption Agreement,
the Plan will accept Participant Rollover Contributions and/or Direct Rollovers of distributions made after
December 31, 2001, from the following types of plans:
(a)
(b)
(c)
5.02
A qualified plan described in Code Sections 401(a) or 403(a), including Employee after-tax
contributions.
An annuity contract described in Code Section 403(b), excluding Employee after-tax contributions.
An eligible plan under Code Section 457(b) which is maintained by a state, political subdivision of a
state, or any agency or instrumentality of a state or political subdivision of a state.
PARTICIPANT ROLLOVER CONTRIBUTIONS FROM IRAs
If Rollover Contributions are permitted by the Employer in Part 14, Section 14-4 of the Adoption Agreement,
the Plan will accept Participant Rollover Contributions made after December 31, 2001, of the portion of a
distribution from an individual retirement account or annuity Contract described in Code Sections 408(a) or
408(b) that is eligible to be rolled over and would otherwise be includible in gross income.
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© Lincoln National Life Insurance Company 2002
ARTICLE VI
ROLLOVERS INCLUDED IN INVOLUNTARY CASH-OUTS
6.01
ROLLOVERS INCLUDED IN DETERMINING VALUE OF ACCOUNT BALANCE FOR
INVOLUNTARY DISTRIBUTIONS
For purposes of Article XI, Section 11.01 of the Plan Document, the value of a Participant’s Vested Account
balance shall be determined by including the portion of the Account balance that is attributable to Rollover
Contributions (and earnings allocable thereto) within the meaning of Code Sections 402(c), 403(a)(4),
403(b)(8), 408(d)(3)(A)(ii), and 457(e)(16). If the value of the Participant’s Vested Account balance as so
determined is $5,000 or less, the Plan shall immediately distribute the Participant’s entire Vested Account
balance. The provision shall apply with respect to distributions made after December 31, 2001.
ARTICLE VII
PLAN LOANS FOR OWNER-EMPLOYEES AND SHAREHOLDER-EMPLOYEES
7.01
LOANS TO OWNER-EMPLOYEES AND SHAREHOLDER-EMPLOYEES
Effective for Plan loans made after December 31, 2001, provisions found in Article IX, Section 9.08(b) of the
Plan Document prohibiting loans to any Shareholder-employee or Owner-employee shall cease to apply.
IN WITNESS HEREOF, the Employer has caused this agreement to be signed by its duly authorized officer and the
Trustees have also signed this Amendment.
(Legal Name of Employer)
By: __________________________________________________
(Signature of Officer)
(Date)
(Typed or Printed Name
and Title of Officer)
CONFIRMATION OF RECEIPT:
____________________
(Date)
__________________________________________________
(Signature of Trustee)
____________________
(Date)
__________________________________________________
(Signature of Trustee)
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© Lincoln National Life Insurance Company 2002
TABLE OF CONTENTS
PART 1
GENERAL EMPLOYER INFORMATION
1-1
1-2
1-3
1-4
1-5
Employer Name .............................................................................................................................
Employer Taxpayer Identification Number/Trust Identification Number ..............................
Employer Fiscal Year ...................................................................................................................
Type of Employer ..........................................................................................................................
Controlled Group Information ....................................................................................................
1
1
1
1
2
PART 2
PLAN INFORMATION
2-1
2-2
2-3
2-4
2-5
2-6
2-7
2-8
2-9
Plan Name ......................................................................................................................................
Plan Number ..................................................................................................................................
Plan Administrator .......................................................................................................................
Named Fiduciary ...........................................................................................................................
Agent For Service Of Legal Process ............................................................................................
Trustee(s) .......................................................................................................................................
ERISA 404(c) Compliance ............................................................................................................
Other Plans ....................................................................................................................................
Adoption Or Restatement Effective Dates ..................................................................................
3
3
3
3
3
3
4
5
5
PART 3
ELECTIONS FOR DEFINED TERMS
3-1
3-2
3-3
3-4
3-5
3-6
3-7
3-8
3-9
3-10
3-11
3-12
3-13
3-14
Compensation ................................................................................................................................
Compensation Determination Period ..........................................................................................
Compensation Adjustments .........................................................................................................
Eligible Compensation ..................................................................................................................
[Reserved]
Hours of Service ............................................................................................................................
A One-Year Break In Service ......................................................................................................
Plan Year .......................................................................................................................................
Valuation Date ...............................................................................................................................
Vesting Years Of Service ..............................................................................................................
Vesting Years Of Service Exclusion ............................................................................................
Year of Service For All Plan Purposes Other Than Vesting Year Of Service .........................
Service With A Predecessor Employer ........................................................................................
Service With An Unrelated Employer .........................................................................................
6
6
6
6
6
7
7
7
7
8
8
8
8
PART 4
ELIGIBILITY REQUIREMENTS AND PARTICIPATION REQUIREMENTS
4-1
4-2
4-3
Employees Excluded From Eligibility For All Plan Purposes ...................................................
[Reserved]
Participation Requirements With Respect To Profit Sharing Contributions And
Safe Harbor Contributions...........................................................................................................
9
9
PART 5
PROFIT SHARING CONTRIBUTIONS AND ALLOCATIONS
5-1
5-2
5-3
5-4
5-5
Profit Sharing Contribution .........................................................................................................
Profit Sharing Allocation ..............................................................................................................
Service Requirement For Participants Employed On Last Day ...............................................
Service Requirement For Participants Not Employed On Last Day ........................................
Waiver Of Service Requirement For Death, Disability, Retirement .......................................
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12
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© Lincoln National Life Insurance Company 2002
PART 6
[RESERVED]
PART 7
[RESERVED]
PART 8
[RESERVED]
PART 9
SAFE HARBOR CONTRIBUTIONS
9-1
9-2
9-3
9-4
9-5
Safe Harbor Provisions .................................................................................................................
Safe Harbor Effective Date ..........................................................................................................
[Reserved]
Participants Eligible To Receive The Safe Harbor Contribution .............................................
Safe Harbor Contribution ............................................................................................................
13
13
13
13
PART 10
[RESERVED]
PART 11
NONDISCRIMINATION TESTING ELECTIONS
11-1
11-2
11-3
[Reserved]
[Reserved]
Top-Paid Group Election .............................................................................................................
13
PART 12
TOP-HEAVY MINIMUM REQUIREMENTS
12-1
12-2
More Than One Qualified Plan....................................................................................................
More Than One Defined Contribution Plan ...............................................................................
14
14
PART 13
LIMITATIONS ON ALLOCATIONS
13-1
Annual Additions Limitation .......................................................................................................
14
PART 14
INVESTMENT DIRECTION, VALUATIONS, ROLLOVERS, LOANS AND LIFE INSURANCE
14-1
14-2
14-3
14-4
14-5
14-6
Participant Investment Direction ................................................................................................
Allocation Of Earnings With Respect To Amounts Which Are Subject To
Participant Investment Direction ................................................................................................
Allocation Of Earnings With Respect To Amounts Which Are Not Subject To
Participant Investment Direction ................................................................................................
Rollover Contributions .................................................................................................................
Participant Loans .........................................................................................................................
Purchase Of Life Insurance ..........................................................................................................
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15
15
15
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© Lincoln National Life Insurance Company 2002
PART 15
FORFEITURES AND VESTING OF EMPLOYER CONTRIBUTIONS
15-1
15-2
15-3
15-4
15-5
Forfeitures Of Employer Contributions......................................................................................
Timing Of Forfeitures ...................................................................................................................
Vesting Of Profit Sharing Contributions ....................................................................................
[Reserved]
Top Heavy Vesting ........................................................................................................................
17
17
17
18
PART 16
RETIREMENT DATES
16-1
16-2
16-3
Normal Retirement Age ................................................................................................................
Normal Retirement Date ..............................................................................................................
Early Retirement Date ..................................................................................................................
20
20
20
PART 17
DISABILITY RETIREMENT BENEFIT
17-1
17-2
Disability Retirement Benefit .......................................................................................................
Disability Determination ..............................................................................................................
