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HomeMy WebLinkAboutContract 2024-019ADocuSign Envelope ID: 553B3B64-5D52-4AF3-A3F2-A5A6AC761 EE3 PROPOSAL City of Clermont June 7, 2024 v EMPOWER' DocuSign Envelope ID: 553B3B64-5D52-4AF3-A3F2-A5A6AC761EE3 Proposal For City of Clermont This proposal valid until: EMPOWER* 9/7/2024 This Proposal was provided at the request of the plan sponsor or the Plan's advisor on behalf of the plan. The fee information provided in this Proposal is based on the assumptions and/or investment options reflected in the Proposal. This Proposal is invalid if the assumptions and/or investment options are inaccurate or change. Plan Assets: Annual Contribution: Plan Participants with a Balance: Total Eligible Employees: Number of Plans: Investment Platform: Investment Fiduciary: Mapping Strategy: Default Fund: Empower Retirement Plan Document Annual Plan Maintenance (Per Plan) Annual Participant Account Maintenance Asset Based Fee Self -Directed Brokerage Account - Installation Fee - Annual Participant Maintenance Investment Access Fee Installation Fee Weighted Average Net Investment Expense Trustee/Custodial Services: Great -West Trust Full Custodian Compliance Services: N/A Auto Enroll: N Additional Education Days: 4 $19,222,041 $1,964,000 381 381 3 Custom NAV Plan Advisor Like Funds Target Date Required $0 Employer $0 Participant 0.13% Participant $0 Employer $50 Participant $1,000 Employer Waived Employer 0.32% Participant BEL Restoration: $50,000 Manual Payroll: N Prospectus Fulfillment: N Addt'I Participant Notice Delivery: N OfficeFor Home Group Account Number: I State Situs: I Product Code: Quote Date: RSD Name: Prepared by: I 401(k) Version: FL I gvmt401 k I 6/7/2024 8:35:53 AM Cam Eck brmt I V16.6 10/11/2023 6:00:00 AM 6/7/2024 8:35:53 AM (410534) (None) (MA-MTR) Then Page 2 DocuSign Envelope ID: 553B3B64-5D52-4AF3-A3F2-A5A6AC761 EE3 City of Clermont (continued) EMPOWER' Plan and Participant Fees Plan Service Fees Fee Type Paid By Asset Based Fee 0.13% Annually 11 Deducted from Participant Accounts Quarterly Participant Account Maintenance $0 Per Unique Account Annually Deducted from Participant AccountsQuarterly Plan Maintenance $0 Annually Per Plan Billed to Plan Sponsor Quarterly Investment Access Fee $1,000 Annually Billed to Plan Sponsor Quarterly Self Directed Account Participant Maintenance $0 One -Time IF Billed to Plan Sponsor Contract Termination Fee IF0.26% of assets year 1, 0.13% of assets year 2 Billed to Plan Sponsor Annual asset based fees will be calculated based upon an average daily balance. Participant Transaction fee .. Fee Loan initiation $95 per request Paid . Netted From Distribution Maintenance fee for NEW loans (recurring) $50 annually Deducted from participant accounts quarterly Withdrawals (including Separation of Service, $75 per request Netted from withdrawal Retirement, Plan Terminations) Withdrawals for small balance force -outs $25 per request Netted from distribution (deminimus) Distributions (including In -Service, Hardship, $50 per request Netted from distribution QDRO, Death, Disability) Express delivery fee $40 per request Netted from distribution Hardship approval services $75 per request Netted from distribution or participant account Beneficiary distribution review services $75 per request Netted from distribution or participant account QDRO review services $400 per request Netted from distribution or participant account Periodic payment setup $50 per request Deducted from participant accounts I IFPeriodic payment maintenance $25 annually Deducted from participant accounts quarterly The above recordkeeping fees will be guaranteed for the initial five (5) year contract term from the Effective Date of the Administrative Services Agreement. Material changes (+/-10%) from assumptions used in pricing (participants, assets, net flow, asset allocations) could void this guarantee. The Participant Transaction services above will be provided to the Plan unless the plan sponsor elects otherwise. 6/7/2024 8:35:53 AM (410534) (None) (MA-MTR) Then Page 3 DocuSign Envelope ID: 553B3B64-5D52-4AF3-A3F2-A5A6AC761 EE3 ." 4q%%ftm"w EM POWER° 6/7/2024 8:35:53 AM (410534) (None) (MA-MTR) Then Page 4 DocuSign Envelope ID: 553B3B64-5D52-4AF3-A3F2-A5A6AC761EE3 City of Clermont (continued) EMPOWER' Fund Information Investment Name Ticker Gross/Net Expense Ratio Revenue Sharing Included In Gross/Net Expense Ratio 11213-11 Admin Assets RFTTX 0.29/0.29% 0.00% 77 $537,241 American Funds 2010 Trgt Date Retire R6 American Funds 2"u 5 Trgt Date Refire RS RFJTX 0.30/0.30% 0.00% 0.00% $537,882 American Funds 2020 Trgt Date Retire R6 RRCTX 0.31/0.31 % 0.00% 0.00% $539,882 American Funds 2025 Trgt Date Retire R6 RFDTX 0.32/0.32% 0.00% 0.00% $539,882 American Funds 2030 Trgt Date Retire R6 RFETX 0.33/0.33% 0.00% 0.00% $527,882 American Funds 2035 Trgt Date Retire R6 RFFTX 0.35/0.35% 0.00% 0.00% $537,882 American Funds 2040 Trgt Date Retire R6 RFGTX 0.37/0.37% 0.37/0.37% 0.00% 0.00% 0.00% 0.00% $537,883 $537,883 American Funds 2045 Trgt Date Retire R6 RFHTX American Funds 2050 Trgt Date Retire R6 RFJTX 0.38/0.38% 0.00% 0.00% $537,883 American Funds 2055 Trgt Date Retire R6 RFKTX 0.38/0.38% 0.00% 0.00% $537,883 American Funds 2060 Trgt Date Retire R6 RFUTX 0.39/0.39% 0.00% 0.00% $537,883 American Funds 2065 Trgt Date Retire R6 RFVTX 0.39/0.39% 0.00% 0.00% $537,883 American Funds Europacific Growth R6 RERGX 0.47/0.47% 0.00% 0.00% $36,900 American Funds Washington Mutual R6 11 RWMGX 0.27/0.27% 0.00% 0.00% $537,883 Cohen & Steers Instl Realty Shares CSRIX 0.76/0.75% ��JII 0.00% 0.101/10 $537,883 Core Plus Bond I (mgd by Western Asset) N/A 0.23/0.23% 0.00% 0.00% $193,782 Fidelity 500 Index FXAIX 0.02/0.02% 0.00% 0.00% $537,883 Fidelity Emerging Markets Idx FPADX 0.08/0.08% 0.00% 0.00% $537,883 Fidelity International index FSPSX 0.04/0.04% 0.00% 0.00% $537,883 Fidelity Large Cap Growth Idx FSPGX 0.04/0.04% 0.00% 0.00% $537,883 Fidelity Mid Cap Index FSMDX 0.03/0.03% 0.00% 0.00% $537,883 Fidelity Small Cap Index FSSNX ° 0.03/0.03 /° 0.00% 0.00% $537,883 Fidelity U.S. Bond Index FMI Large Cap Institutional Guaranteed Income Fund (GIF 65) Hartford Schroders US MidCap Opps SDR Pioneer High Yield Y T. Rowe Price Gr Stk Fund (IS) FXNAX FMIQX N/A SMDRX TYHYX N/A 0.03/0.03% 0.71/0.71 % 0.65/0.65% 0.82/0.82% 0.94/0.86% 0.40/0.40% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.10% 0.00% 0.00% 0.35% 0.00% $537,883 $537,883 $934,026 $537,883 $537,883 $1,947,490 6/7/2024 8:35:53 AM (410534) (None) (MA-MTR) Then Page 5 DocuSign Envelope ID: 553B3B64-5D52-4AF3-A3F2-A5A6AC761EE3 City of Clermont (continued) EM POWEff Fund Information Continued Investment Name Vanguard Equity -Income Adm Ticker Gross/Net Expense Ratio VEIRX 0.18/0.18% Revenue Sharing 0.00% Included In Gross/Net Expense Ratio Admin Assets 0.00% $537,883 Vanguard High -Yield Corporate Adm Vanguard LifeStrategy Cnsry Gr Inv VWEAX VACGX 0.12/0.12% 0.12/0.12% 11 0.00% 0.00%11 0.00% 0.00% $537,883 $537,883 Vanguard LifeStrategy Growth Inv VASGX 0.14/0.14% 0.00% 0.00% $537,883 Vanguard LifeStrategy Income Inv VASIX 0.11/0.11% 0.00% 0.00% $537,883 Vanguard LifeStrategy Mod Gr Inv Shrs 11 VASGX 0.13/0.13% 11 0.00% 11 0.00% $517,883 11 Average Net Expense Ratio 0.32% Not all 12b-1 and Admin fees may flow through the Recordkeeper. A third party may be receiving 12b-1 and/or Admin fee(s) directly that are not reflected above. Allocation to General Account Investments Ticker Fee Estimate Assets Recordkeeper Great -West General AccountGuaranteed Income Fund (GIF 65) 111 -- 1 • 1 1 1 For an explanation of the Fee Estimate and the Allocation to Recordkeeper, please see the "General Account Fund and General Provision" disclosure in the Disclosure Section of this document. 6/7/2024 8:35:53 AM (410534) (None) (MA-MTR) Then Page 6 DocuSign Envelope ID: 553B3B64-5D52-4AF3-A3F2-A5A6AC761EE3 City of Clermont (continued) EMPOWER' Payments to Others Online Investment Advice and Managed Accounts services are optional services that are offered by Advised Assets Group, LLC. Each individual participant may elect to enroll in either one of these services. These participant advice fees are only deducted from participant account balances of those that have enrolled in the service. Plan Sponsor agrees the managed account service fee will be paid for by a Plan Participant unless the following box is selected. r Plan Sponsor Pay 6/7/2024 8:35:53 AM (410534) (None) (MA-MTR) Then Page 7 DocuSign Envelope ID: 553B3B64-5D52-4AF3-A3F2-A5A6AC761EE3 City of Clermont (continued) EMPOWER Disclosures This document contains estimates of plan expenses and is intended to provide a detailed summary of fees being charged to the plan or its participants to the extent such information is in the Recordkeeper's possession. While it is intended to provide information regarding all material fees, this document may not be comprehensive, and it may not include full information on fees associated with some specially negotiated services or with certain investment options, such as Self -Directed Brokerage Accounts, Life Insurance, Employer Stock, etc. For further fee information, please refer to the relevant service agreements and/or prospectuses, including information that may be needed to comply with Participant Disclosure obligations. As your Recordkeeper, we make no representation as to the completeness or accuracy of materials, such as prospectuses, created and/or provided by a third -party investment provider. Float: If the Plan's assets pass through a bank account held by Empower Retirement LLC (Empower) or its affiliates/ subsidiaries (Empower Trust Company, LLC), it may earn credits and/or interest on Plan assets awaiting investment or pending distribution. Plan Sponsor acknowledges that it has received and reviewed the Float Disclosure. Plan Sponsor agrees that, as additional compensation for its services hereunder, ETC, Empower, and/or its affiliates shall retain float consistent with the terms of the Float Disclosure. Recordkeeping Costs Estimate Great -West recordkeeping fees are agreed to with the plan sponsor based on the total value of the relationship with the plan. Great - West may provide recordkeeping fee credits in its sole discretion based on criteria as solely determined by Great -West which may include the plan's use of affiliated and non-affiliated funds or products. Such credits may reduce some or all of the recordkeeping fees that would otherwise be charged by Great -West. The average cost of Great -West recordkeeping services without any reduction or offset is $120.23 per participant for plans less than $50 million, $94.42 per participant for plans between $50m and $500m and $70.13 per participant for plans greater than $500m. Prospectus Delivery: Employer agrees to accept delivery of prospectuses for the selected investment options through the Plan Sponsor section of the Empower Web site - www.emoower-retirement.com, Acceptance and Use of Participant Emails for Electronic Delivery: Plan Sponsor and/or the Participant have authorized the Plan to use the Participant email(s) in the Plan's records to deliver Plan - related notices and documents to the Participant electronically. The Plan Sponsor Directs Empower to accept a transfer of Participant work and/or personal emails to its recordkeeping system as provided by the Plan Sponsor or its delegate, including but not limited to the Plan Administrator, a payroll vendor, a Plan adopting employer, third -party administrator or other current or prior Plan service provider. The Plan Sponsor agrees to provide all Participant work emails in its records to Empower and to make best efforts to provide Empower with work or personal email addresses for all newly eligible Participants. a. Plan Sponsor Directs Empower to deliver Plan notices, including the Transition Guide and Blackout Notice and other Plan documents it has agreed to provide under the services agreement between the parties ("Agreement") to the Participant's email address in the following order: (i) to a work or personal email address provided and agreed to by the Participant. (ii) to a work email address provided by the Plan Sponsor in accordance with the "wired at work" method described in Department of Labor regulation §2520.104b-1. The Plan Sponsor confirms the Participant has the effective ability at work to access notices delivered to the work email addresses provided to Empower. (iii) to a personal email address provided by the Plan Sponsor or Participant in accordance with the "notice and access" method described in Department of Labor regulation §2520.104b-31. F. Check here if the prior record keeper did not distribute "Initial notifications of default electronic delivery" according to Department of Labor regulation §2520.104b-31. 