Rollover Contribution Form Instructions - Merrill

[Pages:4]Rollover Contribution Form Instructions

Dear Plan Participant

Thank you for choosing to roll your account balance into your company's retirement plan. To process your rollover quickly, you, your employer and Merrill Lynch must conform to certain rollover process rules dictated by the Internal Revenue Code (IRC). An acceptable Rollover application consists of three documents mailed to Merrill Lynch in one envelope. These documents are:

? The rollover contribution check ? Distribution qualification document(s) (see #3 below) ? Completed & signed KPMG 401(k) Plan Rollover Contribution Form

Follow these instructions and reduce the risk of delays:

1. Confirm with your current employer that you are eligible to make a rollover contribution into your retirement plan.

2. For a Direct Rollover, contact your former qualified plan, Roth 401(k) Plan, IRA administrator or conduit rollover IRA administrator and request a rollover distribution check made payable to KPMG 401(k) Plan, FBO (your name). Have this distribution check sent to your primary address, do not send directly to Merrill Lynch

? If you took a lump-sum distribution and now want to "roll" that money into your current retirement plan (In-Direct Rollover) you must create a certified check made payable to KPMG 401(k) Plan, FBO (your name). (Follow distribution qualification documents instructions under 3A Below)

3. Collect your distribution qualification documents. Qualification documents prove to Merrill Lynch and the IRS that the dollars are eligible for rollover.

A). If your rollover contribution comes from a qualified retirement plan or IRA include the following documents.

? Include a document (check stub) that shows that the source of the dollars are from an IRC qualified plan or IRA. (e.g. Pre-tax, Roth)

? A copy of your closing statement or a letter of distribution from your former qualified plan or IRA showing the dollars (distribution check) that were distributed.

? Documentation stating that your former plan is intended to be qualified. (e.g. IRS Determination Letter)

B). If rollover distribution is from a conduit IRA or rollover IRA, send copies of both the opening IRA statement showing the original deposit, and the closing IRA statement.

C). If your Direct Rollover is from a former employer's Roth 401(k) Plan, specify the year of your first Roth 401(k) contribution to that plan and provide documentation that reflects the break down of your total Roth 401(k) contributions and earnings that comprise your Direct Rollover.

4. The IRC requires that the rollover check be deposited at Merrill Lynch within 60 days from the day you receive your distribution check.

5. Complete and sign the KPMG 401(k) Plan Rollover Contribution Form. Make sure you select investments.

If you do not follow these instructions your rollover will be delayed. If you have concerns call the KPMG 401(k) Call Center at 1.888.401.KPMG between 7:00 a.m. - 8:00 p.m. Eastern any day that the New York Stock Exchange is open.

KPMG 401(k) Plan #609255

Rollover Contribution Form

Please use this form to make a rollover contribution to your KPMG 401(k) Plan account from a qualified retirement plan, IRA or a conduit IRA, and to indicate how you want the rollover invested. Read the instructions below before you complete the form.

? Complete Sections 1 through 5.

? Sign and date the completed form.

? Keep a copy of the completed form for your records.

? Include a check payable to the "KPMG 401(k) Plan, FBO (your name)" (see section 3).

? Return this completed form with distribution qualification document(s) from the qualified plan or IRA and, if applicable, opening and closing statements from your conduit IRA to: Merrill Lynch, Retirement and Benefit Plan Services, 1400 American Boulevard, NJ2-140-03-50, Pennington, NJ 08534

1. Participant Identification

Please Print

Social Security Number

Name: _______________________________________________________________________________________________________________

Last

First

Middle Initial

Day Time Phone Number

2. 401(k) Participant (Check one of the items below)

Evening Phone Number

I am currently enrolled in the 401(k) Plan. I am eligible to participate in the 401(k) Plan, but have not yet enrolled. I wish to make a rollover contribution but not ongoing 401(k) contributions at this time.

3. Rollover Contribution (Check one of the items below)

I am making a direct rollover from a qualified retirement plan or IRA. A direct rollover is a payment made directly from a qualified

retirement plan or IRA that is made payable to the " KPMG 401(k) Plan, FBO (your name)".

I am making a direct rollover from a conduit IRA. The IRA was established for the sole purpose of preserving the tax-deferred

status of a distribution from a qualified retirement plan, and no IRA contributions were ever made to this account.

I am making an indirect rollover of pre-tax dollars via a certified/cashier's check equal to or less than the amount that was

distributed to me within the past 60 days from a qualified retirement plan, IRA or a conduit IRA.

I am making a Direct Rollover from a previous employer's Roth 401(k) Plan. I have specified the year of my first Roth 401(k)

contribution to that Plan and have attached documentation that reflects a breakdown of my total Roth 401(k) contributions and earnings that comprise my Direct Rollover.

20_____ (YYYY)

$

Please fill in the total dollar amount of your Rollover.

Attach distribution qualification document(s) from the qualified or IRA plan and, if applicable, opening and closing statements from your conduit or rollover IRA.

Continued

4. Investment Election (Check one of the items below)

I am currently enrolled in the 401(k). Please invest my rollover according to my current investment direction. I want to invest my rollover according to the election indicated below. I understand that the percentages must be in 1% increments and must total

100%. A description of investment choices are available on Benefits OnLine at benefits.. If no election is made, my rollover will be invested in the Personal Manager within Advice Access fund that most closely corresponds to my 65th birthday.

