Fillable 403b Distribution Booklet

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403b Distribution Booklet

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Learn about taking distributions from your plan
403(b) Tax-Deferred
Retirement Plan
Distribution Booklet
Table of Contents
Important Information About Distributions From Your 403(b) Plan ........................................................................2
Questions and Answers ....................................................................................................................................................3
Special Tax Notice ..............................................................................................................................................................5
403(b) Distribution Request form
1
IRS Circular 230 Disclosure: American Century Companies, Inc. and its affiliates do not provide tax advice. Accordingly, any discussion
of U.S. tax matters contained herein (including any attachments) is not intended or written to be used, and cannot be used, in connection
with the promotion, marketing or recommendation by anyone unaffiliated with American Century Companies, Inc. of any of the matters
addressed herein or for the purpose of avoiding U.S. tax-related penalties.
The Questions and Answers section
of this booklet provides brief answers
to frequently asked questions about
removing money from your 403(b) plan
and possible rollover options.
American Century Investments
®
requires
that any requests to remove money from
your 403(b) plan be received in writing on
American Century’s 403(b) Distribution
Request form.
If you have any questions, please call
a Business Retirement Specialist at
1-800-345-3533.
Federal tax law requires that most
distributions from qualified retirement
plans that are not directly rolled over to
an IRA or other qualified plan be subject
to federal income tax withholding at the
rate of 20%.
The Custodian is required to provide
you with a written notice explaining your
403(b) rollover options and how certain
distributions may be taxed. You will find
this notice in this booklet. Please read
the tax notice carefully before removing
money from your plan. If you have any
questions about the tax consequences
of the distribution you are taking from
your plan, please consult your tax advisor
before the distribution is made.
You may consider the distribution options
under your 403(b) plan for a minimum
waiting period of 30 days after receipt of
this booklet. You have the right to use the
entire waiting period to decide between
your distribution options, or you may
waive this waiting period by completing
and returning the 403(b) Distribution
Request form. Once you return the
403(b) Distribution Request form, your
decision may not be changed.
Important Information About Distributions
From Your 403(b) Plan
2
Questions and Answers
If I qualify for a 403(b)
distribution, how will it be taxed?
If you receive a distribution and do
not roll it over into an IRA or another
eligible retirement plan, it will be subject
to federal and state income tax unless it
includes only after-tax or qualified Roth
amounts. If you receive a distribution
before you reach age 59½, you also may
have to pay a penalty tax equal to 10% of
the taxable portion of your distribution.
See the Special Tax Notice in this
booklet for more information.
When is a distribution subject
to the 20% mandatory federal
income tax withholding?
If a distribution is made payable directly
to you, it is subject to the 20% mandatory
federal income tax withholding, unless
one of the following exceptions applies:
1. Your distribution is directly rolled over to
an IRA or another eligible retirement plan
2. You are over age 70½ and are
withdrawing only your required
minimum distribution
3. You are withdrawing your benefit over
your life expectancy, the life expectancy
of you and your designated beneficiary,
or a period of 10 years or more
4. You are withdrawing excess contributions
5. You are withdrawing due to a financial
hardship.
If situation 2, 3, 4 or 5 above applies,
distributions will be subject to federal
withholding at the minimum rate of 10%,
unless you elect no withholding on IRS
Form W-4P or the 403(b) Distribution
Request form. If federal income tax
is withheld, then any mandatory state
income tax also will be withheld.
What if I withdraw more than my
required minimum distribution?
If you withdraw more than your required
minimum distribution, the 20% federal
income tax withholding rate, as well
as any mandatory state income tax
withholding, will apply to the amount in
excess of your minimum distribution.
• Payment of tuition, related educational
fees, and room and board for the next 12
months of post-secondary education for
you, your spouse, your primary beneficiary,
children or dependents
•
Payments to prevent eviction from or
foreclosure upon the mortgage of your
principal residence
•
Expenses for the repair of damage of
your principal residence that would qualify
for the casualty deduction under Internal
Revenue Code section 165
•
Burial or funeral expenses for your
deceased parent, spouse, primary
beneficiary, children or dependents
If you make a hardship withdrawal, you
must suspend your salary reduction
contributions to all retirement plans
maintained by your employer for at least
six months.
How much may I withdraw for a
financial hardship?
The amount you may withdraw is the
lesser of your total salary reduction
contributions (not including earnings)
or the amount necessary to meet the
financial hardship. Any amounts received
as a direct rollover from a Traditional IRA
or another eligible retirement plan will not
be available for hardship withdrawal.
Can an alternate payee make
a withdrawal?
An alternate payee is generally an
ex-spouse who has been assigned an
interest in a 403(b) plan account under
a qualified domestic relations order
(QDRO). The terms of the 403(b) plan
and/or QDRO will determine when an
alternate payee may take a distribution
from the plan. Consult your employer
to determine the alternate payee’s
distribution options. See the Special
Tax Notice in this booklet for more
information.
When must I begin withdrawals?
You must begin withdrawals the year
in which you turn age 70½ or retire,
whichever is later.
Listed below are questions that are
frequently asked about retirement
plan distributions. If you have
other questions, contact us at
1-800-345-3533.
When am I eligible to withdraw
money from my 403(b) plan?
Your 403(b) plan is designed for your
retirement. Generally, a distribution may
be taken from your account only if one of
the following qualifying events occurs:
• You have reached age 59½
• You no longer work for the employer
• You are permanently and totally disabled
• You have encountered certain financial
hardships (if hardship withdrawals are
permitted by your employer’s plan)
•
You have made excess contributions to
the account
•
In the event of your death
• Other qualifying events may apply in your
403(b) plan. Check with your employer to
determine if you meet a qualifying event.
You must indicate on the 403(b)
Distribution Request form which
qualifying event occurred before
American Century Investments can
proceed with your request.
How do I qualify for a financial
hardship withdrawal?
To qualify for a hardship withdrawal,
your employer’s plan must permit
hardship withdrawals, you must have an
immediate and heavy financial need, and
the amount of the withdrawal must not
exceed the amount of the need. Unless
your employer’s plan provides otherwise,
the withdrawal must be used for:
• Medical expenses already incurred
or necessary that are not covered by
insurance; these expenses may be
incurred by you, your spouse, your
dependents or primary beneficiary
•
Purchase of your principal residence
3
the excess contribution. American Century
Investments will calculate the gain or loss
on the excess contribution, and any gains
will be distributed with the excess amount.
Taxes and penalties also may apply. Since
special tax considerations may affect
your situation, we suggest you contact
a tax advisor before you remove excess
contributions.
Does my spouse need to consent
to the distribution?
If you are married and your 403(b) plan
is subject to the Employee Retirement
Income Security Act of 1974 (ERISA),
you and your spouse may need to waive
the Qualified Joint and Survivor Annuity
(QJSA) requirement. Please contact your
employer for more information.
Is employer approval required
before I can receive a
distribution?
In most cases, distributions require
employer or Third Party Administrator
(TPA) approval and an authorized
individual from your employer or TPA must
sign the 403(b) Distribution Request
form. Check with your employer or TPA to
determine available distribution options in
your 403(b) plan.
Example: You are age 70½ and your
required minimum distribution is
$1,000, but you withdraw $3,000.
The minimum withholding rate of 10%
applies to the first $1,000, and the
20% rate applies to the additional
$2,000 withdrawn.
Can I roll over my 403(b) into
a Traditional IRA or employer-
sponsored plan?
Yes, unless your distribution is described
in situation 2, 3, 4 or 5 on the previous
page. Special rules may apply to the
employer-sponsored plan. Check with
the plan sponsor to determine if the
plan accepts rollovers. See the Special
Tax Notice in this booklet for more
information.
