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UU Org Retirement Plan Enrollment and Demographics Form
Use this form to submit employment information for your W2 employees (new hire, updates, terminations) NOTE: Must submit for all W2 employees regardless if they are eligible for the Employer Contribution or not. All employees must be enrolled and are eligible to make employee pretax elective contributions (salary deferrals) if they choose.
Select type of submission
Enroll New W2 Employee (use for ALL employees new-to-you)
Update Employee Contact Information
Update Employee Job and/or Compensation (Salary)
Terminate Employee
Submitter's Email
*
example@example.com
Employee Contact and Demographic Information
Employee_SSN
*
Ex. 999-99-9999 (include dashes)
Employer_ID
*
Enter UUA Org/Congregation ID (4 or 6-digit number)
Employee First Name
*
First Name
Employee Last Name
*
Last Name
Employee Middle Name (or Middle Initial)
Middle Name (or Initial)
Employee_Name
Format:LastName, First Name, Middle Name(or Initial)
Employee_Name
Format: Last Name, Suffix, First Name, Middle Initial
Birth_Date
*
/
Month
/
Day
Year
Gender
Please Select
M
F
N
U
Hover over field to see options descriptions
Marital_Status
Please Select
M
S
D
W
Hover over field to see option descriptions
Race_Ethnicity
Select One
AS
BL
HI
NA
PI
WH
TW
Hover over field to see option descriptions
Address_Line_1
*
Include unit, suite or apt numbers with Line 1 if possible, otherwise place in Line 1 and the street address in Line 2
Address_Line_2
Only use Address Line 2 if necessary. Apt/Unit Numbers should be included on Line 1
City
*
State
*
Two Digit State Abbreviation
Zip_Code
*
5-digit
Country_Code
Leave BLANK unless International (Non U.S.)
Mobile_Phone
Mobile Phone is the Primary Phone. Please enter a valid phone number.
Home_Phone
Please enter a valid phone number.
Work_Phone
Work Phone is secondary. Please enter a valid phone number.
Work_Phone_Ext
If applicable (up to 4-digits)
Primary_Email
*
Use employee's personal email for primary email, DO NOT USE WORK EMAIL. example@example.com
Secondary_Email
Use employee's work or secondary email. example@example.com
Employee Job and Compensation (Salary) Information
Job_Title
*
Enter job title as defined by organization.
Job_Category
*
Please Select
MINISTER
RELIGIOUS EDUCATOR
MUSIC AND AV STAFF
MEMBERSHIP STAFF
ADMIN
FINANCE
OPS STAFF
Hover over field to see option descriptions
Job_Level
Please Select
M1
P1
M2
P2
MD
PD
MN
SP
SU
Hover over field to see option descriptions
Employee_Type
*
Please Select
Y
N
I
Select one: Y = Clergy, N = Non-Clergy, I = UU Ministerial Intern (Not eligible for ER Contribution Yet)
Hire_Date
*
/
Month
/
Day
Year
Original hire date
Termination_Date
/
Month
/
Day
Year
If you have terminated this employee, please enter termination date. (if employee was rehired, enter end of service date between original hire and rehire dates)
ReHire_Date
/
Month
/
Day
Year
If you have rehired this employee, please enter the new hire date.
Compensation_Amount
*
Include decimals
Compensation_Qualifier
*
Please Select
A
H
B
W
S
Select one: A = Annual, H = Hourly, B = Bi-Weekly, W = Weekly, S = Semi-Monthly
Compensation Effective Date
/
Month
/
Day
Year
Enter Date Compensation/New Salary amount is effective, if different than hire date. Leave blank if same as hire date.
Pay_Frequency
Please Select
W
B
S
M
Select one: W = Weekly, B = Bi-Weekly, S = Semi-Monthly, M = Monthly
ER_Eligibility_Date
/
Month
/
Day
Year
Enter date employee became eligible for the Employer Contribution in the Plan (if known, otherwise leave blank). If employee came to you already eligible, leave blank.
In_Lieu_of_FICA
If location DOES NOT EXCLUDE In-Lieu of FICA for Retirement Compensation, please enter dollar amount of In Lieu of FICA paid to minister, if applicable
Domestic_Partner_GrossUp
If location DOES NOT EXCLUDE Domestic Partner gross-up for Retirement Compensation, please enter dollar amount of Domestic Partner gross-up, if applicable
Imputed_Ins
If location DOES NOT EXCLUDE Imputed LTD and Life Insurance for Retirement Compensation, please enter dollar amount of Imputed Life-Insurance or Long Term Disability, if applicable
Total_Comp
(Add Compensation Amount + In-Lieu of FICA + Domestic Partner Gross-up + Imputed LTD and Life Insurance)***This is the total compensation amount to be included on the contributions form
ER_Contribution_Percent
*
Elected Employer Contribution Percentage from EPA (Up to Min. 5- Max 14%, Whole percentages only)
ER_Match_Percent
*
Please Select
0
1
2
3
4
5
6
Elected Employer Match Percentage from EPA, if applicable. Enter 0 if no Match is offered on your EPA (Up to 6%, Whole percentages only)
Highly_Comp_Employee
Please Select
Y
Enter Y if $150,000 or greater, otherwise leave blank
Federal_Exemptions
(enter number of exemptions employee has selected on W4 form, if known, otherwise leave blank)
Termination_Code
Please Select
DE
DI
LA
R
S
Hover over field to see option descriptions
Have all employEE contributions that were removed from their pay been remitted to their Plan account? And if they have satisfied the Year of Eligibility Service, have all employER contributions owed (and any matching contributions, if applicable) been remitted to their Plan account?
*
Please Select
Yes
No
If you answered Yes, what date were any final contributions remitted?
-
Month
-
Day
Year
Date
If you answered No, what date will any final contributions be remitted?
-
Month
-
Day
Year
Date
Additional Submission
Would you like to submit information for another employee?
Yes
No, I'm Done
Fields for Recordkeeper Use Only
Base_Compensation
LEAVE BLANK
Plan_Sponsor_Assigned_ID
Leave blank. Not immediately in use, may be used for UUA participant identification #
Eligibility_Code
Empower required field, not in use by UUA
Submit
Should be Empty: