Distribution election

For use with Contract termination If you have questions or need assistance completing this form, call the Lincoln Customer Contact Center at
initiated by Lincoln for: 1-866-521-5382 or contact your retirement plan representative. Please ensure you sign in Section 6.
• Multi-Fund® Group variable annuity
• Lincoln Group Variable Annuity
• New York and Non-NY versions 1 Tell us about yourself.
Is this the correct form?
This form can be used for: I am the: (choose one) Participant Beneficiary
• General distributions
• Rollovers Contract/account number (refer to your statement) Plan ID (refer to your statement)
• Plan-to-plan transfers 891701+009 2175
• Contract exchanges
If you wish to convert to periodic Plan sponsor/employer name
annuity payments over time, please
call 866-521-5382.
Incomplete information will cause
processing delays. Please submit all Name (first, MI, last, suffix) SSN
pages of this form.
- -
If you need assistance completing
this form, please reference the How to Mailing address (street address is required) Date of birth (mm/dd/yyyy)
complete this form section on page 6.
/ /
Beneficiary: If the City State Zip Mobile
participant is deceased,
please complete this
entire section with the personal - -
information of the beneficiary.
Change my address on record as indicated
This is a temporary address to be used for this check only
Email Phone

Marital status: Please - -

provide your marital status Marital status
in order to ensure timely
processing of your distribution. I do not have a living spouse.
I have a living spouse.

Choose the distribution reasons that apply. (Not required for Transfers/Exchanges.)
For Qualified Domestic
Relations Orders: A copy The distribution options below may not be available in your plan or may have additional restrictions.
of the court order, divorce,
or legal separation is required. CURRENT EMPLOYEE FORMER OR NON-EMPLOYEE
If you are totally and permanently Qualified Domestic Relations Order No longer working for the employer that
disabled: A letter from the Social administers this plan
Security Administration or Plan Total and permanent disability
Administrator is required. Date of severance (mm/dd/yyyy)
Age 59½ or older
/ /
Death
Qualified Domestic Relations Order
Total and permanent disability

Continue to the next page for additional information.

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RPS06904-MF11 (01/25) Affiliates are separately responsible for their own financial and contractual obligations. Page 1 of 6
Distribution election
FOR DIRECT DEPOSIT
If your bank account
2 Which distribution option would you like?
information is illegible or
incomplete, Lincoln will issue a check The total amount you receive may be less than the amount requested, depending on your tax withholding.
and mail to your address on file. Please
note: We cannot direct deposit to If this is a 403(b) plan, Lincoln will distribute your RMD before processing a rollover unless you check this box: I will be taking
reloadable bank cards. or have taken my RMD from another financial institution to satisfy my RMD for this 403(b) plan for the year in which this form was
If you direct deposit to a signed.
checking account: A voided If you are the participant (but not a beneficiary) and have Roth money, it will not be included in the RMD calculation (or payments)
check or a verification of for 2024 and later years.
deposit from your financial institution
Send me a cash payment of 100% of my available account balance. (Complete Step 3, Section A.)
is required.
If you direct deposit to a savings Rollover/Exchange/Transfer 100% of my available account balance as indicated in Step 3.
account: A verification of deposit from
your financial institution is required. Send me a partial cash payment in the amount of $ and Rollover/Exchange/Transfer the
FOR ROLLOVER remainder of my account as indicated in Step 3. (Complete Step 3, Section A and B.)
RMD: Lincoln is required
to distribute your required
minimum distribution (RMD) before
processing a rollover unless you opt out 3 How would you like to receive your payment?
by selecting the box in Step 2.
RMD Age: Your RMD Age is 70½ if
you were born before July 1, 1949, 72 I would like my payment to be sent as a (choose one)
if you were born after June 30, 1949
and before 1951, 73 if you were born A. Direct deposit to my personal bank account as described here:
between 1951 and 1959, or 75 if you Select this box if this is a savings account:
were born in 1960 or later.
If you have Roth and/or after tax Name as it appears on your account Bank transit/ABA number (9-digits)
money, please verify that your receiving
company will accept your rollover.
When requesting a rollover of pre-tax
money to a Roth IRA you will still be Financial institution Account number
liable for payment of federal and state
income tax, if applicable, at the time
you prepare your personal tax filing. You
may wish to discuss your personal tax Check, mailed to my address on file.
liability with a qualified tax advisor.
Receiving company information: If Rollover to another company as described below.
your receiving company information is (Complete the rollover information below)
incomplete or inaccurate, we will issue If you have after tax contributions and you elect a rollover, Lincoln will automatically include your after
the check to the receiving company,
but mail it to your address. You will be tax contributions unless you tell us otherwise by checking this box. Do not include my after tax
responsible for mailing the check to contributions in this rollover. (Your after-tax contribution amount will be sent as a check to your address on file.)
the receiving company to complete the
rollover. Contract exchange
If you are a non-spouse beneficiary of Type of receiving plan: 403(b) 403(b) ORP Roth 403(b)
the participant and you want to roll over
a portion or all of your benefit you must Plan-to-plan transfer
roll the funds into an Inherited IRA.
Type of receiving plan: 403(b) 403(b) ORP Roth 403(b)
Rollover: Generally a rollover is used
when moving assets to a different Transfer
employer’s program and/or changing
market/plan types. Type of receiving plan: 401(a) 401(k) 457(b) governmental
Contract exchange: The transfer of
one 403(b) contract to another 403(b) B. If you elected a Rollover/Exchange/Transfer above, complete the receiving company information in this
contract under the same plan. A section.
distributable event is not required. Receiving company name (payable to) Contract number
Any contract exchange requires
evidence that the recipient investment/
contract provider is approved by
the plan sponsor to permit such an Street address
exchange.
Plan-to-plan transfer: A transfer that
moves assets from one 403(b) plan City State Zip
to another 403(b) plan. A distributable
event is not required.
Transfer: A transfer is used to change
investment carriers with the same plan Type of receiving plan:
type, but assets remain in the same 403(b) 403(b) ORP 401(a) 401(a) ORP 401(k)
employer’s plan. A distributable event is
not required. 457(b) governmental IRA Roth 403(b) Roth 401(k) Roth 457(b) governmental
Roth IRA: If requesting a rollover of Inherited IRA (non-spousal beneficiary only)
pretax accounts to a Roth IRA, Section 5
must be completed. Public safety employee’s direct payment for insurance Roth IRA

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Distribution election
4 Do you have a loan that impacts your distribution?

Do you have a loan on this contract? Yes No

If you have an active loan balance, you may (choose one)
Leave loan(s) with Lincoln
Close the active loan and withdraw the balance from the account
(an eligible distribution reason must be indicated in Section 1.)

If no selection is made, the loan will remain active.

y If you withdraw the balance of an active loan, see Section 5:

y If you have a defaulted loan, the loan balance will be deducted automatically from your account balance
once you’ve satisfied an eligible reason for distribution.

y Please note some plans restrict the availability of funds beyond a distribution event.

y If one or more of your active loan balances will be withdrawn from your account balance, the amount
will be reported to the IRS as a taxable event on Form 1099-R for the year of the distribution.