If you are eligible for a distribution, you
may request a rollover by completing a
403(b) Distribution Request form. If your
assets are being rolled over to an IRA
or plan at another institution, a letter of
acceptance is also required.
Can I roll over my 403(b) into a
Roth IRA?
Yes, unless your distribution is described
in situation 2, 3, 4 or 5 on the previous
page. However, certain rollover amounts
may be treated as taxable income to
you. See the Special Tax Notice in this
booklet for more information.
If you are eligible for a distribution, you
may request a rollover by completing
a 403(b) Distribution Request form. If
your assets are being rolled over to a
Roth IRA at another institution, a letter of
acceptance is also required.
Are my distributions reported to
the IRS?
Yes. American Century Investments will
report all distributions, including direct
rollovers, to you and the IRS on Form
1099-R. A transfer from American
Century Investments to your 403(b) with
another custodian will not be reported.
How do I remove an excess
contribution?
On the 403(b) Distribution Request
form, check the “Excess contribution” box
and indicate the exact dollar amount of
4
Special Tax Notice
For plan payments from qualified plans, 403(b) plans and governmental 457(b) plans
PART I: For Payments NOT from a
Designated Roth Account
YOUR ROLLOVER OPTIONS
You are receiving this notice because all or a portion of a payment
you are receiving from your employer’s plan (the “Plan”) is eligible to
be rolled over to an IRA or an employer plan. This notice is
intended to help you decide whether to do such a rollover.
This notice describes the rollover rules that apply to payments
from the Plan that are not from a designated Roth account
(a type of account with special tax rules in some employer plans). If
you also receive a payment from a designated Roth account in the
Plan, refer to Part II of this Special Tax Notice for a separate tax
notice regarding that payment, and the Plan administrator or the
payor will tell you the amount that is being paid from each account.
Rules that apply to most payments from a plan are described in
the “General Information About Rollovers” section. Special rules
that only apply in certain circumstances are described in the
“Special Rules and Options” section.
You may be eligible to leave your retirement assets in the Plan.
The Plan’s investment options and fees may be different than
those of other retirement plans, including IRAs and other
employer plans. Check with your Plan administrator to determine
the Plan options available to you, including the Plan’s investment
options and any associated fees.
GENERAL INFORMATION ABOUT ROLLOVERS
How can a rollo
ver affect my taxes?
You will be taxed on a payment from the Plan if you do not roll it
over. If you are under age 59½ and do not do a rollover, you will
also have to pay a 10% additional income tax on early
distributions (unless an exception applies). However, if you
do a rollover, you will not have to pay tax until you receive
payments later and the 10% additional income tax will not apply
if those payments are made after you are age 59½ (or if an
exception applies).
Where may I roll over the payment?
You may roll over the payment to either an IRA (an individual
retirement account or individual retirement annuity) or an
employer plan (a tax-qualified plan, section 403(b) plan, or
governmental section 457(b) plan) that will accept the rollover.
The rules of the IRA or employer plan that holds the rollover will
determine your investment options, fees, and rights to payment
from the IRA or employer plan (for example, no spousal consent
rules apply to IRAs and IRAs may not provide loans). Further, the
amount rolled over will become subject to the tax rules that apply
to the IRA or employer plan.
How do I do a rollover?
There are two ways to do a rollover. You can do either a direct
rollover or a 60-day rollover.
If you do a direct rollover, the Plan will make the payment
directly to your IRA or an employer plan. You should contact
the IRA sponsor the administrator of the employer plan for
information on how to do a direct rollover.
If you do not do a direct rollover, you may still do a rollover by
making a deposit into an IRA or eligible employer plan that will
accept it. You will have 60 days after you receive the payment to
make the deposit. The 60-day timeframe applies to the non-loan
portion of your payment. (See “If you have an outstanding loan that is
being offset” under the Special Rules and Options section for
information on rolling over the loan portion of your payment.) If you do
not do a direct rollover, the Plan is required to withhold 20% of
the payment for federal income taxes (up to the amount of cash
and property received other than employer stock). This means
that, to rollover the entire payment, you must use other funds to make
up for the 20% withheld. If you do not roll over the entire amount of
the payment, the portion not rolled over will be taxed and will be subject
to the 10% additional income tax on early distributions if you are under
59 ½ (unless an exception applies).
How much may I roll over?
If you wish to do a rollover, you may roll over all or part of the
amount eligible for rollover. Any payment from the Plan is eligible
for rollover, except:
•
Certain payments spread over a period of at least 10 years
or over your life or life expectancy (or the lives or joint life
expectancy of you and your beneficiary)
•
Required minimum distributions after age 70½ (or after
death)
5
•
Hardship distributions
•
Employee stock ownership plan (ESOP) dividends
•
Corrective distributions of contributions that exceed tax
law limitations
•
Loans treated as deemed distributions (for example,
loans in default due to missed payments before your
employment ends)
•
Cost of life insurance paid by the Plan
•
Payments of certain automatic enrollment contributions
requested to be withdrawn within 90 days of the first
contribution
•
Amounts treated as distributed because of a prohibited
allocation of S corporation stock under an ESOP (also, there
will generally be adverse tax consequences if you roll over a
distribution of S corporation stock to an IRA).
The Plan administrator or the payor can tell you what portion of a
payment is eligible for rollover.
If I don’t do a rollover, will I have to pay the 10%
additional income tax on early distributions?
If you are under age 59½, you will have to pay the 10% additional
income tax on early distributions for any payment from the Plan
(including amounts withheld for income tax) that you do not roll over,
unless one of the exceptions listed below applies.
This tax is in addition to the regular income tax on the payment
not rolled over.
The 10% additional income tax does not apply to the following
payments from the Plan:
•
Payments made after you separate from service if you will be
at least age 55 in the year of the separation
•
Payments that start after you separate from service if paid at
least annually in equal or close to equal amounts over your life
or life expectancy (or the lives or joint life expectancy of you
and your beneficiary)
•
Payments from a governmental defined benefit pension plan
made after you separate from service if you are a public safety
employee and you are at least age 50 in the year of the
separation
•
Payments made due to disability
•
Payments after your death
•
Payments of ESOP dividends
•
Corrective distributions of contributions that exceed tax
law limitations
•
Cost of life insurance paid by the Plan
•
Payments made directly to the government to satisfy a
federal tax levy
•
Payments made under a qualified domestic relations order
(QDRO)
•
Payments up to the amount of your deductible medical
expenses
•
Certain payments made while you are on active duty if you
were a member of a reserve component called to duty after
September 11, 2001 for more than 179 days
•
Payments of certain automatic enrollment contributions
requested to be withdrawn within 90 days of the first
contribution.
If I do a rollover to an IRA, will the 10% additional
income tax apply to early distributions from the IRA?
If you receive a payment from an IRA when you are under age
59½, you will have to pay the 10% additional income tax on
early distributions from the IRA, unless an exception applies. In
general, the exceptions to the 10% additional income tax for
early distributions from an IRA are the same as the exceptions
listed above for early distributions from a plan. However, there
are a few differences for payments from an IRA, including:
•
There is no exception for payments after separation from
service that are made after age 55.
•
The exception for QDROs does not apply (although a
special rule applies under which, as part of a divorce or
separation agreement, a tax-free transfer may be made
directly to an IRA of a spouse or former spouse).
•
The exception for payments made at least annually in equal
or close to equal amounts over a specified period applies
without regard to whether you have had a separation
from service.
