457(b) SRA Form City of West Union

New EnrollmentChange

Name*

First NameMiddle NameLast Name

Date of Birth*

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Mailing Address (if different)

CityState / Province

Postal / Zip Code

1.) Effective Date Of Salary Reduction*

Date

*Changes in contribution amounts are permitted on a monthly basis. Changes must be initiated via this form, signed, and returned by the last business day of the month to be effective the first payroll in the following month.

2.) Remit my salary deferral contributions to the Plan Investment Custodian: Pershing, LLC.

3.) Salary Reduction Amount - I elect to defer the following amount from eligible compensation as an elective deferral in accordance with and subject to IRS rules and regulations:

As percentage (%) of my compensation

Per Pay Period as %:

Enter Amount as % (percent) of my eligible compensation, per pay period

As dollar amount ($) of my compensation

Per Pay Period as $:

Enter Amount as $ (dollar amount) of my eligible compensation, per pay period

I elect to not participate in the City of West Union 457(b) Deferred Compensation Plan at this time. No contributions will be made by me or the City of West Union. I acknowledge that the City of West Union and its Plan Representatives have provided me with information regarding the Plan and my eligibility to participate. I understand I may change this election in the future and elect to contribute to the Plan at that time. If I elect to contribute in the future, I understand contributions may start only by submitting a new Salary Reduction Agreement form by the last business day of the month, to be effective with the first payroll of following month.I elect to cease my current contributions to the Plan. The City of West Union will make reasonable administrative efforts to discontinue your contributions before the next payroll. Contributions may resume only by submitting a new Salary Reduction Agreement by the last business day of the month, to be effective with the first payroll of the following month.

I authorize the City of West Union to remit the salary reduction amount designated above to the designated investment company as contributions to the City of West Union 457(b) Employee Retirement Plan, an IRC §457(b) plan and I acknowledge the following:

This agreement will remain in effect until the employee notifies the City of West Union, in writing, to change or discontinue deferrals, or until the City of West Union terminates or modifies this agreement at any time to comply with applicable laws or for any other reason in its sole discretion. Employees will be notified in writing of such modification or termination of this Agreement by the City of West Union.
The City of West Union does not warrant the performance or appropriateness of any investment or the tax consequences resulting from participation in the Plan. The City of West Union will not be responsible for any penalties or tax consequences resulting from this agreement.
The Plan and IRS regulations limit withdrawals, except after age 73, for active City of West Union employees.
The City of West Union 457(b) Employee Retirement Plan is funded with voluntary Employee contributions. The City of West Union does not make contributions to the Plan.
I am aware of the fees and expenses charged by the designated investment company, and I authorize the City of West Union to release or obtain from my vendor any information that may be reasonably required to calculate contribution limits or to administer the City of West Union 457(b) Employee Retirement Plan.
The Internal Revenue Service imposes various limits on contributions to, or benefits from, different retirement plans. In addition, some limits require aggregation of the City of West Union 457(b) Employee Retirement Plan with other plans in which I may participate. These rules may vary depending on the type of plan, the type of contributions, and how the plan is structured. The City of West Union does not monitor your participation in other plans.

INTERNAL REVENUE CODE CONTRIBUTION LIMITS

Internal Revenue Code (IRC) §457(b)(2) limits the amount of salary deferral contributions that can be contributed to the City of West Union 457(b) Employee Retirement Plan and to all IRC §457(b) plans and other similar type of plans in which an employee participates in any calendar year. For further explanation, see the reverse of this form or consult your tax advisor.

Annual Dollar Limit on Elective Deferrals (IRC §457(b)(2))

Internal Revenue Code (IRC) §457(b)(2) limits the amount of salary deferral contributions that can be contributed to the City of West Union 457(b) Employee Retirement Plan and to all IRC §457(b) plans and other similar type of plans in which an employee participates in any calendar year. The annual dollar limit is the lesser of 100 percent of the employee’s compensation for the calendar year, or the “applicable dollar amount” which is $23,500 in 2025 and $24,500 in 2026. An employee must self-monitor elective deferrals made to any other current or former employer retirement plans, to avoid exceeding the IRC limits.

Age 50 or Older Catch-up Contributions (IRC §414(v)(2))

For participants who are at least age 50 before the end of the plan year, the current dollar limits on elective deferrals are increased. The additional elective deferrals that are permitted to be made by an eligible participant is the lesser of the participant’s compensation for the year reduced by any other elective deferrals of the participant for the year or the “applicable dollar amount” which is $7,500 for 2025 and $8,000 for the 2026 calendar year. The Basic Limit and Age 50 Catch-up is $31,000 for 2025 and $32,500 for the 2026 calendar year.

Age 60-63 Super Catch-Up

For participants who turn age 60, 61, 62, or 63 in a calendar year, the current dollar limits on elective deferrals are increased. The additional elective deferrals that are permitted to be made by an eligible participant is the lesser of the participant’s compensation for the year reduced by any other elective deferrals of the participant for the year or the “applicable dollar amount” which is $11,250 for 2025 and $11,250 for the 2026 plan (calendar) year. The Basic Limit and Ages 6-63 Super Catch-up is $34,750 for 2025 and $35,750 for the 2026 calendar year.

Either the Age 50 or Older Catchup, or the Ages 60-63 Super Catch-Up election, but not both, may be elected in any plan (calendar) year.

Special 3-year Plan Catch-Up Limitation

If the applicable year is one of an Employee’s last 3 calendar years ending before the Participant attains Normal Retirement Age, the Employee may be eligible for additional deferrals, which is the twice the Annual Contribution Limit. The Special 3 Year Catch-Up provision is $47,000 for 2025 and $49,000 for 2026. Consult the Plan Representative or Plan Document for additional information.

The City of West Union cannot provide tax advice. If you have questions about how tax law may affect your situation, please consult a tax advisor.

Signature*

Date*

Date

City of West Union 457(b) Employee Retirement Plan

Choose to contribute as percentage (%) or dollar amount ($) of your compensation: