Plan Sponsor`s approved model form of Qualified Domestic

Plan Sponsor’s approved model form of Qualified Domestic Relations Order (“QDRO”)
This is a Model Qualified Domestic Relations Order (“Model QDRO”) that has been preapproved by Empower
Retirement for use by the Plan for outsourced Qualified Domestic Relations Order (“QDRO”) services.
Although this Model QDRO conforms with Federal QDRO requirements, it may need to be revised for state
and/or local law and/or the specific requirements of the Plan itself. Further, the format of the Qualified
Domestic Relations Order may vary depending upon the rules of the court in which the Participant obtains the
Domestic Relations Order. For these reasons, this Model QDRO should be used only by the Plan after
consultation with the Plan’s counsel. Any revisions to the Model QDRO must be submitted to Empower
Retirement for approval for use with our outsourced QDRO services. Nothing contained in this Model QDRO
shall be construed as tax or legal advice.
It is recommended that a proposed version of this order be submitted to Empower Retirement with the body of
the order filled in prior to entry of this order for purposes of your obtaining Empower Retirement’s preapproval
of the proposed order.
Proposed and entered orders should be remitted to the Plan Recordkeeper as follows:
Empower Retirement
P.O. Box 173764
Denver, CO 80217-3764
Fax # (866) 745-5766
……………COURT, CITY OF ………….……., COUNTY OF …………………….….
STATE OF ……………………………
IN RE THE MARRIAGE OF:
………………
No. ………………
Petitioner,
and
Respondent
)
)
QUALIFIED DOMESTIC RELATIONS ORDER
AND NOW, this __________ day of _______________, 20___, based on the findings set forth below,
IT IS HEREBY ORDERED, ADJUDGED AND DECREED:
1. Parties: The parties hereto were husband and wife, and a divorce action is in this Court at the above
number. This Court has personal jurisdiction over the parties. The parties were married on
_______________ and divorced on _____________.
2. Participant Information: The name, last known address, social security number and date of birth of
the plan “Participant” are:
a.
b.
c.
d.
Name:
SSN:
Address:
Date of Birth:
________________________
________________________
________________________________________________
________________________
3. Alternate Payee Information: The name, last known address, social security number and date of
birth of the “Alternate Payee” are:
a.
b.
c.
d.
Name:
SSN:
Address:
Date of Birth:
________________________
________________________
________________________________________________
________________________
The Alternate Payee is the Participant’s former spouse. The Alternate Payee shall have the duty to
notify the Plan Administrator and/or Recordkeeper of any changes in mailing address subsequent to
the entry of this Order.
4. Plan Name. The name of the Plan to which this Order applies is the Kansas Public Employees
Deferred Compensation Plan, (hereafter referred to as “Plan”).
Any changes in the Plan Administrator, Plan Sponsor, or name of the Plan shall not affect Alternate
Payee’s rights as stipulated under this Order.
5. Effect of this Order as a Qualified Domestic Relations Order: This Order creates and recognizes
the existence of an Alternate Payee’s right to receive a portion of the Participant’s benefits payable
under an employer-sponsored defined contribution plan that is qualified under Section 457 of the
Internal Revenue Code (the “Code”). It is intended to constitute a Qualified Domestic Relations Order
(“QDRO”) under Section 414(p) of the Code.
6. Pursuant to State Domestic Relations Law: This Order is entered pursuant to the authority granted
in the applicable domestic relations laws of ____________.
7. Provisions of Marital Property Rights: This Order relates to the provision of marital property rights
as a result of the Order of Divorce between the Participant and the Alternate Payee.
8. Amount of Alternate Payee’s Benefit: This Order assigns to the Alternate Payee an amount equal to
[choose either option 8A1 or 8A2 below]:
8A1 $__________ of the Participant’s Total Account Balance under the Plan as of the date this Order
is processed.
OR
8A2 $_______(dollars and cents) or ____% (percent)] of the Participant’s Total Account Balance
accumulated under the Plan as of ______________________ (or the closest valuation date thereto).
The Alternate Payee’s benefit herein awarded shall be credited with any investment income (or losses)
attributable thereon from the aforesaid valuation date (or the closest valuation date thereto), until the
date of transfer of the Alternate Payee’s share to the Alternate Payee.
(Note to drafting attorney: The Plan’s current recordkeeper is not able to determine the value of the
Participant's account balance and any investment earnings and/or losses prior to January 2, 2015.
The parties will need to arrive at a dollar figure or percentage of benefits payable to the Alternate
Payee as of a date that is no earlier than January 2, 2015. The Plan’s current recordkeeper can
determine the account value and calculate any earnings and/or losses from January 2, 2015 through
the date assets are transferred or distributed to the Alternate Payee. Keep in mind that if you must
adjust the valuation date forward and a percentage is awarded to the Alternate Payee in this section,
you should consider whether to adjust the Alternate Payee’s awarded percentage to account for any
additional contributions (and any gains/losses accruing thereon) made by or for the Participant to the
account after the originally intended valuation date.)
Such Total Account Balance shall be determined after the account is reduced by the outstanding
balance of the Participant’s account reduction loan(s), if any, as of the valuation date specified above,
such that the Account Balance shall not include the outstanding balance of any account reduction
loan(s) as of the valuation date. The obligation to repay any Participant Plan loan(s) from and after the
date of this Order remains solely with the Participant. Such Total Account Balance shall include all
amounts maintained under all of the various accounts and/or sub-accounts established on behalf of the
Participant, including rollover and transfer contributions.