•
There are additional exceptions for (1) payments for
qualified higher education expenses, (2) payments up to
$10,000 used in a qualified first-time home purchase,
and (3) payments for health insurance premiums after
you have received unemployment compensation for 12
consecutive weeks (or would have been eligible to receive
unemployment compensation but for self-employed status).
Will I owe State income taxes?
This notice does not describe any State or local income tax rules
(including withholding rules).
6
SPECIAL RULES AND OPTIONS
If your payment includes after-tax contributions. After-
tax contributions included in a payment are not taxed. If a payment
is only part of your benefit, an allocable portion of your after-tax
contributions is included in the payment, so you cannot
take a payment of only after-tax contributions. However, if you have
pre-1987 after-tax contributions maintained in a separate account,
a special rule may apply to determine whether the after-tax
contributions are included in a payment. In addition, special rules
apply when you do a rollover, as described below.
You may roll over to an IRA a payment that includes after-tax
contributions through either a direct rollover or a 60-day rollover.
You must keep track of the aggregate amount of the after-tax
contributions in all of your IRAs (in order to determine your
taxable income for later payments from the IRAs). If you do
a direct rollover of only a portion of the amount paid from the
Plan and at the same time the rest is paid to you, the portion
directly rolled over consists first of the amount that would
be taxable if not rolled over. For example, assume you are
receiving a distribution of $12,000, of which $2,000 is after-tax
contributions. In this case, if you directly roll over $10,000 to an
IRA that is not a Roth IRA, no amount is taxable because the
$2,000 amount not directly rolled over is treated as being after-tax
contributions. If you do a direct rollover of the entire amount paid
from the Plan to two or more destinations at the same time, you
can choose which destination receives the after-tax contributions.
If you do a 60-day rollover
to an IRA of only a portion of a
payment made to you, the after-tax contributions are treated as
rolled over last. For example, assume you are receiving
a distribution of $12,000, of which $2,000 is after-tax
contributions, and no part of the distribution is directly rolled
over. In this case, if you roll over $10,000 to an IRA that is not
a Roth IRA in a 60-day rollover, no amount is taxable because
the $2,000 amount not rolled over is treated as being after-
tax contributions.
You may roll over to an employer plan all of a payment that
includes after-tax contributions, but only through a direct rollover
(and only if the receiving plan separately accounts for after-tax
contributions and is not a governmental section 457(b) plan).
You can do a 60-day rollover to an employer plan as part of a
payment that includes after-tax contributions, but only up to the
amount of the payment that would be taxable if not rolled over.
If you miss the 60-day rollover deadline.
Generally, the 60-day rollover deadline for the non-loan portion
of your payment cannot be extended. However, the IRS has the
limited authority to waive the deadline under certain extraordinary
circumstances, such as when external events prevented you from
completing the rollover by the 60-day rollover deadline. To apply
for a waiver, you must file a private letter ruling request with the IRS.
Private letter ruling requests require the payment of a
nonrefundable user f
ee. For more information, see IRS Publication
590-A, Contributions to Individual Retirement Arrangements (IRAs).
If your payment includes employer stock that you
do not roll over.
If you do not do a rollover, you can apply a special rule to
payments of employer stock (or other employer securities) that
are either attributable to after-tax contributions or paid in a lump
sum after separation from service (or after age 59½, disability, or
the participant’s death). Under the special rule, the net unrealized
appreciation on the stock will not be taxed when distributed from
the Plan and will be taxed at capital gain rates when you sell
the stock. Net unrealized appreciation is generally the increase in
the valu
e of employer stock after it was acquired by the Plan. If you
do a rollover for a payment that includes employer stock (for
example, by selling the stock and rolling over the proceeds within
60 days of the payment), the special rule relating to the
distributed employer stock will not apply to any subsequent
payments from the IRA or employer plan. The Plan administrator
can tell you the amount of any net unrealized appreciation.
If you have an outstanding loan that is being offset.
If you have an outstanding loan from the Plan, your Plan benefit
may be offset by the amount of the loan, typically when your
employment ends. The loan offset amount is treated as a
distribution to you at the time of the offset and will be taxed
(including the 10% additional income tax on early distributions,
unless an exception applies) unless you do a subsequent rollover
of the loan offset amount to an IRA or employer plan prior to
your individual tax return filing deadline (including extension) for
the year in which the offset occurred.
If you were born on or before January 1, 1936.
If you were born on or before January 1, 1936 and receive a lump
sum distribution that you do not roll over, special rules for
calculating the amount of the tax on the payment might apply to
you. For more information, see IRS Publication 575, Pension and
Annuity Income.
If your payment is from a governmental section
457(b) plan.
If the Plan is a governmental section 457(b) plan, the same rules
described elsewhere in this notice generally apply, allowing you to
roll over the payment to an IRA or an employer plan
that accepts rollovers. One difference is that, if you do not do a
rollover, you will not have to pay the 10% additional income tax
on early distributions from the Plan even if you are under age
59½ (unless the payment is from a separate account holding
rollover contributions that were made to the Plan from a tax-
qualified plan, a section 403(b) plan, or an IRA). However, if you
do a rollover to an IRA or to an employer plan that is not a
governmental section 457(b) plan, a later distribution made
before age 59½ will be subject to the 10% additional income tax
on early distributions (unless an exception applies). Other
7
differences are that you cannot do a rollover if the payment
is due to an “unforeseeable emergency” and the special rules
under “If your payment includes employer stock that you do not roll
over” and “If you were born on or before January 1, 1936” do not
apply.
If you are an eligible retired public safety officer
and your pension payment is used to pay for health
coverage or qualified long-term care insurance.
If the Plan is a governmental plan, you retired as a public safety
officer, and your retirement was by reason of disability or was
after normal retirement age, you can exclude from your taxable
income plan payments paid directly as premiums to an accident
or health plan (or a qualified long-term care insurance contract)
that your employer maintains for you, your spouse, or your
dependents, up to a maximum of $3,000 annually. For this
purpose, a public safety officer is a law enforcement officer,
firefighter, chaplain, or member of a rescue squad or ambulance
crew.
If you roll over your payment to a Roth IRA.
If you roll over a payment from the Plan to a Roth IRA, a special rule
applies under which the amount of the payment rolled over
(reduced by any after-tax amounts) will be taxed. However,
the 10% additional income tax on early distributions will not
apply (unless you take the amount rolled over out of the Roth
IRA within 5 years, counting from January 1 of the year of the
rollover).
If you roll over the payment to a Roth IRA, later payments from
the Roth IRA that are qualified distributions will not be taxed
(including earnings after the rollover). A qualified distribution
from a Roth IRA is a payment made after you are age 59½ (or
after your death or disability, or as a qualified first-time
homebuyer distribution of up to $10,000) and after you have had a
Roth IRA for at least 5 years. In applying this 5-year rule, you count
from January 1 of the year for which your first contribution was
made to a Roth IRA. Payments from the Roth IRA that are not
qualified distributions will be taxed to the extent of earnings after
the rollover, including the 10% additional income tax on early
distributions (unless an exception applies). You do not have to take
required minimum distributions from a Roth IRA during your
lifetime. For more information, see IRS Publication 590-A,
Contributions to Individual Retirement Arrangements (IRAs), and
IRS Publication 590-B, Distributions from Individual Retirement
Arrangements (IRAs).
If you do a rollover to a designated Roth account
in the Plan.
If your Plan allows for rollovers to a designated Roth account in the
Plan and you are eligible to choose that option, the following
provisions apply:
You cannot roll over a distribution to a designated Roth account in
another employer’s plan. However, you can roll the distribution over
into a designated Roth account in the distributing Plan.
If you roll over a payment from the Plan to a designated Roth
account in the Plan, the amount of the payment rolled over
(reduced by any after-tax amounts directly rolled over) will be
taxed. However, the 10% additional tax on early distributions will
not apply (unless you take the amount rolled over out of the
designated Roth account within the 5-year period that begins on
January 1 of the year of the rollover).
If you roll over the payment to a designated Roth account in the
Plan, later payments from the designated Roth account that are
qualified distributions will not be taxed (including earnings after
the rollover). A qualified distribution from a designated Roth
account is a payment made both after you are age 59½ (or after
your death or disability) and after you have had a designated
Roth account in the Plan for at least 5 years. In applying this 5-
year rule, you count from January 1 of the year your first
contribution was made to the designated Roth account. However,
if you made a direct rollover to a designated Roth account in the
Plan from a designated Roth account in a plan of another
employer, the 5-year period begins on January 1 of the year you
made the first contribution to the designated Roth account in the
Plan or, if earlier, to the designated Roth account in the plan of the
other employer. Payments from the designated Roth account that
are not qualified distributions will be taxed to the extent of
earnings after the rollover, including the 10% additional income
tax on early distributions (unless an exception applies).
If you are not a Plan participant.
Payments after death of the participant. If you receive a
distribution after the participant’s death that you do not
roll over, the distribution will generally be taxed in the same
manner described elsewhere in this notice. However, the 10%
additional income tax on early distributions and the special rules
for public safety officers do not apply, and the special rule
described under the section “If you were born on or before
January 1, 1936” applies only if the participant was born on or
before January 1, 1936.
If you are a surviving spouse. If you receive a payment from
the Plan as the surviving spouse of a deceased participant,
you have the same rollover options that the participant would
have had, as described elsewhere in this notice. In addition, if
you choose to do a rollover to an IRA, you may treat the IRA
as your own or as an inherited IRA.
An IRA you treat as your own is treated like any other IRA of
yours, so that payments made to you before you are age
59½ will be subject to the 10% additional income tax on
8
early distributions (unless an exception applies) and required
minimum distributions from your IRA do not have to start until
after you are age 70½.
If you treat the IRA as an inherited IRA, payments from the
IRA will not be subject to the 10% additional income tax on
early distributions. However, if the participant had started
taking required minimum distributions, you will have to
receive required minimum distributions from the inherited
IRA. If the participant had not started taking required
minimum distributions from the Plan, you will not have to
start receiving required minimum distributions from the
inherited IRA until the year the participant would have been
age 70½.
If you are a surviving beneficiary other than a spouse. If you
receive a payment from the Plan because of the participant’s
death and you are a designated beneficiary other than a
surviving spouse, the only rollover option you have is to
do a direct rollover to an inherited IRA. Payments from the
inherited IRA will not be subject to the 10% additional
income tax on early distributions. You will have to receive
required minimum distributions from the inherited IRA.
Payments under a qualified domestic relations order. If you
are the spouse or former spouse of the participant who receives a
payment from the Plan under a QDRO, you generally have the
same options the participant would have (for example, you may roll
over the payment to your own IRA or an eligible employer plan
that will accept it). Payments under the QDRO will not be subject
to the 10% additional income tax on early distributions
.
If you are a nonresident alien.
If you are a nonresident alien and you do not do a direct rollover to a
U.S. IRA or U.S. employer plan, instead of withholding 20%, the
Plan is generally required to withhold 30% of the payment for
federal income taxes. If the amount withheld exceeds the amount
of tax you owe (as may happen if you do a 60-day rollover), you
may request an income tax refund by filing Form 1040NR and
attaching your Form 1042-S. See Form W-8BEN for claiming that
you are entitled to a reduced rate of withholding under an income
tax treaty. For more information, see also IRS Publication 519, U.S.
Tax Guide for Aliens, and IRS Publication 515, Withholding of Tax on
Nonresident Aliens and Foreign Entities.
Other special rules.
If a payment is one in a series of payments for less than 10
years, your choice whether to make a direct rollover will apply to
all later payments in the series (unless you make a different
choice for later payments).
If your payments for the year are less than $200 (not including
payments from a designated Roth account in the Plan), the Plan
is not required to allow you to do a direct rollover and is not
required to withhold for federal income taxes. However, you may
do a 60-day rollover.
Unless you elect otherwise, a
mandatory cash out of more
than $1,000 (not including payments from a designated Roth
account in the Plan) may be directly rolled over to an IRA chosen by
the Plan administrator or the payor. A mandatory cash out
is a payment from a plan to a participant made before age 62 (or
normal retirement age, if later) and without consent, where the
participant’s benefit does not exceed $5,000. This $5,000
threshold may exclude prior rollover amounts depending on the
terms of your Plan. Your Plan administrator should provide you
with a separate notice if this automatic rollover provision
applies to you.
You may have special rollover rights if you recently served in the U.S.
Armed Forces. For more information, see IRS Publication 3, Armed
Forces’ Tax Guide.
FOR MORE INFORMATION
You may wish to consult with the Plan administrator or payor, or a
professional tax advisor, before taking a payment from the Plan.
Also, you can find more detailed information on the federal tax
treatment of payments from employer plans in: IRS Publication
575, Pension and Annuity Income; IRS Publication 590-A,
Contributions to Individual Retirement Arrangements (IRAs); IRS
Publication 590-B, Distributions from Individual Retirement
Arrangements (IRAs); and IRS Publication 571, Tax-Sheltered
Annuity Plans (403(b) Plans). These publications are available
from a local IRS office, on the web at www.irs.gov, or by calling
1-800-TAX-FORM.
9
PART II: For Payments FROM a
Designated Roth Account
YOUR ROLLOVER OPTIONS
You are receiving this notice because all or a portion of a
payment you are receiving from your employer’s plan (the “Plan”) is
eligible to be rolled over to a Roth IRA or designated Roth
account in an employer plan. This notice is intended to help you
decide whether to do a rollover.
This notice describes the rollover rules that apply to payments
from the Plan that are from a designated Roth account. If you
also receive a payment from the Plan that is not from a
designated Roth account, refer to Part I of this Special Tax
Notice for a separate tax notice regarding that payment, and the
Plan administrator or the payor will tell you the amount that is
being paid from each account.
Rules that apply to most payments from a designated Roth
account are described in the “General Information About
Rollovers” section. Special rules that only apply in certain
circumstances are described in the “Special Rules and Options”
section.
You may be eligible to leave your retirement assets in the Plan.
The Plan’s investment options and fees may be different than
those of other retirement plans, including Roth IRAs and other
employer plans. Check with your Plan administrator to determine
the Plan options available to you, including the Plan’s investment
options and any associated fees.
GENERAL INFORMATION ABOUT ROLLOVERS
How can a rollover affect my taxes?
After-tax contributions included in a payment from a designated
Roth account are not taxed, but earnings might be taxed. The tax
treatment of earnings included in the payment depends on
whether the payment is a qualified distribution. If a payment
is only part of your designated Roth account, the payment will
include an allocable portion of the earnings in your designated
Roth account.
If the payment from the Plan is not a qualified distribution and
you do not do a rollover to a Roth IRA or a designated Roth
account in an employer plan, you will be taxed on the earnings in
the payment. If you are under age 59½, a 10% additional income
tax on early distributions will also apply to the earnings (unless an
exception applies). However, if you do a rollover, you will not have
to pay taxes currently on the earnings and you will not have to pay
taxes later on payments that are qualified distributions.