Tax withholding: Withholding

will only apply to the taxable
5 How do taxes impact your distribution?
portion of any amount paid
to you in cash. If you elect to rollover No taxes will be withheld from amounts paid in a direct rollover.
your entire distribution, no federal tax
withholding is required. Lincoln will withhold taxes from the taxable amount of the distribution that is paid to you in cash. If
Important:
applicable, Lincoln will apply the rates detailed below and will automatically send the withholdings
• For pre-tax amounts that are directly to the IRS and/or state on your behalf. For more information on federal tax withholdings, please refer
rolled over to a Roth IRA (a Roth to the Special Tax Notice included with this form and the IRS Form W-4R, Withholding Certificate for
rollover conversion), mandatory Nonperiodic Payments and Eligible Rollover Distributions (IRS Form W-4R).
withholding is not required, but the
amounts converted from pre-tax will y Federal tax (if applicable)
be included in your taxable income. Your withholding options are based on whether your distribution is considered an eligible rollover
• If you have too little tax withheld, distribution.1
you will generally owe tax when
you file your tax return and may y For amounts that are eligible for rollover, the withholding options are as follows:
owe a penalty unless you make Apply the mandatory federal tax withholding rate of 20%.
timely payments of estimated tax.
If too much tax is withheld, you will I am enclosing an IRS Form W-4R to elect a federal tax withholding rate of more than 20% (you
generally be due a refund when you may not elect a lower rate or opt out).
file your tax return.
y For amounts that are not eligible for rollover, the withholding options are as follows:
• The amount of your distribution that
is not rolled over may be subject to Apply the voluntary default federal tax withholding rate of 10%.
an additional 10% early distribution
penalty tax. This penalty tax will
Do not withhold federal income tax.*
be assessed when you file your I am enclosing an IRS Form W-4R to elect another federal tax withholding rate.*
tax return and is not automatically
included in your tax withholding for *You cannot choose less than 10% for payments to be delivered outside the United States and its
this distribution. possessions.
IRS Form W-4R: This form If you have an outstanding loan and you are electing a total distribution of your non-loan balance,
can be found by searching your loan will offset. To the extent that the offset results in taxable income, this amount will be added
on the IRS website to the taxable amount of your cash distribution when determining the federal income tax that is
www.irs.gov for W-4R. withheld.
If no option is selected on this
form, and you do not submit a
1
Eligible rollover distribution is a distribution other than: a hardship; a required minimum distribution
valid IRS Form W-4R with your (RMD); or a series of periodic payments expected to be paid over at least 10 years or over your life/life
distribution form, Lincoln will expectancy or joint life/life expectancies of you and your beneficiary.
apply the default withholding y State tax (if applicable)
percentage from your payment.
Please consult your tax advisor with
State tax is automatically calculated and based on your residence on file.
any questions on making your tax Check this box if you are attaching your state’s applicable withholding certificate to make an
withholding election. alternative election.

Continue to the next page for additional information.

PAD-7468835-122324
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Distribution election
6 Sign and date this form.
By signing below, I certify that:
y I have read and understand the Important Information section and the Important Fraud Notice (RPS33692)
included with this form.
Did you know?
y I have received the Special Tax Notice (RPS33691), and if applicable, I waive the required 30-day notice
If you move this year: Please update period before receiving my distribution.
your address to receive your tax
documents for use when you file your y I am responsible for meeting the federal tax law requirements to qualify for this distribution.
income taxes. y My answers on this form and any documents I have attached are true and accurate.
To update your address: If you are an y If there are not enough funds in my retirement account for the amount requested, Lincoln will process
active employee, contact your employer;
if you are no longer employed, call
the withdrawal from the amount available.
Lincoln. y If applicable to this plan, I have received the Qualified Joint and Survivor Annuity (QJSA) notice; waive the
30 day review period and normal QJSA form of payment; and instead; elect to receive this distribution
as detailed on this form.
y If I am a New York resident, I understand that any person who knowingly and with intent to defraud any
insurance company or other person files an application for insurance or statement of claim containing
any materially false information, or conceals for the purpose of misleading, information concerning any
fact material thereto, commits a fraudulent insurance act, which is a crime and shall also be subject to
civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

Please ensure you have

signed this form, otherwise Your signature (Please sign with a pen. We cannot accept electronic signatures.) Today’s date (mm/dd/yyyy)
this form will be incomplete.
/ /

7 Your spouse’s signature may be required.

In some instances, your spouse may be required to sign this form. Please contact Lincoln to determine
if this is required for your plan. This section is not needed for distributions due to Qualified Domestic
Relations Order.
By signing below, I certify that I am the spouse of the individual named above and that:
y If applicable to this plan, I have received the QJSA notice, consent to my spouse’s election to waive the
normal QJSA form of payment, and consent to my spouse’s election to an immediate distribution as
detailed on this form.
Spouse’s signature (if required) Today’s date (mm/dd/yyyy)

/ /
Plan administrator’s signature or notary’s signature Today’s date (mm/dd/yyyy)
If spousal consent is
required and your plan
administrator does not sign / /
here as a witness to your spouse’s Notary seal/stamp Notary’s commission expires (mm/dd/yyyy)
signature, you must have a notary
sign, seal, and date where noted to
the right. / /

Continue to the next page for additional instructions.

PAD-7468835-122324
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Distribution election
Return all documents to:
Did you remember to: EMAIL MAIL EXPRESS MAIL
Obtain the plan administrator MultiFundForms@LFG.com Lincoln Financial Group Lincoln Financial Group
signature, if required? (Accepted format: .pdf, .tif, .png) P.O. Box 2340 1301 S. Harrison Street
Print, sign and date this form? Fort Wayne, IN 46801-2340 Fort Wayne, IN 46802-3506
FAX
Attach any necessary Lincoln Financial Group
documents?
260-455-9411
If faxing, include both the front
and back of ALL pages of the What you can expect:
form? y Log in to your account at LincolnFinancial.com to verify when funds are removed from your
Questions? retirement account.
VISIT y For ACH deposits, it takes up to two business days to see your payment posted to your bank account
LincolnFinancial.com or once the funds have left your retirement account.
CALL y For checks, your payment will arrive depending on the United States Postal Service delivery schedule.
1-866-521-5382, This generally takes 2-5 business days once the funds have left your retirement account.
M - F, 8 am - 6 pm ET

Plan administrator/trustee/third party administrator (TPA) use only.

Complete the following information:

y Participant’s date of hire (mm/dd/yyyy) / /

y Participant’s date of severance/retirement (mm/dd/yyyy) / /

y Years of service

y Is the participant 100% vested? Yes No

This employee is a long-term part-time employee. Vesting has been calculated in accordance
with the long-term part-time vesting rules.

If “no” indicate the percentage of the employer funds available for distribution
If “no” non-vested moneys will be deposited into the plan’s forfeiture account.

Forfeiture account
If the plan’s forfeiture account is not with Lincoln, please provide the vendor mailing instructions/
account # below.

ERISA plans
By signing here, you certify that the employee’s request for distribution is authorized by the plan
administrator and is in compliance with all provisions of your plan. If authorizing a transfer, non-vested
monies will be transferred unless otherwise directed.

