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2015 Forms & Documents Catalog

Table of Contents

Account Establishment Conversion and Amendment Service......................................................................................................................3 Opening Documents..............................................................................................................................................4

Account Maintenance Forms Forms Handbook...................................................................................................................................................5 IRA Contributions..................................................................................................................................................6 IRA Portability........................................................................................................................................................7 IRA Withdrawals and Withholding.........................................................................................................................8 IRA Beneficiary Designations and IRA Changes.....................................................................................................10 Coverdell Education Savings Account (ESA)..........................................................................................................11 Health Savings Account (HSA)..............................................................................................................................12

IRAdirect® Forms Contributions, Transfers, Account Changes, Distributions, and Payment Elections................................................14 Benefit Claims......................................................................................................................................................15

Plan Establishment SEP Plans.............................................................................................................................................................16 SIMPLE IRA Plans..................................................................................................................................................17 Qualified Retirement Plans...................................................................................................................................18

Plan Maintenance QRP Document Service Options............................................................................................................................20 QRP Transaction Forms.........................................................................................................................................22

More From Ascensus.....................................................................................................................................23 Order Form......................................................................................................................................................24

2015 Forms Catalog | ascensus.com | page 2

Account Establishment Conversion and Amendment Service Converting your IRAs, Coverdell education savings accounts (ESAs), and health savings accounts (HSAs) to Ascensus’ documents is easy. Ascensus offers a variety of Universal Amendments that will update your documents and convert them to the Ascensus forms suite. Either your financial organization or the professionals at Ascensus can provide these amendments to your account owners. Act now and be among the many financial organizations that convert to Ascensus’ documents each year. The typical conversion process is simple. 1. Select the appropriate Universal Amendment. 2. Include the amendment in the next mailing to your existing account owners. In general, no signatures are needed, and no follow-up is required. 3. Document which account owners received the amendment and keep a copy of the mailing in your master file. 4. Continue using Ascensus’ forms for new accounts and for additional transactions. We can further simplify the process for you. By supplying us with a list of your account owners, you can use our Amendment Service to complete the entire conversion for you. Contact your Ascensus Sales Representative for additional information.

Watch for Amendment News Here! Ascensus understands the need for up-to-the-minute, accurate information and offers it to you absolutely free. Go to Latest News at www.ascensus.com to find daily compliance and industry news articles, plus archived news articles. When your organization accesses our Latest News, you can be assured that your staff is receiving current information and a consistent message. Remember to bookmark www.ascensus.com for free daily updates, or simply subscribe to the RSS Feed and the news will be sent directly to your email.

2015 Forms Catalog | ascensus.com | page 3

Account Establishment Opening Documents Ascensus’ IRA, ESA, and HSA opening documents are drafted by in-house senior ERISA staff with more than 50 years of combined experience working with retirement, health, and education savings accounts. Our ERISA specialists continually monitor federal government requirements and carefully design our documents to meet these requirements. Everything you need to properly establish an account is included in our Simplifier®. Traditional IRA #97 Trust1 #98 Custodial #100 Self-Directed Custodial #97-IH Inherited–Trust1 #98-IH Inherited–Custodial #100-IH Inherited–Self-Directed Custodial Roth IRA #6097 Trust1 #6098 Custodial #6100 Self-Directed Custodial #6097-IH Inherited–Trust1 #6098-IH Inherited–Custodial #6100-IH Inherited–Self-Directed Custodial SIMPLE IRA #1097 Trust1 #1098 Custodial #1100 Self-Directed Custodial Coverdell ESA #5097 Trust1 #5098 Custodial HSA #3499 Trust1 #3500 Custodial

Online – integrate Internet-ready forms into your website or IRA platform

Custom Print – present your specific look and coordinate with your other printed materials

Simplifier® Pricing

Imprinted – imprint with your contact information

Multi-Part, 8½ x 11 Quantity 50 100 250 500**

Off-the-Shelf – order forms when you need them and without any minimum order requirements

Nonimprint $104 $157 $323 $450 Imprinted* $134 $202 $380 $550 * Imprinting includes up to four lines of type (black ink). ** Additional quantities are available at a reduced fee.

1

Ascensus’ Forms and Document Delivery Options

See pages 14 and 15 for account maintenance forms for financial organizations who use Ascensus’ Fully-Administered or Self-Administered Programs.

To be used for managed or self-directed trust accounts.

Visit the quick link at www.ascensus.com for a current version of the Printed Forms Checklist.

2015 Forms Catalog | ascensus.com | page 4

Account Maintenance Forms Forms Handbook Make using Ascensus’ forms even easier with the Ascensus Forms Handbook. This practical handbook provides clear instructions for completing each of the Ascensus IRA, ESA, and HSA account maintenance forms. Having the Forms Handbook available not only helps your organization stay in compliance with government regulations but it means no more confusion about which forms to use or how to fill them out.

#889

Forms Handbook

8½ x 11

$21 each

Visit the quick link at www.ascensus.com for a current version of the Printed Forms Checklist.

2015 Forms Catalog | ascensus.com | page 5

Account Maintenance Forms IRA Contributions

#107

Ascensus’ contribution forms can be used internally by your financial organization to track IRA contributions or by your data center to prepare IRS forms. Our IRA Contribution Eligibility forms will help you verify that an individual is eligible to make an IRA contribution. And our IRA Contribution and Investment Selection forms identify the contribution type and tax year, gather deposit and investment information, and satisfy the written election requirement for rollovers and recharacterizations.

#106

Traditional IRA #109 Traditional IRA Contribution Eligibility #107 Traditional IRA Contribution and Investment Selection #106 Special Contributions #110 Conduit IRA Notice and Election Roth IRA #6109 Roth IRA Contribution Eligibility #6107 Roth IRA Contribution and Investment Selection #106 Special Contributions

#6109

SIMPLE IRA #1107 SIMPLE IRA Contribution and Investment Selection

Account Maintenance Forms Pricing 1-Part, 8½ x 11 Quantity 50

100

250 500**

Nonimprint $17 $32 $65 $105 Imprinted* $24 $42 $80 $135 * Imprinting includes up to four lines of type (black ink). ** Additional quantities are available at a reduced fee.

Ascensus’ account maintenance forms capture the information needed to satisfy various IRS requirements relating to record retention, reporting, notices, and written irrevocable elections for certain transactions.

Visit the quick link at www.ascensus.com for a current version of the Printed Forms Checklist.

2015 Forms Catalog | ascensus.com | page 6

Account Maintenance Forms IRA Portability Ascensus’ portability forms are used to document the movement of IRA assets within your organization or the movement of assets between IRAs held at different organizations. Because your organization is responsible for reporting to the IRS and to IRA owners the movement of assets, properly documenting these transactions is crucial to maintaining compliance.

#302

#6305

#302 Traditional & SIMPLE IRA Transfer Request • Gathers current IRA trustee or custodian information •

Provides for the individual’s authorization and instructions

Addresses required minimum distribution or life expectancy payment concerns

#305 IRA Recharacterization Election • Gathers original IRA contribution and current trustee and custodian information •

Satisfies the election requirement

Determines earnings or loss attributable to the recharacterized amount

#487 Direct Rollover Request • Gathers distributing plan information •

Provides for the individual’s authorization and instructions

#6302 Roth IRA Transfer Request • Gathers current IRA trustee or custodian information •

Provides for the individual’s authorization and instructions

Addresses life expectancy payment concerns

#6305 Roth IRA Direct Conversion Request • Gathers current IRA and trustee and custodian information •

Provides for the individual’s authorization and instruction

Complies with the withholding notice and election requirements

IRA Service Center™ The IRA Service CenterTM provides all the basic tools that a financial organization needs to retain assets and to attract new IRA and ESA business using the Internet. One of the tools in the IRA Service Center is the IRA and ESA forms suite, which includes the documents and forms (over 50 in all) that your organization needs to establish and service IRAs and ESAs. Looking for an online HSA solution? See page 12 for information on the HSA Service CenterTM. Contact your Ascensus Sales Representative for additional information or to schedule a free online demonstration.

Visit the quick link at www.ascensus.com for a current version of the Printed Forms Checklist.

2015 Forms Catalog | ascensus.com | page 7

Account Maintenance Forms IRA Withdrawals and Withholding Ascensus’ withdrawal forms can be used internally by your financial organization to track IRA distributions and by your data center to prepare IRS forms. Our IRA withdrawal forms will help you properly report distributions to avoid IRS penalties for incorrect reporting. #123 Traditional IRA Excess Removal Worksheet #6123 Roth IRA Excess Removal Worksheet • Provides the steps an IRA owner must take to correct an excess contribution

#6123 #317

#314 Traditional & SIMPLE IRA Withdrawal Authorization #6314 Roth IRA Withdrawal Authorization • Designates amount and method of withdrawal •

Explains and documents distribution reason

Complies with the withholding notice and election requirements

#317 IRA Withholding Notice and Election • Satisfies the required withholding notice and election requirements •

Identifies prior elections

Allows for change of current withholding election

#319 IRA Substantially Equal Periodic Payment Election • Explains all available substantially equal periodic payment options •

Documents the individual’s state withholding election

Designates start date and payment frequency

Complies with the withholding notice and election requirements

#314

Account Maintenance Forms Pricing 1-Part, 8½ x 11 Quantity 50

100

250 500**

Nonimprint $17 $32 $65 $105 Imprinted* $24 $42 $80 $135 * Imprinting includes up to four lines of type (black ink). ** Additional quantities are available at a reduced fee.