If the payment from the Plan is a qualified distribution, you will
not be taxed on any part of the payment even if you do not do
a rollover. If you do a rollover, you will not be taxed on the amount
you roll over and any earnings on the amount you roll over will not
be taxed if paid later in a qualified distribution.
A qualified distribution from a designated Roth account in the
Plan is a pa
yment made after you are age 59½ (or after your
death or disability) and after you have had a designated Roth
account in the Plan for at least 5 years. In applying the 5-year
rule, you count from January 1 of the year your first contribution
was made to the designated Roth account. However, if you
did a direct rollover to a designated Roth account in the Plan
from a designated Roth account in another employer plan, your
participation will count from January 1 of the year your first
contribution was made to the designated Roth account in the
Plan or, if earlier, to the designated Roth account in the other
employer plan.
Where may I roll over the payment?
You may roll over the payment to either a Roth IRA (a Roth
individual retirement account or Roth individual retirement
annuity) or a designated Roth account in an employer plan (a
tax-qualified plan or section 403(b) plan) that will accept the
rollover. The rules of the Roth IRA or employer plan that
holds the rollover will determine your investment options, fees,
and rights to payment from the Roth IRA or employer plan (for
example, no spousal consent rules apply to Roth IRAs and Roth
IRAs may not provide loans). Further, the amount rolled over will
become subject to the tax rules that apply to the Roth IRA or the
designated Roth account in the employer plan. In general, these tax
rules are similar to those described elsewhere in this notice, but
differences include:
•
If you do a rollover to a Roth IRA, all of your Roth IRAs will
be considered for purposes of determining whether you
have satisfied the 5-year rule (counting from January 1
of the year for which your first contribution was made to
any of your Roth IRAs).
•
If you do a rollover to a Roth IRA, you will not be required to
take a distribution from the Roth IRA during your lifetime and
you must keep track of the aggregate amount of the after-
tax contributions in all of your Roth IRAs (in order to
determine your taxable income for later Roth IRA payments
that are not qualified distributions).
•
Eligible rollover distributions from a Roth IRA can only be
rolled over to another Roth IRA.
If the payment you are receiving is NOT from a
designated Roth account in your employer’s Plan,
this Part II of the Special Tax Notice does not
apply to you and you may disregard the following
sections.
10
How do I do a rollover?
There are two ways to do a rollover. You can either do a direct
rollover or a 60-day rollover.
If you do a direct rollover, the Plan will make the payment
directly to your Roth IRA or designated Roth account in an
employer plan. You should contact the Roth IRA sponsor or the
administrator of the employer plan for information on how to do a
direct rollover.
If you do not do a direct rollover, you may still do a rollover by
making a deposit of the non-loan portion of the payment within
60 days into a Roth IRA, whether the payment is a qualified or
nonqualified distribution. In addition, you can do a rollover by
making a deposit of the non-loan portion of the payment within 60
days into a designated Roth account in an employer plan if the
payment is a nonqualified distribution and the rollover does not
exceed the amount of the earnings in the payment. (See “If you
have an outstanding loan that is being offset” under the Special Rules and
Options section for information on rolling over the loan portion of your
payment.) You cannot do a 60-day rollover to an employer plan of
any part of a qualified distribution. If you receive a distribution that
is a nonqualified distribution and you do not roll over an amount
at least equal to the earnings allocable to the distribution, you
will be taxed on the amount of those earnings not rolled over,
including the 10% additional income tax on early distributions if
you are under age 59½ (unless an exception applies).
If you do a direct rollover of only a portion of the amount paid
from the Plan and a portion is paid to you at the same time, the
portion directly rolled over consists first of earnings.
If you do not do a direct rollover and the payment is not a
qualified distribution, the Plan is required to withhold 20% of the
earnings for federal income taxes (up to the amount of cash and
property received other than employer stock). This means that, in
order to roll over the entire payment in a 60-day rollover to a Roth
IRA, you must use other funds to make up for the 20% withheld.
How much may I roll over?
If you wish to do a rollover, you may roll over all or part of the
amount eligible for rollover. Any payment from the Plan is eligible for
rollover, except:
•
Certain payments spread over a period of at least 10 years or
over your life or life expectancy (or the lives or joint life
expectancy of you and your beneficiary)
•
Required minimum distributions after age 70½
(or after death)
•
Hardship distributions
•
ESOP dividends
•
Corrective distributions of contributions that exceed tax
law limitations
•
Loans treated as deemed distributions (for example,
loans in default due to missed payments before your
employment ends)
•
Cost of life insurance paid by the Plan
•
Payments of certain automatic enrollment contributions
requested to be withdrawn within 90 days of the first
contribution
•
Amounts treated as distributed because of a prohibited
allocation of S corporation stock under an ESOP (also, there
will generally be adverse tax consequences if S corporation
stock is held by an IRA).
The Plan administrator or the payor can tell you what portion of a
payment is eligible for rollover.
If I don’t do a rollover, will I have to pay the 10%
additional income tax on early distributions?
If a payment is not a qualified distribution and you are under age
59½, you will have to pay the 10% additional income tax on early
distributions with respect to the earnings allocated to the
payment that you do not roll over (including amounts withheld for
income tax), unless one of the exceptions listed below applies.
This tax is in addition to the regular income tax on the earnings
not rolled over.
The 10% additional income
tax does not apply to the following
payments from the Plan:
•
Payments made after you separate from service if you will
be at least age 55 in the year of the separation
•
Payments that start after you separate from service if paid at
least annually in equal or close to equal amounts over your
life or life expectancy (or the lives or joint life expectancy of
you and your beneficiary)
•
Payments made due to disability
•
Payments after your death
•
Payments of ESOP dividends
•
Corrective distributions of contributions that exceed tax
law limitations
•
Cost of life insurance paid by the Plan
•
Payments made directly to the government to satisfy a
federal tax levy
•
Payments made under a qualified domestic relations
order (QDRO)
•
Payments up to the amount of your deductible
medical expenses
11
•
Certain payments made while you are on active duty if you
were a member of a reserve component called to duty after
September 11, 2001 for more than 179 days
•
Payments of certain automatic enrollment contributions
requested to be withdrawn within 90 days of the first
contribution.
If I do a rollover to a Roth IRA, will the 10%
additional income tax apply to early distributions
from the IRA?
If you receive a payment from a Roth IRA when you are under
age 59½, you will have to pay the 10% additional income
tax on early distributions on the earnings paid from the Roth IRA,
unless an exception applies, or the payment is a qualified
distribution. In general, the exceptions to the 10% additional
income tax for early distributions from a Roth IRA listed above are
the same as the exceptions for early distributions from a plan.
However, there are a few differences for payments from a Roth
IRA, including:
•
There is no special exception for payments after separation
from service.
•
The exception for QDROs does not apply (although a
special rule applies under which, as part of a divorce or
separation agreement, a tax-free transfer may be made
directly to a Roth IRA of a spouse or former spouse).
•
The exception for payments made at least annually in equal or
close to equal amounts over a specified period applies
without regard to whether you have had a separation
from service.
•
There are additional exceptions for (1) payments for
qualified higher education expenses, (2) payments up to
$10,000 used in a qualified first-time home purchase, and
(3) payments for health insurance premiums after you
have received unemployment compensation for 12
consecutive weeks (or would have been eligible to receive
unemployment compensation but for self-employed status).
Will I owe State income taxes?
This notice does not describe any State or local income tax rules
(including withholding rules).
SPECIAL RULES AND OPTIONS
If you miss the 60-day rollover deadline.