6/7/2024 8:35:53 AM (410534) (None) (MA-MTR) Then Page 8 DocuSign Envelope ID: 553B3B64-5D52-4AF3-A3F2-A5A6AC761EE3 City of Clermont (continued) - EMPOWER' b. If the "notice and access" delivery method is used, Empower will send an initial notification of electronic delivery (§2520.104b-31(g)) via regular mail to each Participant at least 10 days prior to delivering any plan -related documents via email, unless Empower obtains confirmation that the initial notification has already been provided to the Participant from the Plan Administrator, third party administrator or other Plan service provider. (i) If notice of availability of a plan -related document is returned undeliverable, Empower will send the notice to another email on file for the Participant. If no other email is on file for the Participant or such other email is also returned undeliverable, plan related documents will be delivered via regular mail to the Participant until such time as Empower is provided another email address for the Participant. (ii) Participants may request to receive a paper copy of a plan -related document for no cost. In addition, Participants may opt out of electronic delivery and request that their plan -related documents be delivered via regular mail at any time. (iii) Empower will maintain access to plan -related documents on the Participant website in accordance with Department of Labor regulation §2520.104b-31(e). If Empower is not provided with an email address, plan -related documents will be delivered to the Participant via regular mail. Third -Party Fee Debits from Participant Accounts: If the plan fiduciaries authorize payment of a third -party fee (e.g., advisor, auditor, TPA, etc.) from participant accounts, note that the participant fee disclosure prepared by Empower at the plan's transition (and delivered to participants if we have agreed to do so) will not reflect third -party fee payments. The payment process for a third -party fee is set-up following the transition. Third -party fee payments authorized by the Plan Sponsor will be updated to the participant fee disclosure and posted to the participants' accounts online. The plan fiduciaries may wish to discuss the debit of third -party fees from participant accounts with their legal and tax advisors as they deem appropriate and prepare and deliver to participants a supplement to the disclosure prepared by Empower which contains the additional third -party fee information for distribution at transition. Fiduciary Disclosures Advised Assets Group (AAG): If Advised Assets Group, LLC provides services to the Plan under an agreement with Plan Sponsor, it may be a fiduciary and Registered Investment Advisor to the Plan to the extent provided in such agreement. Empower: Empower is not acting as a fiduciary for this plan Investments Mutual Fund Expense Ratio: The Service Provider has entered into agreements with certain funds (or their service providers including advisors, administrators or transfer agents, and underwriters) whereby the Service Provider provides shareholder and/or distribution services and receives compensation from the funds (or their service providers) based on the value of the plan's investment in the funds. This compensation may include fees for administrative and other expenses and/or fees paid under a plan of distribution under SEC Rule 12b-1 ("12b-1 fees"). The fees received by the Service Provider are included in the expense ratio described in the applicable fund's prospectus or similar disclosure document, and reduce the fund's net asset value (NAV). Generally, fees and expenses included in the fund's expense ratio are deducted at regular intervals based on a percentage of the fund's average daily net assets. Redemption Fees: Redemption fees are charged by mutual fund companies to discourage investors from making a short-term "round trip" (i.e., a purchase, typically a transfer, followed by a sale within a short period of time). Many mutual fund companies will impose the fee upon the purchase and subsequent sale occurring within a specified time frame. Please refer to your mutual fund prospectuses for specific redemption fee details. 6/7/2024 8:35:53 AM (410534) (None) (MA-MTR) Then Page 9 DocuSign Envelope ID: 553B3B64-5D52-4AF3-A3F2-A5A6AC761EE3 do City of Clermont (continued) EMPOWER Additional Fund Compensation: Great -West Life & Annuity Insurance Company receives payments from some investment fund families through the Empowering Fund Partnership Program ("EFPP"). Under the EFPP, fund families receive several services based on the EFPP tier in which they participate. These services are provided directly to fund families and include: (i) consideration for inclusion in Empower products developed for some segments of the retirement and IRA market, (ii) inclusion on the Empower Select investment platform, which is available in the small plan recordkeeping market, (iii) a waiver of the connectivity fee described below, (iv) enhanced marketing opportunities, (v) additional reporting capabilities, (vi) collaboration in thought leadership opportunities, (vii) access to meetings with Empower leadership, Empower staff, and the third party advisory and brokerage firms through whom Empower distributes its services, and (viii) access to conferences put on by Empower and Great -West Financial. The yearly fees for EFPP participation are $1,000,000 for tier 1, $500,000 for tier 2, and $250,000 for tier 3. These fees do not vary based on an Empower client's use of the funds offered by the fund family. For additional information about funds that participate in the fund partner program, please visit httos://docs.empower- reti rement.com/advisor/Emr)owerina-Fund-Pa rtnership-Disclosure. odf Great -West Life & Annuity Insurance Company also receives payments from fund families through a connectivity program (the "Connectivity Program"). The Connectivity Program charges fund families for the cost of administering funds on Empower investment platforms, and for building and maintaining data connections between Empower and the fund family. In 2019, the Connectivity Program charges $1,000 per investment fund used on recordkeeping and IRA investment platforms. Beginning in May 2019, if a retirement plan begins receiving recordkeeping services through Empower's small plan recordkeeping segment, and the plan offers a fund from a fund family that does not participate in the Connectivity Program or the EFPP, then Empower will assess a supplemental, separate investment access fee to the plan. Depending on the level of investment in the non -participating