21
21
PART 18
DISTRIBUTIONS
18-1
18-2
18-3
18-4
Form Of Payment Of Benefits......................................................................................................
Timing Of Distributions ...............................................................................................................
[Reserved]
In-service Distributions ................................................................................................................
22
22
23
PART 19
SPECIAL GUST TRANSITION ELECTIONS
19-1
19-2
19-3
19-4
19-5
19-6
19-7
19-8
19-9
19-10
Family Aggregation Of Compensation ........................................................................................
Safe Harbor Operational Compliance .........................................................................................
[Reserved]
[Reserved]
[Reserved]
Definition Of Highly Compensated Employee (Limit HCEs to Top-Paid Group) ..................
Involuntary Distributions .............................................................................................................
[Reserved]
Defined Benefit Annual Addition.................................................................................................
Required Minimum Distributions ...............................................................................................
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© Lincoln National Life Insurance Company 2002
ADOPTION AGREEMENT PREAMBLE
The Preamble to the Adoption Agreement, Parts 1 and 2 contain Employer data and Plan information necessary for
administration of the Plan but which are not provisions of the Plan itself. This preamble information may be changed
upon notification by the Employer to the Plan Administrator without an amendment to the Plan Document or Adoption
Agreement.
PART 1
GENERAL EMPLOYER INFORMATION
1-1
Employer Name:
(exact legal name of Employer)
Business Address:
City, State, Zip Code:
(City)
Business Telephone:
Fax Number:
1-2
1-3
1-4
(
(
)
)
(State)
(Zip Code)
-
E-mail:
(a)
Employer Taxpayer Identification Number (“EIN”):
(b)
Trust Identification Number ("TIN"), if any:
-
Employer Fiscal Year and other pertinent data:
(a)
Date Business Commenced:
/
/
(b)
Employer Fiscal Year begins
(c)
Business Code Number (same as shown on IRS Form 1120):
/
and ends
/
Type of Employer:
(a)
Sole Proprietor
(b)
Partnership (including Limited Liability Partnership)
(c)
Limited Liability Company
taxed as
Partnership
Corporation
S Corporation
(d)
For Profit Corporation
(e)
S Corporation
(f)
Professional Service Employer (also select other applicable type of Employer above)
(g)
Not For Profit Corporation
(h)
Government
(i)
Non-electing Church
(j)
Other
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© Lincoln National Life Insurance Company 2002
1-5
Controlled Group Information:
Are there any Affiliated Employers: Is the Employer a Controlled Group Member (including a group of
businesses under common control), or an Affiliated Service Group Member?
This question must be answered “yes” or “no.” If yes, complete the rest of this section.
(a) Controlled Group Member:
Yes
No
(b) Affiliated Service Group Member:
Yes
No
Affiliated Employers listed below are required to be aggregated with the Employer under Code Sections
414(b), (c), (m) or (o), and shall participate in this Plan to the extent indicated as evidenced by written
resolution adopting this Plan.
Employer
Name & Address
Type of
Employer*
(a)
Employer
EIN #
–
Participating
Employer
Yes
No
Participation
Effective Date
/
/
(b)
–
Yes
No
/
/
(c)
–
Yes
No
/
/
(d)
–
Yes
No
/
/
(e)
–
Yes
No
/
/
*INDICATE TYPE OF EMPLOYER. Use Types of Employers listed in Section 1-4 above.
If an Affiliated Employer adopts this Plan after the date the Adoption Agreement is executed, attach an
addendum to this Adoption Agreement for each Affiliated Employer, including its name, address, type of
Employer, EIN # and Participation Effective Date.
NOTE: Each Affiliated Employer covered by this Plan must adopt the Plan as a Participating Employer.
Employees of an Affiliated Employer which does not adopt this Plan shall not be Eligible Employees. This
Plan could violate Code Section 410(b) coverage rules if all Affiliated Employers do not adopt the Plan, and
may not rely on the opinion letter issued by the Internal Revenue Service that this Plan is qualified
under Code Section 401.
Any Affiliated Employer identified above that elects to adopt this Plan shall evidence such adoption by
written resolution of the Affiliated Employer’s board of directors or other similar governing body and by
execution of the signature page of this Adoption Agreement in which case such Affiliated Employer will
supply identifying information concerning itself and any other plans that it has maintained.
If this Plan is adopted by one or more Affiliated Employers, this Plan shall be administered as one Plan (e.g.,
Employer Contributions and Forfeitures shall not be separated for each Affiliated Employer). Any Eligible
Employee of an Affiliated Employer must be credited with Years of Service and Vesting Years of Service
while employed by any Affiliated Employer, including non-participating Affiliated Employers, for purposes
of Vesting and eligibility under this Plan from the date that employer became an Affiliated Employer.
32610S-PS
2
© Lincoln National Life Insurance Company 2002
PART 2
PLAN INFORMATION
2-1
Plan Name
2-2
Plan Number: (assigned by the Employer):
(a)
001
(b)
002
(c)
003
(d)
(specify)
2-3
Plan Administrator: (Lincoln Life will not serve as Plan Administrator):
Plan Administrator*:
Business Address:
City, State, Zip Code:
(City)
Telephone Number: (
)
(Zip Code)
(State)
-
Fax Number: (
)
-
E-mail:
2-4
Named Fiduciary*:
2-5
Agent For Service Of Legal Process*:
*If same as Employer, write "Same."
2-6
Trustee(s):
(a)
(1)
Individual Trustee(s) who serve as discretionary Trustee(s) over Plan assets not subject to
control by a corporate Trustee:
Name [First Trustee]
Title(s)
(i)
(ii)
Use the Employer address
Use the address and telephone numbers below:
City
Telephone Number: (
Zip Code
State
)
-
Fax Number:
(
)
-
E-mail:
32610S-PS
3
© Lincoln National Life Insurance Company 2002
(2)
Name
[Second Trustee]
(i)
(ii)
Title(s)
Use the Employer address
Use the address and telephone numbers below:
City
Telephone Number: (
Zip Code
State
)
-
Fax Number: (
)
-
E-mail:
NOTE: If more than two Trustees, please provide name and address information on a separate sheet
and attach to this Adoption Agreement.
(b)
Corporate Trustee:
(1)
Name:
(2)
Address and Telephone Number:
City
Telephone Number: (
Zip Code
State
)
-
Fax Number:
(
)
-
E-mail:
AND the corporate Trustee shall serve as:
(3)
a directed (nondiscretionary) Trustee of all Plan assets except for the following:
(4)
a discretionary Trustee over all Plan assets except for the following:
AND, shall a separate trust agreement be used with this Plan?
(5)
(6)
Yes
No
NOTE: If “Yes” is selected, an executed copy of the trust agreement between the Trustee and the Employer
must be attached to this Adoption Agreement. The Plan and trust agreement will be read and construed
together. The responsibilities, rights and powers of the Trustee shall be those specified in the trust agreement.
2-7
ERISA 404(c) Compliance:
(a)
(b)
32610S-PS
This Plan, as administered by the Plan Administrator, is intended to comply with ERISA
Section 404(c). (See requirements in Section 9.04(e) of the Plan Document.)
This Plan is NOT intended to comply with ERISA Section 404(c).
4
© Lincoln National Life Insurance Company 2002
2-8
Other Plans:
The Employer or Affiliated Employer (whether or not participating in this Plan) maintains, or has maintained,
the following employee pension benefit plans. List all plans, including this Plan, ever maintained by the
Employer or other Affiliated Employer (whether or not qualified under the Code) starting with Plan Number
001.
Plan
Number
2-9
Plan Name
---------------Status-------------- Terminated
In Force Frozen
Type of plan
Adoption Or Restatement Effective Dates. The adoption of this Plan constitutes (check appropriate box(es)
and provide information):
(a)
The initial adoption of this Plan by the Employer.
The effective date of this Plan is:
/
/
(month/day/year)
(b)
An amendment and restatement of this Plan.
