Hardship Withdrawal Information Trust HCS 401(k) Plan

Trust HCS 401(k) Plan (2062)

Hardship Withdrawal Information

Information: The attached application is used to apply for a hardship distribution from your account under Trust HCS 401(k) Plan. However, to be considered eligible for a Hardship Withdrawal, certain criteria must be met:

For a financial obligation to be considered a hardship and thus qualify for a distribution, you or your Beneficiary must have an immediate and heavy financial need. The need must be substantial when considered in the context of your compensation level and personal financial statement.

The amount of the hardship distribution may not exceed the amount needed to meet the immediate financial needs of you or your Beneficiary.

You must demonstrate that you have no other funds reasonably available to you from other resources to meet your financial need, including loans available to you from your employer's plan(s).

The amount of the hardship withdrawal may not exceed the amount of money you would be entitled to if you were to terminate employment on the date of withdrawal.

The situation or event which has caused the hardship must be recognized by your plan as an allowable reason for a hardship distribution.

The financial obligation which is causing the hardship must not be covered by insurance or be eligible for other reimbursement. The financial obligation must be incurred by you personally, your Beneficiary, or by a person who is recognized as your

dependent by the Plan. Elective deferrals made to the Plan are available for hardship withdrawal, as well as any earnings on elective deferral

contributions credited prior to 1989. Please refer to your Summary Plan Description for other types of contributions that may be available for hardship withdrawal.

Prior to approving a Hardship Withdrawal Request, the Plan Administrator must assess if your situation meets the rules and regulations set forth by the IRS and is consistent with the limits that are set forth by your Plan. The Plan Administrator may also take into account your individual and family income, assets and obligations, as well as other factors that the Plan Administrator considers relevant and appropriate.

Withholding: Hardship withdrawals are subject to ordinary income tax and to an additional 10% premature distribution penalty tax if you are

under age 59?. Hardship withdrawals, as a non-eligible rollover and a non-periodic distribution, are also subject to an automatic withholding of

10%. Any payee who receives a distribution in the United States that is not an eligible rollover distribution may elect out of

withholding. Refer to IRS Form W-4P for additional information.

Supporting Documentation: The following are the most common reasons for Hardship Withdrawals, and the types of documentation that are required to support the Hardship Withdrawal Request:

? Uninsured Medical Expenses ? Attach bills from hospitals, physicians, therapists, pharmacies, dentists, ophthalmologists, extended care facilities, etc.

? Purchase of a Principal Residence ? Attach agreements of sale, itemized estimated closing costs, and estimated proceeds expected from disposal of current residence.

? Preventing Eviction from your Home ? Attach eviction notice.

? Post-secondary Education Expenses ? Attach a letter of acceptance to the educational institution, tuition bill or receipt, student housing statements, laboratory fee receipts or statements, and bills or statements regarding purchase of books. Note any student assistance such as scholarships, fellowships and student loans that are anticipated or have been received.

? Funeral Expenses ? Attach copies of bills showing that you are the responsible party for payment, a statement indicating the amount of life insurance coverage carried by the deceased, and a copy of the death certificate.

? Repair of Principal Residence ? Attach insurance loss appraisal, a list of all insurance coverage available to you, and all claims appraisals.

Hardship Withdrawal Request

Trust HCS 401(k) Plan (2062)

Instructions: All sections of this form need to be completed before you return this application to the Benefits Office at Trust Healthcare Consulting Services, LLC dba Trust HCS. You may need to provide documentary evidence of hardship for approval of this request. If you are married, you must obtain spousal consent to take the hardship withdrawal. Your spouse's signature must be witnessed by the plan representative or be notarized. You will need to certify your marital status.

1. Employee Information

Name:

Social Security Number:_________?______?________

Mailing Address:

City:

State:

Zip Code:

Date of Birth: _____/_____/_____

2. Hardship Request Hardship Withdrawal Amount: $__________________ (Note if request is more than available hardship amount the maximum amount available will be distributed)

This withdrawal is requested on my behalf. This withdrawal is requested on behalf of my Beneficiary. Purpose for the Withdrawal: (Please provide verifying documentation) Purchase of a primary residence for myself (excluding mortgage payments). Payment of medical expenses not covered by insurance for myself, my spouse, my dependents, or those of my Beneficiary. Payment of tuition and related educational fees for the next 12 months of post-secondary education for myself, my spouse, my dependents, or my Beneficiary. Payment of mortgage or rent to prevent eviction from or the foreclosure of the mortgage on my principal residence. Payment for burial or funeral expenses of my or my Beneficiary's deceased parent, spouse, child, or dependent. Payment of expenses for the repair of damage to my principal residence that would qualify for a casualty deduction under Section 165 of the Internal Revenue Code (such as those resulting from hurricane or flood damage.)