fund family, the investment access fee charge may be more or less than the fees received under the Connectivity Program from the fund family. For additional information about funds that participate in the Connectivity Program, please visit httos://docs.emoower- retirement.com/advisor/Empowerina-Fund-PartnershiD-Disclosure. od f Investment Access Fee: Empower charges an investment access fee if the plan's fiduciary selects a fund for the plan's investment lineup from a fund provider that does not participate in Empower's fund connectivity program, under which the fund provider compensates Empower or its related companies for costs associated with providing and maintaining the fund on investment platforms. The investment access fee is an annual fee shown in this document, billed directly to the Plan Sponsor on a quarter basis. Self -Directed Account Participant Maintenance: Participant transactions and other fees charged by the Self -Directed vendor are in addition to the participant maintenance fee and are not reflected in this document. General Account Fund and Guarantee Provisions: General Account crediting rates are net of cost of capital and expenses, fund and guarantee provisions and any contract series charge, to the extent applicable. Cost of Capital is the return Great -West Life & Annuity Insurance Company of New York (Great -West) earns on Great -West capital. Great -West is required by regulators to hold capital for the purpose of ensuring Great -West can meet all of its obligations associated with the General Account Fund. The amount of Great -West's capital and required return will fluctuate overtime based on regulatory requirements, capital market conditions and the competitive environment. The Fund Provision covers the range of investment expenses that are netted from the crediting rate, such as investment and operating expenses. The Fund Provision is calculated annually in aggregate for all General Account fixed funds offered by Great - West and does not reflect any product or plan specific underwriting adjustments. The Guarantee Provision covers the range of insurance expenses that are netted from the crediting rate, such as asset defaults, cost of insurance guarantees, and other expenses. The Guarantee Provision is calculated annually in aggregate for all General Account fixed funds offered by Great -West and does not reflect any product or plan specific underwriting adjustments. 6/7/2024 8:35:53 AM (410534) (None) (MA-MTR) Then Page 10 DocuSign Envelope ID: 553B3B64-5D52-4AF3-A3F2-A5A6AC761EE3 City of Clermont (continued) EMPOWER A Contract Series Charge may apply to the general account option selected by the plan sponsor. This charge will be explicitly described in the Great -West Investments Fixed Account group annuity contract and is meant to cover expenses related to contract administration, investment management and other services that are provided to the plan pursuant to a separate agreement with the plan. There may be an adjustment to the credited interest rate which is used to reduce the amount for plan record keeping/administration services that would otherwise be charged to the plan. For more information on the General Account Fixed Funds, including termination options, please see your Group Annuity Contract. 6/7/2024 8:35:53 AM (410534) (None) (MA-MTR) Then Page 11 DocuSign Envelope ID: 553B3B64-5D52-4AF3-A3F2-A5A6AC761EE3 City of Clermont (continued) -.0 EMPOWER 9 We are required to disclose certain fees paid between Empower and its related parties (affiliates and subcontractors). This includes compensation paid in connection with the services Empower or its affiliates have agreed to provide to the plan, if the compensation is set on a transaction/incentive basis (such as commissions, soft dollars, or finder's fees) or if the compensation is charged directly against a plan investment and reflected in the investment's net value. The fees disclosed are not in addition to previously disclosed fees; rather, this information is intended to increase transparency about how Empower uses the fees it receives. Affiliates: The following entities are affiliates of the Recordkeeper, in that they directly or indirectly control, are controlled by, or are under common control with the Recordkeeper. These affiliates may receive fees from the plan, or from the Recordkeeper or another affiliate for performing certain services for the plan. Refer to the Itemized Services and Cost section for details regarding affiliate payments. GWFS Equities, Inc. is an affiliate that receives payments from the Investment Provider. Payments are first paid to GWFS Equities, Inc. which in turn pays the Recordkeeper. Great -West Capital Management, LLC is an affiliate that receives payments from the Investment Provider. Great -West Funds, Inc. is an affiliate that receives payments from the Investment Provider. Affiliates: The following are affiliates of Empower, but not all Empower affiliates may pertain to your Plan. • Advised Assets Group, LLC • GWFS Equities, Inc. • EMJAY Corporation • FASCore, LLC • Great -West Capital Management, LLC • Great -West Funds, Inc. • Putnam Investment Company • Great -West Trust Company, LLC • Great -West Life & Annuity of New York Subcontractors: A subcontractor is any person or entity that is not an affiliate of the Recordkeeper and that is expected to receive $1,000 or more in compensation for performing one or more services for your Plan under a contract or arrangement with the Recordkeeper. All such subcontractors that receive the specific types of compensation described above are included. All such subcontractors, if any, are listed in the table below, along with the service they provide. Please refer to the Itemized Services and Cost section for details regarding subcontractor payments. Company Subcontractor [Service Provided QDRO Consultants Plan administration services - QDRO review services 6/7/2024 8:35:53 AM (410534) (None) (MA-MTR) Then Page 12 DocuSign Envelope ID: 553B3B64-5D52-4AF3-A3F2-A5A6AC761EE3 EMPOWER' City of Clermont (continued) Signature Page By signing this signature page, the Plan Sponsor, Broker and any other signatories certify that they have received, read and understand this proposed Fee Schedule and Disclosure Statement. All parties understand the proposal assumptions stated above determine the plan's expenses. A change to the assumptions will cause expenses and fees to also change Plan Sponsor understands and