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HomeMy WebLinkAbout2021-090-10/12/2021-AUTHORIZING EXECUTION OF ADOPTION AGREEMENTS TO FINALIZE PLAN CHANGES TO THE 457(B) DEFERRED COMPENSEligible 457 Plan © 2020 1 ADOPTION AGREEMENT FOR ELIGIBLE GOVERNMENTAL 457 PLAN The undersigned Employer, by executing this Adoption Agreement, establishes an Eligible 457 Plan ("Plan"). The Employer, subject to the Employer's Adoption Agreement elections, adopts fully the Plan provisions. This Adoption Agreement, the basic plan document and any attached Appendices, amendments, or agreements permitted or referenced therein, constitute the Employer's entire plan document. All "Election" references within this Adoption Agreement or the basic plan document are Adoption Agreement Elections. All "Article" or "Section" references are basic plan document references. Numbers in parentheses which follow election numbers are basic plan document references. Where an Adoption Agreement election calls for the Employer to supply text, the Employer may lengthen any space or line, or create additional tiers. When Employer-supplied text uses terms substantially similar to existing printed options, all clarifications and caveats applicable to the printed options apply to the Employer-supplied text unless the context requires otherwise. The Employer makes the following elections granted under the corresponding provisions of the basic plan document. 1. EMPLOYER (1.11). Name: City of Fort Collins Address: 300 LaPorte Avenue Street Fort Collins Colorado 80521 City State Zip Telephone: (970) 221-6535 Taxpayer Identification Number (TIN): 84-6000587 2. PLAN NAME. Name: City of Fort Collins 457(b) Deferred Compensation Plan 3. PLAN YEAR (1.25). Plan Year means the 12 consecutive month period (except for a short Plan Year) ending every (Choose one of a. or b. and choose c. if applicable): [Note: Complete any applicable blanks under Election c. with a specific date, e.g., "June 30" OR "the last day of February" OR "the first Tuesday in January." In the case of a Short Plan Year or a Short Limitation Year, include the year, e.g., "May 1, 2013."] a. [X] December 31. b. [ ] Plan Year: ending: . c. [ ] Short Plan Year: commencing: and ending: . 4. EFFECTIVE DATE (1.08). The Employer's adoption of the Plan is a (Choose one of a. or b. Complete c. if new plan OR complete c. and d. if an amendment and restatement. Choose e. if applicable): a. [ ] New Plan. b. [X] Restated Plan. The Plan is a substitution and amendment of an existing 457 plan. Initial Effective Date of Plan c. [X] January 1, 1995 (enter month day, year; hereinafter called the "Effective Date" unless 4d is entered below) Restatement Effective Date (If this is an amendment and restatement, enter effective date of the restatement.) d. [X] October 1, 2021 (enter month day, year) Special Effective Dates: (optional) e. [ ] Describe: . 5. CONTRIBUTION TYPES. (If this is a frozen Plan (i.e., all contributions have ceased), choose a. only): Frozen Plan a. [ ] Contributions cease. All Contributions have ceased or will cease (Plan is frozen). 1. Effective date of freeze: [Note: Effective date is optional unless this is the amendment or restatement to freeze the Plan.] Exhibit A Eligible 457 Plan © 2020 2 Contributions. The Employer and/or Participants, in accordance with the Plan terms, make the following Contribution Types to the Plan (Choose one or more of b. through d. if applicable): b. [X] Pre-Tax Elective Deferrals. The dollar or percentage amount by which each Participant has elected to reduce his/her Compensation, as provided in the Participant's Salary Reduction Agreement (Choose one or more as applicable.): And will Matching Contributions be made with respect to Elective Deferrals? 1. [X] Yes. See Question 16. 2. [ ] No. And will Roth Elective Deferrals be made? 3. [X] Yes. [Note: The Employer may not limit Deferrals to Roth Deferrals only.] 4. [ ] No. c. [ ] Nonelective Contributions. See Question 17. d. [X] Rollover Contributions. See Question 30. 6. EXCLUDED EMPLOYEES (1.10). The following Employees are Excluded Employees and are not eligible to participate in the Plan (Choose one of a. or b.): a. [ ] No exclusions. All Employees are eligible to participate. b. [X] Exclusions. The following Employees are Excluded Employees (Choose one or more of 1. through 4.): 1. [ ] Part-time Employees. The Plan defines part-time Employees as Employees who normally work less than hours per week. 2. [ ] Hourly-paid Employees. 3. [ ] Leased Employees. The Plan excludes Leased Employees. 4. [X] Specify: See Exhibit 2 . 7. INDEPENDENT CONTRACTOR (1.16). The Plan (Choose one of a., b. or c.): a. [ ] Participate. Permits Independent Contractors to participate in the Plan. b. [X] Not Participate. Does not permit Independent Contractors to participate in the Plan. c. [ ] Specified Independent Contractors. Permits the following specified Independent Contractors to participate: . [Note: If the Employer elects to permit any or all Independent Contractors to participate in the Plan, the term Employee as used in the Plan includes such participating Independent Contractors.] 8. COMPENSATION (1.05). Subject to the following elections, Compensation for purposes of allocation of Deferral Contributions means: Base Definition (Choose one of a., b., c. or d.): a. [ ] Wages, tips and other compensation on Form W-2. b. [ ] Code §3401(a) wages (wages for withholding purposes). c. [ ] 415 safe harbor compensation. d. [X] Alternative (general) 415 Compensation. [Note: The Plan provides that the base definition of Compensation includes amounts that are not included in income due to Code §§401(k), 125,132(f)(4), 403(b), SEP, 414(h)(2), & 457. Compensation for an Independent Contractor means the amounts the Employer pays to the Independent Contractor for services, except as the Employer otherwise specifies below.] Modifications to Compensation definition. The Employer elects to modify the Compensation definition as follows (Choose one of e. or f.): e. [X] No modifications. The Plan makes no modifications to the definition. f. [ ] Modifications (Choose one or more of 1. through 5.): 1. [ ] Fringe benefits. The Plan excludes all reimbursements or other expense allowances, fringe benefits (cash and noncash), moving expenses, deferred compensation and welfare benefits. 2. [ ] Elective Contributions. [1.05(E)] The Plan excludes a Participant's Elective Contributions. Exhibit A Eligible 457 Plan © 2020 3 3. [ ] Bonuses. The Plan excludes bonuses. 4. [ ] Overtime. The Plan excludes overtime. 5. [ ] Specify: . Compensation taken into account. For the Plan Year in which an Employee first becomes a Participant, the Plan Administrator will determine the allocation of matching and nonelective contributions by taking into account (Choose one of g. or h.): g. [X] Plan Year. The Employee's Compensation for the entire Plan Year. (N/A if no matching or nonelective contributions) h. [ ] Compensation while a Participant. The Employee's Compensation only for the portion of the Plan Year in which the Employee actually is a Participant. (N/A if no matching or nonelective contributions) 9. POST-SEVERANCE COMPENSATION (1.05(F)). Compensation includes the following types of Post-Severance Compensation paid within any applicable time period as may be required (Choose one of a. or b.): a. [ ] None. The Plan does not take into account Post-Severance Compensation as to any Contribution Type except as required under the basic plan document. b. [X] Adjustments. The following Compensation adjustments apply (Choose one or more): 1. [X] Regular Pay. Post-Severance Compensation will include Regular Pay and it will apply to all Contribution Types. 2. [X] Leave-Cashouts. Post-Severance Compensation will include Leave Cashouts and it will apply to all Contribution Types. 3. [ ] Nonqualified Deferred Compensation. Post-Severance Compensation will include Deferred Compensation and it will apply to all Contribution Types. 4. [X] Salary Continuation for Disabled Participants. Post-Severance Compensation will include Salary Continuation for Disabled Participants and it will apply to all Contribution Types. 5. [ ] Differential Wage Payments. Post-Severance Compensation will include Differential Wage Payments (military continuation payments) and it will apply to all Contribution Types. 6. [ ] Describe alternative Post-Severance Compensation definition, limit by Contribution Type, or limit by Participant group: . 10. NORMAL RETIREMENT AGE (1.20). A Participant attains Normal Retirement Age under the Plan (Choose one of a. or b.): a. [ ] Plan designation. [Plan Section 3.05(B)] When the Participant attains age . [Note: The age may not exceed age 70 1/2. The age may not be less than age 65, or, if earlier, the age at which a Participant may retire and receive benefits under the Employer's pension plan, if any.] b. [X] Participant designation. [Plan Section 3.05(B) and (B)(1)] When the Participant attains the age the Participant designates, which may not be earlier than age 65 and may not be later than age 70 1/2 . [Note: The age may not exceed age 70 1/2.] Special Provisions for Police or Fire Department Employees (Choose c. and/or d. as applicable): c. [X] Police department employees. [Plan Section 3.05(B)(3)] (Choose 1. or 2.): 1. [ ] Plan designation. [Plan Section 3.05(B)] When the Participant attains age . [Note: The age may not exceed age 70 1/2 and may not be less than age 40.] 2. [X] Participant designation. [Plan Section 3.05(B) and (B)(1)] When the Participant attains the age the Participant designates, which may not be earlier than age 40 (no earlier than age 40) and may not be later than age 70 1/2 . [Note: The age may not exceed age 70 1/2.] d. [X] Fire department employees. [Plan Section 3.05(B)(3)] (Choose 1. or 2.): 1. [ ] Plan designation. [Plan Section 3.05(B)] When the Participant attains age . [Note: The age may not exceed age 70 1/2 and may not be less than age 40.] 2. [X] Participant designation. [Plan Section 3.05(B) and (B)(1)] When the Participant attains the age the Participant designates, which may not be earlier than age 40 (no earlier than age 40) and may not be later than age 70 1/2 . [Note: The age may not exceed age 70 1/2.] 11. ELIGIBILITY CONDITIONS (2.01). (Choose one of a. or b.): a. [X] No eligibility conditions. The Employee is eligible to participate in the Plan as of his/her first day of employment with the employer. b. [ ] Eligibility conditions. To become a Participant in the Plan, an Eligible Employee must satisfy the following eligibility conditions (Choose one or more of 1., 2. or 3.): 1. [ ] Age. Attainment of age . Exhibit A Eligible 457 Plan © 2020 4 2. [ ] Service. Service requirement (Choose one of a. or b.): a. [ ] Year of Service. One year of Continuous Service. b. [ ] Months of Service. month(s) of Continuous Service. 3. [ ] Specify: . 12. PLAN ENTRY DATE (1.24). "Plan Entry Date" means the Effective Date and (Choose one of a. through d.): a. [ ] Monthly. The first day of the month coinciding with or next following the Employee's satisfaction of the Plan's eligibility conditions, if any. b. [ ] Annual. The first day of the Plan Year coinciding with or next following the Employee's satisfaction of the Plan's eligibility conditions, if any. c. [X] Date of hire. The Employee's employment commencement date with the Employer. d. [ ] Specify: . 13. SALARY REDUCTION CONTRIBUTIONS (1.30). A Participant's Salary Reduction Contributions under Election 5b. are subject to the following limitation(s) in addition to those imposed by the Code (Choose one of a. or b.): a. [X] No limitations. b. [ ] Limitations. (Choose one or more of 1., 2. or 3.): 1. [ ] Maximum deferral amount. A Participant's Salary Reductions may not exceed: (specify dollar amount or percentage of Compensation). 2. [ ] Minimum deferral amount. A Participant's Salary Reductions may not be less than: (specify dollar amount or percentage of Compensation). 3. [ ] Specify: . [Note: Any limitation the Employer elects in b.1. through b.3. will apply on a payroll basis unless the Employer otherwise specifies in b.3.] Special NRA Catch-Up Contributions (3.05). The Plan (Choose one of c. or d.): c. [X] Permits. Participants may make NRA catch-up contributions. AND, Special NRA Catch-Up Contributions (Choose one of 1. or 2.): (N/A if no matching contributions) 1. [X] will be taken into account in applying any matching contribution under the Plan. 2. [ ] will not be taken into account in applying any matching contribution under the Plan. d. [ ] Does not permit. Participants may not make NRA catch-up contributions. Age 50 Catch-Up Contributions (3.06). The Plan (Choose one of e. or f.): e. [X] Permits. Participants may make age 50 catch-up contributions. AND, Age 50 Catch-Up Contributions (Choose one of 1. or 2.): (N/A if no matching contributions) 1. [X] will be taken into account in applying any matching contribution under the Plan. 2. [ ] will not be taken into account in applying any matching contribution under the Plan. f. [ ] Does not permit. Participants may not make age 50 catch-up contributions. 14. SICK, VACATION AND BACK PAY (3.02(A)). The Plan (Choose one of a. or b.): a. [X] Permits. Participants may make Salary Reduction Contributions from accumulated sick pay, from accumulated vacation pay or from back pay. b. [ ] Does Not Permit. Participants may not make Salary Reduction Contributions from accumulated sick pay, from accumulated vacation pay or from back pay. 15. AUTOMATIC ENROLLMENT (3.02(B)). Does the Plan provide for automatic enrollment (Choose one of the following) [Note: if Eligible Automatic Contribution Arrangement (EACA), select 15c and complete Questions 31 & 32]: a. [X] Does not apply. Does not apply the Plan's automatic enrollment provisions. Exhibit A Eligible 457 Plan © 2020 5 b. [ ] Applies. Applies the Plan's automatic enrollment provisions. The Employer as a Pre-Tax Elective Deferral will withhold % from each Participant's Compensation unless the Participant elects a different percentage (including zero) under his/her Salary Reduction Agreement. The automatic election will apply to (Choose one of 1. through 3.): 1. [ ] All Participants. All Participants who as of are not making Pre-Tax Elective Deferrals at least equal to the automatic amount. 2. [ ] New Participants. Each Employee whose Plan Entry Date is on or following: . 