PPD Retirement Savings Plan Rollover Contribution Form . - MassMutual

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PPD Retirement Savings PlanRollover Contribution FormPlan ID 990500107Enclosed are the items needed to make a rollover contribution to the PPD Retirement Savings Plan. Please carefully review and complete each of the items as described in the procedures below. Representatives are available to help you complete the forms, or answer general questions you may have about thePlan. You can reach a Representative by calling the Retirement Plan Information Line at 1-800-854-0647 between thehours of 8:00 a.m. and 8:00 p.m. Eastern time. Mail the required documents for processing to MassMutual at one of the following addresses.DO NOT SEND PAPERWORK TO PPD CORPORATE BENEFITS DEPARTMENT. Please note that rollovers from PPD affiliated companies (including: Evidera and Synexus) are NOT allowed to betransferred into the PPD Retirement Savings Plan.Regular MailMassMutual Retirement Services, PO Box 1583, Hartford, CT 06144-1583Overnight Mail OnlyMassMutual Retirement Services, 100 Bright Meadow Boulevard, Enfield, Connecticut 06082ITEMPROCEDURESEND TOMASSMUTUALRolloverContribution FormComplete all relevant sections of the form. Sign and date in thespace provided at the bottom of the form.YesRollover Check1. F or a direct rollover from a qualified plan, the check must be made payable to“MassMutual FBO PPD Retirement Savings Plan FBO Your Name.” Be sure to writeyour Social Security Number on the check if it is not printed there.Yes2. F or a non-direct rollover from a qualified plan or a rollover from an IRA, the checkmust be made payable to “MassMutual FBO PPD Retirement Savings Plan.” Be sureto write your name and Social Security Number on the check.3. R eturn form, rollover check, and supporting documentation to the address above.Your check will be deposited and the rollover contribution posted to your account.Representatives are available to help you complete the forms or answer general questions you may have about theplan. You may reach a Representative by calling the Participant Information Center at 1-800-854-0647 between thehours of 8 a.m. and 8 p.m. Eastern time on any business day.

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PPD Retirement Savings PlanRollover Contribution FormPlan ID 9905001071 Employee InformationSocial Security NumberDate of BirthName (please print)Date of HireStreet AddressCity/StateZipDaytime Phone Number2 Rollover and Investment InformationIf this request represents a non-direct rollover contribution (you have received this money from a prior retirementplan or from an IRA as a check payable to you), you must have received this rollover distribution no more than60 days before the date your rollover contribution is received by the Plan. However, this requirement can bewaived in some hardship circumstances, in accordance with IRS guidance, under a new IRS relief process, andunder new federal law, discussed in Section 4 of this form. See your tax advisor for more information.The amount of your roll over must represent an eligible rollover distribution from a retirement plan or an IRA.If this request represents a direct rollover from a retirement plan, your check should be made payable to“MassMutual fbo PPD Retirement Savings Plan fbo [Participant Name].” If this request represents a non-directrollover contribution (you have received this money from a prior plan or from an IRA), you must have receivedthis rollover distribution no more than 60 days before the date your rollover contribution is received by the Plan.Your check should be made payable to “MassMutual fbo PPD Retirement Savings Plan” and include your SocialSecurity Number on the check.Supporting Documentation: Your rollover will not be processed/invested into the plan without this information.Please attach one of the following items: Letter of Determination from prior plan S tatement of account from prior plan that reflects the type of plan the funds are being rolled out of (e.g.,401(k), 403(b), IRA as allowed by your plan (Direct Rollover) C ertification of the Prior Plan Administrator or IRA Trustee/Custodian (See Certification of Prior PlanAdministrator or IRA Trustee/Custodian Section) Other proof of the prior plan’s qualification status (e.g. letter from prior plan or provider) I f unable to provide any of the above items, please contact the MassMutual Concierge Service Team at1-800-854-0647 between 8:00 AM and 8:00 PM EST, Monday through Friday for assistance.