agrees to all services and fees identified in this Fee Schedule and agrees to pay all fees according to the Service Agreement to which this Fee Schedule applies. The Plan Sponsor further understands that all payroll deduction and matching contributions will be remitted electronically using the Plan Service Center system. Contributions received using any other method will be returned unallocated for resubmission via the Plan Service Center and will not be considered plan assets until such resubmission. Plan Sponsor also understands that no payroll deduction contributions may be withheld until there is a signed Plan Document in place and no contribution or transfer of assets will be accepted earlier than 15 days from the receipt and acceptance of the Client Application in Greenwood Village, CO. The Plan Sponsor directs Empower to reflect the Advisor and Firm below as the Plan's financial advisor on its recordkeeping system and to provide plan data upon request. The Plan Sponsor understands and agrees that Empower does not provide investment advice to the Plan, the Plan Sponsor or the Advisor regarding Plan investment options. I agree any changes to products, plan services, fees, or investment options hereafter must be made post -conversion Plan Sponsor Signature: Print Name: Date: Advisor/Broker Signature: Print Name: Date: r Mi ttt-refEO Brennan Additional Plan Information *****Please complete upon selecting Empower as vour provider***** Le al Name of Plan: Plan Headquartered State: Ell Plan Year End (MM/DD): Plan Contact for Conversion: First Name: Last Name: Phone Number: Email: Is the Financial Representative properly licensed to sell in Headquartered State? Y N NIA Core securities, when offered, are offered through GWFS Equities, Inc. and/or other broker dealers. GWFS Equities, Inc., Member FINRA/SIPC, is a wholly owned subsidiary of Great -West Life & Annuity Insurance Company. Empower RetirementTm refers to the products and services offered in the retirement markets by Great -West Life & Annuity Insurance Company (GWL&A), Corporate Headquarters: Greenwood Village, CO; Great -West Life & Annuity Insurance Company of New York, Home Office: White Plains, NY; and their subsidiaries and affiliates. The trademarks, logos, service marks, and design elements used are owned by GWL&A. The Great -West Family of Companies refers to products and services offered through The Great -West Life Assurance Company, London Life Insurance Company, The Canada Life Assurance Company, Irish Life Assurance Company, Great -West Life & Annuity Insurance Company, Putnam Investments, LLC, and their affiliates and subsidiary companies. 6/7/2024 8:35:53 AM (410534) (MA-MTR) Then Page 13 DocuSign Envelope ID: 553B3B64-5D52-4AF3-A3F2-A5A6AC761 EE3 Non -Standardized Governmental 401(a) ADOPTION AGREEMENT FOR EMPOWER RETIREMENT, LLC NON -STANDARDIZED GOVERNMENTAL 401(a) PRE -APPROVED PLAN CAUTION: Failure to properly fill out this Adoption Agreement may result in disqualification of the Plan. EMPLOYER INFORMATION (An amendment to the Adoption Agreement is not needed solely to reflect a change in this Employer Information Section.) EMPLOYER'S NAME, ADDRESS, TELEPHONE NUMBER, TIN AND FISCAL YEAR Name: Address: 685 West Montrose Street Street Clermont Florida 34711 City State Zip Telephone: (352) 241-7380 Taxpayer Identification Number (TIN): 59-6000290 Employer's Fiscal Year ends: September 30 TYPE OF GOVERNMENTAL ENTITY. This Plan may only be adopted a state or local governmental entity, or agency thereof, including an Indian tribal government and may not be adopted by any other entity, including a federal government and any agency or instrumentality thereof. a. [ ] State government or state agency b. [ ] County or county agency c. [X] Municipality or municipal agency d. [ ] Indian tribal government (see Note below) NOTE: An Indian tribal government may only adopt this Plan if such entity is defined under Code §7701(a)(40), is a subdivision of an Indian tribal government as determined in accordance with Code §7871(d), or is an agency or instrumentality of either, and all of the Participants under this Plan employed by such entity substantially perform services as an Employee in essential governmental functions and not in the performance of commercial activities (whether or not an essential government function). PARTICIPATING EMPLOYERS (Plan Section 1.39). Will any other Employers adopt this Plan as Participating Employers? a. [X] No b. [ ] Yes MULTIPLE EMPLOYER PLAN (Plan Article XI). Will any Employers who are not Affiliated Employers adopt this Plan as part of a multiple employer plan (MEP) arrangement? c. [X] No d. [ ] Yes (Complete a Participation Agreement for each Participating Employer.) PLAN INFORMATION (An amendment to the Adoption Agreement is not needed solely to reflect a change in the information in Question 9.) PLAN NAME: 401(a) City of Clermont Defined Contribution Plan PLAN STATUS a. [ ] New Plan b. [X] Amendment and restatement of existing Plan CYCLE 3 RESTATEMENT (leave blank if not applicable) 1. [ ] This is an amendment and restatement to bring a plan into compliance with the legislative and regulatory changes set forth in IRS Notice 2017-37 (i.e., the 6-year pre -approved plan restatement cycle). EFFECTIVE DATE (Plan Section 1.16) (complete a. if new plan; complete a. AND b. if an amendment and restatement) Initial Effective Date of Plan (except for restatements, cannot be earlier than the first day of the current Plan Year) a. April 22, 1986 (enter month day, year) (hereinafter called the "Effective Date" unless 6.b. is entered below) 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Non -Standardized Governmental 401(a) Restatement Effective Date. If this is an amendment and restatement, the effective date of the restatement (hereinafter called the "Effective Date") is: b. June 26, 2024 (enter month day, year; NOTE: The restatement date may not be prior to the first day of the current Plan Year. Plan contains appropriate retroactive effective dates with respect to provisions for appropriate laws.) PLAN YEAR (Plan Section 1.43) means, except as otherwise provided in d. below: a. [X] the calendar year b. [ ] the twelve-month period ending on (e.g., June 30th) SHORT PLAN YEAR (Plan Section 1.47). This is a Short Plan Year (if the effective date of participation is based on a Plan Year, then coordinate with Question 14): c. [X] N/A d. [ ] beginning on (enter month day, year; e.g., July 1, 2020) and ending on (enter month day, year). 