3. [ ] Describe Application of Automatic Deferrals: . c. [ ] EACA. The Plan will provide an Eligible Automatic Contribution Arrangement (EACA). Complete Questions 31 & 32. 16. MATCHING CONTRIBUTIONS (3.03). The Employer Matching Contributions under Election 5.b.1. are made as follows (Choose one or more of a. through d.): a. [X] Fixed formula. An amount equal to 100% of each Participant's Salary Reduction Contributions. b. [ ] Discretionary formula. An amount (or additional amount) equal to a matching percentage the Employer from time to time may deem advisable of each Participant's Salary Reduction Contributions. c. [ ] Tiered formula. The Employer will make matching contributions equal to a uniform percentage of each tier of each Participant's Salary Reduction Contributions, determined as follows: NOTE: Fill in only percentages or dollar amounts, but not both. If percentages are used, each tier represents the amount of the Participant's applicable contributions that equals the specified percentage of the Participant's Compensation (add additional tiers if necessary): Tiers of Contributions Matching Percentage (indicate $ or %) First % Next % Next % Next % d. [ ] Specify: . Time Period for Matching Contributions. The Employer will determine its Matching Contribution based on Salary Reduction Contributions made during each (Choose one of e. through h.): e. [ ] Plan Year. f. [ ] Plan Year quarter. g. [X] Payroll period. h. [ ] Specify: . Salary Reduction Contributions Taken into Account. In determining a Participant's Salary Reduction Contributions taken into account for the above-specified time period under the Matching Contribution formula, the following limitations apply (Choose one of i. through l.): i. [ ] All Salary Reduction Contributions. The Plan Administrator will take into account all Salary Reduction Contributions. j. [ ] Specific limitation. The Plan Administrator will disregard Salary Reduction Contributions exceeding % of the Participant's Compensation. k. [ ] Discretionary. The Plan Administrator will take into account the Salary Reduction Contributions as a percentage of the Participant's Compensation as the Employer determines. l. [X] Specify: See Exhibit 2 . Allocation Conditions. To receive an allocation of Matching Contributions, a Participant must satisfy the following allocation condition(s) (Choose one of m. or n.): m. [X] No allocation conditions. n. [ ] Conditions. The following allocation conditions apply to Matching Contributions (Choose one or more of 1. through 4.): 1. [ ] Service condition. The Participant must complete the following number of months of Continuous Service during the Plan Year: . Exhibit A Eligible 457 Plan © 2020 6 2. [ ] Employment condition. The Participant must be employed by the Employer on the last day of the Plan Year. 3. [ ] Limited Severance Exception. Any condition specified in 1. or 2. does not apply if the Participant incurs a Severance from Employment during the Plan Year on account of death, disability or attainment of Normal Retirement Age in the current Plan Year or in a prior Plan Year. 4. [ ] Specify: . 17. NONELECTIVE CONTRIBUTIONS (1.19). The Nonelective Contributions under Election 5.c. are made as follows: (Choose one): a. [ ] Discretionary - Pro-Rata. An amount the Employer in its sole discretion may determine. b. [ ] Fixed - Pro Rata. % of Compensation. c. [ ] Other. A Nonelective Contribution may be made as follows: . Allocation Conditions. (3.08). To receive an allocation of Nonelective Contributions, a Participant must satisfy the following allocation condition(s) (Choose one of d. or e.): d. [ ] No allocation conditions. e. [ ] Conditions. The following allocation conditions apply to Nonelective Contributions (Choose one or more of 1. through 4.): 1. [ ] Service condition. The Participant must complete the following number of months of Continuous Service during the Plan Year: . 2. [ ] Employment condition. The Participant must be employed by the Employer on the last day of the Plan Year. 3. [ ] Limited Severance Exception. Any condition specified in 1. or 2. does not apply if the Participant incurs a Severance from Employment during the Plan Year on account of death, disability or attainment of Normal Retirement Age in the current Plan Year or in a prior Plan Year. 4. [ ] Specify: . 18. TIME AND METHOD OF PAYMENT OF ACCOUNT (4.02). The Plan will distribute to a Participant who incurs a Severance from Employment his/her Vested Account as follows: Timing. The Plan, in the absence of a permissible Participant election to commence payment later, will pay the Participant's Account (Choose one of a. through e.): a. [ ] Specified Date. days after the Participant's Severance from Employment. b. [X] Immediate. As soon as administratively practicable following the Participant's Severance from Employment. c. [ ] Designated Plan Year. As soon as administratively practicable in the Plan Year beginning after the Participant's Severance from Employment. d. [ ] Normal Retirement Age. As soon as administratively practicable after the close of the Plan Year in which the Participant attains Normal Retirement Age. e. [ ] Specify: . Method. The Plan, in the absence of a permissible Participant election, will distribute the Participant's Account under one of the following method(s) of distribution (Choose one or more of f. through j. as applicable): f. [X] Lump sum. A single payment. g. [X] Installments. Multiple payments made as follows: may not be less than $100 . h. [ ] Installments for required minimum distributions only. Annual payments, as necessary under Plan Section 4.03. i. [X] Annuity distribution option(s): Annuity Purchase . j. [ ] Specify: . Participant Election. [Plan Sections 4.02(A) and (B)] The Plan (Choose one of k., l. or m.): k. [X] Permits. Permits a Participant, with Plan Administrator approval of the election, to elect to postpone distribution beyond the time the Employer has elected in a. through e. and also to elect the method of distribution (including a method not described in f. through j. above). l. [ ] Does not permit. Does not permit a Participant to elect the timing and method of Account distribution. m. [ ] Specify: . Exhibit A Eligible 457 Plan © 2020 7 Mandatory Distributions. Notwithstanding any other distribution election, following Severance from Employment (Choose n. or o.): n. [X] No Mandatory Distributions. The Plan will not make a Mandatory Distribution. o. [ ] Mandatory Distribution. If the Participant's Vested Account is not in excess of $5,000 (unless a different amount selected below) as of the date of distribution, the Plan will make a Mandatory Distribution following Severance from Employment. 1. [ ] Mandatory Distribution. If the Participant's Vested Account is not in excess of $ as of the date of distribution, the Plan will make a Mandatory Distribution following Severance from Employment. Rollovers in determination of $5,000 threshold. Unless otherwise elected below, amounts attributable to rollover contributions (if any) will be included in determining the $5,000 threshold for timing of distributions, form of distributions or consent rules. p. [ ] Exclude rollovers (rollover contributions will be excluded in determining the $5,000 threshold) NOTE: Regardless of the above election, if the Participant consent threshold is $1,000 or less, then the Administrator must include amounts attributable to rollovers for such purpose. In such case, an election to exclude rollovers above will apply for purposes of the timing and form of distributions. 19. BENEFICIARY DISTRIBUTION ELECTIONS. Distributions following a Participant's death will be made as follows (Choose one of a. through d.): a. [ ] Immediate. As soon as practical following the Participant's death. b. [ ] Next Calendar Year. At such time as the Beneficiary may elect, but in any event on or before the last day of the calendar year which next follows the calendar year of the Participant's death. (N/A if participant is restricted) c. [X] As Beneficiary elects. At such time as the Beneficiary may elect, consistent with Section 4.03. (N/A if participant is restricted) d. [ ] Describe: . [Note: The Employer under Election 19d. may describe an alternative distribution timing or afford the Beneficiary an election which is narrower than that permitted under Election 19c., or include special provisions related to certain beneficiaries, (e.g., a surviving spouse). However, any election under Election 19d. must require distribution to commence no later than the Section 4.03 required date.] 20. DISTRIBUTIONS PRIOR TO SEVERANCE FROM EMPLOYMENT (4.05). A Participant prior to Severance from Employment may elect to receive a distribution of his/her Vested Account under the following distribution options (Choose one of a. or b.): a. [ ] None. A Participant may not receive a distribution prior to Severance from Employment. b. [X] Distributions. Prior to Severance from Employment are permitted as follows (Choose one or more of 1. through 4.): 1. [X] Unforeseeable emergency. A Participant may elect a distribution from his/her Account in accordance with Plan Section 4.05(A) (for the Participant, spouse, dependents or beneficiaries) 2. [X] De minimis exception. [Plan Section 4.05(B)] If the Participant: (i) has an Account that does not exceed $5,000; (ii) has not made or received an allocation of any Deferral Contributions under the Plan during the two-year period ending on the date of distribution; and (iii) has not received a prior Plan distribution under this de minimis exception, then (Choose one of a., b. or c.): a. [ ] Participant election. The Participant may elect to receive all or any portion of his/her Account. b. [ ] Mandatory distribution. The Plan Administrator will distribute the Participant's entire Account. c. [X] Hybrid. The Plan Administrator will distribute a Participant's Account that does not exceed $ 1,000 and the Participant may elect to receive all or any portion of his/her Account that exceeds $ 1,000 but that does not exceed $5,000. 3. [X] Age 70 1/2. A Participant who attains age 70 1/2 prior to Severance from Employment may elect distribution of any or all of his/her Account. 4. [ ] Specify: . [Note: An Employer need not permit any in-service distributions. Any election must comply with the distribution restrictions of Code Section 457(d).] 21. QDRO (4.06). The QDRO provisions (Choose one of a., b. or c.): a. [X] Apply. b. [ ] Do not apply. c. [ ] Specify: . Exhibit A Eligible 457 Plan © 2020 8 22. ALLOCATION OF EARNINGS (5.07(B)). The Plan allocates Earnings using the following method (Choose one or more of a. through f.): a. [X] Daily. See Section 5.07(B)(4)(a). b. [ ] Balance forward. See Section 5.07(B)(4)(b). c. [ ] Balance forward with adjustment. See Section 5.07(B)(4)(c). Allocate pursuant to the balance forward method, except treat as part of the relevant Account at the beginning of the Valuation Period % of the contributions made during the following Valuation Period: . d. [ ] Weighted average. See Section 5.07(B)(4)(d). If not a monthly weighting period, the weighting period is . e. [ ] Directed Account method. See Section 5.07(B)(4)(e). f. [ ] Describe Earnings allocation method: . [Note: The Employer under Election 22f. may describe Earnings allocation methods from the elections available under Election 22 and/or a combination thereof as to any: (i) Participant group (e.g., Daily applies to Division A Employees OR to Employees hired after "x" date. Balance forward applies to Division B Employees OR to Employees hired on/before "x" date.); (ii) Contribution Type (e.g., Daily applies as to Discretionary Nonelective Contribution Accounts. Participant-Directed Account applies to Fixed Nonelective Contribution Accounts); (iii) investment type, investment vendor or Account type (e.g., Balance forward applies to investments placed with vendor A and Participant-Directed Account applies to investments placed with vendor B OR Daily applies to Participant-Directed Accounts and balance forward applies to pooled Accounts).] 23. HEART ACT PROVISIONS (1.31(C)(3)/3.13). The Employer elects to (Choose one of a. or b. and c. or d.): Continued Benefit Accruals. a. [ ] Not apply the benefit accrual provisions of Section 3.13. b. [X] Apply the benefit accrual provisions of Section 3.13. Distributions for deemed severance of employment (1.31(C)(3)) c. [X] The Plan does NOT permit distributions for deemed severance of employment. d. [ ] The Plan permits distributions for deemed severance of employment. 24. VESTING/SUBSTANTIAL RISK OF FORFEITURE (5.11). A Participant's Deferral Contributions are [Note: If a Participant incurs a Severance from Employment before the specified events or conditions, the Plan will forfeit the Participant's non-vested Account. Caution: if a Deferral is subject to vesting schedule or other substantial risk of forfeiture, it does not count as a deferral for purposes of the annual deferral limit until the year it is fully vested.] (Choose all that apply of a. through d.): a. [X] 100% Vested/No Risk of Forfeiture. Immediately Vested without regard to additional Service and no Substantial Risk of Forfeiture. The following contributions are 100% Vested: 1. [X] All Contributions. (skip to 25.) 2. [ ] Only the following contributions. (select all that apply): a. [ ] Salary Reduction Contributions. b. [ ] Nonelective Contributions. c. [ ] Matching Contributions. b. [ ] Forfeiture under Vesting Schedule. Vested according to the following: Contributions affected. The following contributions are subject to the vesting schedule (Choose one or more of 1., 2. or 3.): 1. [ ] Salary Reduction Contributions. 2. [ ] Nonelective Contributions. 3. [ ] Matching Contributions. 4. [ ] Vesting Schedule. Years of Service Vested Percentage % % % % % Exhibit A Eligible 457 Plan © 2020 9 For vesting purposes, a "Year of Service" means: 5. . [Note: It is extremely rare to apply a vesting schedule to Salary Reduction Contributions.] c. [ ] Substantial Risk of Forfeiture. Vested only when no longer subject to the following Substantial Risk of Forfeiture as follows: Contributions affected. The following contributions are subject to the substantial risk of forfeiture under c. (Choose one or more of 1., 2. or 3.): 1. [ ] Salary Reduction Contributions. 2. [ ] Nonelective Contributions. 