Visit the quick link at www.ascensus.com for a current version of the Printed Forms Checklist.

2015 Forms Catalog | ascensus.com | page 8

Account Maintenance Forms #80024 #321 Beneficiary Required Election • Contains all available beneficiary options •

Explains and documents required elections

#324

#322 Traditional & SIMPLE IRA Required Minimum Distribution Scheduled Payment Election • Designates start date and payment frequency •

Documents the RMD election

Complies with the withholding notice and election requirements

#323 Traditional & SIMPLE IRA Required Minimum Distribution Notice • Identifies the date by which the IRA owner must withdraw an RMD •

Provides RMD statement alternatives

#324 IRA Scheduled Payment Election

#324-IH Inherited IRA Scheduled Payment Election is also available.

Documents payment option and reason

Designates start date and payment frequency

Complies with the withholding notice and election requirements

#80024 IRA State Income Tax Withholding Election • Documents the individual’s state withholding election •

Identifies which IRA withdrawal form the election supplements

NIA Calculation “Smart Form” Make calculating net income attributable a customer service for all your IRA and HSA owners by using the Net Income Attributable Calculation smart form from Ascensus. Simply enter the necessary account balance information for the calculation and let the form do the math for you!

Visit the quick link at www.ascensus.com for a current version of the Printed Forms Checklist.

2015 Forms Catalog | ascensus.com | page 9

Account Maintenance Forms IRA Beneficiary Designations #301 IRA Beneficiary Designation

#301

#307 Inherited IRA Beneficiary Designation is also available.

Revokes prior designations

Identifies primary and contingent beneficiaries

Identifies the percentage share for each beneficiary

Provides for spousal consent for community or marital property states

#2310

#301-SU IRA Beneficiary Designation Addendum • Identifies additional primary and contingent beneficiaries •

Identifies the percentage share for each beneficiary

#121 IRA Beneficiary Reminder Notice • Identifies current primary and contingent beneficiaries •

Identifies current share percentage for each beneficiary

IRA Changes #311 IRA Information Change • Identifies information currently on file for the IRA owner •

Provides for a signature authorizing the information change

#2310 IRA HSA Investment Change • Identifies investments currently on file for the IRA owner •

Provides for a signature authorizing the investment change

Account Maintenance Forms Pricing 1-Part, 8½ x 11 Quantity 50

100

250 500**

Nonimprint $17 $32 $65 $105 Imprinted* $24 $42 $80 $135 * Imprinting includes up to four lines of type (black ink). ** Additional quantities are available at a reduced fee.

Visit the quick link at www.ascensus.com for a current version of the Printed Forms Checklist.

2015 Forms Catalog | ascensus.com | page 10

Account Maintenance Forms Coverdell Education Savings Account (ESA) ESA Contributions #5109 Coverdell ESA Contribution Eligibility • Reviews eligibility requirements for each contribution type •

#5109 #5301

Verifies eligibility of the individual to make an ESA contribution

#5107 Coverdell ESA Contribution and Investment Selection • Identifies contribution type and tax year •

Satisfies the written election requirement for rollovers

Gathers deposit and investment information

#106 Special Contributions • Identifies contribution type and tax year •

Gathers deposit and investment information

ESA Portability #5302 Coverdell ESA Transfer Request • Gathers current ESA trustee and custodian information •

Obtains the responsible individual’s authorization and instructions

Verifies designated beneficiary information

ESA Withdrawals #5123 Coverdell ESA Excess Removal Worksheet • Provides the steps a responsible individual must take to correct an excess contribution #5314 Coverdell ESA Withdrawal Authorization • Designates distribution amount requested by the responsible individual and method of the withdrawal •

Explains and documents the distribution reason

ESA Death Beneficiary Designations #5301 Coverdell ESA Death Beneficiary Designation • Revokes prior death beneficiary designations •

Identifies primary and contingent death beneficiaries

Identifies share percentage for each death beneficiary

#5301-SU Death Beneficiary Designation Addendum • Identifies additional primary and contingent death beneficiaries •

Identifies the percentage share for each death beneficiary

ESA Changes #5311 Coverdell ESA Information Change • Identifies information currently on file for the ESA •

Provides for a signature authorizing the information change

Visit the quick link at www.ascensus.com for a current version of the Printed Forms Checklist.