The original effective date of this Plan is:
/
/
(month/day/year)
The effective date of this amendment and restatement is:
(c)
/
/
(month/day/year)
A merger and restatement of the following plans:
(1)
(name of Plan)
Original effective date of the Plan is:
/
/
(month/day/year)
(name of Plan )
Original effective date of the Plan is:
/
/
(month/day/year)
(name of Plan )
Original effective date of the Plan is:
/
/
(month/day/year)
(2)
(3)
(4)
(d)
32610S-PS
Effective date of the Plan merger is:
/
/
(month/day/year)
GUST Restatements: This is an amendment and restatement of a previously established
qualified Plan of the Employer or a merger and restatement pursuant to Section (c) above to
bring the Plan into compliance with GUST. The original Plan effective date was
/
/
. Except as specifically provided in the Plan, the effective date of this
amendment and restatement is
/
/
(enter a date that is no earlier than the first day
of the current Plan Year. The Plan contains appropriate retroactive effective dates with
respect to provisions for the appropriate laws.)
5
© Lincoln National Life Insurance Company 2002
ADOPTION AGREEMENT ELECTIONS
Adoption Agreement elections may only be changed by written Plan amendment pursuant to Section 15.01 of the Plan
Document.
PART 3
ELECTIONS FOR DEFINED TERMS
(See Article I of the Plan Document)
The undersigned Employer elects the following Plan provisions by executing this Standardized Profit Sharing
Prototype Plan and Trust Adoption Agreement for The Lincoln National Life Insurance Company Defined
Contribution Prototype Basic Plan Document and Trust #01. The Plan Document and Adoption Agreement have been
approved as a prototype by the Internal Revenue Service. The Lincoln National Life Insurance Company (“Lincoln
Life”) recommends that the Employer consult its own legal counsel or tax advisor regarding the adoption of the Plan
Document and completion of this Adoption Agreement. The Plan Document and Adoption Agreement together shall
be the written document for the Plan. All defined terms are defined in the Plan Document. References in this
Adoption Agreement to specific Articles and Sections of the Plan Document are only intended as an aid in completion
of the Adoption Agreement and are not intended to be all inclusive. Section numbers may not be consecutive to allow
for consistency among the various Adoption Agreements.
3-1
Compensation (Section 1.13 of the Plan Document) with respect to any Participant means:
(a)
(b)
Code Section 3401(a) wages (as defined in Section 1.13(a)(1) of the Plan Document).
Wages, tips and other compensation on Form W-2 subject to reporting (as defined in
Section 1.13(a)(2) of the Plan Document). NOTE: Currently Box 1 on Form W-2.
3-2
Compensation Determination Period.
Compensation shall be based on the Plan Year.
NOTE: The Limitation Year for Code Section 415 purposes shall be the same as the determination
period for Compensation unless an alternative period is specified here:
.
3-3
Compensation Adjustments. Compensation for all Employer Contributions shall include Compensation which
is not currently includible in the Participant’s gross income by reason of the application of Code Sections 125
[cafeteria plan], 402(e)(3) [401(k) plan], 402(h)(1)(B) [simplified employee pension plan], 414(h) [Employer
pickup contributions under a governmental plan], 403(b) [tax sheltered annuity], or 457(b) [eligible deferred
compensation plan], and for Plan Years beginning on or after January 1, 2001, 132(f)(4).
3-4
Eligible Compensation. Compensation shall be used for allocation of Employer Contributions AND for ALL
nondiscrimination testing:
(a)
(b)
3-6
For the entire Plan Year for each contribution source regardless of entry date.
Only for the period after the initial participation requirements have been satisfied for each
contribution source including the applicable entry date.
Hours Of Service: Hours of Service (Section 1.42 of the Plan Document) shall be determined on the basis of
the method selected below for all Employees. If the elapsed time method is selected in Section 3-10 for
Vesting purposes, Hours of Service as designated below shall be applicable for eligibility to participate and
benefit accrual purposes only (select one):
(a)
(b)
(c)
32610S-PS
Actual hours for which an Employee is paid or entitled to payment.
Days worked. An Employee shall be credited with 10 Hours of Service if, under Section
1.42 of the Plan Document, such Employee would be credited with at least one Hour of
Service during such day.
Weeks worked. An Employee shall be credited with 45 Hours of Service if, under Section
1.42 of the Plan Document, such Employee would be credited with at least one Hour of
Service during such week.
6
© Lincoln National Life Insurance Company 2002
(d)
Semi-monthly payroll periods worked. An Employee shall be credited with 95 Hours of
Service if, under Section 1.42 of the Plan Document, such Employee would be credited
with at least one Hour of Service during such semi-monthly period.
Months worked. An Employee shall be credited with 190 Hours of Service if, under
Section 1.42 of the Plan Document, such Employee would be credited with at least one
Hour of Service during such month.
(e)
3-7
A One-Year Break In Service (Section 1.62 of the Plan Document) means the applicable computation period
during which an Employee has completed fewer than the number of Hours of Service selected below:
(a)
(b)
3-8
500 Hours of Service.
Hours of Service (less than 500).
Plan Year (Section 1.73 of the Plan Document) (select one and complete):
(a)
Shall be the consecutive 12 month period for which records for this Plan shall be
maintained beginning each
/
and ending each
/ .
There shall be a short Plan Year beginning
/
/
and ending
/
/
.
(b)
All subsequent Plan Years shall begin each
and end each
/ .
/
The previous Plan Year prior to this amendment began
and ended
/ .
/
Adjustments for eligibility and Vesting shall be made as required by Section 1.88 of the
Plan Document if the Plan Year is changed.
3-9
Valuation Date (Section 1.97 of the Plan Document):
(a)
Every day that the Trustee, any transfer agent appointed by the Trustee or the Employer,
and any Stock Exchange used by such agent is in session. (Daily valuation)
Other
(b)
Caution: Must be no less frequently than once each Plan Year.
3-10
Vesting Years of Service (Section 1.99 of the Plan Document) shall be computed under the following method
(select one):
(a)
(1)
(2)
(b)
32610S-PS
Hours of Service Method—based on Hours of Service credited under the method selected
in Section 3-6. The Vesting computation period shall be the Plan Year.
Vesting Year of Service means the applicable Plan Year during which an Employee has
completed at least (select one):
1000 Hours of Service
(less than 1,000) Hours of Service.
Elapsed Time Method—based on total time an Employee is employed without regard to
actual hours credited as explained in Section 1.99 of the Plan Document.
Caution: If elapsed time method is selected, see Section 1.62 of the Plan Document for
elapsed time break in service rules for Vesting.
7
© Lincoln National Life Insurance Company 2002
3-11
Vesting Years Of Service Exclusion: Vesting Years of Service shall exclude the years checked below subject
to Section 1.99 of the Plan Document (select all that apply):
(a)
(b)
Not applicable. No Exclusions.
Years of Service before the Employee’s
(cannot exceed 18th) birthday. (If Hours of
Service method is used, the Plan Year in which the Employee attains age 18 shall not be
excluded.)
(c)
Years of Service prior to the original effective date of this Plan or a predecessor plan.
(d)
Years of Service prior to
/
/
. (Date selected may not be later than the original
effective date of this Plan or a predecessor plan.)
NOTE: In general, a predecessor plan is a plan which terminates within the five year period immediately
preceding or following the establishment of this Plan.
3-12
Year of Service For All Plan Purposes Other Than Vesting Year of Service: A 12 consecutive month period
described in Section 1.100 of the Plan Document in which an employee completes at least:
(a)
1,000 Hours of Service.
(b)
Hours of Service (not to exceed 1,000).
NOTE: Year of Service definition is used for eligibility to participate.
3-13
Service With A Predecessor Employer:
(a)
(b)
Not applicable.
Service with
beginning on (date)
/
/
for whom this Employer does not maintain a predecessor
plan shall be considered under the Plan for purposes of (select as desired):
(1)
All purposes of the Plan.
(2)
Receiving an Employer Contribution.
(3)
Vesting.
(4)
Eligibility to participate.
NOTE: If the predecessor Employer maintained this Plan, then Vesting Years of Service and Years of
Service with such predecessor Employer shall be recognized pursuant to Sections 1.99 and 1.100 of the Plan
Document, and Section (b)(1) above will apply for all purposes of the Plan.
