Page 2 of 2 Revised 8/09
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alary Reduction Agreement
401(k) Plan (Traditional and Roth), 457 Plan, and Longevity
www.tn.gov/treasury/dc
Whereas the employer, hereinafter referred to as “Employer” has established a 401(k) Plan and a 457 Plan, hereinafte
referred to as “the Plan(s)” pursuant to Internal Revenue Code (IRC) Section 401(k) and IRC § 457; and
Whereas I, the employee, have elected to participate in the Plan(s) by deferring a portion of my salary into the Plan(s), it i
hereby agreed as follows
I have received a copy of the applicable 401(k) and 457 Deferred Compensation Plan(s) and understand the terms an
provisions thereof
That the Deferred Compensation Plan(s) is/are incorporated into this Participation Agreement and that these togethe
constitute my entire rights and obligations under the Plan
I hereby request and direct that my salary be reduced as of the effective date designated on the front of this form (this
date must be a month after the date this agreement is signed), and that the Employer, its proper officers, agents and
employees contribute these deferrals into
Under applicable Treasury Regulations,
I agree and understand that increasing, decreasing or stopping the amount deferred
per pay period requires that a new Agreement be made, unless I experience an unforeseeable emergency (as defined by the
internal revenue service), in which case deferrals will automatically cease for a minimum time period as designated by the Plan.
I understand that my employer may limit the number of times I am permitted to make a change in any calendar year. I
understand that a Roth after tax deferral is subject to timing restrictions to avoid tax consequences of early disbursement.
I understand that the Internal Revenue Code limits the amount that I may contribute to a 401(k) Plan and or to a 457
plan. It is my responsibility to monitor the amount I contribute per pay period to ensure that my total annual deferrals to
the Plan(s) do not exceed the amount permitted under the Internal Revenue Code as amended from time to time.
Additionally, during the three calendar years ending prior to my normal retirement age as defined by the 457 Plan, I may be
eligible to contribute a catch-up amount if I did not contribute the maximum allowable amount during any year I was eligible to
participate in the 457 plan. I understand that a catch-up contribution may not be made during the calendar year of my normal
retirement age.
Any elective deferral in excess of the applicable limit must be included in my gross income for the year of
deferral.
I understand that this Agreement is legally binding and irrevocable as to salary earned while the Agreement is in effect;
except that the Employer may reduce the amount of the salary reduction if it is determined that such amount will exceed
the limitations of Internal Revenue C
That the amount deferred in accordance with this Agreement shall be paid out only in accordance with the provisions of
the Deferred Compensation Plan(s), which specifically prohibits any payouts as long as I continue in employment with the
State except in the case of severe financial hardship as determined by the Plan Administrator or only if deferred to the
401(k) plan at age 59½. Financial hardships are defined differently for the 457 plan and the 401(k) plan by law.
This Agreement shall continue in effect until terminated. Either I or my Employer may terminate this Agreement with
respect to amounts not yet earned by me by informing the other party in writing. I understand that the Employer will
reduce my salary pursuant to the terms of this Agreement by the amount I have elected to defer in each pay period to the
extent that my net pay will allow.
I understand that if I fail to select a pre-tax or after-tax deferral, the choice will default to pre-tax.
In consideration of Employer’s compliance with the terms of this Agreement, I agree to hold Employer, its members
officers, agents, employees, successors and assigns harmless from and against any and all liability whatsoever arising out o
or in connection with this Agreement, including but not limited to any costs or tax penalties that I may incur as a result of
or in connection with the authorization and direction given by me in this Agreement. In addition, the State shall no
responsible for any loss due to investment of funds and assets in said Deferred Compensation Plan account, nor shall th
State of Tennessee be required to replace any loss whatsoever which may result from said investments
