Fidelity Investments Minimum Required Distribution Form ...

Fidelity Investments

Minimum Required Distribution Form The Nazarene 403(b) Retirement Savings Plan

Plan #72185

What are Minimum Required Distributions? Minimum Required Distributions (MRDs) are legally mandated withdrawals from tax-advantaged retirement plans, including 403(b) and qualified plans. IRS regulations specify when the required distributions must begin and how amounts must be calculated in an effort to provide retirement income over the life expectancies of participants or their beneficiaries. In general, you must begin receiving minimum distributions by April 1 following the later of (1) the year in which you reach age 70? or (2) the year in which you retire from service from the employer maintaining the Plan.

STEP 1 Choose one of the three services in Section 1 1. Calculate MRD only (complete Sections 2, 3, 4, and 9). 2. Calculate MRD and distribute payment (complete all sections). 3.Distribute payment only (no calculation required). (Complete all sections except Section 4. In Section 5, only complete Method D.)

When you select this method, Fidelity will not verify that the MRD payment is the minimum required by law.

STEP 2 Set up one of four methods of distribution payment in Section 5 (if applicable)

Method A: Year(s) for Which You Are Requesting an MRD Check any that apply and provide any required information. Method B: Systematic Withdrawal Plan (SWP) Check the desired frequency for your distribution and the date that you would like this to begin on. Method C: Fidelity Income Annuity (Annuity IRA) Enclose all completed annuity paperwork. Since 100% of your account will be used to purchase the annuity, you may not elect to exclude an amount equal to your December 31, 1986, account balance from the annuity purchase. Note: Distributions under Method C are not eligible for Minister's Housing Allowance under current tax law. Method D: Single Payment Check Method D and indicate the amount of the single payment. NOTE: Fidelity will not verify that the MRD payment is the minimum required by law.

STEP 3 Set up a delivery method in Section 6; complete Section 7 if applicable.

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STEP 4

In Sections 8 and 9, sign and date the form.

Return the completed form to:

Pensions and Benefits USA Church of The Nazarene

17001 Prairie Star Parkway Lenexa, KS 66220 Fax 1-800-334-0634

Questions Call an MRD Specialist toll free at 1-866-NAZARENE (629-2736), Monday through Friday, from 7 a.m. to 11 p.m. Central time.

Remember

?If this is not your first MRD, you must receive your annual MRD by December 31. In order to meet the December 31 deadline for receiving MRDs, we must receive your distribution request in writing by December 1.

?If you are delaying receiving your first MRD to April 1, we must receive your distribution request in writing by March 1 and you will be required to take your next MRD by December 31 of the same year.

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Fidelity Investments

Minimum Required Distribution Form The Nazarene 403(b) Retirement Savings Plan

Plan #72185

Questions? Call Fidelity Investments toll free at 1-866-NAZARENE (629-2736), Monday through Friday, from 7 a.m. to 11 p.m. Central time.

1. SERVICE REQUESTED

Please choose only one: Calculate MRD only (complete Sections 2, 3, 4, and 9) Calculate MRD and Distribute payment (complete all Sections) Distribute payment only (no calculation required). (Complete all Sections except Section 4. In Section 5, only complete Method D.)

2. GENERAL INFORMATION

Please use a black pen and print clearly in CAPITAL LETTERS.

A. Participant Information

Social Security #:

Plan #: 7 2 1 8 5

Date of Birth:

Spouse's Date of Birth:

First Name:

M.I. Last Name:

Street Address:

City:

State:

ZIP:

Daytime Phone:

Evening Phone:

E-mail:

3. HOUSING ALLOWANCE DESIGNATION FOR MINISTERS

Distributions under Method C of Section 5 are not currently eligible for a Minister's Housing Allowance.

I certify that I am a minister in the Church of the Nazarene who qualifies for tax-exempt Minister's Housing Allowance. I wish to have 100% of my Nazarene 403(b) Retirement Savings Plan withdrawal designated as Housing Allowance for retirement housing purposes.