Generally, the 60-day rollover deadline for the non-loan portion of
your payment cannot be extended. However, the IRS has the
limited authority to waive the deadline under certain extraordinary
circumstances, such as when external events prevented you from
completing the rollover by the 60-day rollover deadline. To apply for
a waiver, you must file a private letter ruling request with the IRS.
Private letter ruling requests require the payment of a
nonrefundable user fee. For more information, see IRS Publication
590-A, Contributions to Individual Retirement Arrangements
(IRAs).
If your payment includes employer stock that you
do not roll over.
If you receive a payment that is not a qualified distribution and
you do not roll it over, you can apply a special rule to payments of
employer stock (or other employer securities) tha
t are paid in a
lump sum after separation from service (or after age 59½,
disability, or the participant’s death). Under the special rule, the
net unrealized appreciation on the stock included in the earnings in
the payment will not be taxed when distributed to you from the
Plan and will be taxed at capital gain rates when you sell
the stock. If you do a rollover to a Roth IRA for a nonqualified
distribution that includes employer stock (for example, by selling
the stock and rolling over the proceeds within 60 days of the
distribution), you will not have any taxable income and the special
rule relating to the distributed employer stock will not apply to any
subsequent payments from the Roth IRA or employer plan.
Net unrealized appreciation is generally the increase in the
value of the employer stock after it was acquired by the Plan.
The Plan administrator can tell you the amount of any net
unrealized appreciation.
If you receive a payment that is a qualified distribution that
includes emp
loyer stock and you do not roll it over, your basis in
the stock (used to determine gain or loss when you later sell the
stock) will equal the fair market value of the stock at the time of
the payment from the Plan.
If you have an outstanding loan that is being offset.
If you have an outstanding loan from the Plan, your Plan benefit
may be offset by the amount of the loan, typically when your
employment ends. The loan offset amount is treated as a
distribution to you at the time of the offset and, if the distribution is
a nonqualified distribution, the earnings in the loan offset
will be taxed (including the 10% additional income tax on early
distributions, unless an exception applies) unless you do a
subsequent rollover in the amount of the earnings in the loan
offset to a Roth IRA or designated Roth account in an employer
plan prior to your individual tax filing deadline (including
extension) for the year in which the offset occurred.
If you receive a nonqualified distribution and you
were born on or before January 1, 1936.
If you were born on or before January 1, 1936 and receive a
lump sum distribution that is not a qualified distribution and that
you do not roll over, special rules for calculating the amount of
the tax on the earnings in the payment might apply to you.
For more information, see IRS Publication 575, Pension and
Annuity Income.
12
If you receive a nonqualified distribution, are an
eligible retired public safety officer, and your
pension payment is used to pay for health coverage
or qualified long-term care insurance.
If the Plan is a governmental plan, you retired as a public safety
officer, and your retirement was by reason of disability or was after
normal retirement age, you can exclude from your taxable income
nonqualified distributions paid directly as premiums to an accident
or health plan (or a qualified long-term care insurance contract)
that your employer maintains for you, your spouse, or your
dependents, up to a maximum of $3,000 annually. For this purpose,
a public safety officer is a law enforcement officer, firefighter,
chaplain, or member of a rescue squad or ambulance crew.
If you are not a Plan participant.
Payments after death of the participant. If you receive a
distribution after the participant’s death that you do not roll over,
the distribution will generally be taxed in the same manner
described elsewhere in this notice. However, whether the
payment is a qualified distribution generally depends on when
the participant first contributed to the designated Rothaccount in
the Plan. Also, the 10% additional income tax on early distributions
and the special rules for public safety officers do not apply, and
the special rule described under the section “If you receive a
nonqualified distribution and you were born on or before January
1, 1936” applies only if the participant was born on or before
January 1, 1936.
If you are a surviving spouse. If you receive a payment from
the Plan as the surviving spouse of a deceased participant,
you have the same rollover options that the participant would
have had, as described elsewhere in this notice. In addition,
if you choose to do a rollover to a Roth IRA, you may treat
the Roth IRA as your own or as an inherited Roth IRA.
A Roth IRA you treat as your own is treated like any other
Roth IRA of yours, so that you will not have to receive any
required minimum distributions during your lifetime and
earnings paid to you in a nonqualified distribution before you
are age 59½ will be subject to the 10% additional income
tax on early distributions (unless an exception applies).
If you treat the Roth IRA as an inherited Roth IRA, payments
from the Roth IRA will not be subject to the 10% additional
income tax on early distributions. An inherited Roth IRA is
subject to required minimum distributions. If the participant
had started taking required minimum distributions from the
Plan, you will have to receive required minimum distributions
from the inherited Roth IRA. If the participant had not
started taking required minimum distributions, you will not
have to start receiving required minimum distributions from
the inherited Roth IRA until the year the participant would
have been age 70½.
If you are a surviving beneficiary other than a spouse. If you
receive a payment from the Plan because of the participant’s
death and you are a designated beneficiary other than a
surviving spouse, the only rollover option you have is to do
a direct rollover to an inherited Roth IRA. Payments from the
inherited Roth IRA, even if made in a nonqualified distribution,
will not be subject to the 10% additional income tax on early
distributions. You will have to receive required minimum
distributions from the inherited Roth IRA.
Payments under a qualified domestic relations order. If
you are the spouse or a former spouse of the participant who
receives a payment from the Plan under a QDRO, you generally
have the same options the participant would have (for example, you
may roll over the payment as described in this notice).
If you are a nonresident alien.
If you are a nonresident alien and you do not do a direct rollover to
a U.S. IRA or U.S. employer plan, instead of withholding 20%, the
Plan is generally required to withhold 30% of the payment for
federal income taxes. If the amount withheld exceeds the amount of
tax you owe (as may happen if you do a 60-day rollover), you may
request an income tax refund by filing Form 1040NR and attaching
your Form 1042-S. See Form W-8BEN for claiming that you are
entitled to a reduced rate of withholding under an income tax treaty.
For more information, see also IRS Publication 519, U.S. Tax Guide
for Aliens, and IRS Publication 515, Withholding of Tax on
Nonresident Aliens and Foreign Entities.
Other special rules.
If a payment is one in a series of payments for less than 10
years, your choice whether to make a direct rollover will apply to
all later payments in the series (unless you make a different
choice for later payments).
If your payments for the year (only including payments from the
designated Roth account in the Plan) are less than $200, the
Plan is not required to allow you to do a direct rollover and is not
required to withhold for federal income taxes. However, you can do
a 60-day rollover.
Unless you elect otherwise, a mandatory cash out from the designated
Roth account in the Plan of more than $1,000 may be directly rolled
over to a Roth IRA chosen by the Plan administrator or the payor. A
mandatory cash out is a payment from a plan to
a participant made before age 62 (or normal retirement age, if later)
and without consent, where the participant’s benefit does not
exceed $5,000. This $5,000 threshold may exclude prior rollover
amounts depending on the terms of your Plan. Your Plan
administrator should provide you with a separate notice if this
automatic rollover provision applies to you.
You may have special rollover rights if you recently served in the U.S.
Armed Forces. For more information, see IRS Publication 3, Armed
Forces’ Tax Guide.
13
FOR MORE INFORMATION
You may wish to consult with the Plan administrator or payor, or a
professional tax advisor, before taking a payment from the Plan. Also,
you can find more detailed information on the federal tax treatment of
payments from employer plans in: IRS Publication 575, Pension and
Annuity Income; IRS Publication 590-A, Contributions to Individual
Retirement Arrangements (IRAs); IRS Publication 590-B, Distributions
from Individual Retirement Arrangements (IRAs); and IRS Publication
571, Tax-Sheltered Annuity Plans (403(b) Plans). These publications
are available from a local IRS office, on the web at www.irs.gov, or by
calling 1-800-TAX-FORM.