PPD Retirement Savings PlanRollover Contribution FormPlan ID 990500107For Indirect Rollovers, you must also attach: Statement of account, transaction confirmation or other formal documentation from prior plan or prior planprovider that includes distribution transaction detail (e.g. date, amount of distribution, tax withholding, etc.) forthe funds that you are submitting in connection with your rollover request.Any tax consequences related to this rollover are your responsibility and you agree that PPD Retirement SavingsPlan and MassMutual will not be held responsible for these tax consequences.Amount of Rollover: .Amount (if any) that represents Roth contribution (Note: Rollovers will be assumed to consist of pre-tax contributions and earnings unless a Roth amount isindicated. Rollovers from IRA’s will be assumed to consist entirely of pre-tax amounts because after-taxrollovers cannot be made).Please complete the following if you are requesting a rollover of your Roth contributions:Roth first contribution date:Roth basis amount: Roth earnings amount: Source of the Rollover. Indicate whether this rollover is from an IRA or employer-sponsored retirement plan,and indicate the type of retirement plan if it is from a retirement plan.Please note that rollovers from PPD affiliated companies (including: Evidera and Synexus) are NOT allowed tobe transferred into the PPD Retirement Savings Plan. IRA (the amount rolled over is deemed to consist entirely of pre-tax contributions and earnings) 401(a) plan, including 401(k) plans, money purchase plans, profit sharing plans 403(b) plan Government Section 457 plan (special requirements may apply – see your tax advisor) Other – State Type:Check if applicable: This rollover represents proceeds from my deceased spouse’s retirement plan T his rollover represents a distribution payable to me as a spouse (or former spouse) alternate payee asa result of a QDRO

PPD Retirement Savings PlanRollover Contribution FormPlan ID 990500107Investment Elections (Your entries must be in whole percentages for each fund and total 100%.)I elect to invest my rollover as follows:MFS Growth Fund%Fidelity Freedom Index Inc Instl Prem%Hartford International Opportunities Fund%Fidelity Freedom Index 2010 Instl Prem%MassMutual Select Mid Cap Growth EquityFund II%Fidelity Freedom Index 2015 Instl Prem%MFS Mid Cap Value Fund%Fidelity Freedom Index 2020 Instl Prem%American Funds EuroPacific Fund%Fidelity Freedom Index 2025 Instl Prem%Vanguard Total Bond Market Index Fund%Fidelity Freedom Index 2030 Instl Prem%Vanguard Extended Market Index Fund%Fidelity Freedom Index 2035 Instl Prem%Vanguard Total International Stock Index Fund%Fidelity Freedom Index 2040 Instl Prem%JPMorgan Core Bond Fund%Fidelity Freedom Index 2045 Instl Prem%PIMCO Real Return Fund%Fidelity Freedom Index 2050 Instl Prem%JPMorgan Small Cap Equity Fund%Fidelity Freedom Index 2055 Instl Prem%Victory Small Company Opportunity Fund%Fidelity Freedom Index 2060 Instl Prem%Fidelity Freedom Index 2065 Instl Prem% 3 Participant Certification for Rollover and Authorization(Please complete, sign, date, and return this form to: MassMutual Retirement Services, PO Box 1583Hartford, CT 06144-1583).I confirm that (1) the prior Plan is a qualified plan or an individual conduit retirement account; (2) this money represents an eligible rolloverdistribution to an eligible plan; and (3) I understand that these rollover funds, once deposited in the PPD Retirement Savings Plan, will besubject to all provisions of the Plan, including all distribution restrictions. In addition, if this is a 60-day (indirect) rollover, I certify that thisrollover is being completed within 60 days from receipt, or, if it is over 60 days since my receipt of the distribution from the paying planor financial institution, I have provided certification to the plan sponsor that the funds being rollover over qualify for a waiver from the60-day requirement and that any self-certification letter required has been provided to the plan sponsor and a copy kept with my owntax records (Participant should review the information in Section 4 if depositing an indirect rollover, which also refers to an IRS website foradditional information).Employee SignatureDate