Non-ERISA plans or ERISA plans with contracts excluded under Field Assistance Bulletins 2009-02 and
2010-01
By signing this form, you, the plan administrator are not approving this request; rather, you are
acknowledging that the employee information supplied is accurate to the best of your knowledge and the
request is in compliance with all provisions of your plan document.
Plan administrator/trustee/TPA’s name

Plan administrator/trustee/TPA’s signature Today’s date (mm/dd/yyyy)

/ /

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Distribution election
How to complete this form:
y If requesting a rollover, complete all sections except Section 5.
y If requesting a contract exchange, complete all sections except Section 5.
IMPORTANT INFORMATION
Multi-Fund® variable annuities (contract
y If requesting a plan-to-plan transfer, complete all sections except Section 5
number 28883 and state variations) y If requesting a transfer, complete all sections except Section 5
are issued by The Lincoln National Life
y If your contract is subject to ERISA, please have your plan sponsor (employer) complete Plan
Insurance Company, Fort Wayne, IN,
and distributed by Lincoln Financial
administrative/trustee/third party administrator (TPA) use only section.
Distributors, Inc., a broker-dealer. y If your contract is not subject to ERISA, or if ERISA contracts are excluded under Field Assistance
Contractual obligations are subject to Bulletins 2009-02 and 2010-01, please have your plan sponsor (employer) complete Plan administrator/
the claims-paying ability of The Lincoln trustee/third party administrator (TPA) use only section, page 5. For questions regarding ERISA
National Life Insurance Company. contracts excluded under FAB 2009-02 and FAB 2010-01, please contact your employer.
Product and features subject to state y If your plan requires spousal consent, your spouse must sign Section 7.
availability. Limitations and exclusions
may apply. y If this request is for a death claim, additional information is required. Please contact your
representative or the Customer Contact Center at 866-521-5382, Monday through Friday, from 8:00
For Non-NY contracts: Lincoln Group
Variable Annuity (contract numbers a.m. to 8:00 p.m. Eastern.
GAC96-101 and GAC96-103-VAR, and y When requesting overnight delivery service and providing a billing account for carrier, you must
state variations) is issued by The Lincoln specify a valid billing name and billing address of this account. If information provided is not a valid
National Life Insurance Company, Fort match, your distribution will be sent via standard mail service.
Wayne, IN, and distributed by Lincoln
Financial Distributors, Inc., a broker-dealer. y Please ensure you have signed this form in Section 6, otherwise this form will be incomplete.
The Lincoln National Life Insurance
Company does not solicit business in the
state of New York, nor is it authorized to
do so. Contractual obligations are subject
to the claims-paying ability of The Lincoln
National Life Insurance Company.
Product and features subject to state
availability. Limitations and exclusions
may apply.
For NY contracts: Lincoln Life Group
Variable Annuity, a group variable annuity
contract, is issued on contract form
numbers GAC91-101NY, GAC95-111NY,
GAC96-101NY, GAC96-103NY by Lincoln
Life & Annuity Company of New York,
Syracuse, NY, and distributed by Lincoln
Financial Distributors, Inc., Radnor, PA,
a broker-dealer. Contractual obligations
are subject to the claims-paying ability of
Lincoln Life & Annuity Company of New
York. Limitations and exclusions may
apply.
The Lincoln National Life Insurance
Company or Lincoln Life & Annuity
Company of New York may act as the
administrative agent for First UNUM
Life Insurance Company and UNUM Life
Insurance Co. of America.
Your employer may restrict the availability
of some investment options. The
investment return and principal value of
an investment will fluctuate so that when
withdrawn from the contract it may be
worth more or less than the original cost.
Lincoln Financial Group® affiliates, their
affiliated distributors, and their respective
employees, representatives, and/or
insurance agents do not provide tax,
accounting, or legal advice. Clients should
consult their own independent financial
professional as to any tax, accounting
or legal statements made herein. We
recommend that you consult a tax advisor
regarding the distribution rules as they
pertain to your personal circumstances.

PAD-7468835-122324
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 Important fraud notice
Residents of all states except Alabama, Arkansas, California, for insurance is guilty of a crime and may be subject to fines and
Colorado, District of Columbia, Florida, Kansas, Kentucky, Louisiana, confinement in prison.
Maine, Maryland, New Jersey, New Mexico, New York, Ohio, For New Jersey residents only: Any person who includes any false
Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Vermont, or misleading information on an application for an insurance policy is
Virginia and Washington, please note: Any person who knowingly, subject to criminal and civil penalties.
and with intent to defraud any insurance company or other person, For New Mexico residents only: Any person who knowingly presents
files or submits an application or statement of claim containing any a false or fraudulent claim for payment of a loss or benefit or knowingly
materially false or deceptive information, or conceals, for the purpose presents false information in an application for insurance is guilty of a
of misleading, information concerning any fact material thereto, crime and may be subject to civil fines and criminal penalties.
commits a fraudulent insurance act, which is a crime and may subject For New York residents only: Any person who knowingly and with intent
such person to criminal and civil penalties. to defraud any insurance company or other person files an application
For Alabama residents only: Any person who knowingly presents for insurance or statement of claim containing any materially false
a false or fraudulent claim for payment of a loss or benefit or who information, or conceals for the purpose of misleading, information
knowingly presents false information in an application for insurance is concerning any fact material thereto, commits a fraudulent insurance
guilty of a crime and may be subject to restitution fines or confinement act, which is a crime and shall also be subject to civil penalty not to
in prison, or any combination thereof. exceed five thousand dollars and the stated value of the claim for each
For Arkansas, Louisiana, and Rhode Island residents only: Any person such violation.
who knowingly presents a false or fraudulent claim for payment of a For Ohio residents only: Any person who, with intent to defraud or
loss or benefit or knowingly presents false information in an application knowing that he is facilitating a fraud against an insurer, submits an
for insurance is guilty of a crime and may be subject to fines and application or files a claim containing a false or deceptive statement is
confinement in prison. guilty of insurance fraud.
For California residents only: Any person who knowingly presents For Oklahoma residents only: WARNING: Any person who knowingly,
false or fraudulent information to obtain or amend insurance coverage and with intent to injure, defraud or deceive any insurer, makes any claim
or to make a claim for the payment of a loss is guilty of a crime and may for the proceeds of an insurance policy containing any false, incomplete
be subject to fines and confinement in state prison. or misleading information is guilty of a felony.
For Colorado, Kentucky, Maine, and Tennessee residents only: Any For Oregon residents only: Any person who knowingly, and with intent
person who, knowingly and with intent to injure, defraud or deceive any to defraud any insurance company or other person, files or submits
insurance company or other person, files an application for insurance an application or statement of claim containing any materially false
or statement of claim containing any materially false information or or deceptive information, or conceals, for the purpose of misleading,
conceals for the purpose of misleading, information concerning any information concerning any fact material thereto, may commit a
fact material thereto commits a fraudulent insurance act, which is a fraudulent insurance act, which may be a crime and may be subject
crime and may subject such person to criminal and civil penalties, fines, such person to criminal and civil penalties.
imprisonment, or a denial of insurance benefits. For Pennsylvania residents only: Any person who knowingly and
For District of Columbia residents only: WARNING: it is a crime to with intent to defraud any insurance company or other person files
provide false or misleading information to an insurer for the purpose an application for insurance or statement of claim containing any
of defrauding the insurer or any other person. Penalties include materially false information or conceals for the purpose of misleading,
imprisonment and/or fines. In addition, an insurer may deny insurance information concerning any fact material thereto commits a fraudulent
benefits if false information materially related to a claim was provided insurance act, which is a crime and subjects such person to criminal
by the applicant. and civil penalties.
For Florida residents only: Any person who knowingly and with intent For Vermont residents only: Any person who knowingly presents
to injure, defraud, or deceive any insurer files a statement of claim or an a false statement in an application for insurance may be guilty of a
application containing any false, incomplete, or misleading information criminal offense and subject to penalties under state law.
is guilty of a felony of the third degree. For Virginia residents only: Any person who, with the intent to defraud
For Kansas residents only: Any person who knowingly, and with intent or knowing that he is facilitating a fraud against an insurer, submits an
to defraud any insurance company or other person, files or submits application or files a claim containing a false or deceptive statement
an application or statement of claim containing any materially false may have violated the state law.
or deceptive information, or conceals, for the purpose of misleading, For Washington residents only: It is a crime to knowingly provide false,
information concerning any fact material thereto, may be guilty of fraud incomplete, or misleading information to an insurance company for the
as determined by a court of law. purpose of defrauding the company. Penalties include imprisonment,
For Maryland residents only: Any person who knowingly or willfully fines, and denial of insurance benefits.
presents a false or fraudulent claim for payment of a loss or benefit or
who knowingly or willfully presents false information in an application