3-14
Service With An Unrelated Employer (not an Affiliated Employer) (Section 1.96 of the Plan Document):
NOTE: Past Service with an Unrelated Employer must meet the safe harbor requirements of Section
1.401(a)(4)-(5)(a)(3) of the Internal Revenue Service Regulations.
(a)
(b)
Not applicable.
Service with
,
(1)
(2)
(3)
(4)
32610S-PS
(not a Controlled Group Member or Affiliated Service Group Member with the Employer),
commencing on (date)
/ /
shall be considered under the Plan for purposes of
(select as desired):
All purposes of the Plan.
Receiving an Employer Contribution.
Vesting.
Eligibility to participate.
8
© Lincoln National Life Insurance Company 2002
PART 4
ELIGIBILITY REQUIREMENTS AND PARTICIPATION REQUIREMENTS
(See Article II of the Plan Document)
Plan Participant: For all Plan purposes, a Plan Participant shall be an Eligible Employee of the Employer (i.e., not
excluded in Section 4-1 below), who has satisfied the least restrictive conditions of participation for one of the elected
contribution sources. However, the Participant may not be eligible to participate in various sources of contributions
until such time as the Participant satisfies the participation requirements, including the applicable entry date, for that
source of contribution.
4-1
Employees Excluded From Eligibility For All Plan Purposes:
The following categories of Employees shall be excluded from eligibility to participate for all purposes under
the Plan. The categories of Employees who are excluded by checking one or more boxes below shall not be
eligible to make Elective Deferrals, and shall not be eligible to receive any source of Employer Contributions.
Select all excluded Employees. If no box is checked, all Employees shall be Eligible Employees, subject to
additional conditions of participation for the various sources of contributions described below:
(a)
(b)
(c)
Collectively bargained (union) Employees (as described in Section 1.23 of the Plan
Document).
Non-resident aliens (as described in Section 1.23 of the Plan Document).
Employees who became Employees as the result of a merger or acquisition (as described in
Section 1.23 of the Plan Document).
NOTE: Each Affiliated Employer covered by this Plan should adopt the Plan as a Participating Employer.
Employees of an Affiliated Employer which does not adopt this Plan shall not be Eligible Employees. This
Plan could violate the Code Section 410(b) coverage rules if all Affiliated Employers do not adopt the Plan
(see Section 1.05 of the Plan Document), and may not rely on the opinion letter issued by the Internal
Revenue Service that this Plan is qualified under Code Section 401.
Additional Conditions Of Participation: Any Employee not excluded in this Section 4-1 will be eligible to
participate in various sources of contributions upon satisfaction of the specific requirements for participation
for those sources of contributions as selected below.
4-3
Participation Requirements With Respect To Profit Sharing Contributions and Safe Harbor Contributions
(select all that apply):
(a)
(b)
32610S-PS
No age or service required (Go to Section (d) below).
Completion of the following service requirement, which is based on Years of Service:
(1)
No service requirement.
(2)
months of service (may not exceed 24 months). If more than 12 months is
selected, Profit Sharing Contributions are immediately 100% Vested. If the
Year(s) of Service selected is or includes a fractional year or months of service, an
Eligible Employee will not be required to complete any specified number of Hours
of Service to receive credit for such fractional year.
(3)
Hours of Service (not to exceed 1,000) within
months (not to exceed 12)
from the Eligible Employee’s employment commencement date. If an Employee
does not complete the stated Hours of Service during the specified time period, the
Employee is subject to the One Year of Service requirement in Section (b)(4)
below.
(4)
One Year of Service (as defined in Section 3-12 above).
9
© Lincoln National Life Insurance Company 2002
(5)
Two Years of Service (may only be selected if Profit Sharing Contributions are
immediately 100% Vested).
The second and following Year of Service shall be measured based on:
(i)
Employment year
(ii)
Plan Year.
(c)
Attainment Of The Following Age Requirement:
(1)
No age requirement.
(2)
Age 20½.
(3)
Age 21.
(4)
Other:
(may not exceed age 21).
(d)
Employer Contribution Entry Date: The Eligible Employee shall be eligible to participate in the
Profit Sharing Contribution and Safe Harbor Contribution beginning with the entry date selected
below that is on or next following satisfaction of the minimum age and service requirement selected
in Sections (b) and (c) above:
(1)
The day on which such requirements are satisfied.
(2)
The first day of the month coinciding with or next following the date on which
such requirements are satisfied.
(3)
The first day of the Plan Year quarter coinciding with or next following the date
on which such requirements are satisfied.
(4)
The earlier of the first day of the seventh month or the first day of the Plan Year
coinciding with or next following the date on which such requirements are
satisfied.
(5)
The first day of the Plan Year next following the date on which such requirements
are satisfied. (NOTE: Service requirement must be six months of service (or 18
months of service if 100% immediate Vesting is selected) or less and age 20½ or
less.)
(e) The
age and/or
service requirement specified above shall be waived with respect to any Eligible
Employee who was employed on
/
/
and such Eligible Employee shall have met the
participation requirements for the Profit Sharing Contribution and Safe Harbor Contribution portion of
the Plan as of the date specified herein. Such specified date will be deemed an entry date.
32610S-PS
10
© Lincoln National Life Insurance Company 2002
PART 5
PROFIT SHARING CONTRIBUTIONS AND ALLOCATIONS
(See Article III of the Plan Document)
If the only Profit Sharing Contribution that will be made under this Plan is a Safe Harbor Non-Elective Contribution,
complete only Section 5-1(a) of this Part 5. See Part 9 for Safe Harbor elections.
5-1
Profit Sharing Contribution.
The Employer will make the following Profit Sharing Contribution (select one):
(a)
(b)
(1)
(2)
5-2
Not applicable. The Employer will make no Profit Sharing Contribution under this Part 5.
Do not complete the remainder of this Part 5.
The Employer may make a discretionary Profit Sharing Contribution without regard to
current or accumulated profits. The amount of such contribution shall be [select (1) or (2)
below]:
As determined by the Employer each year.
Other
.
Profit Sharing Allocation:
The Employer Profit Sharing Contribution for the Plan Year will be allocated (Section 3.03 of the Plan
Document) as follows (select one):
NOTE: If any Employee eligible to participate under this Plan is covered by another plan of the Employer
(including plans of non-participating employers required to be aggregated under Section 414(b), (c), (m) or
(o) of the Code) which is integrated with Social Security, an integrated allocation formula may Not be elected
for this Plan.
(a)
NON-INTEGRATED FORMULA
(1)
(2)
(b)
In the same ratio as each Participant’s Compensation (as defined in Section 1.13 of
the Plan Document and modified in Sections 3-1 through 3-4 above) bears to the
total of such Compensation for all Participants eligible to receive an allocation for
the Plan Year.
In the same dollar amount to all Participants eligible to receive an allocation for
the Plan Year.
PERMITTED DISPARITY (INTEGRATED WITH SOCIAL SECURITY)
In accordance with Section 3.03 of the Plan Document based on a Participant’s Compensation (as
defined in Section 1.13 of the Plan Document and modified in Sections 3-1 through 3-4 above) in
excess of (select one):
(1)
The Taxable Wage Base. [The maximum amount of earnings which may be
considered wages for a year under Section 3121(a)(1) of the Code in effect as of
the first day of the Plan Year.]
(2)
$
(3)
% (must be less than 100%) of the Taxable Wage Base rounded to the next
highest dollar amount.
(4)
80% of the Taxable Wage Base plus $1.00.
(must be less than the Taxable Wage Base).
If (2), (3) or (4) is selected above, the maximum integration percentage of 5.7% will be reduced to
the applicable percentage determined in accordance with the table below:
32610S-PS
11
© Lincoln National Life Insurance Company 2002
If the integration level:
Is more
But less than
The applicable
than
or equal to
percentage is
20% of TWB* 80% of TWB*
4.3%
80% of TWB* 99.9% of TWB*
5.4%
*TWB = Taxable Wage Base at the beginning of the Plan Year.
The TWB for 2001 is $80,400.