2015 Forms Catalog | ascensus.com | page 11

Account Maintenance Forms Health Savings Account (HSA) HSA Contributions #3107 HSA Contribution and Investment Selection • Identifies contribution type and tax year •

Satisfies the written election requirement for rollovers and recharacterizations

Gathers deposit and investment information

#3107 #3302

#3109 HSA Contribution Eligibility • Reviews requirements for each contribution type •

Verifies eligibility of the individual to make an HSA contribution

#3322 Qualified HSA Funding Distribution Request • Gathers distributing IRA and trustee and custodian information •

Provides for the individual’s authorization and instruction

#3315 HSA Mistaken Distribution Repayment • Documents mistaken distribution information and repayment date HSA Portability #3302 HSA Transfer Request • Gathers current HSA trustee and custodian information •

#3322

Obtains the individual’s authorization and instructions

HSA Withdrawals #3123 HSA Excess Removal Worksheet • Provides the steps an HSA owner must take to correct an excess contribution. #3314 HSA Withdrawal Authorization • Explains and documents distribution reason •

Designates amount and method of withdrawal

Account Maintenance Forms Pricing 1-Part, 8½ x 11 Quantity 50

100

250 500**

Nonimprint $17 $32 $65 $105 Imprinted* $24 $42 $80 $135 * Imprinting includes up to four lines of type (black ink). ** Additional quantities are available at a reduced fee.

Visit the quick link at www.ascensus.com for a current version of the Printed Forms Checklist.

2015 Forms Catalog | ascensus.com | page 12

HSA Beneficiary Designations #3301 HSA Beneficiary Designation • Revokes prior designations •

Identifies primary or contingent beneficiaries

Identifies the percentage share for each beneficiary

Provides for spousal consent for community or marital property states

#3311 #3121

#3301-SU HSA Beneficiary Designation Addendum • Identifies additional primary and contingent beneficiaries •

Identifies the percentage share for each beneficiary

#3121 HSA Beneficiary Reminder Notice • Identifies current primary and contingent beneficiaries •

Identifies current share percentage for each beneficiary

HSA Changes #3311 HSA Information Change • Identifies information currently on file for the HSA owner •

Provides for a signature authorizing the information change

#2310 IRA HSA Investment Change • Identifies investments currently on file for the HSA owner •

Provides for a signature authorizing the investment change

HSA Service Center™ Looking for an online solution for HSA establishment and maintenance? The HSA Service CenterTM allows your clients to establish and service HSAs online. Alternatively, you may choose to limit online access only to your financial organization’s internal network. As with all Ascensus web-based solutions, branding and customization are available. Contact your Ascensus Sales Representative for additional information or to schedule a free online demonstration.

Visit the quick link at www.ascensus.com for a current version of the Printed Forms Checklist.

2015 Forms Catalog | ascensus.com | page 13

IRAdirect® Forms* Contributions, Transfers, Account Changes, Distributions, and Payment Elections Contributions #21943 IRA Contribution Recharacterization – Form 2319 (Pricing Code 1)

#21943

#80026

Transfers #80026 IRA Direct Transfer Instructions – Form 2325 (Pricing Code 1)

#21996 Coverdell ESA Direct Transfer Instructions – Form 2525E (Pricing Code 1) #26638 HSA Direct Transfer Instructions – Form 2625H (Pricing Code 1)

Account Changes #80015 Traditional IRA Change Notice – Form 2309 (Pricing Code 1)

#21220 Roth IRA Change Notice – Form 2409R (Pricing Code 1)

#21995 Coverdell ESA Change Notice – Form 2509E (Pricing Code 1)

#26067 HSA Change Notice – Form 2609H (Pricing Code 1)

Distributions #80014 Traditional IRA Withdrawal Instruction – Form 2306T (Pricing Code 1) #21218 Roth IRA Withdrawal Instruction – Form 2406R (Pricing Code 1)

IRAdirect Forms Pricing

#21998 Coverdell ESA Withdrawal Instruction – Form 2506E (Pricing Code 1)

Pricing Code 1

#23464 North Carolina Withholding Notice – Form 2317NC (Pricing Code 2)

Multi-Part, Carbonless, 8½ x 11 Quantity 50 100 250 500** Nonimprint $41 $69 $140 $220 Imprinted* – $101 $195 $315

Pricing Code 2

#26636 HSA Withdrawal Instruction – Form 2606H (Pricing Code 1)

#80024 IRA State Income Tax Withholding – Form 2312 (Pricing Code 1)

#80023 Withholding Notice – Form 2317 (Pricing Code 2)

1-Part, 8½ x 11 Quantity 50 100 250 500** Nonimprint $17 $32 $65 $105

Pricing Code 3 12-Page, 37⁄8 x 8½ Booklet Quantity 50 100 250 500** Nonimprint $57 $101 $220 $380 * Imprinting includes CUID and up to four lines of type (black ink). **Additional quantities are available at a reduced fee.