Affiliates of Lincoln National Corporation include, but are not limited to, The Lincoln National Life Insurance Company,
Lincoln Life & Annuity Company of New York, Lincoln Retirement Services Company, LLC, Lincoln Financial Group Trust
Company, LLC, Lincoln Financial Distributors, Inc., and Lincoln Variable Insurance Products Trust, herein separately and
collectively referred to as “Lincoln.”
PAD-7265092-110524 01/25 Lincoln Financial is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately
RPS33692 responsible for their own financial and contractual obligations.
 Special tax notice regarding plan payment from
non-Roth and designated Roth accounts
Your rollover options If the payment from the Plan is a qualified distribution, you will not be
taxed on any part of the payment even if you do not do a rollover. If you
You are receiving this notice because all or a portion of a payment you
do a rollover, you will not be taxed on the amount you roll over and any
are receiving from an employer-sponsored retirement plan (“Plan”) may
earnings on the amount you roll over will not be taxed if paid later in a
be eligible to be rolled over to an IRA, an employer plan, or Roth IRA.
qualified distribution.
This notice is intended to help you decide whether to do such a rollover.
A qualified distribution from a designated Roth account in the Plan is a
This notice describes the rollover rules that apply to payments that are
payment made after you are age 59½ (or after your death or disability)
from a “designated Roth account” (an account for after-tax, Roth elective
and after you have had a designated Roth account in the Plan for at
deferral contributions), and employer or matching contributions that
least 5 years. In applying the 5-year rule, you count from January 1 of the
may be treated as Roth contributions and payments from a “non-Roth
year your first contribution was made to the designated Roth account.
account” (generally an account with pre-tax employee and employer
However, if you did a direct rollover to a designated Roth account in the
contributions). If you are only receiving a payment from one of these
Plan from a designated Roth account in another employer plan, your
types of accounts, you need only read the sections of this notice that
participation will count from January 1 of the year your first contribution
apply to that type of account. If you are receiving payments from both
was made to the designated Roth account in the Plan or, if earlier, to the
types of accounts, you should read the entire notice. In addition, the
designated Roth account in the other employer plan.
Plan administrator or payor will tell you the amount that is being paid
from each account if you are receiving payments from both types of What types of retirement accounts and plans may accept
accounts. my rollover?
Rules that apply to most payments from a plan are described in the
Non-Roth account
“General Information About Rollovers” section. Special rules that only
You may roll over the payment to either an IRA (an individual retirement
apply in certain circumstances are described in the “Special Rules and
account or individual retirement annuity) or an employer plan (a tax-
Options” section.
qualified plan, section 403(b) plan, or governmental section 457(b)
General information about rollovers plan) that will accept the rollover. The rules of the IRA or employer plan
that holds the rollover will determine your investment options, fees, and
How can a rollover affect my taxes? rights to payment from the IRA or employer plan (for example, IRAs are
Non-Roth account not subject to spousal consent rules, and IRAs may not provide loans).
Further, the amount rolled over will become subject to the tax rules that
You will be taxed on a payment from a non-Roth account under the
apply to the IRA or employer plan.
Plan if you do not roll it over. If you are under age 59½ and do not do a
rollover, you will also have to pay a 10% additional income tax on early Designated Roth account
distributions (generally distributions made before age 59½), unless an
You may roll over the payment from a designated Roth account to
exception applies. However, if you do a rollover, you will not have to pay
either a Roth IRA (a Roth individual retirement account or Roth individual
tax until you receive payments later and the 10% additional income tax
retirement annuity) or a designated Roth account in an employer
will not apply if those payments are made after you are age 59½ (or if
plan (a tax-qualified plan, section 403(b) plan or governmental 457(b)
an exception to the 10% additional income tax applies).
plan) that will accept the rollover. The rules of the Roth IRA or employer
Designated Roth account plan that holds the rollover will determine your investment options, fees,
and rights to payment from the Roth IRA or employer plan (for example,
After-tax contributions included in a payment from a designated Roth
Roth IRAs are not subject to spousal consent rules, and Roth IRAs may
account are not taxed, but earnings might be taxed. The tax treatment
not provide loans). Further, the amount rolled over will become subject
of earnings included in the payment depends on whether the payment
to the tax rules that apply to the Roth IRA or the designated Roth
is a qualified distribution. If a payment is only part of your designated
account in the employer plan. In general, these tax rules are similar to
Roth account, the payment will include an allocable portion of the
those described elsewhere in this notice, but differences include:
earnings in your designated Roth account.
y If you do a rollover to a Roth IRA, all of your Roth IRAs will be
If the payment from the Plan is not a qualified distribution and you
considered for purposes of determining whether you have
do not do a rollover to a Roth IRA or a designated Roth account in an
satisfied the 5-year rule (counting from January 1 of the year for
employer plan, you will be taxed on the portion of the payment that is
which your first contribution was made to any of your Roth IRAs).
earnings. If you are under age 59½, a 10% additional income tax on the
y If you do a rollover to a Roth IRA (or, beginning January 1, 2024,
early distributions (generally distributions made before age 59 ½) will
rollover to a designated Roth account in an employer plan), you
also apply to the earnings (unless an exception applies). However, if you
will not be required to take a distribution from the Roth IRA (or
do a rollover, you will not have to pay taxes currently on the earnings
designated Roth account in an employer plan, beginning January
and you will not have to pay taxes later on payments that are qualified
1, 2024) during your lifetime and you must keep track of the
distributions.
aggregate amount of the after-tax contributions in all of your Roth