8. VALUATION DATE (Plan Section 1.53) means: a. [X] every day that the Trustee (or Insurer), any transfer agent appointed by the Trustee (or Insurer) or the Employer, and any stock exchange used by such agent are open for business (daily valuation) b. [ ] the last day of each Plan Year c. [ ] the last day of each Plan Year quarter d. [ ] other (specify day or days): (must be at least once each Plan Year) NOTE: The Plan always permits interim valuations. 9. ADMINISTRATOR'S NAME, ADDRESS AND TELEPHONE NUMBER (If none is named, the Employer will be the Administrator (Plan Section 1.2).) a. [X] Employer (use Employer address and telephone number) b. [ ] The Committee appointed by the Employer (use Employer address and telephone number) c. [ ] Other: Name: Address: Street City State Zip Telephone: 10. TYPE OF PLAN (select one) a. [X] Profit Sharing Plan. b [ ] Money Purchase Pension Plan. 11. CONTRIBUTION TYPES The selections made below must correspond with the selections made under the Contributions and Allocations Section of this Adoption Agreement. FROZEN PLAN OR CONTRIBUTIONS HAVE BEEN SUSPENDED (Plan Section 4.1(c)) (optional) a. [ ] This is a frozen Plan (i.e., all contributions cease) (if this is a temporary suspension, select a.2): 1. [ ] All contributions ceased as of, or prior to, the effective date of this amendment and restatement and the prior Plan provisions are not reflected in this Adoption Agreement (may enter effective date at 3. below and/or select prior contributions at g. - j. (optional), skip questions 12-18 and 22-30) 2. [ ] All contributions ceased or were suspended and the prior Plan provisions are reflected in this Adoption Agreement (must enter effective date at 3. below and select contributions at b. - f.) Effective date 3. [ ] as of (effective date is optional unless a.2. has been selected above or this is the amendment or restatement to freeze the Plan). CURRENT CONTRIBUTIONS The Plan permits the following contributions (select one or more): b. [X] Employer contributions other than matching (Questions 24-25) 1. [ ] This Plan qualifies as a Social Security Replacement Plan (Question 24.e. must be selected) c. [ ] Employer matching contributions (Questions 26-28) d. [ ] Mandatory Employee contributions (Question 30) 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Non -Standardized Governmental 401(a) e. [ ] After-tax voluntary Employee contributions f. [ ] Rollover contributions (Question 36) PRIOR CONTRIBUTIONS The Plan used to permit, but no longer does, the following contributions (choose all that apply, if any): g. [ ] Employer matching contributions h. [ ] Employer contributions other than matching contributions i. [ ] Rollover contributions j. [ ] After-tax voluntary Employee contributions ELIGIBILITY REQUIREMENTS 12. ELIGIBLE EMPLOYEES (Plan Section 1.17) means all Employees (including Leased Employees) EXCEPT those Employees who are excluded below or elsewhere in the Plan: (select a. or b.) a. [ ] No excluded Employees. There are no additional excluded Employees under the Plan (skip to Question 13). b. [X] Exclusions. The following Employees are not Eligible Employees for Plan purposes (select one or more): 1. [ ] Union Employees (as defined in Plan Section 1.17) 2. [ ] Nonresident aliens (as defined in Plan Section 1.17) 3. [ ] Leased Employees (Plan Section 1.29) 4. [X] Part-time Employees. A part-time Employee is an Employee whose regularly scheduled service is less than 25 Hours of Service in the relevant eligibility computation period (as defined in Plan Section 1.55). 5. [X] Temporary Employees. A temporary Employee is an Employee who is categorized as a temporary Employee on the Employer's payroll records. 6. [X] Seasonal Employees. A seasonal Employee is an Employee who is categorized as a seasonal Employee on the Employer's payroll records. 7. [X] Other: As to All Contributions, exclude Police Officers, Firefighters, and City Managers (must be definitely determinable under Regulation § 1.401-1(b). Exclusions may be employment title specific but may not be by individual name) NOTE: If option 4. - 6. (part-time, temporary and/or seasonal exclusions) is selected, when any such excluded Employee actually completes 1 Year of Service, then such Employee will no longer be part of this excluded class. For this purpose, the Hours of Service method will be used for the 1 Year of Service override regardless of any contrary selection at Question 16. 13. CONDITIONS OF ELIGIBILITY (Plan Section 3.1) a. [ ] No age and service required. No age and service required for all Contribution Types (skip to Question 14). b. [X] Eligibility. An Eligible Employee will be eligible to participate in the Plan upon satisfaction of the following (complete c. and d., select e. and f. if applicable): Eligibility Requirements c. [X] Age Requirement 1. [X] No age requirement 2. [ ] Age 20 1/2 3. [ ] Age 21 4. [ ] Age (may not exceed 26) d. [X] Service Requirement 1. [ ] No service requirement 2. [ ] (not to exceed 60) months of service (elapsed time) 3. [X] 1 Year of Service 4. [ ] (not to exceed 5) Years of Service 5. [ ] consecutive month period from the Eligible Employee's employment commencement date and during which at least Hours of Service are completed. 6. [ ] consecutive months of employment. 7. [ ] Other: (e.g., date on which 1,000 Hours of Service is completed within the computation period) (must satisfy the Notes below) NOTE: If c.4. or d.7. is selected, the condition must be an age or service requirement that is definitely determinable and may not exceed age 26 and may not exceed 5 Years of Service. NOTE: Year of Service means Period of Service if the elapsed time method is chosen. Waiver of conditions. The service and/or age requirements specified above will be waived in accordance with the following (leave blank if there are no waivers of conditions): e. [ ] If employed on the following requirements, and the entry date requirement, will be waived. The waiver applies to any Eligible Employee unless 3. selected below. Such Employees will enter the Plan as of such date (select 1. and/or 2. AND 3. if applicable): 1. [ ] service requirement (may let part-time Eligible Employees into the Plan) 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Non -Standardized Governmental 401(a) 2. [ ] age requirement 3. [ ] waiver is for: Amendment or restatement to change eligibility requirements f. [ ] This amendment or restatement (or a prior amendment and restatement) modified the eligibility requirements and the prior eligibility conditions continue to apply to the Eligible Employees specified below. If this option is NOT selected, then all Eligible Employees must satisfy the eligibility conditions set forth above. 