NOTE: If any Participant in this Plan is covered by any other plan of the Employer
[including plans of non-Participating Employers required to be aggregated under Section
414(b), (c), (m) or (o) of the Code] which is integrated with Social Security, an integrated
allocation formula may not be selected for this Plan.
5-3
Service requirement for Participants who are employed on the last day of the Plan Year. Participants shall
receive a Profit Sharing Contribution allocation for the Plan Year.
5-4
Service requirement for Participants who are not employed on the last day of the Plan Year (except as
otherwise provided in Section 5-5 below) to receive a Profit Sharing Contribution allocation for the Plan Year
select one):
(a)
(b)
5-5
500 Hours of Service during the Plan Year.
Hours of Service during the Plan Year.
(must be less than 500 Hours of Service, may be 0)
Waiver Of Service Requirement For Death, Disability, Retirement. Regardless of the selection in Section 5-4
above, Participants who are not employed on the last day of the Plan Year because of one of the following
events will be eligible to share in the Profit Sharing Contribution allocation for the Plan Year (select all that
apply):
(a)
(b)
(c)
(d)
32610S-PS
Not applicable. The provisions elected in Section 5-4 apply.
Death.
Termination of Service on account of Disability.
Termination of Service after attaining Early, Normal or Late Retirement Date.
12
© Lincoln National Life Insurance Company 2002
PART 9
SAFE HARBOR CONTRIBUTIONS
(See Article V of the Plan Document)
9-1
9-2
9-4
Safe Harbor Provisions:
(a)
Not applicable. The Employer will not utilize Safe Harbor Contributions.
[Do not complete the remainder of this Part 9]
(b)
The Employer will make a Safe Harbor Non-Elective Contribution to this Plan in order to
meet the Safe Harbor Contribution requirements for another 401(k) plan maintained by the
Employer and paired with this Plan. Enter name of other plan:
Safe Harbor Effective Date:
(a)
The Safe Harbor provisions are effective as of the later of the effective date of this Plan, or
if this is an amendment or restatement, the effective date of the amendment or restatement.
(b)
The Safe Harbor provisions are effective for the Plan Year beginning:
/
/
.
(Enter the first day of the Plan Year for which the provisions are (or, for GUST updates,
were) effective and, if necessary, enter any other special effective dates that apply with
respect to the provisions.)
Caution: Restrictions apply to the effective date due to short Plan Year requirements and
Safe Harbor notice requirements.
Participants Eligible To Receive The Safe Harbor Contribution (Section 5.02 of the Plan Document)
(select one):
(a)
(b)
All Highly Compensated Employees and all Non-Highly Compensated Employees
All Non-Highly Compensated Employees only
who satisfy the participation requirements selected below (select one):
9-5
Safe Harbor Contribution:
The Employer will make the following Safe Harbor Contribution (see Section 5.05 of the Plan Document)
A Safe Harbor Non-Elective Contribution (Section 5.05(a)(1) of the Plan Document) equal to
%
(must be at least 3%).
NOTE: May not be used as a part of the Profit Sharing Contribution allocation described in Part 5
above.
PART 11
NONDISCRIMINATION TESTING ELECTIONS
(See Article IV of the Plan Document)
11-3
Top-Paid Group Election. For purposes of defining Highly Compensated Employees, the Employer elects to
limit the number of Highly Compensated Employees to the Top-Paid Group (Section 1.93 of the Plan
Document):
(a)
(b)
32610S-PS
Yes.
No.
13
© Lincoln National Life Insurance Company 2002
PART 12
TOP-HEAVY MINIMUM REQUIREMENTS
(See Article VII of the Plan Document)
12-1
More Than One Qualified Plan. Does the Employer sponsor more than one paired Qualified Plan?
(a)
(b)
12-2
No, the Employer sponsors only this Plan. Go to Part 13.
Yes, the Employer sponsors this Plan and another paired defined contribution Plan.
Complete 12-2 below.
More Than One Defined Contribution Plan. The Employer maintains this defined contribution Plan and
another paired defined contribution plan. When a Non-Key Employee is a Participant in this Plan and in the
other paired defined contribution plan maintained by the Employer, indicate which method shall be utilized to
avoid duplication of the Top Heavy minimum benefit requirement (see Sections 7.05 and 7.06 of the Plan
Document):
(a)
(b)
(c)
The minimum, non-integrated contribution of up to 3% of each Non-Key Employee’s
415 Compensation shall be provided in this profit sharing Plan.
The minimum, non-integrated contribution of up to 3% of each Non-Key Employee’s 415
Compensation shall be provided in the other plan.
Name of plan.
Specify the method under which the plans will provide the Top Heavy minimum benefits
for Non-Key Employees that will preclude Employer discretion and avoid inadvertent
omissions.
PART 13
LIMITATIONS ON ALLOCATIONS
(See Article VIII of the Plan Document)
13-1
Annual Additions Limitation. If any Participant is covered under another paired qualified defined
contribution plan maintained by the Employer, or if the Employer maintains a welfare benefit fund, as
defined in Code Section 419(e), or an individual medical account, as defined in Code Section 415(1)(2),
under which amounts are treated as Annual Additions with respect to any Participant in this Plan (see Section
8.02 of the Plan Document):
(a)
Not applicable. The Employer does not maintain another plan which provides an Annual
Addition.
(b)
The provisions of Section 8.03(b) of the Plan Document shall apply.
(c)
Provide below, the method under which the plans shall limit total Annual Additions to the
Maximum Permissible Amount and shall properly reduce any Excess Amounts in a manner
that precludes Employer discretion.
NOTE: If (b) or (c) is selected, an Employer may not rely on the opinion letter issued by the Internal Revenue
Service that this Plan is qualified under Code Section 401.
32610S-PS
14
© Lincoln National Life Insurance Company 2002
PART 14
INVESTMENT DIRECTION, VALUATIONS, ROLLOVERS,
LOANS AND LIFE INSURANCE
(See Article IX of the Plan Document)
14-1
Participant investment direction is permitted for the following Accounts (select all that apply):
(See Section 9.04 of the Plan Document)
(a)
(b)
Not applicable. No Participant investment direction will be permitted.
All Accounts (recommended).
Caution: A combination of Employer directed and Participant directed Accounts may generate additional
administrative expenses and may not be permitted by your service provider. Not recommended.
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(j)
(k)
14-2
Allocation of earnings with respect to amounts which are subject to Participant investment direction will be
determined:
(a)
(b)
(c)
(d)
14-3
Not applicable. No Participant investment direction will be permitted.
By daily valuation.
Based on the Participant Account balance as of the previous Valuation Date plus one-half
of all contributions, minus all withdrawals and plus transfers in, minus transfers out.
Other method
.
Allocation of earnings with respect to amounts which are NOT subject to Participant investment direction
will be determined:
(a)
(b)
(c)
(d)
14-4
Rollover Account.
Elective Deferral Account.
Qualified Non-Elective Account.
Qualified Matching Account.
Matching Account.
Profit Sharing Account.
Prevailing Wage Account.
Safe Harbor Account.
Other.
.
Not applicable. All Accounts are subject to Participant investment direction.
By daily valuation.
Based on the Participant Account balance as of the previous Valuation Date plus one-half
of all contributions, minus all withdrawals and plus transfers in, minus transfers out.
Other method
.
Rollover Contributions (see Section 9.05 of the Plan Document) shall be permitted under this Plan.
(a)
Yes.
Complete Sections (c), (d) and (e) below.
(b)
No.
Go to Section 14-5 below.
(c)
32610S-PS
Rollover Contributions shall be accepted from:
(1)
Participants only.
(2)
Participants and non-Participants (Eligible Employees who have not satisfied the
age and/or service requirement and entry date for participation, if any).
15
© Lincoln National Life Insurance Company 2002
14-5
(d)
Rollovers of existing loans:
(1)
Will be permitted.
(2)
Will not be permitted.
(e)
Distributions from a Participant’s Rollover Account may be made:
(1)
At any time.
(2)
Only when the Participant is otherwise entitled to any allowable distribution
under the Plan.