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RPS33691 (10/23) Affiliates are separately responsible for their own financial and contractual obligations. Page 1 of 8
Special tax notice regarding plan payment from non-Roth and designated
Roth accounts
IRAs (and designated Roth account in each employer plan) in order How much may I roll over?
to determine your taxable income for later Roth IRA distributions The following rules are the same for both non-Roth and designated
(and distributions from a designated Roth account in an employer Roth accounts.
plan) that are not qualified distributions.
y Eligible rollover distributions from a Roth IRA can only be rolled If you wish to do a rollover, you may roll over all or part of the amount
over to another Roth IRA. eligible for rollover. Any payment from the Plan is eligible for rollover,
except:
How do I do a rollover? y Certain payments spread over a period of at least 10 years
There are two ways to do a rollover. You can either do a direct rollover or over your life or life expectancy (or the joint lives or joint life
or a 60-day rollover. expectancies of you and your beneficiary)
y Required minimum distributions after age 70½ (if you were born
Non-Roth account
before July 1, 1949), after age 72 (if you were born after June 30,
If you do a direct rollover, the Plan will make the payment directly to 1949 , and before January 1, 1951), after age 73 (if you were born
your IRA or an employer plan. You should contact the IRA sponsor or after December 31, 1950) or after death
the administrator of the employer plan for information on how to do a y Hardship distributions
direct rollover. y Payments of employee stock ownership plan (ESOP) dividends
If you do not do a direct rollover, you may still do a rollover by making a y Corrective distributions of contributions that exceed tax law
deposit into an IRA or eligible employer plan that will accept it. Generally, limitations
you will have 60 days after you receive the payment to make the deposit. y Loans treated as deemed distributions (for example, loans in
If you do not do a direct rollover, the Plan is required to withhold 20% default due to missed payments before your employment ends)
of the payment for federal income taxes (up to the amount of cash and y Cost of life insurance paid by the Plan
property received other than employer stock). This means that, in order y Payments of certain automatic enrollment contributions that you
to roll over the entire payment in a 60-day rollover, you must use other request to withdraw within 90 days of your first contribution
funds to make up for the 20% withheld. If you do not roll over the entire y Amounts treated as distributed because of a prohibited allocation
amount of the payment, the portion not rolled over will be taxed and will of S corporation stock under an ESOP (also, there generally will
be subject to the 10% additional income tax on early distributions if you be adverse tax consequences if you roll over a distribution of S
are under age 59½ (unless an exception applies). corporation stock to an IRA)
y Distributions of certain premiums for health and accident
Designated Roth account insurance.
If you do a direct rollover, the Plan will make the payment directly to your The Plan administrator or the payor can tell you what portion of a
Roth IRA or designated Roth account in an employer plan. You should payment is eligible for rollover.
contact the Roth IRA sponsor or the administrator of the employer plan
for information on how to do a direct rollover. If I don’t do a rollover, will I have to pay the 10% additional
If you do not do a direct rollover, you may still do a rollover by making a
income tax on early distributions?
deposit (generally within 60 days) into a Roth IRA, whether the payment Non-Roth account
is a qualified or nonqualified distribution. In addition, you can do a rollover If you are under age 59½, you will have to pay the 10% additional income
by making a deposit within 60 days into a designated Roth account in tax on early distributions for any payment from the Plan (including
an employer plan if the payment is a nonqualified distribution and the amounts withheld for income tax) that you do not roll over, unless one
rollover does not exceed the amount of the earnings in the payment. of the exceptions listed below applies. This tax applies to the part of the
You cannot do a 60-day rollover to an employer plan of any part of a distribution that you must include in income and is in addition to the
qualified distribution. If you receive a distribution that is a nonqualified regular income tax on the payment not rolled over.
distribution and you do not roll over an amount at least equal to the
earnings allocable to the distribution, you will be taxed on the amount Designated Roth account
of those earnings not rolled over, including the 10% additional income If the payment is not a qualified distribution and you are under age 59½,
tax on early distributions if you are under age 59½ (unless an exception you will have to pay the 10% additional income tax on early distributions
applies). with respect to the earnings allocated to the payment that you do not
If you do a direct rollover of only a portion of the amount paid from the roll over (including amounts withheld for income tax), unless one of the
Plan and a portion is paid to you at the same time, the portion directly exceptions listed below applies. This tax is in addition to the regular
rolled over consists first of earnings. income tax on the earnings not rolled over.

If you do not do a direct rollover and the payment is not a qualified Both Non-Roth accounts and designated Roth accounts
distribution, the Plan is required to withhold 20% of the earnings for The 10% additional income tax does not apply to the following payments
federal income taxes (up to the amount of cash and property received from the Plan:
other than employer stock). This means that, in order to roll over the
y Payments made after you separate from service if you will be at
entire payment in a 60-day rollover to a Roth IRA, you must use other
least age 55 in the year of the separation
funds to make up for the 20% withheld.

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Special tax notice regarding plan payment from non-Roth and designated
Roth accounts
y Payments that start after you separate from service if paid at least income tax for early distributions from an IRA are the same as the
annually in equal or close to equal amounts over your life or life exceptions listed above for early distributions from a plan. However,
expectancy (or the joint lives or joint life expectancies of you and there are a few differences for payments from an IRA including:
your beneficiary) y The exceptions for payments made after you separate from
y Payments from a governmental retirement plan made after you service if you will be at least age 55 in the year of separation (or
separate from service if you are a qualified public safety employee age 50 or following 25 years of service for qualified public safety
and you (1) will be at least age 50 in the year of the separation employees and employees providing firefighting services) do not
or (2) have at least 25 years of service under the plan. The term apply.
“qualified public safety employee” generally means public safety y The exception for qualified domestic relations orders (QDROs)
employees of a state, political subdivision of a state; and specified does not apply (although a special rule applies under which, as
federal law enforcement officers, federal customs and border part of a divorce or separation agreement, a tax-free transfer may
protection officers, federal firefighters and air traffic controllers be made directly to an IRA of a spouse or former spouse).
y Payments from a tax-qualified plan or section 403(b) plan made y The exception for payments made at least annually in equal or
after you separate from service if you are an employee who close to equal amounts over a specified period applies without
provides firefighting services and you (1) will be at least age 50 regard to whether you have had a separation from service.
in the year of separation or (2) have at least 25 years of service
Additional exceptions apply for payments from an IRA, including:
under the plan.
y Payments made due to disability y Payments for qualified higher education expenses
y Payments made while you are terminally ill y Payments up to $10,000 used in a qualified first-time home
y Payments after your death purchase
y Payments of ESOP dividends y Payments for health insurance premiums after you have received
y Corrective distributions of contributions that exceed tax law unemployment compensation for 12 consecutive weeks (or would
limitations have been eligible to receive unemployment compensation but for
y Cost of life insurance paid by the Plan self- employed status).
y Payments made directly to the government to satisfy a federal tax Designated Roth account
levy If you receive a payment from a Roth IRA when you are under age 59½,
y Payments made under a qualified domestic relations order (QDRO) you will have to pay the 10% additional income tax on early distributions
y Payments of up to $5,000 made to you from a defined contribution on the earnings paid from the Roth IRA, unless an exception applies or
plan if the payment is a qualified birth or adoption distribution the payment is a qualified distribution. In general, the exceptions to the
y Payments up to the amount of your deductible medical expenses 10% additional income tax for early distributions from a Roth IRA listed
(without regard to whether you itemize deductions for the taxable above are the same as the exceptions for early distributions from a
year) plan. However, there are a few differences for payments from a Roth
y Certain payments made while you are on active duty if you were IRA, including:
a member of a reserve component called to duty after September
y The exceptions for payments made after you separate from
11, 2001 for more than 179 days
service if you will be at least age 55 in the year of separation (or
y Payments of certain automatic enrollment contributions that you
age 50 or following 25 years of service for qualified public safety
request to withdraw within 90 days of your first contribution
employees and employees providing firefighting services) do not
y Payments of up to $22,000 made in connection with federally
apply.
declared disasters
y The exceptions for qualified domestic relations orders (QDROs)
y Phased retirement payments made to federal employees (non-
does not apply (although a special rule applies under which, as
Roth)
part of a divorce or separation agreement, a tax-free transfer may
y Certain payments if you are a domestic abuse victim (beginning
be made directly to a Roth IRA of a spouse or former spouse).
January 1, 2024)
y The exception for payments made at least annually in equal or
y Payments related to personal or family emergency expenses
close to equal amounts over a specified period applies without
(beginning January 1, 2024)
regard to whether you have had a separation from service.
If I do a rollover to an IRA (or Roth IRA for payments from Additional exceptions apply for payments from an IRA, including:
a designated Roth account) will the 10% additional income y Payments for qualified higher education expenses
tax apply to early distributions from the IRA? y Payments up to $10,000 used in a qualified first-time home
Non-Roth account purchase
If you receive a payment from an IRA when you are under age 59½, you y Payments for health insurance premiums after you have received
will have to pay the 10% additional income tax on early distributions unemployment compensation for 12 consecutive weeks (or would
on the part of the distribution that you must include income, unless have been eligible to receive unemployment compensation but for
an exception applies. In general, the exceptions to the 10% additional self- employed status).
y Payments of net income attributable to an excess IRA contribution