3. [ ] Matching Contributions. Risk Provisions: Vested only when no longer subject to the following Substantial Risk of Forfeiture as follows (Choose one of 4. or 5.): 4. [ ] The Participant must remain employed by the Employer until , unless earlier Severance from Employment occurs on account of death or disability, as the Plan Administrator shall establish. 5. [ ] Specify: . Additional Provisions (Choose d. if applicable) d. [ ] Specify: . FORFEITURE ALLOCATION. [Plan Sections 5.11(A) and 5.14] The Plan Administrator will allocate any Plan forfeitures as selected below. The Employer has the option to use forfeitures to pay plan expenses first and then allocate the remaining forfeitures in accordance with the selections below: (Choose one of the following): e. [ ] Additional Contributions. As the following contribution type (Choose one of 1. or 2.): 1. [ ] Nonelective. As an additional Nonelective Contribution. 2. [ ] Matching. As an additional Matching Contribution. f. [ ] Reduce Fixed Contributions. To reduce the following fixed contribution (Choose one of 1. or 2.): 1. [ ] Nonelective. To reduce the Employer's fixed Nonelective Contribution. 2. [ ] Matching. To reduce the Employer's fixed Matching Contribution. g. [ ] Specify: . 25. TRUST PROVISIONS. The following provisions apply to Article VIII of the Plan (Choose as applicable; leave blank if not applicable): a. [ ] Modifications. The Employer modifies the Article VIII Trust provisions as follows: . The remaining Article VIII provisions apply. b. [X] Substitution. The Employer replaces the Trust with the Trust Agreement attached to the Plan. 26. CUSTODIAL ACCOUNT/ANNUITY CONTRACT (8.16). The Employer will hold all or part of the Deferred Compensation in one or more custodial accounts or annuity contracts which satisfy the requirements of Code §457(g) (Choose a. or b., c. if applicable): a. [ ] Custodial account(s). b. [ ] Annuity contract(s). c. [ ] Specify: . [Note: The Employer under c. may wish to identify the custodial accounts or annuity contracts or to designate a portion of the Deferred Compensation to be held in such vehicles versus held in the Trust.] 27. VALUATION. In addition to the last day of the Plan Year, the Trustee (or Plan Administrator as applicable) must value the Trust Fund (or Accounts) on the following Valuation Date(s) (Choose one of a. or b.): a. [ ] No additional Valuation Dates. b. [X] Additional Valuation Dates. (Choose one or more of 1., 2. or 3.): 1. [X] Daily Valuation Dates. Each business day of the Plan Year on which Plan assets for which there is an established market are valued and the Trustee or Employer is conducting business. 2. [ ] Last day of a specified period. The last day of each of the Plan Year. Exhibit A Eligible 457 Plan © 2020 10 3. [ ] Specified Valuation Dates: . [Note: The Employer under Election 26b.3. may describe Valuation Dates from the elections available under Election 26b. and/or a combination thereof as to any: (i) Participant group (e.g., No additional Valuation Dates apply to Division A Employees OR to Employees hired after "x" date. Daily Valuation Dates apply to Division B Employees OR to Employees hired on/before "x" date.); (ii) Contribution Type (e.g., No additional Valuation Dates apply as to Discretionary Nonelective Contribution Accounts. The last day of each Plan Year quarter applies to Fixed Nonelective Contribution Accounts); (iii) investment type, investment vendor or Account type (e.g., No additional Valuation Dates apply to investments placed with vendor A and Daily Valuation Dates apply to investments placed with vendor B OR Daily Valuation Dates apply to Participant-Directed Accounts and no additional Valuation Dates apply to pooled Accounts).] 28. TRUSTEE (Select all that apply; leave blank if not applicable.): a. [ ] Individual Trustee(s) who serve as Trustee(s) over assets not subject to control by a corporate Trustee. (Add additional Trustees as necessary.) Name(s) Title(s) Address and Telephone number (Choose one of 1. or 2.): 1. [ ] Use Employer address and telephone number. 2. [ ] Use address and telephone number below: Address: Street City State Zip Telephone: b. [X] Corporate Trustee Name: Nationwide Trust Company Address: 10 West Nationwide Blvd. Street Columbus Ohio 43215 City State Zip Telephone: (614) 435-5633 AND, the Corporate Trustee shall serve as: c. [X] a Directed (nondiscretionary) Trustee over all Plan assets except for the following: d. [ ] a Discretionary Trustee over all Plan assets except for the following: 29. PLAN LOANS (5.02(A)). The Plan permits or does not permit Participant Loans (Choose one of a. or b.): a. [X] Does not permit. b. [ ] Permitted pursuant to the Loan Policy. 30. ROLLOVER CONTRIBUTIONS (3.09). The Rollover Contributions under Election 5.d. are made as follows: Who may roll over (Choose one of a. or b.): a. [X] Participants only. b. [ ] Eligible Employees or Participants. Exhibit A Eligible 457 Plan © 2020 11 Sources/Types. The Plan will accept a Rollover Contribution (Choose one of c. or d.): c. [X] All. From any Eligible Retirement Plan and as to all Contribution Types eligible to be rolled into this Plan. d. [ ] Limited. Only from the following types of Eligible Retirement Plans and/or as to the following Contribution Types: . Distribution of Rollover Contributions (Choose one of e., f. or g.): e. [X] Distribution without restrictions. May elect distribution of his/her Rollover Contributions Account in accordance with Plan Section 4.05(C) at any time. f. [ ] No distribution. May not elect to receive distribution of his/her Rollover Contributions Account until the Plan has a distributable event under Plan Section 4.01. g. [ ] Specify: 31. EACA Automatic Deferral Provisions (3.14). Participants subject to the Automatic Deferral Provisions. The Automatic Deferral Provisions apply to Employees who become Participants after the Effective Date of the EACA (except as provided in d. below). Employees who became Participants prior to such Effective Date are subject to the following (a. – d. are optional): a. [ ] All Participants. All Participants, regardless of any prior Salary Reduction Agreement, unless and until a Participant makes an Affirmative Election after the Effective Date of the EACA. b. [ ] Election of at least Automatic Deferral amount. All Participants, except those who, on the Effective Date of the EACA, are deferring an amount which is at least equal to the Automatic Deferral Percentage. c. [ ] No existing Salary Reduction Agreement. All Participants, except those who have in effect a Salary Reduction Agreement on the effective date of the EACA regardless of the Salary Reduction Contribution amount under the Agreement. d. [ ] Describe: . Automatic Deferral Percentage. Unless a Participant makes an Affirmative Election, the Employer will withhold the following Automatic Deferral Percentage (select e. or f.): e. [ ] Constant. The Employer will withhold % of Compensation each payroll period. Escalation of deferral percentage (select one or leave blank if not applicable) 1. [ ] Scheduled increases. This initial percentage will increase by % of Compensation per year up to a maximum of of Compensation. 2. [ ] Other (described Automatic Deferral Percentage): Automatic Deferral Optional Elections f. [ ] Optional elections (select all that apply or leave blank if not applicable) Suspended Salary Reduction Contributions. If a Participant's Salary Reduction Contributions are suspended pursuant to a provision of the Plan (e.g., distribution due to military leave covered by the HEART Act), then a Participant's Affirmative Election will expire on the date the period of suspension begins unless otherwise elected below. 1. [ ] A Participant's Affirmative Election will resume after the suspension period. Special Effective Date. Provisions will be effective as of the earlier of the Effective Date of the EACA provisions unless otherwise specified below. 2. [ ] Special Effective Date: 32. In-Plan Roth Rollover Contributions. a. [X] Yes, allowed. Effective Date (enter date) 1. [X] In-Plan Roth Rollover Effective Date: January 1, 2013 33. In-Plan Roth Rollover Transfers. a. [X] Yes, allowed. Effective Date (enter date) 1. [X] In-Plan Roth Rollover Transfers Effective Date: January 1, 2013 Exhibit A Eligible 457 Plan © 2020 12 This Plan is executed on the date(s) specified below: Use of Adoption Agreement. Failure to complete properly the elections in this Adoption Agreement may result in disqualification of the Employer's Plan. The Employer only may use this Adoption Agreement only in conjunction with the corresponding basic plan document. Separate Trust Agreement. An executed copy of the trust agreement must be attached to this Plan. The responsibilities, rights and powers of the Trustee shall be those specified in the trust agreement. The signature of the Trustee appears on the separate trust agreement. EMPLOYER: City of Fort Collins By: DATE SIGNED Exhibit A City of Fort Collins 457(b) Deferred Compensation Plan Exhibit 2 to the Adoption Agreement for Eligible Governmental 457 Plan Sec. 6. Excluded Employees Any Employee not classified as: Classified (including part-time and Public Records Employees) Classified participating in the General Employees’ Retirement Plan (GERP) Classified that have opted out of GERP Community Service Officers (CSOs) Classified Unclassified Management and Department Heads Service Area/Unit Directors Police and Dispatchers Council Employees/Executive Staff Sec. 16. Matching Contributions The Employer Matching Contributions under Election 5.b.1. are made as follows: An amount equal to 100% of each Participant’s Salary Reduction Contributions In determining a Participant’s Salary Reduction Contributions taken into account under the Matching Contribution formula, the following limitations apply: Classified that have opted out of GERP (including part-time and Public Records Employees) Salary Reduction Contributions matched up to 7.5% of Compensation Police and Dispatchers Salary Reduction Contributions matched up to 3.0% of Compensation The following Employee Classifications will not receive an allocation of Employer Matching Contributions: Classified (including part-time and Public Records Employees) Classified participating in the General Employees’ Retirement Plan (GERP) CSOs Classified Unclassified Management and Department Heads Service Area/Unit Directors Council Employees/Executive Staff Exhibit A Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 1 ADOPTION AGREEMENT FOR NATIONWIDE FINANCIAL SERVICES, INC. GOVERNMENTAL VOLUME SUBMITTER MONEY PURCHASE PLAN CAUTION: Failure to properly fill out this Adoption Agreement may result in disqualification of the Plan. EMPLOYER INFORMATION (An amendment to the Adoption Agreement is not needed solely to reflect a change in this Employer Information Section.) 1. EMPLOYER'S NAME, ADDRESS, TELEPHONE NUMBER, TIN AND FISCAL YEAR Name: City of Fort Collins Address: 300 LaPorte Avenue Street Fort Collins Colorado 80521 City State Zip Telephone: (970) 221-6535 Taxpayer Identification Number (TIN): 84-6000587 Employer's Fiscal Year ends: December 31 2. TYPE OF GOVERNMENTAL ENTITY. This Plan may only be adopted a state or local governmental entity, or agency thereof, including an Indian tribal government and may not be adopted by any other entity, including a federal government and any agency or instrumentality thereof. a. [ ] State government or state agency b. [ ] County or county agency c. [X] Municipality or municipal agency d. [ ] Indian tribal government (see Note below) e. [ ] Other: NOTE: An Indian tribal government may only adopt this Plan if such entity is defined under Code §7701(a)(40), is a subdivisi on of an Indian tribal government as determined in accordance with Code §7871(d), or is an agency or instrumentality of either, and all of the Participants under this Plan employed by such entity substantially perform services as an Employee in essential governmental functions and not in the performance of commercial activities (whether or not an essential government function). 3. PARTICIPATING EMPLOYERS (Plan Section 1.38). Will any other Employers adopt this Plan as Participating Employers? a. [X] No b. [ ] Yes PLAN INFORMATION (An amendment to the Adoption Agreement is not needed solely to reflect a change in the information in Questions 9. through 10.) 4. PLAN NAME: City of Fort Collins Service Directors' and Council Employees' Plan 5. PLAN STATUS a. [ ] New Plan b. [X] Amendment and restatement of existing Plan PPA RESTATEMENT (leave blank if not applicable) 1. [ ] This is an amendment and restatement to bring a plan into compliance with the Pension Protection Act of 2006 ("PPA") and other legislative and regulatory changes (i.e., the 6-year pre-approved plan restatement). 6. EFFECTIVE DATE (Plan Section 1.16) (complete a. if new plan; complete a. AND b. if an amendment and restatement) Initial Effective Date of Plan a. December 1, 1974 (enter month day, year) (hereinafter called the "Effective Date" unless 6.b. is entered below) Restatement Effective Date. If this is an amendment and restatement, the effective date of the restatement (hereinafter called the "Effective Date") is: b. October 1, 2021 (enter month day, year; may enter a restatement date that is the first day of the current Plan Year. Plan contains appropriate retroactive effective dates with respect to provisions for appropriate laws.) Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 2 7. PLAN YEAR (Plan Section 1.42) means, except as otherwise provided in d. below: a. [X] the calendar year b. [ ] the twelve-month period ending on (e.g., June 30th) SHORT PLAN YEAR (Plan Section 1.46). This is a Short Plan Year (if the effective date of participation is based on a Plan Year, then coordinate with Question 14): c. [X] N/A d. [ ] beginning on (enter month day, year; e.g., July 1, 2013) and ending on (enter month day, year). 8. VALUATION DATE (Plan Section 1.52) means: a. [X] every day that the Trustee (or Insurer), any transfer agent appointed by the Trustee (or Insurer) or the Employer, and any stock exchange used by such agent are open for business (daily valuation) b. [ ] the last day of each Plan Year c. [ ] the last day of each Plan Year quarter d. [ ] other (specify day or days): (must be at least once each Plan Year) NOTE: The Plan always permits interim valuations. 