The final regulations under section 403(b) of the Internal Revenue Code require that an Employer must generally maintain a list of those Investment Providers that are eligible to receive contributions for the Employer’s 403(b) Retirement Plan (“Plan”). The Plan incorporates this list by reference. Because of this requirement in the final Code section 403(b) regulations, this list should be consistently maintained.

This list identifies: 1) the providers approved for on-going contributions to the Plan (“Investment Provider”); and 2) the former Investment Providers (vendors who were previously approved for on-going contributions but now are no longer eligible to receive contributions). Investment Providers and Vendors on this list will be subject to requirements and restrictions under the Plan, provided however that such requirements and restrictions are not intended to enlarge the rights and benefits otherwise set forth in the investment product.

Types of providers listed on this form:

  • Investment Provider — A provider who is authorized under the Plan to receive ongoing contributions (i.e., has a “payroll slot” with the employer’s 403(b) plan).
  • Former Investment Provider — A provider who was authorized to receive contributions after Dec. 31, 2004, but is no longer authorized under the Plan to receive contributions (does not have a current “payroll slot” with the employer’s 403(b) plan). These are sometimes called “orphan contracts.”
     

Employer: _____________________________________   Effective Date: _____________


Select one of the two options below:

  • Servant Solutions is the sole Investment Provider under the Plan. This means that for any participant in the Employer’s plan after Dec. 31, 2004, no contributions will be made, were ever made, and/or funds ever transferred to a 403(b) Investment Provider or Vendor other than Servant Solutions. Section 403(b) contracts issued before 2005 and to which no contributions have been made since 2004 are “grandfathered”. The Employer does not have any 403(b) compliance responsibility with respect to these contracts and does not have to obtain any information or provide contact information with respect to them. The participant and the contract issuer are responsible for such compliance, not the Employer. If Servant Solutions is the sole retirement plan provider, as described above, information in Servant Solutions’ recordkeeping system can be used to assist in compliance with the 403(b) regulations as they relate to contributions, hardship distributions and minimum distribution requirements – a simplification of compliance administration for the Employer.
  • Servant Solutions is not the sole Investment Provider under the Plan. In addition to Servant Solutions, list below the Investment Providers currently authorized to receive contributions under the Plan.

Whether or not Servant Solutions is the sole Investment Provider under the Plan, please complete this section if any contributions were made after 2004 to a 403(b) issuer that will not be authorized to receive contributions on January 1, 2009.

NOTE: Even though these Former Investment Providers are not authorized to receive contributions the Employer must coordinate information necessary for compliance with the final Code section 403(b) regulations among all Investment Providers and Vendors. (This includes making good faith efforts to get information on all “orphan contracts”).

By signing below, you hereby certify that the foregoing list of Investment Providers and Vendors has been authorized by the Employer as required by law and that the person signing below on behalf of the Employer is authorized to execute such document and to take such action as deemed necessary or advisable to carry out the terms and provisions of the Plan.

Authorized Officer or Representative Signature:

___________________________________________________

Printed Name: ________________________________________

Title: _______________________________________________

Date: ________________

Keep original for your records

Do not return a copy to Servant Solutions