* Unless otherwise noted, these forms are available for organizations on the Fully-Administered and Self-Administered Programs.

Payment Elections #22552 Traditional IRA Periodic Payment Change – Form 2345 (Pricing Code 1) #80021 Individual Retirement Account Periodic Payments Before Age 70½ – Form 2316 (Pricing Code 1) #80055 Traditional IRA Post-70½ Payment Election – Form 2318 (Pricing Code 1) #80079 Required Minimum Distributions From Your Traditional IRA at Age 70½ (Pricing Code 3) #80102 Required Minimum Distributions From Your Traditional IRA After Age 70½ (Pricing Code 3)

2015 Forms Catalog | ascensus.com | page 14

IRAdirect® Forms* Benefit Claims Beneficiary and Benefit Claims Processing #80025 Traditional IRA Selection of Survivor Benefits – • Form 2321T (Pricing Code 1)

#27309 #27373

#22550 Roth IRA Selection of Survivor Benefits – Form • 2421R (Pricing Code 1) #27309 Beneficiary Payment Options for Traditional •• IRAs (Death Before Required Beginning Date) (Pricing Code 3) #27373 Beneficiary Payment Options for Traditional •• IRAs (Death On or After Required Beginning Date) (Pricing Code 3) #27374 Beneficiary Payment Options for Roth IRAs •• (Pricing Code 3) #80018 Death Notice – Form 2320 (Pricing Code 1) ••

#27374

IRA Resource Center™ The IRA Resource Center™ is full of information and tools to help you improve your IRA and savings plan programs. Be sure your IRA and marketing experts have access to this online resource so they can enroll for eBrochures and review lobby brochures, newspaper ads, and compliance updates, as well as our many training opportunities. For IRAdirect users, the IRA Resource Center link can be found on the IRAdirect homepage. Have questions about accessing the IRA Resource Center? Call 800-356-9140.

* Unless otherwise noted, these forms are available for organizations on the Fully-Administered and Self-Administered Programs. • F or Self-Administered Program clients only. •• For Fully-Administered Program clients only.

2015 Forms Catalog | ascensus.com | page 15

Plan Establishment SEP Plans Simplified employee pension (SEP) plans provide a unique retirement plan solution with tax benefits to small businesses and are easy to administer. Business owners have several plan options to choose from. Prototype Plans #400 Standard SEP Prototype Plan Kit This easy-to-use IRS-approved kit includes the following. •

Employer Eligibility Form

Plan Document

Adoption Agreement

Summary for Employees

#411 and #421 SEP Plan Employee Information Booklets The Department of Labor requires employers to provide a summary of the SEP plan to employees. These booklets are a simple solution to satisfy this requirement.

SEP Prototype Plan Employee Information Booklets* #411 Universal SEP Plan 5½ x 8½ Booklet Quantity 25 50 100 250 Nonimprint $42 $75 $136 $308

#421 Standard SEP Plan

#410 Universal SEP Prototype Plan Kit This IRS-approved kit allows an employer to either establish or update a SEP plan, a salary reduction SEP (SAR-SEP) plan, or a combination plan (allowing employer and employee contributions).* This kit includes all the pieces offered in our Standard SEP Prototype Plan kit plus the following. •

Salary Reduction Agreement

Discrimination Test Worksheet

Top-Heavy Test Worksheet

Notification of Excess Elective Deferrals/ Notification of Disallowed Deferrals

*New SAR-SEP plans may no longer be established. Existing plans established before January 1, 1997, however, may continue to be updated and funded.

5½ x 8½ Booklet Quantity 25 50 100 250 Nonimprint $38 $68 $123 $278 *Available to financial organizations that sponsor the appropriate prototype plan documents.

To enroll in the Ascensus SEP prototype plan document program, contact your Ascensus Sales Representative at 800-346-3860. Need employee-level Traditional IRA opening documents? Refer to page 4 for additional information.

IRS Model-Based SEP Plan Kit #416 5305-SEP Plan Kit This IRS model kit includes the following. • General information about the plan

SEP Prototype Plan Employer Establishment Kits* #400 Standard SEP Plan

• Employer eligibility checklist

8½ x 11 Kit

• IRS 5305-SEP plan document

$6.67 each

#410 Universal SEP Plan 9 x 12 Kit

$6.67 each

*Available to financial organizations that sponsor the appropriate prototype plan documents.

• Instructions to establish the SEP plan

#416

5305-SEP Plan Kit

8½ x 11 Booklet

$4.02 each

Visit the quick link at www.ascensus.com for a current version of the Printed Forms Checklist.

2015 Forms Catalog | ascensus.com | page 16

Plan Establishment SIMPLE IRA Plans Savings incentive match plan for employees of small employers (SIMPLE) IRA plans are a cost-effective alternative to 401(k) plans. Prototype Plan #600 SIMPLE IRA Prototype Plan Kit The Ascensus SIMPLE IRA prototype plan allows financial organizations the flexibility of determining designated financial institution (DFI) status. This IRS-approved kit includes the following. •

“About the SIMPLE IRA Plan” Feature Sheet

Eligibility Form

Adoption Agreement

Basic Plan Document

Participation Notice & Summary Description

Salary Reduction Agreement

Instructions for Establishing the SIMPLE IRA Plan

#600

SIMPLE IRA Prototype Plan Employer Establishment Kit*

8½ x 11 Kit

$6.67 each

*Available to financial organizations that sponsor the appropriate prototype plan documents.

To enroll in the Ascensus SIMPLE IRA prototype plan document program, contact your Ascensus Sales Representative at 800-346-3860. Need employee-level SIMPLE IRA opening documents? Refer to page 4 for additional information.

IRS Model-Based SIMPLE IRA Plan Kits #516 5305-SIMPLE IRA Plan Kit (For use as a DFI)

#517 5304-SIMPLE IRA Plan Kit (Not subject to DFI rules)

This IRS model kit includes the following.

This IRS model kit includes the following.

General information about the plan

• General information about the plan

Employer eligibility checklist

• Employer eligibility checklist

IRS 5305-SIMPLE plan document and instructions

• IRS 5304-SIMPLE plan document and instructions

Participation Notice & Summary Description

• Participation Notice & Summary Description

Salary Reduction Agreement

• Salary Reduction Agreement

#516

5305-SIMPLE IRA Plan Kit

8½ x 11 Kit

#517 $4.02 each

5304-SIMPLE IRA Plan Kit

8½ x 11 Kit

$4.02 each

Visit the quick link at www.ascensus.com for a current version of the Printed Forms Checklist.

2015 Forms Catalog | ascensus.com | page 17

Plan Establishment Qualified Retirement Plans Ascensus’ IRS-approved defined contribution qualified retirement plan (QRP) prototype plan documents are easy to use and provide you with a competitive advantage in the market. PPA Prototype Plan Document Adoption Agreements* Plan Type

Form Number

Super Simplified – ideal for employers who prefer to select only the basic provision choices such as eligibility and entry dates Profit Sharing Standardized

Flexible – provides more extensive provisions to meet most employers’ business objectives Profit Sharing Nonstandardized #4233 Money Purchase Pension

#4211

Individual(k)™ Standardized

Form Number

Standardized #4230 #4210

Money Purchase Pension Standardized

Plan Type

Standardized #4231 Nonstandardized #4234

#4212 or #4312

Simplified – offers simplicity, while including key small business provisions, such as vesting options and Social Security integration Profit Sharing Standardized #4220 Nonstandardized #4223 Money Purchase Pension Standardized #4221 Nonstandardized #4224 401(k) Standardized #4222 Nonstandardized #4225

401(k) Standardized #4232 Nonstandardized #4235 Comprehensive – accommodates highly customized plan designs on a sophisticated document Profit Sharing Standardized #4240 Nonstandardized #4243 Money Purchase Pension Standardized #4241 Nonstandardized #4244 401(k) Standardized #4242 Nonstandardized #4245

*Available to financial organizations that sponsor the appropriate prototype plan documents.

2015 Forms Catalog | ascensus.com | page 18

Plan Establishment Qualified Retirement Plan Kits Each IRS-approved kit includes the following. •

Adoption Agreement

Basic Plan Document

Employee Data Worksheet

Designation of Beneficiary

#4200-KT Qualified Retirement Plan Kit 9 x 12 Kit

Includes one adoption agreement $14.50

#4300-KT Individual(k) Plan Kit 9 x 12 Kit

Includes one adoption agreement $11.30

IMPORTANT: To properly establish or restate a defined contribution qualified retirement plan, employers must receive a basic plan document, an adoption agreement, and any applicable interim amendments. Employers also should receive a summary plan description (SPD) and any other participant-level notices that are applicable to the types of plans being established or restated. All of Ascensus’ prototype plan document sponsors receive qualified retirement plan supplemental documents and instructions for such amendments, SPDs, and notices.