P.O. Box 419385 | Kansas City, MO 64141-6385 | Automated Information Line: 1-800-345-8765 | Business Retirement Specialist: 1-800-345-3533 | americancentury.com
American Century Investment Services, Inc., Distributor. ©2018 American Century Proprietary Holdings, Inc. All rights
reserved. BR-SPL-94423 1808
14
Page 1 of 6
1
2
Complete this form to request a distribution from your 403(b) plan.
• If you are married and your 403(b) plan is subject to ERISA, you may need to waive the qualified joint and
survivor annuity (QJSA) requirement. Please contact your employer for more information.
• Before completing this form, you must read the Special Tax Notice in this booklet.
• You may want to consult a tax advisor before selecting a distribution option.
• For payments that represent less than 100% of the account balance, distributions are paid from each
fund and money type proportionally unless you provide other instructions.
• Employer or Third Party Administrator approval is required for all distributions.
Please print clearly in CAPITAL letters using black ink and sign in step 7. If you have questions, please
call us at 1-800-345-3533.
Provide Information About Yourself
Please note: If you are a beneficiary, you must enter information about yourself in this step.
U.S. Social Security number Date of birth (month-day-year)
Mr. / Mrs. / Ms. First name Middle initial Last name
Street address Apartment/Unit
City State ZIP
Telephone number (daytime) Plan ID/Plan Name
Check here if this is a new address. If you are changing your address or have changed your address in the last
7 days, a signature guarantee is required on distributions over $100,000.
Select Reason for Distribution — Qualifying Event
Distributions from a 403(b) plan may only be taken if one of the following qualifying events occurs. If you are
planning to roll over your assets from this plan into another eligible retirement plan, you must still indicate which
of the following qualifying events occurred before you can receive a distribution.
Select only one reason from the following:
Severance from employment
(Provide effective date below)
Date of severance (month-day-year)
Over age 59½
Permanent and total disability
Required minimum distribution
Excess contribution for (year)
_______________________
Contribution type (select one):
Pre-tax elective deferrals
Roth elective deferrals
Employer contribution
Death of plan participant.
Provide plan participant’s name:
Financial hardship
(You also must complete step 6)
Plan termination
Divorce (alternate payee)
403(b) Distribution Request
Page 2 of 6
3
Select Type of Distribution
Select the type(s) of distribution(s) you want to receive. If you are age 70½ or older and have not taken your
required minimum distribution for the current year, you must complete “Required Minimum Distribution” (option C
below) in addition to any other type of distribution you request in this step.
A. Total Distribution (Lump Sum Distribution)
B. Periodic Distribution
Please pay my benefit in equal installments until my plan account balance is zero. I understand that when I
reach age 70½ or older, my installment payments must be large enough to meet certain minimum distribution
requirements. I understand I may need to increase my installment payments at that time to avoid penalty taxes.
$
Amount Start date (month-day-year)
If you do not indicate the frequency of payments, American Century Investments
®
will pay your distribution
quarterly. We’ll make the distribution on the 15th of the month, unless you specify another date in the space
above. If the applicable date falls on a weekend or holiday, we’ll make the distribution the next business day.
Payment frequency: Annually Semiannually Quarterly Monthly
C. Required Minimum Distribution (RMD)
If you have selected an RMD in addition to another type of distribution in this step (options A, B, D or E),
American Century Investments will calculate your RMD and mail you a check for the required amount before
processing your other distribution. The check will be mailed to your address of record for this account unless
you provide alternate payment instructions.
One-time distribution: Distribute my RMD for tax year _____________________.
Periodic distribution: Start an automatic distribution to satisfy my RMD for this year and all future years.
Start date (month-day-year)
If you do not indicate the frequency of payments, American Century Investments will pay your distribution
quarterly. We’ll make the distribution on the 15th of the month, unless you specify another date in the space
above. If the applicable date falls on a weekend or holiday, we’ll make the distribution the next business day.
Payment frequency: Annually Semiannually Quarterly Monthly
Information About Your Beneficiary
The information you provide below will be used for the sole purpose of calculating an RMD and does not
constitute a designation of beneficiary.
Check the appropriate box below (if applicable) and provide information about your spouse. If neither box
applies, you may skip this section. The information below must match your beneficiary designation on file. If it
doesn’t, please submit a new Designation of Beneficiary form.
My sole primary beneficiary is my spouse, who is more than 10 years younger than I am.
My sole primary beneficiary is a qualifying trust. The sole primary beneficiary of the trust is my spouse, who
is more than 10 years younger than I am.
Mr. / Mrs. / Ms. Spouse’s first name Middle initial Spouse’s last name
Spouse’s U.S. Social Security number Spouse’s date of birth (month-day-year)
D. One-Time Partial Distribution
$
Amount
E. Annuity Distribution
Qualified joint and survivor annuity (QJSA).
Page 3 of 6
4
5
Complete Withholding Election
If you are a non-resident alien, call us before completing this section.
Notice of Withholding: The amounts you receive from the plan are subject to federal income tax withholding. See
the Special Tax Notice for complete information.
• If your distribution is eligible for rollover to another retirement plan and you do not elect a direct rollover, the
distribution is subject to mandatory federal income tax withholding at the rate of 20%. State tax withholding
also may apply.
• If your distribution is not eligible for rollover, you may elect to have withholding apply to the distribution by
checking the box below and indicating the rate of withholding. If you do NOT want us to withhold federal
income tax from your payments, do NOT check the box.
I elect to have federal income tax withheld at the rate of __________%. (Percentage must be between
10-100%. If no percentage is indicated, or if you indicated a percentage of 1-9%, withholding will be made
at the minimum rate of 10%.)
Note: State tax will be withheld according to state regulations if, at the time of your distribution, your tax
residency is within one of the mandatory withholding states.
Remember, even if you elect not to have income tax withheld, you are liable for paying income tax on the taxable
portion of your withdrawal. If you elect not to have income tax withheld, or you don’t have enough income tax
withheld, you may be responsible for payment of estimated tax. You may incur penalties under the estimated tax
rules if your withholding and estimated tax payments are not sufficient.
For automatic periodic distributions only, you have the right to revoke your withholding election at any time, and
any election you make will remain in effect until revoked by filing a new election.
Provide Direction for Payment
Select a method of payment. If you select more than one method, indicate the dollar amount or percentage to be
paid by each method.
Please note that required minimum distributions, hardship withdrawals and installment payments over a period of
10 years or more may be paid only by direct payment (option C) or transfer to a non-retirement account (option D).
A. Direct Rollover to Eligible Retirement Account at American Century Investments
Roll over my distribution directly into my American Century IRA or other retirement plan at American Century
Investments. I have attached a letter of acceptance from the plan administrator. [Attach the appropriate
American Century Investments IRA Application to open a new American Century IRA and/or Roth IRA. The
amount of your investment must meet the stated minimum for the fund(s) you select.]
Tell us what type of account the money is going to (check one)
1
:
Rollover/Traditional IRA
2
Roth IRA Employer-sponsored retirement plan
%
Fund name Account number Percentage
%
Fund name Account number Percentage
1
Check only one option unless you are rolling over both pre-tax and Roth assets. Roth assets must be rolled over to either
a Roth IRA or a 401(k), 403(b) or 457(b) that accepts Roth contributions.
2
Refer to Combining Contributions below.
Combining Contributions
(If you are a non-spouse beneficiary completing this form, you may skip this section.)