9. TRUSTEE(S) OR INSURER(S) (Plan Sections 1.25 and 1.50): a. [ ] Insurer. This Plan is funded exclusively with Contracts and the name of the Insurer(s) is: (1) (2) (if more than 2, add names to signature page). b. [ ] Individual Trustee(s). Individual Trustee(s) who serve as Trustee(s) over assets not subject to control by a corporate Trustee. (add additional Trustees as necessary) Name(s) Title(s) Address and telephone number 1. [ ] Use Employer address and telephone number 2. [ ] Use address and telephone number below: Address: Street City State Zip Telephone: c. [X] Corporate Trustee(s) (add additional Trustees as necessary) Name: Nationwide Trust Company Address: 10 W Nationwide Blvd Street Columbus Ohio 43215 City State Zip Telephone: (614)435-5633 Directed/Discretionary Trustee. Unless otherwise specified below, if there is a corporate Trustee, it will serve as a Directed (nondiscretionary) Trustee (Plan Section 1.21) and if there is an individual Trustee, he or she will serve as a Discretionary Trustee (Plan Section 1.22) over all Plan assets (select all that apply; leave blank if defaults apply) d. [ ] Directed Trustee exceptions (leave blank if no exceptions): Directed Trustee over specified Plan assets (select all that apply; leave blank if none apply) 1. [ ] The corporate Trustee will serve as Directed Trustee over the following assets: Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 3 2. [ ] The individual Trustee(s) will serve as Directed Trustee over the following assets: Individual Trustee will serve as Directed Trustee (may not be selected with d.1. or d.2.) 3. [ ] over all Plan assets e. [ ] Discretionary Trustee exceptions (leave blank if no exceptions): Discretionary Trustee over specified Plan assets (select all that apply; leave blank if none apply) 1. [ ] The individual Trustee(s) will serve as Discretionary Trustee over the following assets: 2. [ ] The corporate Trustee will serve as Discretionary Trustee over the following assets: Corporate Trustee will serve as Discretionary Trustee (may not be selected with e.1. or e.2.) 3. [ ] over all Plan assets Separate trust. Will a separate trust agreement that is approved by the IRS for use with this Plan be used? f. [ ] No g. [X] Yes NOTE: If Yes is selected, an executed copy of the trust agreement between the Trustee and the Employer must be attached to this Plan. The Plan and trust agreement will be read and construed together. The responsibilities, rights and powers of the Trustee will be those specified in the trust agreement. 10. ADMINISTRATOR'S NAME, ADDRESS AND TELEPHONE NUMBER (If none is named, the Employer will be the Administrator (Plan Section 1.2).) a. [X] Employer (use Employer address and telephone number) b. [ ] Other: Name: Address: Street City State Zip Telephone: 11. CONTRIBUTION TYPES The selections made below must correspond with the selections made under the Contributions and Allocations Section of this Adoption Agreement. FROZEN PLAN OR CONTRIBUTIONS HAVE BEEN SUSPENDED (Plan Section 4.1(c)) (optional) a. [ ] This is a frozen Plan (i.e., all contributions cease) (if this is a temporary suspension, select a.2): 1. [ ] All contributions ceased as of, or prior to, the effective date of this amendment and restatement and the prior Plan provisions are not reflected in this Adoption Agreement (may enter effective date at 3. below and/or select contributions at b. - f. (optional), skip questions 12-18 and 22-29) 2. [ ] All contributions ceased or were suspended and the prior Plan provisions are reflected in this Adoption Agreement (must enter effective date at 3. below and select contributions at b. - f.) Effective date 3. [ ] as of (effective date is optional unless a.2. has been selected above or this is the amendment or restatement to freeze the Plan). CONTRIBUTIONS The Plan permits the following contributions (select one or more): b. [X] Employer contributions other than matching (Questions 24-25) 1. [ ] This Plan qualifies as a Social Security Replacement Plan (Question 24.c. must be selected) c. [X] Employer matching contributions (Questions 26-28) d. [ ] Mandatory Employee contributions (Question 31) e. [ ] After-tax voluntary Employee contributions (Question 32) f. [X] Rollover contributions (Question 39) ELIGIBILITY REQUIREMENTS 12. ELIGIBLE EMPLOYEES (Plan Section 1.17) means all Employees (including Leased Employees) EXCEPT those Employees who are excluded below or elsewhere in the Plan: a. [ ] No excluded Employees. There are no additional excluded Employees under the Plan (skip to Question 13). b. [X] Exclusions. The following Employees are not Eligible Employees for Plan purposes (select one or more): 1. [ ] Union Employees (as defined in Plan Section 1.17) 2. [ ] Nonresident aliens (as defined in Plan Section 1.17) 3. [ ] Leased Employees (Plan Section 1.28) Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 4 4. [ ] Part-time/temporary/seasonal Employees. A part-time, temporary or seasonal Employee is an Employee whose regularly scheduled service is less than Hours of Service in the relevant eligibility computation period (as defined in Plan Section 1.54). However, if any such excluded Employee actually completes a Year of Service, then such Employee will no longer be part of this excluded class. 5. [X] Other: See Exhibit 1 (must be definitely determinable under Regulations §1.401-1(b). Exclusions may be employment title specific but may not be by individual name nor result in only a finite group of individuals (e.g., excluding anyone hired after 12/31/12.) 13. CONDITIONS OF ELIGIBILITY (Plan Section 3.1) a. [X] No age or service required. No age or service required for all Contribution Types (skip to Question 14). b. [ ] Eligibility. An Eligible Employee will be eligible to participate in the Plan upon satisfaction of the following (complete c. and d., select e. and f. if applicable): Eligibility Requirements c. [ ] Age Requirement 1. [ ] No age requirement 2. [ ] Age 20 1/2 3. [ ] Age 21 4. [ ] Age (may not exceed 26) d. [ ] Service Requirement 1. [ ] No service requirement 2. [ ] (not to exceed 60) months of service (elapsed time) 3. [ ] 1 Year of Service 4. [ ] (not to exceed 5) Years of Service 5. [ ] consecutive month period from the Eligible Employee's employment commencement date and during which at least Hours of Service are completed. 6. [ ] consecutive months of employment from the Eligible Employee's employment commencement date. 7. [ ] Other: (e.g., date on which 1,000 Hours of Service is completed within the computation period) (must satisfy the Notes below) NOTE: If c.4. or d.7. is selected, the condition must be an age or service requirement that is definitely determinable and may not exceed age 26 and may not exceed 5 Years of Service. NOTE: Year of Service means Period of Service if elapsed time method is chosen. Waiver of conditions. The service and/or age requirements specified above will be waived in accordance with the following (leave blank if there are no waivers of conditions): e. [ ] If employed on the following requirements, and the entry date requirement, will be waived. The waiver applies to any Eligible Employee unless 3. selected below. Such Employees will enter the Plan as of such date (select 1. and/or 2. AND 3. if applicable): 1. [ ] service requirement (may let part-time Eligible Employees into the Plan) 2. [ ] age requirement 3. [ ] waiver is for: Amendment or restatement to change eligibility requirements f. [ ] This amendment or restatement (or a prior amendment and restatement) modified the eligibility requirements and the prior eligibility conditions continue to apply to the Eligible Employees specified below. If this option is NOT selected, then all Eligible Employees must satisfy the eligibility conditions set forth above. 1. [ ] The eligibility conditions above only apply to Eligible Employees who were not Participants as of the effective date of the modification. 2. [ ] The eligibility conditions above only apply to individuals who were hired on or after the effective date of the modification. 14. EFFECTIVE DATE OF PARTICIPATION (ENTRY DATE) (Plan Section 3.2) An Eligible Employee who has satisfied the eligibility requirements will become a Participant in the Plan as of the: a. [ ] date such requirements are met b. [ ] first day of the month coinciding with or next following the date on which such requirements are met c. [ ] first day of the Plan Year quarter coinciding with or next following the date on which such requirements are met d. [ ] earlier of the first day of the Plan Year or the first day of the seventh month of the Plan Year coinciding with or next following the date on which such requirements are met e. [ ] first day of the Plan Year coinciding with or next following the date on which such requirements are met (Eligibility must be six months of service (or 1 1/2 Years (or Periods) of Service if 100% immediate vesting is selected) or less and age must be 20 1/2 or less.) f. [ ] first day of the Plan Year in which such requirements are met g. [ ] first day of the Plan Year in which such requirements are met, if such requirements are met in the first 6 months of the Plan Year, or as of the first day of the next succeeding Plan Year if such requirements are met in the last 6 months of the Plan Year. h. [X] other: First payroll after meeting Eligibility (must be definitely determinable) Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 5 SERVICE 15. RECOGNITION OF SERVICE WITH OTHER EMPLOYERS (Plan Sections 1.39 and 1.54) a. [X] No service with other employers is recognized except as otherwise required by law (e.g., the Plan already provides for the recognition of service with Employers who have adopted this Plan as well as service with Affiliated Employers and predecessor Employers who maintained this Plan; skip to Question 16). b. [ ] Prior service with the designated employers is recognized as follows (answer c. and select one or more of c.1. - 3.; select d. - f. as applicable) (if more than 3 employers, attach an addendum to the Adoption Agreement or complete option h. under Section B of Appendix A): Contribution Other Employer Eligibility Vesting Allocation c. [ ] Employer name: 1. [ ] 2. [ ] 3. [ ] d. [ ] Employer name: 1. [ ] 2. [ ] 3. [ ] e. [ ] Employer name: 1. [ ] 2. [ ] 3. [ ] Limitations f. [ ] The following provisions or limitations apply with respect to the 1. [ ] 2. [ ] 3. [ ] recognition of prior service: (e.g., credit service with X only on/following 1/1/13) NOTE: If the other Employer(s) maintained this qualified Plan, then Years (and/or Periods) of Service with such Employer(s) must be recognized pursuant to Plan Sections 1.39 and 1.54 regardless of any selections above. 16. SERVICE CREDITING METHOD (Plan Sections 1.39 and 1.54) NOTE: If no selections are made in this Section, then the provisions set forth in the definition of Year of Service in Plan Section 1.54 will apply, including the following defaults: 1. A Year of Service means completion of at least 1,000 Hours of Service during the applicable computation period. 2. Hours of Service (Plan Section 1.24) will be based on actual Hours of Service. 3. For eligibility purposes, the computation period will be as defined in Plan Section 1.54 (i.e., shift to the Plan Year if the eligibility condition is one (1) Year of Service or less). 4. For vesting and allocation purposes, the computation period will be the Plan Year. a. [X] Elapsed time method. (Period of Service applies instead of Year of Service) Instead of Hours of Service, elapsed time will be used for: 1. [X] all purposes (skip to Question 17) 2. [ ] the following purposes (select one or more): a. [ ] eligibility to participate b. [ ] vesting c. [ ] sharing in allocations or contributions b. [ ] Alternative definitions for the Hours of Service method. Instead of the defaults, the following alternatives will apply for the Hours of Service method (select one or more): 1. [ ] Eligibility computation period. Instead of shifting to the Plan Year, the eligibility computation period after the initial eligibility computation period will be based on each anniversary of the date the Employee first completes an Hour of Service 2. [ ] Vesting computation period. Instead of the Plan Year, the vesting computation period will be the date an Employee first performs an Hour of Service and each anniversary thereof. 3. [ ] Equivalency method. Instead of using actual Hours of Service, an equivalency method will be used to determine Hours of Service for: a. [ ] all purposes b. [ ] the following purposes (select one or more): 1. [ ] eligibility to participate 2. [ ] vesting 3. [ ] sharing in allocations or contributions Such method will apply to: c. [ ] all Employees d. [ ] Employees for whom records of actual Hours of Service are not maintained or available (e.g., salaried Employees) e. [ ] other: (e.g., per-diem Employees only) Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 6 Hours of Service will be determined on the basis of: f. [ ] days worked (10 hours per day) g. [ ] weeks worked (45 hours per week) h. [ ] semi-monthly payroll periods worked (95 hours per semi-monthly pay period) i. [ ] months worked (190 hours per month) j. [ ] bi-weekly payroll periods worked (90 hours per bi-weekly pay period) k. [ ] other: (e.g., option f. is used for per-diem Employees and option g. is used for on-call Employees). 