PPD Retirement Savings PlanRollover Contribution FormPlan ID 990500107Certification of Prior Plan Administrator or IRA Trustee/Custodian(Complete only if this Certification is needed for “Supporting Documentation” section above).Certification by IRA Institution or for direct and indirect rollovers; Certification by Prior Employer’sPlan Administrator for indirect rollovers.This section must be completed by the trustee (or custodian) of the traditional IRA or by the administrator ofthe eligible employer plan from which the distribution was distributed.1. The Plan Administrator or Custodian of your Prior Plan must complete the certification below if this rollover isan indirect rollover or a direct rollover from a traditional IRA.2. Evidence of the date of Distribution from your Prior Plan or IRA must be provided if the funds are not comingdirectly from your Prior Plan or IRA, e.g. copy of the original distribution confirmation statement or check stub.I, as the Plan Administrator or Trustee/Custodian of the above Plan or IRA, certify that the funds have beendistributed from an eligible retirement plan intended to satisfy the requirements of Internal Revenue CodeSection 401(a) 403(a) 403(b) 457(b) or IRA qualified under 408(a) and 408(b). I am unaware of any Plan provision or operation that woulddisqualify the Plan.Type or print name of Financial Institution Representative or Prior Plan AdministratorSignature of Prior Plan Administrator or Trustee/CustodianDate(Name of Institution)Contact Phone NumberAddressBefore investing, consider the fund's investment objectives, risks, charges, and expenses. For a prospectuscontaining this and other information, log on to your Retirement Access account at ppd401k.com andclick on "Pricing and Performance," visit the fund company's Web site or call the fund company. Read theprospectus carefully.Please complete, sign, and return this form with the rollover check and supporting documentation by mail to:MassMutualRetirement ServicesPO Box 1583Hartford, CT 06144-1583

PPD Retirement Savings PlanRollover Contribution FormPlan ID 9905001074 Important InformationROLLOVERGood Order – "Good Order" means that all sections of the form are complete, the participant has providedtheir signature authorizing the transaction (if required) and the Plan Sponsor has provided their signatureauthorizing MassMutual to process the transaction requested on the form.Rules for Rollovers – The amount you roll over must represent an eligible rollover distribution from certaintypes of eligible retirement plans and Traditional IRA’s that are allowed as a rollover contribution into this Planby your Plan Sponsor. Note that for a Traditional IRA rollover only the amount that otherwise would have beentaxable (had it been paid directly to the individual account owner and not rolled over) can be rolled over froma Traditional IRA into an eligible retirement plan. In determining the amount that can be rolled over from aTraditional IRA, all of the individual’s Traditional IRA’s are aggregated and the total taxable amount at the timeof the rollover is the maximum that can be rolled over into a retirement plan. See your tax advisor for moreinformation. Your Plan Administrator may ask you for documentation to prove the amount rolled into the Planfrom a Traditional IRA is eligible.As a result of recent tax law changes, it has become possible to transfer assets between different types ofretirement plans in the form of a direct or indirect rollover. Please check with your current Plan Administrator toconfirm the types of rollover contributions accepted by this Plan, as the Plan may restrict certain rollover types.After-tax and Roth Rollovers – A rollover of traditional after-tax or Roth after-tax amounts generally can only bemade to a defined contribution plan if it is processed as a ‘direct rollover’. This means that the traditional aftertax or Roth after-tax amount could not have been paid to you and then rolled over, but must have been paiddirectly to this Plan. However, Roth taxable earnings can be rolled over even if the amount was paid directly toyou. Also, if the rollover is from a Governmental 457(b) plan or property (assets other than cash) was distributed,special requirements may apply and you should contact your tax advisor before initiating any rollover.Indirect Rollovers – If this request to rollover is for a '60-day' indirect rollover (i.e., the distribution was originallymade payable to the 'participant', which for these purposes includes the spousal beneficiary after the death ofthe participant or alternate payee where the alternate payee was the spouse or former spouse of the participantwho now wishes to rollover to a separate plan account), the rollover must be made within 60 days of theparticipant's receipt of the funds. If it is too late to make the rollover within 60 days of receipt of the participant'sfunds, then there generally are four ways by which a participant can qualify for a waiver of this 60-day timingrequirement: 1. An automatic waiver of the 60-day rollover requirement (as described in Revenue Procedure2003-16); 2. A private letter ruling waiving the 60-day rollover requirement due to an acceptable hardshipexception (as described in Revenue Procedure 2003-16); 3. Qualify for and use the self-certification procedurefor a waiver of the 60-day requirement (as described in Revenue Procedure 2016-47); and 4. An extension of therollover period pursuant to the provisions of the Tax Cuts and Jobs Act of 2017, whereby the rollover amountequals a qualified plan loan offset amount (for which “qualified plan loan offset amount” is defined as an amounttreated as distributed to the participant solely by reason of (i) the termination of a qualified retirement planor (ii) the failure to meet the plan loan repayment terms due to the participant’s severance from employment)AND the transfer of the rollover amount is being made prior to the participant’s due date (including extensions)for filing his/her tax return for the taxable year in which such qualified plan loan offset amount was treated asdistributed from a qualified employer plan.These methods for waivers are described in more detail below. These should also be discussed with your legalor tax advisor.