Participant Loans (Section 9.08 of the Plan Document):
(a)
(b)
14-6
Loans to Participants shall be permitted in accordance with this Plan and the Employer’s
written loan policy.
Loans to Participants shall not be permitted.
Purchase Of Life Insurance (See Section 9.09 of the Plan Document) Is Not Permitted.
32610S-PS
16
© Lincoln National Life Insurance Company 2002
PART 15
FORFEITURES AND VESTING OF EMPLOYER CONTRIBUTIONS
(See Articles III and X of the Plan Document)
15-1
Forfeitures Of Employer Contributions will be (select one):
(a)
Used to reduce any Employer Contribution in the Plan Year in which the forfeiture occurs
or the next following Plan Year.
Added to any Employer Contribution in the Plan Year in which the forfeiture occurs or the
next following Plan Year.
Allocated as a Profit Sharing Contribution in the Plan Year in which the forfeiture occurs or
the next following Plan Year. However, Forfeitures shall not be allocated to Participants
who are not employed on the last day of the Plan Year and who do not have 500 Hours of
Service during the Plan Year unless such allocation is required to satisfy the coverage fail
safe provisions described in Section 3.08 of the Plan Document.
(b)
(c)
NOTE: (a) is recommended. However, if the Employer does not make an Employer Contribution for the Plan
Year, any available Forfeiture shall be treated as an Employer Contribution, pursuant to Section 3.06 of the
Plan Document.
15-2
Timing Of Forfeitures. Forfeitures from non-vested Participant Accounts will occur as of the earlier of:
(a)
(b)
The last day of the Plan Year in which the Participant who has Terminated
Service incurs five (5) consecutive One-Year Breaks in Service, or
The distribution of the entire Vested portion of the Participant’s Account.
Caution: Pursuant to Section 1.36 of the Plan Document, if a Participant who has Terminated service is
eligible to share in an allocation of Employer Contributions, the Forfeiture will not occur until the end of the
first Plan Year for which such Participant is not eligible to share in the allocation.
15-3
Vesting Of Profit Sharing Contributions (Section 10.06 of the Plan Document):
The Vesting Schedule for benefits (derived from the Profit Sharing Contributions pursuant to Part 5) upon
Termination of Service shall be determined according to the selection based on Vesting Years of Service (or
Periods of Service if the elapsed time method is selected) as credited in accordance with Section 1.99 of the
Plan Document, and Section 3-10.
Caution: Safe Harbor Contributions must be 100% Vested at all times. (select one)
(a)
(b)
Not applicable. There are no Profit Sharing Contributions subject to a Vesting Schedule.
100% Vested at all times upon entering the Plan. (Required if participation requirement
is greater than one Year of Service.)
Vesting of Profit Sharing Contributions shall be determined according to the following
schedule:
(c)
(1)
Three Year Cliff Vesting Schedule
0-2 years
0%
3 years
(3)
32610S-PS
(2)
100%
Four Year Graded Vesting Schedule
1 year
25%
2 years
50%
3 years
75%
4 years
100%
17
Five Year Cliff Vesting Schedule
0-4 years
0%
5 years
(4)
100%
Five Year Graded Vesting Schedule
1 year
20%
2 years
40%
3 years
60%
4 years
80%
5 years
100%
© Lincoln National Life Insurance Company 2002
(d)
(5)
Six Year Graded Vesting Schedule
2 years
20%
3 years
40%
4 years
60%
5 years
80%
6 years
100%
(7)
Other - Must be at least as liberal as either (2) or (6) above
YEARS
PERCENTAGE
Seven Year Graded Vesting Schedule
3 years
20%
4 years
40%
5 years
60%
6 years
80%
7 years
100%
For amended Plans and merged Plans (Section 10.06 of the Plan Document). If the Vesting
Schedule has been amended, enter the pre-amended Vesting Schedule below:
(1)
(2)
(3)
(4)
15-5
(6)
Not applicable. Vesting Schedule has not been amended or amended Vesting
Schedule is more favorable in all years.
YEARS
PERCENTAGE
Adoption date of amendment to Vesting Schedule:
/
/
.
The Vesting Schedule in Section (b) or (c) above shall apply to Employees hired
after
/
/
(date must be on or after adoption date of amendment).
Top Heavy Vesting (Section 7.04 of the Plan Document):
If this Plan becomes a Top Heavy Plan, the following Vesting Schedule, based on the number of Years of
Service (or Periods of Service if the elapsed time method is selected), for such Plan Year and each succeeding
Plan Year, whether or not the Plan is then a Top Heavy Plan, shall apply to Profit Sharing Contributions and
shall be treated as a Plan amendment pursuant to this Plan. Once effective, this Vesting Schedule shall also
apply to all contributions made before the Plan became a Top Heavy Plan.
(a)
Not applicable. The regular Vesting Schedules selected in Sections 15-3 above already
satisfy one of the minimum Top Heavy Vesting Schedules.
(b)
Vesting in the Employer Profit Sharing Contribution shall be determined according to the
following Vesting Schedule: (Select a Top Heavy Vesting Schedule only if the Vesting
Schedule selected in Section 15-3 above for Profit Sharing Contribution does not satisfy
one of the minimum Top Heavy Vesting Schedules.)
(1)
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100% Vested at all times:
18
© Lincoln National Life Insurance Company 2002
(2)
Six Year Graded Vesting Schedule:
0-1 year
0%
2 years
20%
3 years
40%
4 years
60%
5 years
80%
6 years
100%
(3)
Three Year Cliff Vesting Schedule:
0 - 2 years
0%
3 years
100%
(4)
(i)
(ii)
Other - Must be at least as liberal as either (2) or (3) above:
Applies to Profit Sharing Contribution.
Applies to Matching Contribution.
YEARS
PERCENTAGE
NOTE: This Section does not apply to the Participant Account balances of any Participant who does not
have an Hour of Service after the Plan has initially become Top Heavy. Such Participant’s Vested Account
balances attributable to Employer Contributions and Forfeitures will be determined without regard to this
Section.
32610S-PS
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© Lincoln National Life Insurance Company 2002
PART 16
RETIREMENT DATES
(See Article I of the Plan Document)
16-1
Normal Retirement Age (“NRA”) (Section 1.59 of the Plan Document) means:
(a)
(b)
(1)
(2)
16-2
The date of a Participant’s
birthday (not to exceed 65th).
The later of the date of a Participant’s
birthday (not to exceed 65th) or the:
(not to exceed 5th) anniversary of the first day of the Plan Year
in which participation in the Plan commenced.
(not to exceed 5th) anniversary of the first day the Participant
completed an Hour of Service with the Employer.
Normal Retirement Date (select one):
The Participant’s NRA (selected in Section 16-1 above).
(a)
OR
(select one):
(b)
(c)
(d)
16-3
The first day of the month on or next following the Participant’s NRA.
The first day of the Plan Year on or next following the Participant’s NRA.
Other
.
Caution: May not be later than Section (c) above.
Early Retirement Date (Section 1.20 of the Plan Document) (select one):
(a)
(b)
(c)
Not applicable. No Early Retirement Date. (Go to Part 17.)
First day of the month on or next following:
First day of the Plan Year on or next following:
The date on which the Participant (select one):
(1)
Attains age
.
(2)
Attains age
and completes at least
(or Periods of Service).
(3)
Attains age
and completes at least
Participant’s earliest entry date.
(d)
Years of Service from the
Early Retirement Benefit: Upon reaching Early Retirement Date, a Participant shall (select one):
(1)
(2)
32610S-PS
Vesting Years of Service.
Automatically become 100% Vested in all Participant Accounts.
Be entitled to the Vested portion of the Participant Account balances based on the
applicable Vesting Schedule(s) designated in Part 15 of this Adoption Agreement.
20
© Lincoln National Life Insurance Company 2002
PART 17
DISABILITY RETIREMENT BENEFIT
(See Articles I and X of the Plan Document)
17-1
Disability Retirement Benefit: In the event of Termination of Service with the Employer on account of
Disability, a Participant shall (select one):
(a)
(b)
17-2
Automatically become 100% Vested in all Participant Accounts.