1. [ ] The eligibility conditions above only apply to Eligible Employees who were not Participants as of the effective date of the modification. 2. [ ] The eligibility conditions above only apply to individuals who were hired on or after the effective date of the modification. 14. EFFECTIVE DATE OF PARTICIPATION (ENTRY DATE) (Plan Section 3.2) An Eligible Employee who has satisfied the eligibility requirements will become a Participant in the Plan as of the: a. [X] date such requirements are met b. [ ] first day of the month coinciding with or next following the date on which such requirements are met c. [ ] first day of the Plan Year quarter coinciding with or next following the date on which such requirements are met d. [ ] earlier of the first day of the Plan Year or the first day of the seventh month of the Plan Year coinciding with or next following the date on which such requirements are met e. [ ] first day of the Plan Year coinciding with or next following the date on which such requirements are met f. [ ] first day of the Plan Year in which such requirements are met g. [ ] first day of the Plan Year in which such requirements are met, if such requirements are met in the first 6 months of the Plan Year, or as of the first day of the next succeeding Plan Year if such requirements are met in the last 6 months of the Plan Year. h. [ ] other: (must be definitely determinable) SERVICE 15. RECOGNITION OF SERVICE WITH OTHER EMPLOYERS (Plan Sections 1.40 and 1.55) a. [X] No service with other employers is recognized except as otherwise required by law (e.g., the Plan already provides for the recognition of service with Employers who have adopted this Plan as well as service with Affiliated Employers and predecessor Employers who maintained this Plan; skip to Question 16). b. [ ] Service with the designated employers is recognized as follows (select c. — e. and one or more of columns 1. - 3.; chose other options as applicable) (if more than 3 employers, attach an addendum to the Adoption Agreement or complete option h. under Section B of Appendix A): Other Employer c. [ ] Employer name: d. [ ] Employer name: e. [ ] Employer name: Limitations f [ ] The following provisions or limitations apply with respect to the recognition of prior service: (e.g., credit service with X only on/following 1/l/19) 1. 2. 3. Contribution Eligibility Vesting Allocation I I I g. [ ] The following provisions or limitations apply with respect to the recognition of service with other employers: (e.g., credit service with X only on/following 1/1/19 or credit all service with entities the Employer acquires after 12/31/18) NOTE: If the other Employer(s) maintained this qualified Plan, then Years (and/or Periods) of Service with such Employer(s) must be recognized pursuant to Plan Sections 1.40 and 1.55 regardless of any selections above. 16. SERVICE CREDITING METHOD (Plan Sections 1.40 and 1.55) NOTE: If any Plan provision is based on a Year of Service, then the provisions set forth in the definition of Year of Service in Plan Section 1.55 will apply, including the following defaults, except as otherwise elected below: 1. A Year of Service means completion of at least 1,000 Hours of Service during the applicable computation period. 2. Hours of Service (Plan Section 1.24) will be based on actual Hours of Service except that for Employees for whom records of actual Hours of Service are not maintained or available (e.g., salaried Employees), the monthly equivalency will be used. 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Non -Standardized Governmental 401(a) 3. For eligibility purposes, the computation period will be as defined in Plan Section 1.55 (i.e., shift to the Plan Year if the eligibility condition is one (1) Year of Service or less). 4. For vesting, allocation, and distribution purposes, the computation period will be the Plan Year. 5. Upon an Employee's rehire, all prior service with the Employer is taken into account for all purposes. a. [X] Elapsed time method. (Period of Service applies instead of Year of Service) Instead of Hours of Service, elapsed time will be used for: 1. [X] all purposes (skip to Question 17) 2. [ ] the following purposes (select one or more): a. [ ] eligibility to participate b. [ ] vesting c. [ ] allocations, distributions and contributions b. [ ] Alternative definitions for the Hours of Service method. Instead of the defaults, the following alternatives will apply for the Hours of Service method (select one or more): 1. [ ] Eligibility computation period. Instead of shifting to the Plan Year, the eligibility computation period after the initial eligibility computation period will be based on each anniversary of the date the Employee first completes an Hour of Service 2. [ ] Vesting computation period. Instead of the Plan Year, the vesting computation period will be the date an Employee first performs an Hour of Service and each anniversary thereof. 3. [ ] Equivalency method. Instead of using actual Hours of Service, an equivalency method will be used to determine Hours of Service for: a. [ ] all purposes b. [ ] the following purposes (select one or more): 1. [ ] eligibility to participate 2. [ ] vesting 3. [ ] allocations, distribution and contributions Such method will apply to: c. [ ] all Employees d. [ ] Employees for whom records of actual Hours of Service are not maintained or available (e.g., salaried Employees) e. [ ] other: (e.g., per -diem Employees only) Hours of Service will be determined on the basis of- f. [ ] days worked (10 hours per day) g. [ ] weeks worked (45 hours per week) h. [ ] semi-monthly payroll periods worked (95 hours per semi-monthly pay period) i. [ ] months worked (190 hours per month) j. [ ] bi-weekly payroll periods worked (90 hours per bi-weekly pay period) k. [ ] other: (e.g., option f is used for per -diem Employees and option g. is used for on -call Employees). 