OMAHA/LINCOLN MEMBERS ONLY – EFFECTIVE 3/1/2010

SHEET METAL WORKERS LOCAL #3 401(K) PLAN

VOLUNTARY DEFERRAL CHANGE FORM

 

Section I. General Information  (Please complete all information)

 

Name    _________________________________                     Social Security # ___________________________

 

Address _________________________________                   Current Contractor __________________________

                                                                                                                                                                (Required Field)

________________________________________                   Phone # ___________________________________

 

________________________________________                   Date of Birth _______________________________

 

 

Section II. Contribution Changes

 

Your total 401(k) contribution is as follows:  Automatic deferral + Voluntary deferral = Total 401(k) contribution.

Automatic deferral per hour is determined by your experience as follows:

*pre-apprentice or semester 1-4 apprentice    $0.00/Hr

*semester 5 apprentice or more experience $0.50/Hr (Sioux City)  $1.00/Hr (Lincoln)) $1.20/Hr (Omaha)

 

PLEASE READ THROUGH YOUR ELECTION CAREFULLY

These changes will be calculated off the most recent signed deferral

form Benefit Plans has on file for your deferral.

Text Box: Office Use Only Prior Def  $________ Change ___________ New Deferral $_________

 

 

 


 

CHOOSE ONE OPTION – Fill in Blank (must be in $0.10 increments)

 

 

Raise my current voluntary deferral by            $___________ per hour    OR

 

 

Lower my current voluntary deferral by          $___________ per hour    OR

 

 

Change my current voluntary deferral to         $___________ per hour    

 

 

 

 

 

 

 

Section III.  Signature: _______________________________________   Date ________________

 

 

Please return No later than February 24th to:

Benefit Plans, Inc. 16924 Frances Street, Suite 100, Omaha NE  68130

OR Fax to 402-891-0444  Attn: Martha

OR Email to marthad@bpiomaha.com

 

 

*Do not submit investment election changes with this form.  Benefit Plans Inc. is not authorized to process transfer requests. 

Investment questions can be directed to Mark Slattery or Shannon Case at (402) 502-5700.