PPD Retirement Savings PlanRollover Contribution FormPlan ID 990500107Automatic Waiver – To satisfy the automatic waiver' requirements pertaining to indirect rollovers, theparticipant must generally show that the financial institution which received the funds received them before theend of the 60-day period, he must have followed all the procedures set by the financial institution for depositingthe funds into the recipient plan or IRA, the funds were not deposited within 60 days because the financialinstitution made an error, the funds are deposited within one year from the beginning of the 60-day rolloverperiod, and it would have been a valid 60-day rollover transaction if the financial institution had deposited thefunds as instructed.Private Letter Ruling – To qualify for a private letter ruling issued by the IRS to waive the 60-day rolloverrequirement for an indirect rollover, the participant must apply for a ruling from the IRS in accordance withformal procedures. These procedures are described in Revenue Procedure 2016-4 and Revenue Procedure 200316, and the fees associated with filing for a Ruling are described in Revenue Procedure 2016-8. In general, theTreasury Secretary could waive the 60-day requirement “where the failure to waive such requirement would beagainst equity or good conscience, including casualty, disaster, or other events beyond the reasonable control ofthe individual subject to such requirement.” There is a fee for the letter requestSelf-Certification Procedure – Under the self-certification procedure for indirect rollovers, the participantshould complete the 60-day Rollover Self Certification at the end of this Form. In this certification, the participantcertifies that s/he missed the 60-day deadline for one of the 11 permissible IRS-provided reasons, including,for example, an error created by the distributing financial institution, misplaced check, damage to the principalresidence, or the illness or death of a family member. The participant must also certify that s/he is making therollover deposit as soon as practicable after the reason or reasons no longer prevented him from making thecontribution (this requirement is deemed to be satisfied if the contribution is made within 30 days after thereason(s) no longer prevent the taxpayer from making the contribution), and that the representations that theparticipant is making are true, the IRS has not previously denied a request for a waiver of the 60-day rollover withrespect to the same funds, and that the participant's certification may be relied on by the plan administratorunless the plan administrator has actual knowledge to the contrary.Participants and the Plan Sponsor should consult with their own respective legal advisors for more informationconcerning these waivers. They may also obtain more detailed information by visiting the following IRSwebsite: rrequirement#2. Please note that this information is as of December 31, 2016 and that plan sponsors andparticipants may obtain more current information on the IRS website and/or through their own legal/tax advisors.Extension of Rollover Period for Qualified Plan Loan Offset Amounts – To satisfy the “extension”requirements pertaining to indirect rollovers of qualified plan loan offset amounts, the participant must generallyshow that an amount equal to the rollover was treated as distributed to the participant by a qualified planloan solely by reason of (i) the termination of a qualified retirement plan or (ii) the failure to meet the plan loanrepayment terms due to the participant’s severance from employment) and the transfer of the rollover amount isbeing made prior to the participant’s due date (including extensions) for filing his/her tax return for the taxableyear in which such qualified plan loan offset amount was treated as distributed from a qualified employer plan.Traditional IRA or Roth IRA Rollover – Nondeductible contribution rollovers or Roth rollovers cannot be madeto this Plan from a Traditional or Roth IRA.

PPD Retirement Savings PlanRollover Contribution FormPlan ID 990500107Stale Address – It is important that you notify us if you change your address. Going forward, your addressmay change in our records either at your or your employer's direction or as a result of an address confirmationservice provided under our agreement with your employer. Under this service, the addresses in our records arecompared against and updated quarterly with addresses received from commercial address update services(e.g., the U.S. Postal Service). If your mail is returned to us or your employer tells us your address is incorrect,we are likely to suspend future mailings until a new address is obtained. Unless preempted by federal law,failure to give us a current address may also result in uncashed distributions from your participant account beingconsidered abandoned property under state law, and remitted to the applicable state. To update your address,contact your Plan Administrator or, if permitted by your Plan, log in to our web site at www.MassMutual.com/corp select the change address link under your personal settings.Investing Your Rollover – Before investing, consider the fund’s investment objectives, risks, charges andexpenses. For a prospectus containing this and other information, log on to your account and click on “Pricingand Performance,” visit the fund company’s website or call the fund company. Please read the prospectuscarefully. You may change your investment elections at any time by accessing MassMutual's website or callingthe Customer Service Center.

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60 DAY ROLLOVER SELF-CERTIFICATION (Participant Completes)This 60 Day Rollover Self-Certification section below is only to be used if the indirect rolloverwas credited more than 60 days from the date of receipt and the participant wishes to takeadvantage of the relief available for ‘late rollovers’ discussed in more detail under the ‘SelfCertification Procedure’ in the IMPORTANT INFORMATION section provided above.60-Day Rollover Self-CertificationPursuant to Internal Revenue Service Procedure 2016-47, I certify that my contribution missed the 60-day rolloverdeadline for the reason(s) selected below. I am making this contribution as soon as practicable after the reasonor reasons listed below no longer prevent me from making the contribution. I understand that this certificationconcerns only the 60-day requirement for a rollover and that, to complete the rollover, I must comply with allother tax law requirements for a valid rollover and with your rollover procedures.Pursuant to Revenue Procedure 2016-47, unless you have actual knowledge to the contrary, you may rely on thiscertification to show that I have satisfied the conditions for a waiver of the 60-day rollover requirement for theamount identified above. You may not rely on this certification in determining whether the contribution satisfiesother requirements for a valid rollover.Reasons for Late Contribution (check the box) An error was committed by the financial institution making the distribution or receiving the contribution. The distribution was in the form of a check and the check was misplaced and never cashed. T he distribution was deposited into and remained in an account that I mistakenly thought was a retirementplan or IRA. My principal residence was severely damaged. One of my family members died. I or one of my family members was seriously ill. I was incarcerated. Restrictions were imposed by a foreign country. A postal error occurred. The distribution was made on account of an IRS levy and the proceeds of the levy have been returned to me. T he party making the distribution delayed providing information that the receiving plan or IRA required tocomplete the rollover despite my reasonable efforts to obtain this information.I declare that the representations made in this document are true and that the IRS has not previously denied arequest for a waiver of the 60-day rollover requirement with respect to a rollover of all or part of the distributionto which this contribution relates. I understand that in the event I am audited and the IRS does not grant a waiverfor this contribution, I may be subject to income and excise taxes, interest and penalties. I also understand thatI should retain a copy of this signed certification with my tax records and provide a copy to the plan sponsor forplan records.Employee SignatureDate

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2. For a non-direct rollover from a qualified plan or a rollover from an IRA, the check must be made payable to "MassMutual FBO PPD Retirement Savings Plan." Be sure to write your name and Social Security Number on the check. 3. Return form, rollover check, and supporting documentation to the address above.