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Special tax notice regarding plan payment from non-Roth and designated
Roth accounts
made in a calendar year where such amounts are distributed by extraordinary circumstances, such as when external events prevented
tax return deadline for the year (including extensions) and no you from completing the rollover by the 60-day rollover deadline. Under
deduction is allowed for the excess contribution. certain circumstances, you may claim eligibility for a waiver of the 60-
day rollover deadline by making a written self-certification. Otherwise,
Will I owe State income taxes? to apply for a waiver, you must file a private letter ruling request
This notice does not address any State or local income tax rules with the IRS. Private letter ruling requests require the payment of a
(including withholding rules). nonrefundable user fee. For more information, see IRS Publication 590-
A, Contributions to Individual Retirement Arrangements (IRAs).
Special rules and options If your payment includes employer stock that you do not
If your payment includes after-tax contributions roll over
After-tax contributions included in a payment are not taxed. If you Non-Roth account
receive a partial payment of your total benefit, an allocable portion of
If you do not do a rollover, you can apply a special rule to payments of
your after-tax contributions is included in the payment, so you cannot
employer stock (or other employer securities) that are either attributable
take a payment of only after-tax contributions. However, if you have
to after-tax contributions or paid in a lump sum after separation from
pre-1987 after-tax contributions maintained in a separate account, a
service (or after age 59½, disability, or the participant’s death). Under
special rule may apply to determine whether the after-tax contributions
the special rule, the net unrealized appreciation on the stock will not be
are included in a payment. In addition, special rules apply when you do
taxed when distributed from the Plan and will be taxed at capital gain
a rollover, as described below.
rates when you sell the stock. Net unrealized appreciation is generally
You may roll over to an IRA a payment that includes after-tax the increase in the value of employer stock after it was acquired by the
contributions through either a direct rollover or a 60-day rollover. You Plan. If you do a rollover from a payment that includes employer stock
must keep track of the aggregate amount of the after-tax contributions (for example, by selling the stock and rolling over the proceeds within
in all of your IRAs (in order to determine your taxable income for later 60 days of the payment), the special rule relating to the distributed
payments from the IRAs). If you do a direct rollover of only a portion of employer stock will not apply to any subsequent payments from the IRA
the amount paid from the Plan and at the same time the rest is paid or, generally, the Plan. The Plan administrator can tell you the amount of
to you, the portion rolled over consists first of the amount that would any net unrealized appreciation.
be taxable if not rolled over. For example, assume you are receiving a
distribution of $12,000, of which $2,000 is after-tax contributions. In Designated Roth account
this case, if you directly roll over $10,000 to an IRA that is not a Roth If you receive a payment that is not a qualified distribution and you do
IRA, no amount is taxable because the $2,000 amount not directly rolled not roll it over, you can apply a special rule to payments of employer
over is treated as being after-tax contributions. If you do a direct rollover stock (or other employer securities) that are paid in a lump sum after
of the entire amount paid from the Plan to two or more destinations at separation from service (or after age 59½, disability, or the participant’s
the same time, you can choose which destination receives the after-tax death). Under the special rule, the net unrealized appreciation on the
contributions. stock included in the earnings in the payment will not be taxed when
distributed to you from the Plan and will be taxed at capital gain rates
Similarly, if you do a 60-day rollover to an IRA of only a portion of a
when you sell the stock. If you do a rollover to a Roth IRA for a nonqualified
payment made to you, the portion rolled over consists first of the
distribution that includes employer stock (for example, by selling the
amount that would be taxable if not rolled over. For example, assume
stock and rolling over the proceeds within 60 days of the distribution),
you are receiving a distribution of $12,000, of which $2,000 is after-tax
you will not have any taxable income and the special rule relating to the
contributions, and no part of the distribution is directly rolled over. In
distributed employer stock will not apply to any subsequent payments
this case, if you roll over $10,000 to an IRA that is not a Roth IRA in a
from the Roth IRA or, generally, the Plan. Net unrealized appreciation
60-day rollover, no amount is taxable because the $2,000 amount not
is generally the increase in the value of the employer stock after it was
rolled over is treated as being after- tax contributions.
acquired by the Plan. The Plan administrator can tell you the amount of
You may roll over to an employer plan all of a payment that includes any net unrealized appreciation.
after-tax contributions, but only through a direct rollover (and only if
If you receive a payment that is a qualified distribution that includes
the receiving plan separately accounts for after-tax contributions
employer stock and you do not roll it over, your basis in the stock (used
and is not a governmental section 457(b) plan). You can do a 60- day
to determine gain or loss when you later sell the stock) will equal the
rollover to an employer plan of part of a payment that includes after-tax
fair market value of the stock at the time of the payment from the Plan.
contributions, but only up to the amount of the payment that would be
taxable if not rolled over. If you have an outstanding loan that is being offset
If you miss the 60-day rollover deadline Non-Roth account
Generally, the 60-day rollover deadline cannot be extended. However, If you have an outstanding loan from the Plan, your Plan benefit may
the IRS has the limited authority to waive the deadline under certain be offset by the outstanding amount of the loan, typically when your

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Special tax notice regarding plan payment from non-Roth and designated
Roth accounts
employment ends. The offset amount is treated as a distribution to you described elsewhere in this notice generally apply, allowing you to roll
at the time of the offset. Generally, you may roll over all or any portion over the payment to an IRA or an employer plan that accepts rollovers.
of the offset amount. Any offset amount that is not rolled over will be One difference is that, if you do not do a rollover, you will not have to
taxed (including the 10% additional income tax on early distributions, pay the 10% additional income tax on early distributions from the Plan
unless an exception applies). You may roll over offset amounts to an even if you are under age 59½ (unless the payment is from a separate
IRA or an employer plan (if the terms of the employer plan permit the account holding rollover contributions that were made to the Plan from
plan to receive plan loan offset rollovers). a tax-qualified plan, a section 403(b) plan, or an IRA). However, if you do
a rollover to an IRA or to an employer plan that is not a governmental
How long you have to complete the rollover depends on what kind of
section 457(b) plan, a later distribution made before age 59½ will be
plan loan offset you have. If you have a qualified plan loan offset, you
subject to the 10% additional income tax on early distributions (unless
will have until your tax return due date (including extensions) for the
an exception applies). Other differences include that you cannot do a
tax year during which the offset occurs to complete your rollover. A
rollover if the payment is due to an “unforeseeable emergency” and the
qualified plan loan offset occurs when a plan loan in good standing is
special rules under “If your payment includes employer stock that you
offset because your employer plan terminates, or because you sever
do not roll over” and “If you were born on or before January 1, 1936” do
from employment. If your plan loan offset occurs for any other reason
not apply.
(such as a failure to make level loan repayments that result in a deemed
distribution), then you have 60 days from the date the offset occurs to
If you are an eligible retired public safety officer and your
complete your rollover.
payment is used to pay for health coverage or qualified
Designated Roth account long-term insurance
If you have an outstanding loan from the Plan, your Plan benefit may If the Plan is a governmental plan, you retired as a public safety officer,
be offset by the outstanding amount of the loan, typically when your and your retirement was by reason of disability or was after normal
employment ends. The offset amount is treated as a distribution to you retirement age, you can exclude from your taxable income Plan
at the time of the offset. Generally, you may roll over all or any portion payments (including nonqualified distributions from a designated Roth
of the offset amount. If the distribution attributable to the offset is not account) paid as premiums to an accident or health plan (or a qualified
a qualified distribution and you do not roll over the offset amount, you long-term care insurance contract) that your employer maintains for
will be taxed on any earnings included in the distribution (including the you, your spouse, or your dependents, up to a maximum of $3,000
10% additional income tax on early distributions, unless an exception annually. For this purpose, a public safety officer is a law enforcement
applies). You may roll over the earnings included in the loan offset officer, firefighter, chaplain, or member of a rescue squad or ambulance
to a Roth IRA or designated Roth account in an employer plan (if the crew.
terms of the employer plan permit the plan to receive plan loan offset
If you are not a Plan participant
rollovers). You may also roll over the full amount of the offset to a Roth
IRA. Non-Roth account
How long you have to complete the rollover depends on what kind of Payments after death of the participant. If you receive a distribution
plan loan offset you have. If you have a qualified plan loan offset, you after the participant’s death that you do not roll over, the distribution
will have until your tax return due date (including extensions) for the generally will be taxed in the same manner described elsewhere in this
tax year during which the offset occurs to complete your rollover. A notice (the sections applicable to payments from non-Roth accounts).
qualified plan loan offset occurs when a plan loan in good standing is However, the 10% additional income tax on early distributions and the
offset because your employer plan terminates, or because you sever special rules for public safety officers do not apply, and the special rule
from employment. If your plan loan offset occurs for any other reason, described under the section “If you were born on or before January 1,
then you have 60 days from the date the offset occurs to complete your 1936” applies only if the deceased participant was born on or before
rollover. January 1, 1936.
If you are a surviving spouse. If you receive a payment from the
If you were born on or before January 1, 1936 Plan as the surviving spouse of a deceased participant, you have
If you were born on or before January 1, 1936 and receive a lump the same rollover options that the participant would have had, as
sum distribution that you do not roll over, special rules for calculating described elsewhere in this notice. In addition, if you choose to do
the amount of the tax on the payment might apply to you. If the lump a rollover to an IRA, you may treat the IRA as your own or as an
sum distribution is a nonqualified distribution from a designated Roth inherited IRA.
account that you do not roll over, special rules for calculating the amount
An IRA you treat as your own is treated like any other IRA of yours, so
of the tax on the earnings in the payment might apply to you. For more
that payments made to you before you are age 59½ will be subject
information, see IRS Publication 575, Pension and Annuity Income.
to the 10% additional income tax on early distributions (unless an
If your payment is from a governmental section 457(b) exception applies) and required minimum distributions from your
plan (applicable to both non-Roth and designated Roth IRA do not have to start until after you are age 70½ (if you were born
accounts) before July 1, 1949) or age 72 (if you were born after June 30, 1949).
If the Plan is a governmental section 457(b) plan, the same rules that are If you treat the IRA as an inherited IRA, payments from the IRA will not