4. [ ] Number of Hours of Service required. Instead of 1,000 Hours of Service, Year of Service means the applicable computation period during which an Employee has completed at least (not to exceed 1,000) Hours of Service for: a. [ ] all purposes b. [ ] the following purposes (select one or more): 1. [ ] eligibility to participate 2. [ ] vesting 3. [ ] sharing in allocations or contributions VESTING 17. VESTING OF PARTICIPANT'S INTEREST – EMPLOYER CONTRIBUTIONS (Plan Section 6.4(b)) a. [ ] N/A (no Employer contributions; skip to Question 19) b. [X] The vesting provisions selected below apply. Section B of Appendix A can be used to specify any exceptions to the provisions below. NOTE: The Plan provides that contributions for converted sick leave and/or vacation leave are fully Vested. Vesting for Employer contributions other than matching contributions c. [ ] N/A (no Employer contributions (other than matching contributions); skip to f.) d. [X] 100% vesting. Participants are 100% Vested in Employer contributions (other than matching contributions) upon entering Plan. e. [ ] The following vesting schedule, based on a Participant's Years of Service (or Periods of Service if the elapsed time method is selected), applies to Employer contributions (other than matching contributions): 1. [ ] 6 Year Graded: 0-1 year-0%; 2 years-20%; 3 years-40%; 4 years-60%; 5 years-80%; 6 years-100% 2. [ ] 4 Year Graded: 1 year-25%; 2 years-50%; 3 years-75%; 4 years-100% 3. [ ] 5 Year Graded: 1 year-20%; 2 years-40%; 3 years-60%; 4 years-80%; 5 years-100% 4. [ ] Cliff: 100% vesting after (not to exceed 15) years 5. [ ] Other graded vesting schedule (must provide for full vesting no later than 15 years of service; add additional lines as necessary) Years (or Periods) of Service Percentage % % % % % % Vesting for Employer matching contributions f. [ ] N/A (no Employer matching contributions) g. [X] The schedule above will also apply to Employer matching contributions. h. [ ] 100% vesting. Participants are 100% Vested in Employer matching contributions upon entering Plan. i. [ ] The following vesting schedule, based on a Participant's Years of Service (or Periods of Service if the elapsed time method is selected), applies to Employer matching contributions: 1. [ ] 6 Year Graded: 0-1 year-0%; 2 years-20%; 3 years-40%; 4 years-60%; 5 years-80%; 6 years-100% 2. [ ] 4 Year Graded: 1 year-25%; 2 years-50%; 3 years-75%; 4 years-100% 3. [ ] 5 Year Graded: 1 year-20%; 2 years-40%; 3 years-60%; 4 years-80%; 5 years-100% 4. [ ] Cliff: 100% vesting after (not to exceed 15) years 5. [ ] Other graded vesting schedule (must provide for full vesting no later than 15 years of service; add additional lines as necessary) Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 7 Years (or Periods) of Service Percentage % % % % % % 18. VESTING OPTIONS Excluded vesting service. The following Years of Service will be disregarded for vesting purposes (select all that apply; leave blank if none apply): a. [ ] Service prior to the initial Effective Date of the Plan or a predecessor plan (as defined in Regulations §1.411(a)-5(b)(3)) b. [ ] Service prior to the computation period in which an Employee has attained age . c. [ ] Service during a period for which an Employee did not make mandatory Employee contributions. Vesting for death, Total And Permanent Disability and Early Retirement Date. Regardless of the vesting schedule, a Participant will become fully Vested upon (select all that apply; leave blank if none apply): d. [ ] Death e. [ ] Total and Permanent Disability f. [ ] Early Retirement Date RETIREMENT AGES 19. NORMAL RETIREMENT AGE ("NRA") (Plan Section 1.32) means: a. [X] Specific age. The date a Participant attains age 55 (may not exceed 65) b. [ ] Age/participation. The later of the date a Participant attains age (may not exceed 65) or the (may not exceed 10th) anniversary of the first day of the Plan Year in which participation in the Plan commenced NOTE: Effective for Plan Years beginning on or after the later of (1) January 1, 2015, or (2) the close of the first regular legislative session of the legislative body with the authority to amend the plan that begins on or after the date that is three months after the final regulations are published in the Federal Register, Normal Retirement Age of less than age 62 must meet Regulation §1.401(a)-1(b)(2). Qualified police or firefighters. Normal Retirement Age for qualified public safety employees (as defined in Code §72(t)(1)) (leave blank if not applicable) c. [ ] Age (may not be less than 50) 20. NORMAL RETIREMENT DATE (Plan Section 1.33) means, with respect to any Participant, the: a. [X] date on which the Participant attains "NRA" b. [ ] first day of the month coinciding with or next following the Participant's "NRA" c. [ ] first day of the month nearest the Participant's "NRA" d. [ ] Anniversary Date coinciding with or next following the Participant's "NRA" e. [ ] Anniversary Date nearest the Participant's "NRA" f. [ ] Other: (e.g., first day of the month following the Participant's "NRA"). 21. EARLY RETIREMENT DATE (Plan Section 1.15) a. [X] N/A (no early retirement provision provided) b. [ ] Early Retirement Date means the: 1. [ ] date on which a Participant satisfies the early retirement requirements 2. [ ] first day of the month coinciding with or next following the date on which a Participant satisfies the early retirement requirements 3. [ ] Anniversary Date coinciding with or next following the date on which a Participant satisfies the early retirement requirements Early retirement requirements 4. [ ] Participant attains age AND, completes.... (leave blank if not applicable) a. [ ] at least Years (or Periods) of Service for vesting purposes b. [ ] at least Years (or Periods) of Service for eligibility purposes c. [ ] Early Retirement Date means: (must be definitely determinable) Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 8 COMPENSATION 22. COMPENSATION with respect to any Participant is defined as follows (Plan Sections 1.10 and 1.23). Base definition a. [X] Wages, tips and other compensation on Form W-2 b. [ ] Code §3401(a) wages (wages for withholding purposes) c. [ ] 415 safe harbor compensation NOTE: Plan Section 1.23(c) provides that the base definition of Compensation includes deferrals that are not included in income due to Code §§401(k), 125, 132(f)(4), 403(b), 402(h)(1)(B)(SEP), 414(h)(2), & 457(b). Determination period. Compensation will be based on the following "determination period" (this will also be the Limitation Year unless otherwise elected at option f. under Section B of Appendix A): d. [X] the Plan Year e. [ ] the Fiscal Year coinciding with or ending within the Plan Year f. [ ] the calendar year coinciding with or ending within the Plan Year Adjustments to Compensation (for Plan Section 1.10). Compensation will be adjusted by: g. [ ] No adjustments (skip to i. below) h. [X] Adjustments. Compensation will be adjusted by (select all that apply): 1. [ ] excluding salary reductions (401(k), 125, 132(f)(4), 403(b), SEP, 414(h)(2) pickup, & 457(b)) 2. [ ] excluding reimbursements or other expense allowances, fringe benefits (cash or non-cash), moving expenses, deferred compensation (other than deferrals specified in 1. above) and welfare benefits. 3. [ ] excluding Compensation paid during the "determination period" while not a Participant in the Plan. 4. [X] excluding Military Differential Pay 5. [X] excluding overtime 6. [X] excluding bonuses 7. [ ] other: (e.g., describe Compensation from the elections available above or a combination thereof as to a Participant group (e.g., no exclusions as to Division A Employees and exclud e bonuses as to Division B Employees); and/or describe another exclusion (e.g., exclude shift differential pay)). Military Differential Pay Special Effective Date (leave blank if not applicable) i. [ ] If this is a PPA restatement and the provisions above regarding Military Differential Pay (included unless h.4. is selected) have a later effective date than Plan Years beginning after December 31, 2008, then enter the date such provisions were first effective: (may not be earlier than January 1, 2009; for Plan Years beginning prior to January 1, 2009, Military Differential Pay is treated in accordance with the post-severance Compensation provisions in the following Question). 23. POST-SEVERANCE COMPENSATION (415 REGULATIONS) The following optional provision of the 415 Regulations will apply to Limitation Years beginning on or after July 1, 2007 unless otherwise elected below: 415 Compensation (post-severance compensation adjustments) (select all that apply at a.; leave blank if none apply) NOTE: Unless otherwise elected under a. below, the following defaults apply: 415 Compensation will include (to the extent provided in Plan Section 1.23), post-severance regular pay, leave cash-outs and payments from nonqualified unfunded deferred compensation plans. a. [X] The defaults listed above apply except for the following (select one or more): 1. [ ] Leave cash-outs will be excluded 2. [X] Nonqualified unfunded deferred compensation will be excluded 3. [X] Military Differential Pay will be included (Plan automatically includes for Limitation Years beginning after December 31, 2008) 4. [X] Disability continuation payments will be included Plan Compensation (post-severance compensation adjustments) b. [ ] Defaults apply. Compensation will include (to the extent provided in Plan Section 1.10 and to the extent such amounts would be included in Compensation if paid prior to severance of employment) post-severance regular pay, leave cash-outs, and payments from nonqualified unfunded deferred compensation plans. c. [ ] Exclude all post-severance compensation. Exclude all post-severance compensation for allocation purposes. d. [X] Post-severance adjustments. The defaults listed at b. apply except for the following (select one or more): 1. [ ] Exclude all post-severance compensation 2. [ ] Regular pay will be excluded 3. [ ] Leave cash-outs will be excluded 4. [X] Nonqualified unfunded deferred compensation will be excluded 5. [ ] Military Differential Pay will be included 6. [ ] Disability continuation payments will be included Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 9 NOTE: The above treatment of Military Differential Pay only applies to Plan Years beginning prior to January 1, 2009. For Plan Years beginning after such date, Military Differential Pay is not considered post-severance compensation and the provisions of Question 22 apply. Post-severance compensation special effective date (leave blank if not applicable) e. [ ] If this is a PPA restatement and the post-severance compensation adjustments above for 415 Compensation or Plan Compensation applied other than the first day of the Plan Year beginning on or after July 1, 2007, then enter the date such provisions were first effective: CONTRIBUTIONS AND ALLOCATIONS 24. EMPLOYER CONTRIBUTIONS (OTHER THAN MATCHING CONTRIBUTIONS) (Plan Section 4.1(a)(2)) (skip to Question 26 if Employer contributions are NOT selected at Question 11.b.) CONTRIBUTION FORMULA (select one or more of the following contribution formulas:) a. [X] Fixed contribution equal to (only select one): 1. [ ] % of each Participant's Compensation for each: a. [ ] Plan Year b. [ ] calendar quarter c. [ ] month d. [ ] pay period e. [ ] week 2. [ ] $ per Participant. 3. [ ] $ per Hour of Service worked while an Eligible Employee a. [ ] up to hours (leave blank if no limit) 4. [X] other: 10% of Participant's Compensation contributed bi-weekly (the formula described must satisfy the definitely determinable requirement under Regulations §1.401-1(b)). b. [ ] Sick leave/vacation leave conversion. The Employer will contribute an amount equal to an Employee's current hourly rate of pay multiplied by the Participant's number of unused accumulated sick leave and/or vacation days (as selected below). Only unpaid sick and vacation leave for which the Employee has no right to receive in cash may be included. In no event will the Employer's contribution for the Plan Year exceed the maximum contribution permitted under Code §415(c). The following may be converted under the Plan: (select one or both): 1. [ ] Sick leave 2. [ ] Vacation leave Eligible Employees. Only the following Participants shall receive the Employer contribution for sick leave and/or vacation leave (select 3. and/or 4; leave blank if no limitations provided, however, that this Plan may not be used to only provide benefits for terminated Employees) 3. [ ] Former Employees. All Employees terminating service with the Employer during the Plan Year and who have satisfied the eligibility requirements based on the terms of the Employer's accumulated benefits plans checked below (select all that apply; leave blank if no exclusions): a. [ ] The Former Employee must be at least age (e.g., 55) b. [ ] The value of the sick and/or vacation leave must be at least $ (e.g., $2,000) c. [ ] A contribution will only be made if the total hours is over (e.g., 10) hours d. [ ] A contribution will not be made for hours in excess of (e.g., 40) hours 4. [ ] Active Employees. Active Employees who have not terminated service during the Plan Year and who meet the following requirements (select all that apply; leave blank if no exclusions): a. [ ] The Employee must be at least age (e.g., 55) b. [ ] The value of the sick and/or vacation leave must be at least $ (e.g., $2,000) c. [ ] A contribution will only be made if the total hours is over (e.g., 10) hours d. [ ] A contribution will not be made for hours in excess of (e.g., 40) hours c. [ ] Social Security Replacement Plan. An amount equal to 7.5% of the Participant's Compensation for the entire Plan Year, reduced by Employee and Employer contributions to this Plan actually contributed to the Participant's Account during such Plan Year. (may only be selected if Question 11.b.1. has also been selected) Include only part-time, seasonal and temporary Employees (leave blank if not applicable) 1. [ ] Regardless of any other provision in this to the contrary, the contribution above will only be made for part- time, seasonal, or temporary Employees who are not otherwise covered by another qualifying public retirement system as defined for purposes of Regulation §31.3121(b)(7)-2. Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 10 25. ALLOCATION CONDITIONS (Plan Section 4.3). If 24.a. is selected above, indicate requirements to share in allocations of Employer contributions (select a. OR b. and all that apply at c. - e.) a. [X] No conditions. All Participants share in the allocations regardless of service completed during the Plan Year or employment status on the last day of the Plan Year (skip to Question 26). b. [ ] Allocation conditions apply (select one of 1. - 5. AND one of 6. - 9. below) Conditions for Participants NOT employed on the last day of the Plan Year 1. [ ] A Participant must complete at least (not to exceed 1,000) Hours of Service (or (not to exceed 12) months of service if the elapsed time method is selected). 2. [ ] A Participant must complete a Year of Service (or Period of Service if the elapsed time method is selected). 3. [ ] Participants will NOT share in the allocations, regardless of service. 4. [ ] Participants will share in the allocations, regardless of service. 