Be entitled to the Vested portion of the Participant Account balances based on the
applicable Vesting Schedule(s) designated in Part 15 of this Adoption Agreement.
Disability Determination. Disability, as defined in Section 1.19 of the Plan Document, must result in
(select one):
(a)
(b)
(c)
(d)
32610S-PS
An inability to engage in any substantial gainful activity for which the Participant is
reasonably suited by reason of training, education and experience as determined by the Plan
Administrator. The Plan Administrator may require that the Participant be examined by
physician(s) selected by the Plan Administrator.
The Participant being entitled to Social Security Disability Benefits. In the event a
Participant has applied for Social Security Disability Benefits, the disability benefits
provided by this Plan shall commence upon qualifying for Social Security Disability
Benefits.
An inability to perform the normal duties for the Employer as determined by the Plan
Administrator. The Plan Administrator may require that the Participant be examined by
physician(s) selected by the Plan Administrator.
An inability to engage in any substantial gainful activity.
21
© Lincoln National Life Insurance Company 2002
PART 18
DISTRIBUTIONS
(See Articles X, XI and XII of the Plan Document)
18-1
Form Of Payment Of Benefits (Article XI of the Plan Document):
Distributions under the Plan may be made (select all that apply):
(a)
(b)
(c)
AND
(d)
(e)
(f)
In the form of a Lump Sum Distribution.
In substantially equal installments for a period elected by the Participant.
The period cannot exceed the life expectancy of the Participant.
Partial withdrawals provided the minimum withdrawal is $
.
No annuities are allowed (Section 11.02 of the Plan Document will apply and the Qualified
Joint and Survivor rules of Sections 11.03 and 11.04 of the Plan Document will not apply to
the Plan).
Annuities are the normal form of distribution [the Qualified Joint and Survivor rules of
Sections 11.03 and 11.04 of the Plan Document will automatically apply for Plans that do
not comply with the requirements of Code Section 401(a)(11)(B)(iii)].
Annuities are allowed but are not the normal form of distribution (Section 11.02 of the Plan
Document will apply and the joint and survivor rules of Code Sections 401(a)(11) and 417
will only apply under the circumstances described in Code Section 401(a)(11)(B)(iii), e.g.,
if an annuity form of distribution is selected by the Participant).
AND if Section (e) or (f) is selected, and if applicable, the normal form of the Qualified Joint and Survivor
Annuity will be:
(1)
Qualified Joint and 50% survivor annuity.
(2)
Joint and 66 2/3% survivor annuity.
(3)
Joint and 75% survivor annuity.
(4)
Joint and 100% survivor annuity.
NOTE: If this is an amendment to a Plan which required annuities as a form of distribution with respect to
any portion of the Plan’s assets (or if this Plan has accepted a Trustee to Trustee transfer of assets from a plan
which required annuities as a form of distribution) and the Qualified Joint and Survivor Annuity rules and
Qualified Pre-Retirement Survivor Annuity rules apply to this portion of assets, specify below the assets
subject to such rules.
18-2
Timing Of Distributions. Participant directed distributions of all Account balances upon Termination of
Service shall be made as soon as administratively feasible at the Participant’s election following (select one):
(a)
Termination of Service.
(b)
A period of
months following Termination of Service.
(c)
The end of the Plan Year on or following Termination of Service.
(d)
The end of the Plan Year during which a One-Year Break in Service occurs.
(e)
Earliest of: Early Retirement Date, Normal Retirement Age, death or Disability.
32610S-PS
22
© Lincoln National Life Insurance Company 2002
18-4
In-service Distributions (i.e., Prior To Termination of Service) (Section 10.07 of the Plan Document):
(a)
(b)
(1)
(2)
3)
(c)
In-service distributions may NOT be made. Do not complete the remaining
Sections 18-4 (b) through (e). Go to Part 19.
In-service distributions from the Accounts selected below may be made (select one):
For any reason.
ONLY for reasons of hardship.
The Plan shall use the following description of hardship (select one):
(i)
Safe harbor hardship (Subsection (a) of Section 10.08 of the Plan
Document).
(ii)
Facts and circumstances hardship (subsection (a) of Section 10.09 of the
Plan Document).
Other distribution limitation:
Minimum in-service distribution shall be $
(may not exceed $1,000).
Accounts Available For In-service Distributions:
(Select only those Accounts that are provided for under the Plan.)
(d)
Profit Sharing Account. In-service distributions may be made from the Participant’s Vested
Profit Sharing Account to a Participant who has not Terminated Service provided the
following conditions have been satisfied (select all that apply):
NOTE: Must select (1) and/or (2). May also select (3).
(1)
The Participant has attained age
.
(2)
The Participant has been a Participant in the Plan for at least five years or the
amounts being distributed have accumulated in the Plan for at least two years.
(3)
The Participant is 100% Vested in the Matching Account.
(e)
32610S-PS
Safe Harbor Accounts. In-service distributions may be made from the Safe Harbor Account
to a Participant who has not Terminated Service provided the Participant has attained age
(may not be less than 59½).
23
© Lincoln National Life Insurance Company 2002
PART 19
SPECIAL GUST TRANSITION ELECTIONS
The following questions only apply if this is a GUST Restatement (i.e., Section 2-9(d) is selected). If this is not a
GUST restatement, this Part 19 should not be completed, and this Plan will not be considered an individually designed
Plan merely because this Part 19 is deleted from the Adoption Agreement or left blank.
DO NOT COMPLETE THIS PART 19 UNLESS THIS DOCUMENT IS A GUST RESTATEMENT.
19-1
Family Aggregation Of Compensation:
The family aggregation rules of Code Section 401(a)(17) and Code Section 414(q)(6) [prior to the enactment
of Small Business Job Protection Act] to determine the amount of contributions allocated to a Participant
were not applied beginning with the following Plan Year:
(a)
1997
(b)
1998
(c)
1999
(d)
2000
(e)
2001
(f)
2002
NOTE: If family aggregation continued to apply after 1996, the Plan was not a safe harbor plan for Code
Section 401(a)(4) purposes, and may not rely on the opinion letter issued by the Internal Revenue Service that
this Plan was qualified under Code Section 401(a) for those Plan Years.
19-2
Safe Harbor Operational Compliance:
Check (a) and/or (b) below if, prior to the adoption of this Adoption Agreement, the Plan was operated in
accordance with Safe Harbor provisions and this Adoption Agreement is conforming the Plan to such
operational compliance for the period prior to the adoption of this Adoption Agreement:
(a)
(b)
19-6
Effective Date Of Safe Harbor Provisions: The Safe Harbor provisions are effective for the
Plan Year beginning
/
/
(may not be earlier than January 1, 1999).
Modifications: Describe each of the Safe Harbor provisions that were in operation prior to
the effective date of this Adoption Agreement, if such provisions were different from those
reflected in the elections made in Part 9, and provide the effective dates of those provisions:
Definition Of Highly Compensated Employee (Limit HCEs To Top-Paid Group):
For purposes of defining Highly Compensated Employees during the remedial amendment period, the
Employer elects to limit the number of HCEs to the Top-Paid Group (top 20%) of Employees as defined in
IRS Section 414(q) for the following Plan Years (this selection must be consistent for all Plans sponsored by
the Employer):
Plan Year
1997
N/A
Yes
No
And for all years following unless otherwise designated
in this Part until the GUST restatement date.
1998
And for all years following unless otherwise designated
in this Part until the GUST restatement date.
1999
And for all years following unless otherwise designated
in this Part until the GUST restatement date.
2000
And for all years following unless otherwise designated
in this Part until the GUST restatement date.
2001
And for all years following unless otherwise designated
in this Part until the GUST restatement date.
2002
And for all years following unless otherwise designated
in this Part until the GUST restatement date.
32610S-PS
24
© Lincoln National Life Insurance Company 2002
19-7
Involuntary Distributions:
Involuntary distributions of amounts less than $5,000 will be made in accordance with the provisions of
Section 11.01 of the Plan Document.
(a)
The increase in the involuntary amount threshold from $3,500 to $5,000 (or $
if less)
became effective with respect to distributions made on or after August 6, 1997, or if later
/
/
.