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Special tax notice regarding plan payment from non-Roth and designated
Roth accounts
be subject to the 10% additional income tax on early distributions. minimum distributions from the Plan, you will have to receive
However, if the participant had started taking required minimum required minimum distributions from the inherited Roth IRA. If the
distributions, you will have to receive required minimum distributions participant had not started taking required minimum distributions,
from the inherited IRA. If the participant had not started taking you will not have to start receiving required minimum distributions
required minimum distributions from the Plan, you will not have to from the inherited Roth IRA until the year the participant would have
start receiving required minimum distributions from the inherited been age 70½ (if the participant was born before July 1, 1949), age 72
IRA until the year the participant would have been age 70½ (if the (if the participant was born after June 30, 1949 and before January
participant was born before July 1, 1949), age 72 (if the participant 1, 1951), or age 73 (if the participant was born after December 31,
was born after June 30, 1949) and before January 1, 1951), or age 1950).
73 (if the participant was born after December 30, 1950).
If you are a surviving beneficiary other than a spouse. If you receive
If you are a surviving beneficiary other than a spouse. If you receive a payment from the Plan because of the participant’s death and
a payment from the Plan because of the participant’s death and you are a designated beneficiary other than a surviving spouse, the
you are a designated beneficiary other than a surviving spouse, the only rollover option you have is to do a direct rollover to an inherited
only rollover option you have is to do a direct rollover to an inherited Roth IRA. Payments from the inherited Roth IRA, even if made in a
IRA. Payments from the inherited IRA will not be subject to the 10% nonqualified distribution, will not be subject to the 10% additional
additional income tax on early distributions. You will have to receive income tax on early distributions. You will have to receive required
required minimum distributions from the inherited IRA. minimum distributions from the inherited Roth IRA.
Payments under a QDRO. If you are the spouse or a former spouse of Payments under a QDRO. If you are the spouse or a former spouse of
the participant who receives a payment from the Plan under a qualified the participant who receives a payment from the Plan under a QDRO
domestic relations order (QDRO), you generally have the same options from a designated Roth account, you generally have the same options
and the same tax treatment the participant would have (for example, and the same tax treatment the participant would have (for example,
you may roll over the payment to your own IRA or an eligible employer you may roll over the payment to your own Roth IRA or a designated
plan that will accept it). However, payments under the QDRO will not be Roth account in an eligible employer plan that will accept it).
subject to the 10% additional income tax on early distributions.
If you are a nonresident alien
Designated Roth account
Non-Roth account
Payments after death of the participant. If you receive a distribution
If you are a nonresident alien and you do not do a direct rollover to a
after the participant’s death that you do not roll over, the distribution
U.S. IRA or U.S. employer plan, instead of withholding 20%, the Plan is
generally will be taxed in the same manner described elsewhere in
generally required to withhold 30% of the payment for federal income
this notice (the sections applicable to payments from designated Roth
taxes. If the amount withheld exceeds the amount of tax you owe (as
accounts). However, whether the payment is a qualified distribution
may happen if you do a 60-day rollover), you may request an income
generally depends on when the participant first made a contribution
tax refund by filing Form 1040NR and attaching your Form 1042-S. See
to the designated Roth account in the Plan. Also, the 10% additional
Form W-8BEN for claiming that you are entitled to a reduced rate of
income tax on early distributions and the special rules for public safety
withholding under an income tax treaty. For more information, see also
officers do not apply, and the special rule described under the section
IRS Publication 519, U.S. Tax Guide for Aliens, and IRS Publication 515,
“If you were born on or before January 1, 1936” applies only if the
Withholding of Tax on Nonresident Aliens and Foreign Entities.
deceased participant was born on or before January 1, 1936.
If you are a surviving spouse. If you receive a payment from the Designated Roth account
Plan as the surviving spouse of a deceased participant, you have If you are a nonresident alien, you do not do a direct rollover to a U.S. IRA
the same rollover options that the participant would have had, as or U.S. employer plan, and the payment is not a qualified distribution,
described elsewhere in this notice. In addition, if you choose to do a the Plan is generally required to withhold 30% (instead of withholding
rollover to a Roth IRA, you may treat the Roth IRA as your own or as 20%) of the earnings for federal income taxes. If the amount withheld
an inherited Roth IRA. exceeds the amount of tax you owe (as may happen if you do a 60-day
A Roth IRA you treat as your own is treated like any other Roth IRA rollover), you may request an income tax refund by filing Form 1040NR
of yours, so that you will not have to receive any required minimum and attaching your Form 1042-S. See Form W-8BEN for claiming that
distributions during your lifetime and earnings paid to you in a you are entitled to a reduced rate of withholding under an income
nonqualified distribution before you are age 59½ will be subject tax treaty. For more information, see also IRS Publication 519, U.S.
to the 10% additional income tax on early distributions (unless an Tax Guide for Aliens, and IRS Publication 515, Withholding of Tax on
exception applies). Nonresident Aliens and Foreign Entities.