5. [ ] Other: (must be definitely determinable, not subject to Employer discretion and may not require more than one Year of Service (or Period of Service if the elapsed time method is selected)). Conditions for Participants employed on the last day of the Plan Year 6. [ ] No service requirement. 7. [ ] A Participant must complete a Year of Service (or Period of Service if the elapsed time method is selected). 8. [ ] A Participant must complete at least (not to exceed 1,000) Hours of Service during the Plan Year. 9. [ ] Other: (must be definitely determinable, not subject to Employer discretion and may not require more than one Year of Service (or Period of Service if the elapsed time method is selected)). Waiver of conditions for Participants NOT employed on the last day of the Plan Year. If b.1., 2., 3., or 5. is selected, Participants who are not employed on the last day of the Plan Year in which one of the following events occur will be eligible to share in the allocations regardless of the above conditions (select all that apply; leave blank if none apply): c. [ ] Death d. [ ] Total and Permanent Disability e. [ ] Termination of employment on or after Normal Retirement Age 1. [ ] or Early Retirement Date 26. EMPLOYER MATCHING CONTRIBUTIONS (Plan Section 4.1(a)(3)). (skip to Question 29 if matching contributions are NOT selected at Question 11.c.) The Employer will make the following matching contributions: A. Elective deferrals taken into account. For purposes of applying the matching contribution provisions below, elective deferrals include elective deferral (pre-tax and Roth) contributions to the following Employer plan(s) (insert name of Plan(s) to which the elective deferral contributions being matched will be made): a. [X] 457 plan(s). Enter Plan name: City of Fort Collins 457(b) Deferred Compensation Plan b. [ ] 403(b) plan(s). Enter Plan name: NOTE: If selected at Question 32, after-tax voluntary Employee contributions are also considered elective deferrals for purposes of matching contributions. B. Matching Formula. (select one) c. [X] Fixed - uniform rate/amount. The Employer will make matching contributions equal to 100 % (e.g., 50) of the Participant's elective deferrals 1. [X] that do not exceed 3 % of a Participant's Compensation (leave blank if no limit) d. [ ] Fixed - tiered. The Employer will make matching contributions equal to a uniform percentage of each tier of each Participant's elective deferrals, determined as follows: NOTE: Fill in only percentages or dollar amounts, but not both. If percentages are used, each tier represents the amount of the Participant's applicable contributions that equals the specified percentage of the Participant's Compensation (add additional tiers if necessary): Tiers of Contributions Matching Percentage (indicate $ or %) First % Next % Next % Next % Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 11 e. [ ] Fixed - Years of Service. The Employer will make matching contributions equal to a uniform percentage of each Participant's elective deferrals based on the Participant's Years of Service (or Periods of Service if the elapsed time method is selected), determined as follows (add additional tiers if necessary): Years (or Periods) of Service Matching Percentage % % % For purposes of the above matching contribution formula, a Year (or Period) of Service means a Year (or Period) of Service for: 1. [ ] vesting purposes 2. [ ] eligibility purposes f. [ ] Other: (the formula described must satisfy the definitely determinable requirement under Regulations §1.401-1(b)) 27. MATCHING CONTRIBUTION PROVISIONS A. Maximum matching contribution. The total matching contribution made on behalf of any Participant for any Plan Year will not exceed: a. [X] N/A (no Plan specific limit on the amount of matching contribution) b. [ ] $ . c. [ ] % of Compensation. B. Period of determination. The matching contribution formula will be applied on the following basis (and elective deferrals and any Compensation or dollar limitation used in determining the matching contribution will be based on the applicable period): d. [ ] the Plan Year e. [X] each payroll period f. [ ] each month g. [ ] each Plan Year quarter h. [ ] each payroll unit (e.g., hour) 28. ALLOCATION CONDITIONS FOR MATCHING CONTRIBUTIONS (Plan Section 4.3). Select a. OR b. and all that apply of c. - h. a. [ ] No conditions. All Participants share in the allocations regardless of service completed during the Plan Year or employment status on the last day of the Plan Year (skip to Question 29). b. [X] Allocation conditions apply (select one of 1. -5. AND one of 6. - 9. below) Conditions for Participants NOT employed on the last day of the Plan Year. 1. [ ] A Participant must complete at least (not to exceed 1,000) Hours of Service (or (not to exceed 12) months of service if the elapsed time method is selected). 2. [ ] A Participant must complete a Year of Service (or Period of Service if the elapsed time method is selected). 3. [ ] Participants will NOT share in the allocations, regardless of service. 4. [ ] Participants will share in the allocations, regardless of service. 5. [X] Other: Only Employees classified as a Service Area/Unit Director or Council Employees/Executive Staff are eligible for Employer Matching (must be definitely determinable, not subject to Employer discretion and may not require more than one Year of Service (or Period of Service if the elapsed time method is selected)). Conditions for Participants employed on the last day of the Plan Year 6. [ ] No service requirement. 7. [ ] A Participant must complete a Year of Service (or Period of Service if the elapsed time method is selected). 8. [ ] A Participant must complete at least (not to exceed 1,000) Hours of Service during the Plan Year. 9. [X] Other: Only Employees classified as a Service Area/Unit Director or Council Employees/Executive Staff are eligible for Employer Matching (must be definitely determinable, not subject to Employer discretion and may not require more than one Year of Service (or Period of Service if the elapsed time method is selected)). Waiver of conditions for Participants NOT employed on the last day of the Plan Year. If b.1., 2., 3., or 5. is selected, Participants who are not employed on the last day of the Plan Year in which one of the following events occur will be eligible to share in the allocations regardless of the above conditions (select all that apply; leave blank if none apply): c. [ ] Death d. [ ] Total and Permanent Disability e. [ ] Termination of employment on or after Normal Retirement Age 1. [ ] or Early Retirement Date Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 12 Conditions based on period other than Plan Year. The allocation conditions above will be applied based on the Plan Year unless otherwise selected below. If selected, the above provisions will be applied by substituting the term Plan Year with th e specified period (e.g., if Plan Year quarter is selected below and the allocation condition is 250 Hours of Service per quarter, enter 250 hours (not 1000) at b.8. above). f. [ ] The Plan Year quarter. g. [ ] Payroll period. h. [ ] Other: (must be definitely determinable and not subject to Employer discretion and may not be longer than a twelve month period). 29. FORFEITURES (Plan Sections 1.21 and 4.3(e)) Forfeitures of Employer contributions other than matching contributions will be: a. [ ] added to the Employer contribution and allocated in the same manner b. [X] used to reduce any Employer contribution c. [ ] allocated to all Participants eligible to share in the allocations of Employer contributions or Forfeitures in the same proportion that each Participant's Compensation for the Plan Year bears to the Compensation of all Participants for such year d. [ ] other: (describe the treatment of Forfeitures in a manner that is definitely determinable and not subject to Employer discretion; e.g., Forfeitures attributable to transferred balances from Plan X are allocated as additional discretionary contributions only to former Plan X Participants) Forfeitures of Employer matching contributions will be: e. [ ] N/A. Same as above or no Employer matching contributions. f. [X] used to reduce the Employer matching contribution. g. [ ] used to reduce any Employer contribution. h. [ ] other: (describe the treatment of Forfeitures in a manner that is definitely determinable and not subject to Employer discretion; e.g., Forfeitures attributable to transferred balances from Plan X are allocated as additional discretionary contributions only to former Plan X Participants) 30. ALLOCATION OF EARNINGS (Plan Section 4.3(c)) Allocation of earnings with respect to amounts which are not subject to Participant investment direction and which are contributed to the Plan after the previous Valuation Date will be determined: a. [X] N/A. (all assets in the Plan are subject to Participant investment direction) b. [ ] by using a weighted average based on the amount of time that has passed between the date a contribution or distribution is made and the prior Valuation Date c. [ ] by treating one-half of all such contributions as being a part of the Participant's nonsegregated Account balance as of the previous Valuation Date d. [ ] by using the method specified in Plan Section 4.3(c) (balance forward method) e. [ ] other: (must be a definite predetermined formula) 31. MANDATORY EMPLOYEE CONTRIBUTIONS (Plan Section 4.8) (skip if mandatory Employee contributions NOT selected at Question 11.d.) a. [ ] An Eligible Employee must contribute to the Plan % (not to exceed 25%) of Compensation. b. [ ] An Eligible Employee must, prior to his or her first Entry Date, make a one-time irrevocable election to contribute to the Plan from % (not less than 1%) to % (not to exceed 25%) of Compensation. c. [ ] Other: (must be definitely determinable) Employer pick-up contribution. The mandatory Employee contribution is "picked up" by the Employer under Code §414(h)(2) unless elected below. d. [ ] The mandatory Employee contribution is not "picked-up" by the Employer. 32. AFTER-TAX VOLUNTARY EMPLOYEE CONTRIBUTIONS (Plan Section 4.9) (skip if after-tax voluntary Employee contributions NOT selected at Question 11.e.) Matching after-tax voluntary Employee contributions. There are no Employer matching contributions on after-tax voluntary Employee contributions unless elected below. a. [ ] After-tax voluntary Employee contributions are considered elective deferrals for purposes of applying any matching contributions under the Plan. DISTRIBUTIONS 33. FORM OF DISTRIBUTIONS (Plan Sections 6.5 and 6.6) Distributions under the Plan may be made in (select all that apply; must select at least one): a. [X] lump-sums b. [X] substantially equal installments c. [ ] partial withdrawals, provided the minimum withdrawal is $ (leave blank if no minimum) Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 13 d. [ ] partial withdrawals or installments are only permitted for Participants or Beneficiaries who must receive required minimum distributions under Code §401(a)(9) except for the following (e.g., partial is not permitted for death benefits; leave blank if no exceptions): 1. [ ] e. [ ] annuity: (describe the form of annuity or annuities) f. [X] other: Any other sequence as requested by the Participant (must be definitely determinable and not subject to Employer discretion) NOTE: Regardless of the above, a Participant is not required to request a withdrawal of his or her total Account for an in-service distribution, a hardship distribution, or a distribution from the Participant's Rollover Account. Cash or property. Distributions may be made in: g. [X] cash only, except for (select all that apply; leave blank if none apply): 1. [ ] insurance Contracts 2. [ ] annuity Contracts 3. [ ] Participant loans h. [ ] cash or property, except that the following limitation(s) apply: (leave blank if there are no limitations on property distributions): 1. [ ] (must be definitely determinable and not subject to Employer discretion) 34. CONDITIONS FOR DISTRIBUTIONS UPON SEVERANCE OF EMPLOYMENT. Distributions upon severance of employment pursuant to Plan Section 6.4(a) will not be made unless the following conditions have been satisfied: A. Accounts in excess of $5,000 a. [X] Distributions may be made as soon as administratively feasible following severance of employment. b. [ ] Distributions may be made as soon as administratively feasible after the last day of the Plan Year coincident with or next following severance of employment. c. [ ] Distributions may be made as soon as administratively feasible after the last day of the Plan Year quarter coincident with or next following severance of employment. d. [ ] Distributions may be made as soon as administratively feasible after the Valuation Date coincident with or next following severance of employment. e. [ ] Distributions may be made as soon as administratively feasible after months have elapsed following severance of employment. f. [ ] No distributions may be made until a Participant has reached Early or Normal Retirement Date. g. [ ] Other: (must be objective conditions which are ascertainable and may not exceed the limits of Code §401(a)(14) as set forth in Plan Section 6.7) B. Accounts of $5,000 or less h. [X] Same as above i. [ ] Distributions may be made as soon as administratively feasible following severance of employment. j. [ ] Distributions may be made as soon as administratively feasible after the last day of the Plan Year coincident with or next following severance of employment. k. [ ] Other: (must be objective conditions which are ascertainable and may not exceed the limits of Code §401(a)(14) as set forth in Plan Section 6.7) C. Timing after initial distributable event. If a distribution is not made in accordance with the above provisions upon the occurrence of the distributable event, then a Participant may elect a subsequent distribution at any time after the time the amount was first distributable (assuming the amount is still distributable), unless otherwise selected below (may not be selected with 34.f. and 34.h.): l. [ ] Other: (e.g., a subsequent distribution request may only be made in accordance with l. above (i.e., the last day of another Plan Year); must be objective conditions which are ascertainable and may not exceed the limits of Code §401(a)(14) as set forth in Plan Section 6.7) D. Participant consent (i.e., involuntary cash-outs). Should Vested Account balances less than a certain dollar threshold be automatically distributed without Participant consent (mandatory distributions)? NOTE: The Plan provides that distributions of amounts of $5,000 or less are only paid as lump-sums. m. [ ] No, Participant consent is required for all distributions. n. [X] Yes, Participant consent is required only if the distribution is over: 1. [ ] $5,000 2. [X] $1,000 3. [ ] $ (less than $1,000) NOTE: If 2. or 3. is selected, rollovers will be included in determining the threshold for Participant consent. Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 14 Automatic IRA rollover. With respect to mandatory distributions of amounts that are $1,000 or less, if a Participant makes no election, the amount will be distributed as a lump-sum unless selected below. 4. [ ] If a Participant makes no election, then the amount will be automatically rolled over to an IRA provided the amount is at least $ (e.g., $200). E. Rollovers in determination of $5,000 threshold. Unless otherwise elected below, amounts attributable to rollover contributions (if any) will be included in determining the $5,000 threshold for timing of distributions, form of distributions, or consent rules. o. [ ] Exclude rollovers (rollover contributions will be excluded in determining the $5,000 threshold) NOTE: Regardless of the above election, if the Participant consent threshold is $1,000 or less, then the Administrator must include amounts attributable to rollovers for such purpose. In such case, an election to exclude rollovers above will apply for purposes of the timing and form of distributions. 35. DISTRIBUTIONS UPON DEATH (Plan Section 6.8(b)(2)) Distributions upon the death of a Participant prior to the "required beginning date" will: a. [X] be made pursuant to the election of the Participant or "designated Beneficiary" b. [ ] begin within 1 year of death for a "designated Beneficiary" and be payable over the life (or over a period not exceeding the "life expectancy") of such Beneficiary, except that if the "designated Beneficiary" is the Participant's Spouse, begin prior to December 31st of the year in which the Participant would have attained age 70 1/2 c. [ ] be made within 5 (or if lesser ) years of death for all Beneficiaries d. [ ] be made within 5 (or if lesser ) years of death for all Beneficiaries, except that if the "designated Beneficiary" is the Participant's Spouse, begin prior to December 31st of the year in which the Participant would have attained age 70 1/2 and be payable over the life (or over a period not exceeding the "life expectancy") of such "surviving Spouse" NOTE: The elections above must be coordinated with the Form of distributions (e.g., if the Plan only permits lump-sum distributions, then options a., b. and d. would not be applicable). 36. OTHER PERMITTED DISTRIBUTIONS (select all that apply; leave blank if none apply) A. IN-SERVICE DISTRIBUTIONS (Plan Section 6.11) In-service distributions will NOT be allowed (except as otherwise permitted under the Plan without regard to this provision) unless selected below (if applicable, answer a. - e.; leave blank if not applicable): a. [X] In-service distributions may be made to a Participant who has not separated from service provided the following has been satisfied: 1. [X] Age. The Participant has reached: a. [ ] Normal Retirement Age b. [ ] age 62 c. [X] age 70 1/2 (may not be earlier than age 62) Special effective date (may be left blank if same as Plan or Restatement Effective Date) d. [ ] (if this is a PPA restatement and the provisions were effective prior to the Restatement Effective Date, then enter the date such provisions were first effective; may not be earlier than the first day of the Plan Year beginning in 2007) Account restrictions. In-service distributions are permitted from the following Participant Accounts: b. [ ] all Accounts c. [ ] only from the following Accounts (select one or more): 1. [ ] Account attributable to Employer matching contributions 2. [ ] Account attributable to Employer contributions other than matching contributions 3. [ ] Rollover Account 4. [ ] Transfer Account 5. [ ] Other: (specify Account(s) and conditions in a manner that satisfies the definitely determinable requirement under Regulations §1.401-1(b) and is not subject to Employer discretion) Limitations. The following limitations apply to in-service distributions: d. [X] N/A (no additional limitations) e. [ ] Additional limitations (select one or more): 1. [ ] The minimum amount of a distribution is $ . 2. [ ] No more than distribution(s) may be made to a Participant during a Plan Year. 3. [ ] Distributions may only be made from Accounts which are fully Vested. 4. [ ] In-service distributions may be made subject to the following provisions: (must satisfy the definitely determinable requirement under Regulations §1.401-1(b) and not be subject to Employer discretion). 37. HEART ACT PROVISIONS (Plan Section 6.17) Continued benefit accruals. a. [X] Continued benefit accruals will NOT apply b. [ ] Continued benefit accruals will apply Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 15 Special effective date. If this is a PPA restatement and the provision applied other than as of the first day of the 2007 Plan Year, then enter the date such provision was first effective: (leave blank if not applicable) c. [ ] (may not be earlier than the first day of the 2007 Plan Year) Distributions for deemed severance of employment d. [X] The Plan does NOT permit distributions for deemed severance of employment e. [ ] The Plan permits distributions for deemed severance of employment Special effective date (may be left blank if same as Plan or Restatement Effective Date) 1. [ ] (if this is a PPA restatement and the provisions were effective prior to the Restatement Effective Date, then enter the date such provisions were first effective; may not be earlier than January 1, 2007) MISCELLANEOUS 38. LOANS TO PARTICIPANTS (Plan Section 7.6) a. [ ] New loans are NOT permitted. b. [X] New loans are permitted. NOTE: Regardless of whether new loans are permitted, if the Plan permits rollovers, then the Administrator may, in a uniform manner, accept rollovers of loans into this Plan. 39. ROLLOVERS (Plan Section 4.6) (skip if rollover contributions are NOT selected at 11.f.) Eligibility. Rollovers may be accepted from all Participants who are Employees as well as the following (select all that apply; leave blank if not applicable): a. [X] Any Eligible Employee, even prior to meeting eligibility conditions to be a Participant b. [ ] Participants who are Former Employees Distributions. When may distributions be made from a Participant's Rollover Account? c. [X] At any time d. [ ] Only when the Participant is otherwise entitled to a distribution under the Plan PPA TRANSITION RULES The following questions only apply if this is a PPA restatement (i.e., Question 5.b.1. is selected). If this is not a PPA restatement, then this Plan will not be considered an individually designed plan merely because the following questions are deleted from the Adoption Agreement. NOTE: The following provisions are designed to be left unanswered if the selections do not apply to the Plan. 40. WRERA - RMD WAIVERS FOR 2009 (Plan Section 6.8(f)) Suspension/continuation of RMDs. Unless otherwise elected below, required minimum distributions (RMDs) for 2009 were suspended unless a Participant or Beneficiary elected to receive such distributions: a. [ ] RMDs for 2009 were suspended for any Participant or Beneficiary who was scheduled to receive his/her first RMD for 2009 or who did not make a continuing election prior to 2009 to receive his/her RMD (unless the Participant or Beneficiary made an election to receive such distribution). RMDs for 2009 were continued for any Participant or Beneficiary who had made a continuing election to receive an RMD prior to 2009 (unless the Participant or Beneficiary made an election to suspend such distribution). b. [ ] RMDs continued unless otherwise elected by a Participant or Beneficiary. c. [ ] RMDs continued in accordance with the terms of the Plan (i.e., no election available to Participants or Beneficiaries). d. [ ] Other: Direct rollovers. The Plan also treated the following as "eligible rollover distributions" in 2009 (If no election is made, then a "direct rollover" was only offered for "2009 RMDs"): e. [ ] "2009 RMDs" and "Extended 2009 RMDs." f. [ ] "2009 RMDs" but only if paid with an additional amount that is an "eligible rollover distribution" without regard to Code §401(a)(9)(H). 41. NON-SPOUSAL ROLLOVERS (Plan Section 6.14(d)). Non-spousal rollovers are permitted effective for distributions after December 31, 2006 unless an alternative effective date is selected at a. below: a. [ ] Non-spousal rollovers are allowed effective (may not be earlier than January 1, 2007 and not later than January 1, 2010; the Plan already provides for non-spousal rollovers effective as of January 1, 2010) Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 16 The adopting Employer may rely on an advisory letter issued by the Internal Revenue Service as evidence that the Plan is qualified under Code §401 only to the extent provided in Rev. Proc. 2011-49 or subsequent guidance. The Employer may not rely on the advisory letter in certain other circumstances or with respect to certain qualification requirements, which are specified in the advisory letter issued with respect to the Plan and in Rev. Proc. 2011-49 or subsequent guidance. In order to have reliance in such circumstances or with respect to such qualification requirements, application for a determination letter must be made to Employee Plans Determinations of the Internal Revenue Service. This Adoption Agreement may be used only in conjunction with the Volume Submitter basic Plan document #09. This Adoption Agreement and the basic Plan document will together be known as Nationwide Financial Services, Inc. Governmental Volume Submitter Money Purchase Plan #09-002. The adoption of this Plan, its qualification by the IRS, and the related tax consequences are the responsibility of the Employer and its independent tax and legal advisors. Nationwide Financial Services, Inc. will notify the Employer of any amendments made to the Plan or of the discontinuance or abandonment of the Plan. Furthermore, in order to be eligible to receive such notification, the Employer agrees to notify Nationwide Financial Services, Inc. of any change in address. In addition, this Plan is provided to the Employer either in connection with investment in a product or pursuant to a contract or other arrangement for products and/or services. Upon cessation of such investment in a product or cessation of such contract or arrangement, as applicable, the Employer is no longer considered to be an adopter of this Plan and Nationwide Financial Services, Inc. no longer has any obligations to the Employer that relate to the adoption of this Plan. With regard to any questions regarding the provisions of the Plan, adoption of the Plan, or the effect of an advisory letter from the IRS, call or write (this information must be completed by the sponsor of this Plan or its designated representative): Name: Nationwide Retirement Solutions Address: P.O. Box 182797 Columbus Ohio 43218 Telephone: (877) 496-1630 The Employer and Trustee (or Insurer) hereby cause this Plan to be executed on the date(s) specified below: EMPLOYER: City of Fort Collins By: DATE SIGNED TRUSTEE (OR INSURER): [X] The signature of the Trustee or Insurer appears on a separate agreement or Contract, OR (add additional Trustee signature lines as necessary) Nationwide Trust Company TRUSTEE OR INSURER DATE SIGNED Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 1 APPENDIX A SPECIAL EFFECTIVE DATES AND OTHER PERMITTED ELECTIONS A. Special effective dates (leave blank if not applicable): a. [ ] Special effective date(s): . For periods prior to the specified special effective date(s), the Plan terms in effect prior to its restatement under this Adoption Agreement will control for purposes of the designated provisions. A special effective date may not result in the delay of a Plan provision beyond the permissible effective date under any applicable law. B. Other permitted elections (the following elections are optional): a. [ ] No other permitted elections The following elections apply (select one or more): b. [ ] Deemed 125 compensation (Plan Section 1.23). Deemed 125 compensation will be included in Compensation and 415 Compensation. c. [ ] Reemployed after five (5) 1-Year Breaks in Service ("rule of parity" provisions) (Plan Section 3.5(d)). The "rule of parity" provisions in Plan Section 3.5(d) will apply for (select one or both): 1. [ ] eligibility purposes 2. [ ] vesting purposes d. [X] Beneficiary if no beneficiary elected by Participant (Plan Section 6.2(e)). In the event no valid designation of Beneficiary exists, then in lieu of the order set forth in Plan Section 6.2(e), the following order of priority will be used: 1.) Surviving Spouse 2.) Participant's Estate (specify an order of beneficiaries; e.g., children per stirpes, parents, and then step-children). e. [ ] Common, collective or pooled trust funds (Plan Sections 7.2(c)(5) and/or 7.3(b)(6)). The name(s) of the common, collective or pooled trust funds available under the Plan is (are): . f. [ ] Limitation Year (Plan Section 1.29). The Limitation Year for Code §415 purposes will be (must be a consecutive twelve month period) instead of the "determination period" for Compensation. g. [ ] 415 Limits when 2 defined contribution plans are maintained (Plan Section 4.4). If any Participant is covered under another qualified defined contribution plan maintained by the Employer or an Affiliated Employer, or if the Employer or an Affiliated Employer maintains a welfare benefit fund, as defined in Code §419(e), or an individual medical account, as defined in Code §415(l)(2), under which amounts are treated as "annual additions" with respect to any Participant in this Plan, then the provisions of Plan Section 4.4(b) will apply unless otherwise specified below: 1. [ ] Specify, in a manner that precludes Employer discretion, the method under which the plans will limit total "annual additions" to the "maximum permissible amount" and will properly reduce any "excess amounts": . h. [ ] Recognition of Service with other employers (Plan Sections 1.39 and 