The Alternate Payee’s portion of the benefits described above shall be allocated on a pro rata basis
first from all of the core accounts and/or core investment options maintained under the Plan on behalf
of the Participant other than life insurance or Self-Directed Brokerage (“SDB”), if any. The Plan shall
redeem amounts from a life insurance contract, if any, issued for the Participant under the Plan only to
the extent necessary to obtain the amount that this order awards to the Alternate Payee. If there are
any SDB investments, and if the balance in the core investments is insufficient to satisfy the judgment,
Participant must initiate a transfer of the amount needed to satisfy the judgment from the SDB into the
core investments. If participant fails to initiate such a transfer, or if the transfer is insufficient to satisfy
the judgment, one hundred percent (100%) of the SDB Money Market Fund will be transferred to the
core investments. If the balance is still insufficient to satisfy the judgment, the entire SDB account may
be liquidated and transferred to the core investments.
Unless the Alternate Payee elects an immediate lump sum distribution by the Plan at the time this
Order is submitted to, and approved by, the Plan, such benefits shall also be segregated and
separately maintained in a nonforfeitable Account(s) established on behalf of the Alternate Payee.
This Account(s) will initially be established proportionately in the same core investment options as the
Participant account. Alternate Payee may make subsequent investment selections as and when
permitted under the terms of the Plan. Alternate Payee’s account shall experience gains and or losses
according to the investment experience of the investment options in which Alternate Payee’s share is
invested.
9. Commencement Date and Form of Payment to Alternate Payee: If the Alternate Payee so elects
on an appropriate form, the benefits shall be paid to the Alternate Payee as soon as administratively
feasible following the date this Order is approved as a QDRO by the Plan. Benefits will be payable to
the Alternate Payee in any form or permissible option otherwise available to participants under the
terms of the Plan, except a joint and survivor annuity. The Alternate Payee will be responsible for
paying any applicable withdrawal charges imposed under any investment account(s) with respect to his
or her share under the plan.
10. Alternate Payee’s Rights and Privileges: On and after the date that this Order is deemed to be a
QDRO, but before the Alternate Payee receives a total distribution under the Plan, the Alternate Payee
shall be entitled to all of the rights and election privileges that are afforded to Plan beneficiaries,
including, but not limited to, the rules regarding the right to designate a beneficiary for death benefit
purposes and the right to direct Plan investments, only to the extent permitted under the provisions of
the Plan.
11. Death of Alternate Payee: In the event of the Alternate Payee’s death prior to receiving the full
amount of benefits assigned under this Order and under the benefit option chosen by the Alternate
Payee, such Alternate Payee’s beneficiary(ies), as designated on the appropriate form provided to the
Plan or, in the absence of a beneficiary designation, the remainder of any unpaid benefits under the
terms of this Order shall be paid in accordance with the terms of the Plan.
12. Death of Participant: Should the Participant predecease the Alternate Payee, such Participant’s
death shall in no way affect the Alternate Payee’s right to the portion of the benefits as stipulated
herein.
13. Savings Clause: This Order is not intended, and shall not be construed in such a manner as to
require the Plan:
a. to provide any type or form of benefits or any option not otherwise provided under the Plan;
b. to provide increased benefits to the Alternate Payee;
c.
to pay any benefits to the Alternate Payee which are required to be paid to another alternate
payee under another order previously determined to be a QDRO; or
d. to make any payment or take any action which is inconsistent with any federal or state law,
rule, regulation or applicable judicial decision.
14. Certification of Necessary Information: All payments made pursuant to this Order shall be
conditioned on the certification by the Alternate Payee and the Participant to the Plan of such
information as the Plan may reasonably require from such parties.
15. Continued Qualified Status of Order: It is the intention of the parties that this QDRO continue to
qualify as a QDRO, as it may be amended from time to time, and that the Plan shall reserve the right to
reconfirm the qualified status of the Order at the time benefits become payable hereunder.
16. Tax Treatment of Distributions Made Under This Order: For purposes Sections 402(a)(1) and 72 of
the Code, or any successor Code section, any Alternate Payee who is the spouse or former spouse of
the Participant shall be treated as the distributee of any distribution or payments made to the Alternate
Payee under the terms of this Order, and as such, will be required to pay the appropriate federal
income taxes on such distribution.
17. Parties Responsibilities in Event of Error: In the event that the Plan inadvertently pays the
Participant any benefits that are assigned to the Alternate Payee pursuant to the terms of this Order,
the Participant shall immediately reimburse the Alternate Payee to the extent that the Participant has
received such benefit payments by paying such amounts directly to the Alternate Payee within ten (10)
days of receipt.
In the event that the Plan inadvertently pays the Alternate Payee any benefits that are to remain the
sole property of the Participant pursuant to the terms of this Order, if the Participant has experienced a
distributable event under the terms of the Plan, the Alternate Payee shall immediately reimburse the
Participant to the extent that the Alternate Payee has received such benefit payments by paying such
amounts directly to the Participant within ten (10) days of receipt. If the Participant has not
experienced a distributable event under the terms of the Plan, the Alternate Payee shall immediately
return such overpayment to the Plan within ten (10) days of receipt.
18. Effect of Plan Termination: In the event of a Plan termination, the Alternate Payee shall be entitled to
receive his or her portion of the Participant’s benefits as stipulated herein in accordance with the Plan’s
termination provisions for participants and beneficiaries.
19. Continued Jurisdiction: The Court retains jurisdiction over this matter to amend this Order to
establish or maintain its status as a qualified domestic relations order, as amended and the original
intent of the parties as stipulated herein. The Court shall also retain jurisdiction to enter such further
orders as are necessary to enforce the assignment of benefits to the Alternate Payee as set forth
herein.
BY THE COURT:
……………………………………….
JUDGE
………………………………………….
Petitioner
………………………………………….
Respondent