3. Employee Acknowledgement and Certification I am not requesting more than is necessary to meet my or my Beneficiary's financial emergency, and I cannot meet the emergency through any other sources. Hardship withdrawals are subject to ordinary income tax and to an additional 10% premature distribution penalty tax if you are under age 59?. Hardship withdrawals, as a non-eligible rollover and a non-periodic distribution, are also subject to an automatic withholding of 10%. Any payee who receives a distribution in the United States that is not an eligible rollover distribution may elect out of withholding. Refer to Form W-4P for additional information.

I hereby certify that: I am not currently married and further certify to Trust Healthcare Consulting Services, LLC dba Trust HCS under penalties of perjury that there are no Plan benefits due a former spouse under a Qualified Domestic Relations Order ("QDRO").

I hereby certify that: I am legally married. I have completed and attached a Spousal Consent to Hardship Distribution.

I hereby certify that my spouse cannot be located.

Date

Signature of Employee

For Use by Trust Healthcare Consulting Services, LLC dba Trust HCS Only

The participant's request and supporting documentation have been received, reviewed, and approved by Trust Healthcare Consulting Services, LLC dba Trust HCS.

Date

Signature of Authorized Plan Representative or Trustee

Spousal Consent to Hardship Distribution

Trust HCS 401(k) Plan (2062)

Instructions: If you are married, this form needs to be completed by you and your spouse. Your spouse's consent to your receiving a hardship distribution must be witnessed by either the Plan Representative or by a Notary Public.

1. Employee Information Name:

Social Security Number:_________?______?________

Mailing Address:

City:

State:

Zip Code:

Date of Birth: _____/_____/_____

2. Spousal Consent I certify that I am the spouse of the participant named above and I have read and understand the form as completed and signed by my spouse. I hereby consent to, acquiesce in, and understand the effect of my consent to my spouse receiving a hardship distribution will be to reduce the benefits I would be entitled to receive upon by spouse's death.

Date

Signature of Spouse

STATE OF COUNTY OF

Acknowledgement of Witness:

On __________________________ before me, _____________________________________, personally appeared

(insert name and title of the officer)

_______________________________________________, who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of ________________________________ that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

Signature ___________________________________

Seal

Trust HCS 401(k) Plan (2062)

Special Distribution Payment Request (Optional Form)

Instructions

Only complete this form if you would like the proceeds from your distribution to be sent via overnight check delivery or via wire transfer to your bank account. Select one of the options below and sign under the Consent Agreement prior to returning the completed form to the Benefits Office at Trust Healthcare Consulting Services, LLC dba Trust HCS with your distribution request. If this form is not completed, you will receive a check for the amount of your distribution via U.S. Mail.

1. Employee Information Name: Mailing Address: City: Phone Number:

State:

Social Security Number: _________?______?________

Zip Code: Email Address:

Date of Birth: _____/_____/_____

2. Overnight Check Delivery Instructions

Please pay the proceeds of my distribution via check and send via overnight delivery to the address indicated on the Distribution Request Form.

By signing under the Consent Agreement section below, I acknowledge that there will be a $25 fee associated with this process and authorize the fee to be deducted from the proceeds of my distribution prior to the check being sent out. I further understand that the address provided on the Distribution Request Form cannot be a P.O. Box.

3. Wire Instructions

Please wire the proceeds of my distribution to my bank account. I understand that ALL requested items need to be completed in their entirety in order to wire transfer the proceeds and that there will be an additional $50 wire redirect fee taken from the proceeds of the distribution if the wire transfer is rejected by the receiving bank.

Bank Name:

Incoming Bank Routing Number (ABA#): Please confirm the ABA number with your bank. Some banks have different ABA numbers for incoming and outgoing wires.

Participant's Bank Account Name: Please use Name of Account Holder on the account. For example: "John Smith or John and Jane Smith"

Participant's Account Number:

4. Consent Agreement By signing below, I hereby authorize the special distribution delivery instructions indicated above and their associated fees.

Date

Signature of Employee

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