Proceeds from certain retirement plans that are rolled over to an IRA are normally deposited in a separate
account designated as a Rollover IRA. Maintaining a separate account for rollover funds generally makes it
easier to roll over these funds to another qualified retirement plan in the future. If you do not wish to preserve
this option, please check the box below.
I have read the explanation above, and I understand the consequences of combining contributions. You may
use this as your authority to combine my rollover with my Traditional IRA.
Step 5 continued on the following page
Page 4 of 6
Provide Direction for Payment (continued)
B. Direct Rollover to Eligible Retirement Account at Another Institution
Roll over my distribution directly into my IRA or other retirement plan at the financial institution named below.
I have attached a letter of acceptance from the receiving institution.
Tell us what type of account the money is going to (check one)
1
:
Traditional IRA Roth IRA Employer-sponsored retirement plan
State Teacher Retirement Plan Thrift Savings Plan
1
Check only one option unless you are rolling over both pre-tax and Roth assets. Roth assets must be rolled over to either
a Roth IRA or a 401(k), 403(b) or 457(b) that accepts Roth contributions.
Tell us what to do with your shares:
(If no box is checked, we will sell your shares and send a check to the institution you name below.)
Sell my shares and send a check to the institution named below.
Transfer my shares to the institution named below (transfer in kind).
Name of Custodian/Trustee
Account number OR Plan name
Name of institution
Street address Apartment/Unit
City State ZIP
Plan contact name
Telephone number
C. Direct Payment to Participant
Pay my distribution according to the method I selected below. (If neither box is checked, American Century
Investments will pay your distribution by check.)
By check mailed to the address in step 1 of this form.
By automated clearing house (ACH) to my bank account on file with American Century Investments.*
* If you do not have bank information on file, please contact us. For your security, we will not transfer any money to that
account until 7 days after your bank information has been received and accepted by American Century Investments.
D. Transfer to a Non-Retirement Account at American Century Investments
Attach the appropriate account application if you do not have an existing American Century Investments
account to receive your distributions. For new accounts, the amount of your investment must meet the stated
minimum for the fund(s) you select.
%
Fund name Account number Percentage
%
Fund name Account number Percentage
Page 5 of 6
6
7
Complete for Financial Hardship Distributions
Skip this section unless you are requesting a financial hardship distribution.
State the reason(s) for your request for a financial hardship distribution. You must provide all the information
requested below.
This hardship distribution is necessary to satisfy an immediate and heavy financial need due to the following
(please check all that apply):
To prevent eviction from my principal residence or a foreclosure on the mortgage of my principal residence
The payment of tuition, related educational fees or room and board for the next 12 months of post-secondary
education for myself, my spouse, my primary beneficiary, my children under the age of 19 (or age 24 if a
full-time student) or my dependents
The purchase (excluding mortgage payments) of my principal residence
Significant expenses incurred by me, my spouse, my primary beneficiary or my dependents for medical care or
in order to obtain such medical care (not covered by insurance or other coverage)
Expenses for the repair of damage of my principal residence that would qualify for the casualty deduction
under Internal Revenue Code section 165
Burial or funeral expenses for my deceased parent, spouse, primary beneficiary, child under the age of 19 (or
age 24 if a full-time student) or dependent
I hereby certify that the distribution amount I have requested does not exceed the amount required to meet my
immediate and heavy financial need, and that this cannot be satisfied from other reasonably available resources
including, but not limited to, the following:
• By other distributions available from this plan or any other plan in which I participate
• By borrowing from commercial sources on reasonable commercial terms
• Through reimbursement or compensation by insurance or otherwise
• By reasonable liquidation of my assets (including assets of my spouse and minor children that are reasonably
available to me)
• By cessation of tax-deferred contributions under the plan
I understand that:
• Only salary deferrals are eligible for financial hardship distribution. Earnings on deferrals made after
December 31, 1988, are not available for distribution.
• Financial hardship distributions are not eligible for rollover.
• I am required to suspend my salary reduction contributions to all 403(b) or other tax-deferred programs
maintained by my employer for at least six months after receipt of the hardship distribution. I am responsible for
revoking my salary reduction agreement to suspend contributions.
• A 10% early distribution penalty may be assessed by the Internal Revenue Service (IRS) if I am under age 59½.
• I am responsible for satisfying any other IRS requirements relative to this hardship distribution; substantial
penalties may be imposed if the financial hardship is disallowed by the IRS.
Sign Your Name and Date on Next Page (Participant or Beneficiary)
I certify that I am aware of the Plan’s provisions and requirements relating to distributions, and I understand the
tax consequences of this distribution.
I understand that if I have requested that my pre-tax funds be rolled over to a Roth IRA, the taxable amount rolled
over is taxable income.
Step 7 continued on the following page
8
American Century Investments
P.O. Box 419385
Kansas City, MO 64141-6385
1-800-345-3533
americancentury.com
American Century Investment Services, Inc., Distributor
©2015 American Century Proprietary Holdings, Inc. All rights reserved.
BR-FRM-85766 1505
Page 6 of 6
Sign Your Name and Date Below (Participant or Beneficiary) (continued)
I request a distribution in the manner indicated on this form. I also acknowledge that I have received, read and
understood the Special Tax Notice. If I have elected a direct rollover, I certify, by my signature below, that the
Custodian/Trustee named in step 5 will accept a direct rollover of my distribution. I acknowledge that I made an
election to receive a benefit payment within 180 days of receipt of the Special Tax Notice. I waive the 30-day
waiting period and request to have the distribution made now.
A signature guarantee is only required if you redeem more than $100,000 and your address on file has changed
within 7 days of the redemption.
Signature Date
Signature Guarantee
A signature guarantee is a warranty by the guarantor that the signature is genuine and that the person signing is
competent and authorized to sign. The signature must correspond in every particular, without alteration, with the
name printed on the current account registration.
Each signature must be guaranteed by a participant in a Securities Transfer Association Signature Guarantee
Program. Many domestic banks, trust companies, credit unions, brokers, dealers, national securities exchanges,
registered securities associations, clearing agencies and savings associations participate in such programs. Each
guarantee must be an original ink stamp that states “Signature Guaranteed/Medallion Guaranteed” and must be
signed on behalf of the guarantor by an authorized person.
NOTE: Acknowledgement of signature by notary public is NOT acceptable. Please affix signature
guarantee ink stamp below with appropriate signature, title of officer and date.
Obtain Employer or Third Party Administrator Signature (required)
This section must be completed by your employer or Third Party Administrator (TPA).
Participant Vesting
If the Plan includes a vesting schedule, I confirm the participant’s vested percentage below (if left blank, I confirm
the participant is 100% vested). ________________%
Vested percentage
• If the participant has requested a financial hardship distribution, I acknowledge the participant’s elective deferral
contributions must be suspended for at least six months. I also acknowledge that I have received the proper
supporting documentation from the participant.
• I hereby confirm the qualifying event indicated in step 2 and acknowledge the participant has met all
requirements under the 403(b) plan.
Check this box if the distribution is mandatory upon severance from employment because the vested account
balance is $5,000 or less. No participant signature is necessary.
Printed name of employer or TPA
Printed name and title of employer representative or TPA
Employer representative or TPA’s signature Date
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This page intentionally left blank.
American Century Investment Services, Inc., Distributor
©2018 American Century Proprietary Holdings, Inc. All rights reserved.
BR-BKT-94447 1809
PO Box 419385 | Kansas City, MO 64141-6385 | Business Retirement Specialist: 1-800-345-3533
Automated Information Line: 1-800-345-8765 | americancentury.com
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403b Distribution Booklet

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Completed 12 May 2021

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