For a complete list of QRP transaction forms, see page 22.

2015 Forms Catalog | ascensus.com | page 19

Plan Maintenance QRP Document Service Options The Pension Protection Act of 2006 (PPA) and other guidance have made profound changes that affect QRP operations, including 401(k), profit sharing, and money purchase pension plan rules. The IRS is requiring that all QRP documents be replaced with updated documents that incorporate those changes. As one of the nation’s largest providers of QRP documents, Ascensus can supply you with all of your new PPA plan document and offer QRP program support. Ascensus PPA Documents Ascensus’ PPA documents are easy to use and provide plan document sponsors with a competitive advantage in the QRP market. The Ascensus PPA document is •

tailored to fit today’s market,

comprehensive for takeover business,

simplified for mass marketing, and

priced appropriately.

As an Ascensus plan document sponsor, depending on your business needs, you may receive your PPA documents in preprinted kits, through a copyright license agreement, or through the Ascensus Plan Adoption System™. You also will automatically receive future discretionary and required amendments to incorporate subsequent changes in QRP rules. Ascensus’ documents include materials for communicating the changes to your employer plan clients as well as supplemental materials such as participant notices. Plan Adoption System™ The Ascensus Plan Adoption System (PAS) is an online application that organizes and selects the documents necessary to establish QRPs, applying compliance logic to help you easily complete the plan establishment process and track plan documents. PAS also includes dynamic summary plan description (SPD) generation, based on the adoption agreement and elections. Amendment Mailing and Restatement Services To help you inform your employer plan clients about changes in QRP rules, Ascensus can coordinate and fulfill discretionary and required amendments, including plan restatements, to your employer plan clients. Optional services include tracking employer plan client responses for signature events and taking employer plan client calls regarding the amendment. Enhanced Service

Enhanced Service

Document Compliance Service

As a plan document sponsor, keeping up with amendment mailings and restatements can be a complicated time-consuming, and costly process. When you sign up for the Ascensus Document Compliance Service (DCS), Ascensus will handle the amendment and restatement process directly with your employer plan clients. For new plans, Ascensus will prepare all required prototype plan documents, including the SPD, and send them directly to the employer. Your employer plan clients and financial advisors have access to an Ascensus call center to get the answers to their plan document and amendment questions. DCS is an annual service and includes all amendments pertaining to rule changes each year in addition to complete restatement services every six years.

Enhanced Service

Prototype Document Service

Ascensus can become your total outsource solution by taking care of the amendment and restatement processes for you and by being the prototype plan document sponsor for all your current and future employer plan clients. With the Prototype Document Service, Ascensus takes on all of your responsibilities as the plan document sponsor, such as maintaining employer client data, maintaining plan document and amendment requirements and history, ensuring that employers adopt required amendments timely, and notifying the employers of disqualification issues. This service creates an ongoing agreement between Ascensus and each of your employer plan clients, who will have access to an Ascensus call center to get the answers to their plan document and amendment questions.

2015 Forms Catalog | ascensus.com | page 20

Plan Maintenance

Enhanced Services Financial Organization Document Sponsorship

Plan Adoption System

Amendment Mailing and Restatement Services

3

3

3

Document Compliance Service

3

3

3

3

3

3

3

Prototype Document Service

Fulfillment

Ongoing Document Amendments

Ascensus Document Sponsorship

Call Center

Option

3 3

3

How efficient is your QRP program? estatements.

How much time do you spend updating your QRP documents? Overwhelmed by the responsibilities of operating your QRP program? Thinking about getting out of the QRP business? Before making any decisions about your QRP program, contact your Ascensus Sales Representative at 800-346-3860. Find out how we can help streamline your plan establishment process and simplify your plan amendments and restatements.

2015 Forms Catalog | ascensus.com | page 21

Plan Maintenance QRP Transaction Forms #203 Deposit Form (Pricing Code A1)

#486* Application For Distribution (Pricing Code A1)

This form documents deposits as well as investment changes.

Plan participants use this form to request distributions and to waive the qualified joint and survivor annuity and federal income tax withholding (Form W-4P).

#222 Qualified Plan Transfer Request (Pricing Code A1) This form is used to authorize the transfer of plan assets and highlights the key issues an employer should consider when making a transfer of plan assets. #223 Withholding Reminder Notice (Pricing Code A1) The law requires a withholding notice at least annually to plan participants receiving certain periodic distributions. This form helps to keep your clients current on tax withholding rules and reminds them of the withholding elections previously made. #237 QRP Plan Administrator’s Guide (Pricing Code A3) ALL NEW! #279 401(k) Plan Administrator’s Guide (Pricing Code A3) These guides are quick reference tools for plan administrators using the Ascensus defined contribution prototype plan document. These booklets are intended to alert plan administrators to various concepts and issues that are common to plan operations. #272 401(k) Enrollment/ Investment Selection Form (Pricing Code A1) With this form, employees can easily indicate their salary deferral status, select from the investment options available under the plan, and choose how they want their 401(k) contributions invested. #481* Designation of Beneficiary (Pricing Code A1) This form provides for designation of beneficiary and allows plan participants and their spouses to waive the qualified preretirement survivor annuity. All notices required as a part of the annuity waiver are provided on this form. #482* Distribution Notice (Pricing Code A2) This form contains all of the IRS-required information (under IRC Sec. 402(f)) that a plan administrator needs to provide to plan participants when distributions are made.

QRP Transaction Forms Pricing Pricing Code A1 Multi-Part, Carbonless, 8½ x 11 Quantity 50 100 250 500** Nonimprint $41 $69 $140 $220

Pricing Code A2 Multi-Page, 8½ x 11 Quantity 50 100 250 500** Nonimprint $41 $69 $140 $220

Pricing Code A3 5½ x 8½ Booklet Quantity 50 100 250 500** Nonimprint $65 $124 $303 $540 **Additional quantities are available at a reduced fee.

#221

QRP Loan Kit

This kit contains everything a plan administrator using Ascensus’ defined contribution prototype plan needs—including loan policy, loan application, and loan agreement. 8½ x 11, multiple pages with cover wrap $10.02 each

Ascensus Offers 404(c) Compliance Assistance ERISA Section (Sec.) 404(c) allows employers to shift responsibility for investment direction to the participants. Ascensus has all the resources available to help you assist employers with ERISA Sec. 404(c) compliance. All New #760 Employee Investment Handbook #761 ERISA Section 404(c) Employer Guidelines #762 404(c) Employee Information Sheet Contact your Ascensus Sales Representative for pricing.

*NOTE (REA Safe Harbor Plans): Certain profit sharing and 401(k) plans are not required to provide annuities as the standard form of benefit. These are referred to as REA safe harbor plans. Ascensus’ QRP transaction forms can be used with either safe harbor or nonsafe harbor plans.

2015 Forms Catalog | ascensus.com | page 22

More from Ascensus

Resource Solutions Learn From Ascensus’ Professional Trainers Ascensus is the foremost provider of retirement and savings plan education. We deliver training that simplifies processes and promotes growth within financial organizations. Choose from multiple delivery methods of training for you and your staff: instructor-led training, distance learning, and internal training products. Visit www.ascensus.com for a current listing of available education events. Looking for continuing education credits? Earning and maintaining a professional designation is an excellent way to obtain proficiency. It also proves your dedication to developing your career. Ascensus programs are submitted for numerous designations, including CISP, CTFA, CRSP, CFP, CIS, and CIP. Contact Ascensus at 800-346-3860 or 800-356-9140, to learn if specific continuing education credits have been approved.

Lobby Brochures Ascensus’ lobby brochures provide your clients with general consumer education about the retirement and savings plan products that your organization promotes. Use lobby brochures separately or package them with your organization’s other promotional materials. Technical References Provide your clients more efficient, quality service and stay in compliance while supporting your knowledge base with Ascensus’ retirement and savings plan desktop guides and comprehensive reference materials. Training Products Ascensus knows that a successful retirement or savings plan program depends on a well-trained team. But conducting your own training can be challenging and time-consuming. Ascensus’ training products provide everything you need for effective retirement and savings plan training—at your pace and on your schedule. Visit the Resource Solutions eCatalog at www.ascensus.com/catalogs.

2015 Forms Catalog | ascensus.com | page 23

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Ascensus® and the Ascensus logo are registered trademarks of Ascensus, Inc. IRAdirect® and Simplifier® are registered trademarks of Ascensus, Inc. IRA Resource Center™, Individual(k)™, IRA Service Center™, HSA Service Center™, and Plan Adoption System™ are trademarks of Ascensus, Inc. Copyright ©2014 Ascensus, Inc. All Rights Reserved. ACMP-CAT-00003 (12/2014)

2015 Forms Catalog | ascensus.com | page 24

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