American Funds EuroPacific Growth Fund Class R6 _______ % American Funds Growth Fund of America Class R6 _______ %

Artisan Mid Cap Fund Institutional Class _______ % Artisan Mid Cap Value Fund Investor Class _______ % BlackRock Extended Equity Market Fund Class K _______ %

BlackRock FedFund Class Institutional _______ % BlackRock MSCI ACWI ex-US Index NL Fund Class M _______ %

Dodge & Cox International Stock Fund _______ % Goldman Sachs Emerging Markets Equity Fund _______ %

Goldman Sachs High Yield Fund Class I _______ % Hotchkis & Wiley Small Cap Value Fund Class I _______ % John Hancock Global Absolute Return Strategy Fund Class I ______ %

MFS Emerging Markets Debt Fund Class R6 _______ % MFS Value Fund Class R6 _______ %

Morgan Stanley Instl Fund, Inc. Global Real Estate Class I _______ % Retirement Bank Account3 _______ %

SSGA US Treasury Inflation Protected Securities Index Fund _____ % Templeton Global Total Return Fund Class R6 _______ % Vanguard EE Benefit Index Fund _______ % Vanguard Explorer Fund Admiral Class _______ %

Vanguard Intermediate Term Treasury Fund Admiral Class _______ % Vanguard REIT Index Fund Institutional Class _______ %

Vanguard Short-Term Bond Index Fund Institutional Class _______ % Vanguard Total Bond Market Index Fund Inst Plus _______ %

Total of all Investment Elections Must Equal 100%

Please carefully check the confirmation you'll be receiving in the mail to make sure your investment instructions have been implemented properly.

This form is updated periodically. For the most current listing of funds available in your plan, please log on to benefits..

Investing in mutual funds, which are intended as long-term investments, involves risk, including the possible loss of principal. Investments in foreign securities or sector funds, including technology or real estate stocks, are subject to substantial volatility due to adverse political, economic or other developments and may carry additional risk resulting from lack of industry diversification. Funds that invest in small- or mid-capitalization companies experience a greater degree of market volatility than those of large-capitalization stocks and are riskier investments. Bond funds have the same interest rate, inflation, and credit risks associated with the underlying bonds owned by the fund. Generally, the value of bond funds rises when prevailing interest rates fall and falls when interest rates rise. Investing in lower-grade debt securities ("junk" bonds) may be subject to greater market fluctuations and risk of loss of income and principal than securities in higher rated categories. There are ongoing fees and expenses associated with owning mutual funds. Bear in mind that higher return potential is accompanied by higher risk.

Investors should consider the investment objectives, risks, charges and expenses of investment options carefully before investing. This, and additional information about the investment options, can be found in the prospectuses and, if available, the summary prospectuses which can be obtained on Benefits OnLine at benefits. or by calling Merrill Lynch at 1.888.401.KPMG. Investors should read the prospectuses and, if available, the summary prospectuses carefully before investing.

1 This investment option is not a mutual fund, registered under the Investment Company Act of 1940. A prospectus is not available and shares are not publicly traded or listed on exchanges.

? Although the Fund seeks to preserve the value of your investment at $1.00 per share, It is possible to lose money by investing in the Fund. The Fund is neither insured nor guaranteed by the Federal Deposit Insurance Corporation or any other government agency.

? The Retirement Bank Account ("RBA") is an FDIC-insured, interest-bearing, money market bank deposit account. The objective of the RBA is to seek to provide a rate of interest determined at the discretion of the Depository Institution in a deposit account insured by the Federal Deposit Insurance Corporation (FDIC) up to $250,000 per plan participant, per ownership category, per depository institution. The RBA may be appropriate for the participants looking for the safety of a bank guarantee and FDIC insurance. For further details about RBA and FDIC, you may log-in to Benefits OnLine at benefits. or call the Retirement & Benefits Contact Center at 1.888.401.KPMG to speak to a Participant Service Representative.

5. Employee Certification

I certify that this rollover consists of a distribution either from a qualified retirement plan, or from a conduit IRA that was established exclusively to preserve the tax-deferred status of a distribution from a qualified retirement plan. I also certify that I have read the prospectus of the 401(k) plan and have been advised to consult a tax specialist about the eligibility of this rollover.

Participant's Signature ____________________________________________________________ Date ____________________ Merrill Lynch Use Only

Plan # ______________________

Date Received _______________________________

Rev ________________________

Employee: Please make a copy of this form for yourself, then return the original with all supporting documentation to: Merrill Lynch

Retirement and Benefit Plan Services 1400 American Boulevard Mail-Stop NJ2-140-03-50 Pennington, NJ 08534

Merrill Lynch makes available products and services offered by Merrill Lynch, Pierce, Fenner & Smith Incorporated (MLPF&S) and other subsidiaries of Bank of America Corporation (BofA Corp). MLPF&S is a registered brokerdealer, Member SIPC and a wholly owned subsidiary of BofA Corp.

Investment Products:

Are Not FDIC Insured

Are Not Bank Guaranteed

May Lose Value

?2016 Bank of America Corporation. All rights reserved.

609255rol12/21/16aj

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