Note: Minister's Housing Allowance withdrawals will be coded as "taxable amounts not determined" on IRS Form 1099-R. It is the Minister's responsibility to meet the IRS Guidelines on the amount of Housing Allowance that can be considered tax-exempt.

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4. CALCULATION OF MINIMUM REQUIRED DISTRIBUTION A. Method of Payment

Unless you check one of the boxes below, your minimum required distribution (MRD) payment will be calculated using the Uniform Lifetime Table, which provides a distribution factor based on your age for the applicable calendar year. If you check one of the boxes below, you must provide your spouse's date of birth in Section 2 of this form. Your MRD payment will be calculated using the Joint Life Expectancy Table, which provides a distribution factor based on the joint life expectancy for you and your spouse for the applicable calendar year.

My exclusive primary beneficiary is my spouse and my spouse is more than 10 years younger than I. My spouse will be my sole beneficiary at all times during the distribution calendar year. My exclusive primary beneficiary is an irrevocable look-through trust and my spouse is the 100% primary beneficiary of the trust while alive and my spouse is more than 10 years younger than I. You must provide Fidelity Investments with a trust certification that your spouse is the 100% primary beneficiary of the irrevocable look-through trust. (NOTE: Fidelity Investments may require a copy of the entire trust document.) B. To be completed by Participants Under Age 75 Participants who are under age 75 may exclude from their MRD calculation any amounts accumulated in the Nazarene 403(b) Retirement Savings Plan as of December 31, 1986. If you are eligible, and if account balances as of December 31, 1986, were accounted for separately, please indicate below if you want your entire Plan balance to be included in your MRD calculation or if you want to exclude your adjusted December 31, 1986, balance. Any amounts taken from this account other than MRD payments, must reduce your December 31, 1986, 403(b) balance. This amount is called your adjusted December 31, 1986, balance. I am under age 75 as of December 31 of the calendar year in which I am taking an MRD from my post-December 31, 1986, balance and request that Fidelity Investments (check one): Use my entire 403(b) Plan balance, including amounts accrued prior to December 31, 1986. Exclude my adjusted December 31, 1986, 403(b) Plan balance of $ __________________________. If you have transferred assets from another 403(b) custodian to Fidelity Investments since 1986 and you want Fidelity Investments to account for the 12/31/86 balance, you must include a letter or a copy of a statement from the previous custodian showing the 12/31/86 balance attributable to the account transferred.

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5. METHOD OF DISTRIBUTION PAYMENT

Your minimum required distribution (MRD) will be taken proportionately over all available investment options. Please choose the method of distribution in which you would like to receive your MRD payments (check one):

M ethod A: Year(s) for which You are Requesting an MRD (check any that apply and provide any required information):

This year (Distribution will be paid immediately upon approval of your request.)

This year AND future years (Complete Method B below.)

Deferred MRD from last calendar year (Applies ONLY if you have not taken the MRD[s] for an earlier year[s]. Distribution will be paid immediately upon approval of your request.)

Missed MRD from more than one year ago: (Do NOT combine with deferred MRD from last calendar year. Applies ONLY if you have not taken the MRD[s] for an earlier year[s]. Distribution will be paid immediately upon approval of your request.)

Missed years:

Method B: Systematic Withdrawal Payment Frequency (check one):

Monthly

Quarterly

Annually

Systematic Withdrawal Beginning Date:

Method C: Fidelity Income Annuity (Annuity IRA)

P lease enclose all completed annuity paperwork.

I would like to purchase a joint and 60% survivor annuity for my entire account balance. Since 100% of your account will be used to purchase the annuity, you may not elect to exclude an amount equal to your December 31, 1986, account balance from the annuity purchase. Note: Distributions paid under Method C are not eligible for a Minister's Housing Allowance under current tax law.

Method D: Single Payment

Please indicate single payment amount: $

,

.

D istribution amounts in excess of your MRD must be made under separate request. Please call a Fidelity Retirement Services

Specialist to obtain the appropriate distribution form.

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