Not applicable - Plan did not make involuntary distributions or threshold amount was not
changed pursuant to the terms of the Plan.
(b)
19-9
Defined Benefit Annual Addition (see Section 8.02 of the Plan Document for some defined terms):
(a)
Not applicable. The Employer does not and has never maintained a defined benefit plan.
(b)
If, prior to the 2000 Plan Year, the Participant is or has ever been a participant in a defined
benefit plan maintained by the Employer, the contribution in this Plan was reduced as
follows:
In any Limitation Year, the Annual Additions credited to the Participant under this
Plan may not cause the sum of the Defined Benefit Fraction and the Defined
Contribution Fraction to exceed 1.0. If the Employer Contribution that would
otherwise be made on the Participant’s behalf during the Limitation Year would
cause the 1.0 limitation to be exceeded, the rate of contribution under this Plan will
be reduced so that the sum of the fractions equals 1.0. If the 1.0 limitation is
exceeded because of an Excess Amount, such Excess Amount will be reduced in
accordance with Section 8.03(f) of the Plan Document.
(1)
(2)
19-10
Provide below the method under which the Plan shall limit total Annual Additions
to the Maximum Permissible Amount and shall properly reduce any excess
amounts in a manner that precludes Employer discretion.
Required Minimum Distributions (See Section 12.02 of the Plan Document for some defined terms):
Prior to the adoption of this Adoption Agreement, for Participants (i) whose Required Beginning Date was
prior to January 1, 1997 (or enter date if later:
/
/
), (ii) who had not retired from the Employer, and
(iii) who were not Five Percent (5%) Owners:
(a)
Not applicable, the Employer is a government or church entity.
(b)
Participants were allowed to elect to stop or defer required minimum distributions until
actual retirement with the Employer or Affiliated Employer, or the year Participants
became Five Percent (5%) Owners.
(1)
(2)
(c)
32610S-PS
AND, if the Plan was subject to the Qualified Joint and Survivor Annuity rules, upon
commencement of distributions:
There will be a new Annuity Starting Date.
There will NOT be a new Annuity Starting Date.
Participants were required to continue to receive distributions according to the required
minimum distribution requirements in effect prior to January 1, 1997, pursuant to the Plan
Document.
25
© Lincoln National Life Insurance Company 2002
The adopting Employer may rely on an opinion letter issued by the Internal Revenue Service as evidence that the plan
is qualified under Code Section 401 except to the extent provided in Rev. Proc. 2000-20, 2000-6 I.R.B. 553 and
Announcement 2001-77, 2001-30 I.R.B.
An Employer who has ever maintained or who later adopts any plan (including a welfare benefit fund, as defined in
Code section 419(e), which provides post-retirement medical benefits allocated to separate accounts for key
employees, as defined in Code Section 419A(d)(3), or an individual medical account, as defined in Section 415(l)(2)
of the Code) in addition to this Plan may not rely on the opinion letter issued by the National Office of the Internal
Revenue Service as evidence with respect to the requirements of Code Sections 415 and 416 in addition to this Plan
(other than paired Plan #003 or #007).
If the Employer who adopts or maintains multiple plans wishes to obtain reliance with respect to the requirements of
Code Sections 415 and 416, application for a determination letter must be made to Employee Plans Determinations of
the Internal Revenue Service.
The Employer may not rely on the opinion letter in certain other circumstances, which are specified in the opinion
letter issued with respect to the plan or in Revenue Procedure 2000-20 and Announcement 2001-77.
This Adoption Agreement may be used only in conjunction with the Lincoln National Life Insurance Company
Defined Contribution Prototype Basic Plan Document and Trust #01.
The adoption of this Plan, its qualification by the IRS and the related tax consequences are the responsibility of the
Employer and its independent tax and legal advisors.
Provided the adoption of this Plan is properly registered with the prototype sponsor, the prototype sponsor shall inform
the adopting Employer of any amendments made to the Plan or of the discontinuance or abandonment of the Plan.
The adoption of the Plan is not properly registered unless the attached registration form fee is returned to:
Lincoln Retirement Financial Services
915 South Clinton Street
P.O. Box 2248
Ft. Wayne, IN 46801-2248
Furthermore, in order to be eligible to receive such notification, the adopting Employer agrees to notify the prototype
sponsor of any changes to its current mailing address, fax number, E-mail address and telephone number. The
Employer also agrees to provide the prototype sponsor written notification if it ceases to use this Prototype Plan.
Use of this Adoption Agreement and Plan Document requires the written consent of an authorized officer of Lincoln
Financial Group or use of a Lincoln Financial Group investment vehicle to fund the Plan.
Inquiries by adopting Employers regarding the adoption of this Plan, the intended meaning of any Plan provisions or
the effect of the Opinion Letter may be directed to the prototype sponsor at the above address or phone
1-800-248-0838.
32610S-PS
26
© Lincoln National Life Insurance Company 2002
Use of this Plan Document without proper registration constitutes an unauthorized use.
The Employer represents that it has consulted with its attorney with respect to its adoption of this Plan, and
agrees to the provisions of the Plan.
IN WITNESS HEREOF, the Employer has caused this Agreement to be signed by its duly authorized Officer and the
Trustee(s) has accepted the appointment and signed this Agreement, certifying acceptance of such appointment and
receipt of a copy of the Adoption Agreement and Plan Document.
(Legal Name of Employer)
By:
(Signature of Officer)
(Date)
(Typed or Printed Name
and Title of Officer)
Accepted By:
(Date)
(Signature of Trustee)
(Date)
(Signature of Trustee)
(Date)
(Signature of Trustee)
Participating Employer
Authorized Signature
Date
Execution of this Adoption Agreement may be made by Electronic Signature in a manner acceptable to the Prototype
Sponsor.
Failure to properly complete this Adoption Agreement may result in disqualification of the Plan.
32610S-PS
27
© Lincoln National Life Insurance Company 2002
REGISTRATION
OF
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY
STANDARDIZED
401(k) PROFIT SHARING PROTOTYPE PLAN AND TRUST
PLAN # 005 IRS SERIAL #K273888a
Plan Name:
(typed or printed name)
Employer:
(typed or printed name)
Address:
Telephone Number:
(
)
-
Fax Number:
(
)
-
E-Mail Address:
Employer Taxpayer Identification Number (“EIN”):
-
Use of this Adoption Agreement and Plan Document requires the use of a Lincoln Financial Group investment vehicle
to fund the Plan or written consent of an authorized officer of Lincoln Financial Group.
List all investment contracts and Plan numbers assigned by Lincoln Financial Group:
The Employer agrees to provide Lincoln Retirement Financial Services with any changes to its current mailing
address, fax number, E-mail address, and telephone number. The Employer also agrees to provide Lincoln Retirement
Financial Services with written notification if it ceases to use this Prototype Plan.
In consideration of the above, Lincoln Retirement Financial Services agrees to:
*
Provide the Employer with a copy of the current Lincoln National Life Insurance Company Defined
Contribution Prototype Basic Plan Document and Trust #01 and Adoption Agreement; (“Prototype Plan”);
*
Advise the Employer of any amendments made to the Prototype Plan by Lincoln Life;
*
Inform the Employer of any changes in the Prototype Plan’s qualified status; and
*
Inform the Employer of any discontinuance or abandonment of the Prototype Plan.
This registration does not affect the rights and obligations of Lincoln Retirement Financial Services or the Employer
under any other arrangement, including (but not limited to) Lincoln Retirement Financial Services’ right to charge a
fee for providing an updated Prototype Plan Document and/or Adoption Agreement.
Continued reliance by the Employer upon the Prototype Plan’s favorable Opinion Letter from the IRS is dependent
upon the Employer adopting the current version of the Prototype Plan Document.
Please sign and return this registration form to:
Lincoln Retirement Financial Services
Attention: Plan Document Management
915 South Clinton Street
P.O. Box 2248
Fort Wayne, IN 46801-2248
____________________________________________________________________________________
(Signature of Employer)
32610S-PS
(Title)
28
(Date)
© Lincoln National Life Insurance Company 2002