1.54). Service with the following employers (in addition to those specified at Question 15) will be recognized as follows (select one or more): Contribution Eligibility Vesting Allocation 1. [ ] Employer name: a. [ ] b. [ ] c. [ ] 2. [ ] Employer name: a. [ ] b. [ ] c. [ ] 3. [ ] Employer name: a. [ ] b. [ ] c. [ ] 4. [ ] Employer name: a. [ ] b. [ ] c. [ ] 5. [ ] Employer name: a. [ ] b. [ ] c. [ ] 6. [ ] Employer name: a. [ ] b. [ ] c. [ ] Limitations 7. [ ] The following provisions or limitations apply with respect to the a. [ ] b. [ ] c. [ ] recognition of prior service: (e.g., credit service with X only on/following 1/1/13) Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 2 i. [ ] Other vesting provisions. The following vesting provisions apply to the Plan (select one or more): 1. [ ] Special vesting provisions. The following special provisions apply to the vesting provisions of the Plan: (must be definitely determinable and satisfy the parameters set forth at Question 17) 2. [ ] Pre-amendment vesting schedule. (Plan Section 6.4(b)). If the vesting schedule has been amended and a different vesting schedule other than the schedule at Question 17 applies to any Participants, then the following provisions apply (must select one of a. – d. AND complete e.): Applicable Participants. The vesting schedules in Question 17 only apply to: a. [ ] Participants who are Employees as of (enter date). b. [ ] Participants in the Plan who have an Hour of Service on or after (enter date). c. [ ] Participants (even if not an Employee) in the Plan on or after (enter date). d. [ ] Other: (e.g., Participants in division A) Vesting schedule e. The schedule that applies to Participants not subject to the vesting schedule in Question 17 is: Years (or Periods) of Service Percentage % % % % % % j. [ ] Minimum distribution transitional rules (Plan Section 6.8(e)(5)) NOTE: This Section does not apply to (1) a new Plan, (2) an amendment or restatement of an existing Plan that never contained the provisions of Code §401(a)(9) as in effect prior to the amendments made by the Small Business Job Protection Act of 1996 (SBJPA), or (3) a Plan where the transition rules below do not affect any current Participants. The "required beginning date" for a Participant is: 1. [ ] April 1st of the calendar year following the year in which the Participant attains age 70 1/2. (pre-SBJPA rules continue to apply) 2. [ ] April 1st of the calendar year following the later of the year in which the Participant attains age 70 1/2 or retires (the post-SBJPA rules), with the following exceptions (select one or both; leave blank if both applied effective as of January 1, 1996): a. [ ] A Participant who was already receiving required minimum distributions under the pre-SBJPA rules as of (may not be earlier than January 1, 1996) was allowed to stop receiving distributions and have them recommence in accordance with the post-SBJPA rules. Upon the recommencement of distributions, if the Plan permits annuities as a form of distribution then the following apply: 1. [ ] N/A (annuity distributions are not permitted) 2. [ ] Upon the recommencement of distributions, the original Annuity Starting Date will be retained. 3. [ ] Upon the recommencement of distributions, a new Annuity Starting Date is created. b. [ ] A Participant who had not begun receiving required minimum distributions as of (may not be earlier than January 1, 1996) may elect to defer commencement of distributions until retirement. The option to defer the commencement of distributions (i.e., to elect to receive in-service distributions upon attainment of age 70 1/2) applies to all such Participants unless selected below: 1. [ ] The in-service distribution option was eliminated with respect to Participants who attained age 70 1/2 in or after the calendar year that began after the later of (1) December 31, 1998, or (2) the adoption date of the restatement to bring the Plan into compliance with the SBJPA. k. [ ] Other spousal provisions (select one or more) 1. [ ] Definition of Spouse. The term Spouse includes a spouse under federal law as well as the following: . 2. [ ] Automatic revocation of spousal designation (Plan Section 6.2(f)). The automatic revocation of a spousal Beneficiary designation in the case of divorce does not apply. 3. [ ] Timing of QDRO payment. A distribution to an Alternate Payee shall not be permitted prior to the time a Participant would be entitled to a distribution. l. [ ] Applicable law. Instead of using the applicable laws set forth in Plan Section 9.4(a), the Plan will be governed by the laws of: m. [X] Total and Permanent Disability. Instead of the definition at Plan Section 1.49, Total and Permanent Disability means: A physical or mental impairment which is of such permanence and degree that, as determined by the Employer, a participant is unable because of such impairment to perform any substantial gainful activity for which he/she is suited Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 3 by virtue of his/her experience, training, or education and that has lasted, or can be expected to last, for a continuous period of not less than twelve (12) months, or can be expected to result in death. The permanence and degree of such impairment shall be supported by medical evidence. If the Employer maintains a long-term disability plan, the definition of Total and Permanent Disability shall be the same as the definition of disability in the long-term disability plan (must be definitely determinable). n. [ ] Permissible Trust (or Custodian) modifications. The Employer makes the following modifications to the Trust (or Custodial) provisions as permitted under Rev. Proc. 2011-49 (or subsequent IRS guidance) (select one or more of 1. - 3. below): NOTE: Any elections below must not: (i) conflict with any Plan provision unrelated to the Trust or Trustee; or (ii) cause the Plan to violate Code §401(a). In addition, this may not be used to substitute all of the Trust provisions in the Plan. 1. [ ] Investments. The Employer amends the Trust provisions relating to Trust investments as follows: 2. [ ] Duties. The Employer amends the Trust provisions relating to Trustee (or Custodian) duties as follows: 3. [ ] Other administrative provisions. The Employer amends the other administrative provisions of the Trust as follows: Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 1 ADMINISTRATIVE PROCEDURES The following are optional administrative provisions. The Administrator may implement procedures that override any elections in this Section without a formal Plan amendment. In addition, modifications to these procedures will not affect an Employer's reliance on the Plan. A. Loan Limitations. (complete only if loans to Participants are permitted; leave blank if none apply) a. [X] Limitations (select one or more): 1. [X] Loans will be treated as Participant directed investments. 2. [ ] Loans will only be made for hardship or financial necessity as specified below (select i. or ii.) a. [ ] hardship reasons specified in Plan Section 6.12 b. [ ] financial necessity (as defined in the loan program). 3. [X] The minimum loan will be $ 1,000 . 4. [X] A Participant may only have one (1) (e.g., one (1)) loan(s) outstanding at any time. 5. [ ] All outstanding loan balances will become due and payable in their entirety upon the occurrence of a distributable event (other than satisfaction of the conditions for an in-service distribution (including a hardship distribution), if applicable). 6. [ ] Account restrictions. Loans will only be permitted from the following Participant Accounts (select all that apply or leave blank if no limitations apply): a. [ ] Account(s) attributable to Employer matching contributions b. [ ] Account attributable to Employer contributions other than matching contributions c. [ ] Rollover Account d. [ ] Transfer Account e. [ ] Other: AND, if loans are restricted to certain accounts, the limitations of Code §72(p) will be applied: f. [ ] by determining the limits by only considering the restricted accounts. g. [ ] by determining the limits taking into account a Participant's entire interest in the Plan. Additional Loan Provisions (select all that apply; leave blank if none apply) b. [X] Loan payments. Loans are repaid by (if left blank, then payroll deduction applies unless Participant is not subject to payroll (e.g., partner who only has a draw)): 1. [ ] payroll deduction 2. [X] ACH (Automated Clearing House) 3. [ ] check a. [ ] Only for prepayment c. [X] Interest rate. Loans will be granted at the following interest rate (if left blank, then 3. below applies): 1. [X] .5 percentage points over the prime interest rate 2. [ ] % 3. [ ] the Administrator establishes the rate at the time the loan is made d. [X] Refinancing. Loan refinancing is allowed. B. Life Insurance. (Plan Section 7.5) a. [X] Life insurance may not be purchased. b. [ ] Life insurance may be purchased... 1. [ ] at the option of the Administrator 2. [ ] at the option of the Participant Limitations 3. [ ] N/A (no limitations) 4. [ ] The purchase of initial or additional life insurance will be subject to the following limitations (select one or more): a. [ ] Each initial Contract will have a minimum face amount of $ . b. [ ] Each additional Contract will have a minimum face amount of $ . c. [ ] The Participant has completed Years (or Periods) of Service. d. [ ] The Participant has completed Years (or Periods) of Service while a Participant in the Plan. e. [ ] The Participant is under age on the Contract issue date. f. [ ] The maximum amount of all Contracts on behalf of a Participant may not exceed $ . g. [ ] The maximum face amount of any life insurance Contract will be $ . C. Plan Expenses. Will the Plan assess against an individual Participant's Account certain Plan expenses that are incurred by, or are attributable to, a particular Participant based on use of a particular Plan service? a. [ ] No b. [X] Yes Exhibit B Governmental Money Purchase Plan © 2014 Nationwide Financial Services, Inc. or its suppliers 2 D. Directed investments a. [ ] Participant directed investments are NOT permitted. b. [X] Participant directed investments are permitted from the following Participant Accounts: 1. [X] all Accounts 2. [ ] only from the following Accounts (select one or more): a. [ ] Account attributable to Employer contributions b. [ ] Rollover Account c. [ ] Transfer Account d. [ ] Other: (specify Account(s) and conditions in a manner that is definitely determinable and not subject to Employer discretion) E. Rollover Limitations. Will the Plan accept rollover contributions and/or direct rollovers from the sources specified below? a. [ ] No, Administrator determines in operation which sources will be accepted. b. [X] Yes Rollover sources. Indicate the sources of rollovers that will be accepted (select one or more) 1. [X] Direct Rollovers. The Plan will accept a direct rollover of an eligible rollover distribution from (select one or more): a. [ ] a qualified plan described in Code §401(a) (including a 401(k) plan, profit sharing plan, defined benefit plan, stock bonus plan and money purchase plan), excluding after-tax employee contributions b. [X] a qualified plan described in Code §401(a) (including a 401(k) plan, profit sharing plan, defined benefit plan, stock bonus plan and money purchase plan), including after-tax employee contributions c. [ ] a plan described in Code §403(a) (an annuity plan), excluding after-tax employee contributions d. [X] a plan described in Code §403(a) (an annuity plan), including after-tax employee contributions e. [ ] a plan described in Code §403(b) (a tax-sheltered annuity), excluding after-tax employee contributions f. [X] a plan described in Code §403(b) (a tax-sheltered annuity), including after-tax employee contributions g. [X] a plan described in Code §457(b) (eligible deferred compensation plan) Direct Rollovers of Participant Loan. The Plan will NOT accept a direct rollover of a Participant loan from another plan unless selected below (leave blank if default applies) h. [ ] The Plan will accept a direct rollover of a Participant loan i. [ ] The Plan will only accept a direct rollover of a Participant loan only in the following situation(s): (e.g., only from Participants who were employees of an acquired organization). 2. [X] Participant Rollover Contributions from Other Plans (i.e., not via a direct plan-to-plan transfer). The Plan will accept a contribution of an eligible rollover distribution (select one or more): a. [X] a qualified plan described in Code §401(a) (including a 401(k) plan, profit sharing plan, defined benefit plan, stock bonus plan and money purchase plan) b. [X] a plan described in Code §403(a) (an annuity plan) c. [X] a plan described in Code §403(b) (a tax-sheltered annuity) d. [X] a governmental plan described in Code §457(b) (eligible deferred compensation plan) 3. [X] Participant Rollover Contributions from IRAs: The Plan will accept a rollover contribution of the portion of a distribution from a traditional IRA that is eligible to be rolled over and would otherwise be includible in gross income. Rollovers from Roth IRAs or a Coverdell Education Savings Account (formerly known as an Education IRA) are not permitted because they are not traditional IRAs. A rollover from a SIMPLE IRA is allowed if the amounts are rolled over after the individual has been in the SIMPLE IRA for at least two years. Exhibit B City of Fort Collins Service Directors’ and Council Employees’ Plan Exhibit 1 to the Adoption Agreement for Nationwide Financial Services, Inc. Governmental Volume Submitter Money Purchase Plan and Governmental Defined Contribution Volume Submitter Basic Plan Document Adoption Agreement Sec. 12. Eligible Employees. An Eligible Employee for Plan Purposes shall mean any person employed in the following Eligible Groups: Deputy City Manager Assistant City Manager Service Area Director Service Unit Director Chief of Police City Manager City Attorney Municipal Judge Basic Plan Document Article I (Definitions), Sec. 1.8 “Beneficiary” means the person (or entity) to whom all or a portion of a deceased Participant's interest in the Plan is payable, subject to the restrictions of Sections 6.2 and 6.6. Upon death, the Participant’s surviving spouse is the Beneficiary unless he or she consents to the Participant’s naming another Beneficiary. Exhibit B