If you treat the Roth IRA as an inherited Roth IRA, payments from If you have a non-Roth account and you roll over your
the Roth IRA will not be subject to the 10% additional income tax payment to a Roth IRA
on early distributions. An inherited Roth IRA is subject to required If you roll over a payment from the Plan to a Roth IRA, a special rule
minimum distributions. If the participant had started taking required applies under which the amount of the payment rolled over (reduced

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Special tax notice regarding plan payment from non-Roth and designated
Roth accounts
by any after-tax amounts) will be taxed. In general, the 10% additional above for the rules applicable to rollovers from a designated Roth
income tax on early distributions will not apply. However, if you take account to a Roth IRA.
the amount rolled over out of the Roth IRA within the 5 year period
that begins on January 1 of the year of the rollover, the 10% additional If your payment is subject to the mandatory cashout rules
income tax will apply (unless an exception applies). Non-Roth account
If you roll over the payment to a Roth IRA, later payments from the Unless you elect otherwise, a mandatory cashout of more than $1,000
Roth IRA that are qualified distributions will not be taxed (including (not including payments from a designated Roth account in the Plan)
earnings after the rollover). A qualified distribution from a Roth IRA is a will be directly rolled over to an IRA chosen by the Plan administrator
payment made after you are age 59½ (or after your death or disability, or the payor. A mandatory cashout is a payment from a plan to a
or as a qualified first-time homebuyer distribution of up to $10,000) participant made before age 62 (or normal retirement age, if later)
and after you have had a Roth IRA for at least 5 years. In applying this and without consent, where the participant’s benefit does not exceed
5-year rule, you count from January 1 of the year for which your first $5,000 (not including any amounts held under the plan as a result of
contribution was made to a Roth IRA. Payments from the Roth IRA that a prior rollover made to the plan). For distributions after December 31,
are not qualified distributions will be taxed to the extent of earnings 2023, a plan may raise the $5,000 cashout threshold to $7,000.
after the rollover, including the 10% additional income tax on early
Not every plan provides for mandatory cashouts. If your Plan does not
distributions (unless an exception applies). You do not have to take
provide for mandatory cashouts, the above rules will not apply. Some
required minimum distributions from a Roth IRA during your lifetime.
plans may require mandatory rollover of $1,000 or less be directly rolled
For more information, see IRS Publication 590-A, Contributions to
over to an IRA. For more information about the Plan’s cashout rules,
Individual Retirement Arrangements (IRAs), and IRS Publication 590-B,
check with the Plan administrator and/or refer to the Plan’s summary
Distributions from Individual Retirement Arrangements (IRAs).
plan description (SPD).
If you do a rollover to a designated Roth account in the Plan Designated Roth account
You cannot roll over a distribution to a designated Roth account in
Unless you elect otherwise, a mandatory cashout from a designated
another employer’s plan. However, you can roll the distribution over into
Roth account in the Plan of more than $1,000 will be directly rolled
a designated Roth account in the distributing Plan. If you roll over a
over to a Roth IRA chosen by the Plan administrator or the payor. A
payment from the Plan to a designated Roth account in the Plan, the
mandatory cashout is a payment from a plan to a participant made
amount of the payment rolled over (reduced by any after- tax amounts
before age 62 (or normal retirement age, if later) and without consent,
directly rolled over) will be taxed. In general, the 10% additional tax on
where the participant’s benefit does not exceed $5,000 (not including
early distributions will not apply. However, if you take the amount rolled
any amounts held under the plan as a result of a prior rollover made to
over out of the Roth IRA within the 5-year period that begins on January
the plan). For distributions after December 31, 2023, a plan may raise
1 of the year of the rollover, the 10% additional income tax will apply
the $5,000 cashout threshold to $7,000.
(unless an exception applies).
Not every plan provides for mandatory cashouts. If your Plan does not
If you roll over the payment to a designated Roth account in the Plan,
provide for mandatory cashouts, the above rules will not apply. Some
later payments from the designated Roth account that are qualified
plans may require mandatory rollover of $1,000 or less be directly rolled
distributions will not be taxed (including earnings after the rollover).
over to a Roth IRA. For more information about the Plan’s cashout rules,
A qualified distribution from a designated Roth account is a payment
check with the Plan administrator and/or refer to the Plan’s summary
made both after you are age 59½ (or after your death or disability) and
plan description (SPD).
after you have had a designated Roth account in the Plan for at least
5 years. In applying this 5-year rule, you count from January 1 of the Other special rules (applicable to both non-Roth and
year your first contribution was made to the designated Roth account. designated Roth accounts)
However, if you made a direct rollover to a designated Roth account in
If a payment is one in a series of payments for less than 10 years, your
the Plan from a designated Roth account in a plan of another employer,
choice whether to do a direct rollover will apply to all later payments in
the 5-year period begins on January 1 of the year you made the first
the series (unless you make a different choice for later payments).
contribution to the designated Roth account in the Plan or, if earlier,
to the designated Roth account in the plan of the other employer. If your payments for the year are less than $200, the Plan is not required
Payments from the designated Roth account that are not qualified to allow you to do a direct rollover and is not required to withhold for
distributions will be taxed to the extent of earnings after the rollover, federal income taxes. However, you can do a 60-day rollover.
including the 10% additional income tax on early distributions (unless You may have special rollover rights if you recently served in the U.S.
an exception applies). With respect to taxable years beginning after Armed Forces. For more information, see IRS Publication 3, Armed
2023, you are not required to take required minimum distributions from Forces’ Tax Guide.
a designated Roth account during your lifetime.
You also may have special rollover rights if you were affected by
If your Plan does not provide for designated Roth Accounts, the above a federally declared disaster (or similar event), or if you received a
rules will not apply. See the “Designated Roth account” section under distribution on account of a disaster. For more information on special
“What types of retirement accounts and plans may accept my rollover”

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Special tax notice regarding plan payment from non-Roth and designated
Roth accounts
rollover rights related to disaster relief, see the IRS website at www.irs. federal income tax and, based on your specific circumstance, an
gov. additional 10% tax may apply. You should carefully consider how
you will make up these contributions and accumulate adequate
Are there consequences of failing to defer distributions earnings in order to retire when you would like.
until retirement?
Saving adequately for retirement is one of the most important decisions
Additional information regarding payout options
you will make during your employment years. For participants that have This notice summarizes the federal tax rules that may apply to your
recently severed employment, (1) electing to leave your account in your payment. You are encouraged to obtain further information from your
former employer’s retirement Plan, (2) rolling the account to a Roth IRA, Plan administrator describing payout alternatives and expenses specific
IRA or new employer’s plan, or (3) taking the distribution in cash is a to your Plan. A Summary Plan Description (SPD), for 401(a), including
decision that should be weighed very carefully in order to meet your 401(k), and ERISA 403(b) plans, can also be a valuable resource as you
long-term savings goals. Factors you should consider include: weigh your distribution/rollover options. Investment prospectus(es)
or investment profiles are also a valuable source for fee/expense
y Generally, if your vested account balance is more than $5,000, you
comparisons. To view information regarding fees and expenses, please
may leave your retirement account with your previous employer’s
visit LincolnFinancial.com.
Plan until the later of age 62 or the date you reach the plan’s normal
retirement age. For distributions after December 31, 2023, a plan
may raise the $5,000 cashout threshold to $7,000. For more information
y As an investor, with an ultimate goal of saving the maximum You may wish to consult with the Plan administrator or payor, or a
for retirement while also managing investment risk, you should professional tax advisor, before taking a payment from the Plan. Also,
review the investment fees and administrative costs associated you can find more detailed information on the federal tax treatment
with your current Plan, any future employer’s Plan and various of payments from an employer plan in: IRS Publication 575, Pension
IRAs that are available in the marketplace. Such investment fees and Annuity Income; IRS Publication 590-A, Contributions to Individual
and administrative costs may be lower in your employer’s plan Retirement Arrangements (IRAs); IRS Publication 590-B, Distributions
than you will be able to find elsewhere. from Individual Retirement Arrangements (IRAs); and IRS Publication
y Electing to take a distribution in cash now may cause you to 571, Tax-Sheltered Annuity Plans (403(b) Plans). These publications are
have insufficient funds to retire. In addition, distributions of non- available from a local IRS office, on the web at www.irs.gov, or by calling
Roth and earnings from designated Roth accounts are subject to 1-800-TAX-FORM.

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