4. [ ] Number of Hours of Service required. Instead of 1,000 Hours of Service, Year of Service means the applicable computation period during which an Employee has completed at least (not to exceed 1,000) Hours of Service for: a. [ ] all purposes b. [ ] the following purposes (select one or more): 1. [ ] eligibility to participate 2. [ ] vesting 3. [ ] allocations, distributions and contributions c. [ ] Alternative for counting all prior service. Instead of the default which recognizes all prior service for rehired Employees, the Plan will not recognize prior service and rehired Employee are treated as new hires for the following purposes: (select one) 1. [ ] all purposes 2. [ ] the following purposes (select one or more): a. [ ] eligibility to participate b. [ ] vesting c. [ ] sharing in allocations or contributions 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Non -Standardized Governmental 401(a) d. [ ] Other service crediting provisions: (must be definitely determinable; e.g., for vesting a Year of Service is based on 1,000 Hours of Service but for eligibility a Year of Service is based on 900 Hours of Service.) NOTE: Must not list more than 1,000 hours in this Section. This servicing credit provision will be used for: 1. [ ] All purposes 2. [ ] The following purposes (select one or more): a. [ ] eligibility to participate b. [ ] vesting c. [ ] allocations, distributions and contributions VESTING 17. VESTING OF PARTICIPANT'S INTEREST — EMPLOYER CONTRIBUTIONS (Plan Section 6.4(b)) a. [ ] N/A (no Employer contributions; skip to Question 19) b. [X] The vesting provisions selected below apply. Section B of Appendix A can be used to specify any exceptions to the provisions below. NOTE: The Plan provides that contributions for converted sick leave and/or vacation leave are fully Vested. Vesting for Employer contributions other than matching contributions c. [ ] N/A (no Employer contributions (other than matching contributions); skip to f.) d. [ ] 100% vesting. Participants are 100% Vested in Employer contributions (other than matching contributions) upon entering Plan. e. [X] The following vesting schedule, based on a Participant's Years of Service (or Periods of Service if the elapsed time method is selected), applies to Employer contributions (other than matching contributions): 1. [ ] 6 Year Graded: 0-1 year-0%; 2 years-20%; 3 years-40%; 4 years-60%; 5 years-80%; 6 years-100% 2. [ ] 4 Year Graded: 1 year-25%; 2 years-50%; 3 years-75%; 4 years-100% 3. [ ] 5 Year Graded: 1 year-20%; 2 years-40%; 3 years-60%; 4 years-80%; 5 years-100% 4. [X] Cliff 100% vesting after 5 (not to exceed 15) years 5. [ ] Other graded vesting schedule (must provide for full vesting no later than 15 years of service; add additional lines as necessary) Years (or Periods) of Service Percentage Vesting for Employer matching contributions f. [X] N/A (no Employer matching contributions) g. [ ] The schedule above will also apply to Employer matching contributions. h. [ ] 100% vesting. Participants are 100% Vested in Employer matching contributions upon entering Plan. i. [ ] The following vesting schedule, based on a Participant's Years of Service (or Periods of Service if the elapsed time method is selected), applies to Employer matching contributions: 1. [ ] 6 Year Graded: 0-1 year-0%; 2 years-20%; 3 years-40%; 4 years-60%; 5 years-80%; 6 years-100% 2. [ ] 4 Year Graded: 1 year-25%; 2 years-50%; 3 years-75%; 4 years-100% 3. [ ] 5 Year Graded: 1 year-20%; 2 years-40%; 3 years-60%; 4 years-80%; 5 years-100% 4. [ ] Cliff 100% vesting after (not to exceed 15) years 5. [ ] Other graded vesting schedule (must provide for full vesting no later than 15 years of service; add additional lines as necessary) 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Non -Standardized Governmental 401(a) Years (or Periods) of Service Percentage NOTE: If any Part-time/Seasonal/Temporary Employees who are not covered under Social Security are participating in this Plan as a Social Security Replacement Plan, any contributions used to satisfy the minimum contribution requirements of Question 24.e. will be 100% vested. 18. VESTING OPTIONS Excluded vesting service. The following Years of Service will be disregarded for vesting purposes (select all that apply; leave blank if none apply): a. [ ] Service prior to the initial Effective Date of the Plan or a predecessor plan (as defined in Regulations § 1.411(a)-5(b)(3)) b. [ ] Service prior to the computation period in which an Employee has attained age c. [ ] Service during a period for which an Employee did not make mandatory Employee contributions. Vesting for death, Total And Permanent Disability and Early/Normal Retirement. Regardless of the vesting schedule, a Participant will become fully Vested upon (select all that apply; leave blank if none apply): d. [ ] Death e. [ ] Total and Permanent Disability f [ ] Early Retirement Date g. [ ] Normal Retirement Age RETIREMENT AGES 19. NORMAL RETIREMENT AGE ("NRA") (Plan Section 1.33) means: 19 This Question 19 and Question 20 may be skipped if the Plan does not base any benefits, distributions or other features on Normal Retirement Age. a. [ ] Specific age. The date a Participant attains age b. [X] Age/participation. The later of the date a Participant attains age 62 or the loth anniversary of the first day of the Plan Year in which participation in the Plan commenced c. [ ] Other: (must be definitely determinable) NOTE: If this is a Money Purchase Pension Plan and in-service distributions at Normal Retirement Age are permitted, then the Normal Retirement Age cannot be less than age 62, or age 50 if substantially all Participants are qualified public safety employees (as defined in Code §72(t)(1)). The "substantially all" requirement for qualified public safety employees will no longer be a requirement as of the effective date of the final regulations once they are issued & effective. If an age less than 62 is inserted (unless the age 50 safe harbor is applicable for a qualified public safety employee), no reliance will be afforded on the Opinion Letter issued to the Plan that such age is reasonably representative of the typical retirement age for the industry in which the Participants works. Effective for Employees hired during Plan Years beginning on or after the later of (1) January 1, 2015, or (2) the close of the first legislative session of the legislative body with the authority to amend the plan that begins on or after the date that is three (3) months after the final regulations are published in the Federal Register, an NRA of less than age 62 must comply with the final regulations under §401(a). Qualified public safety employees. Normal Retirement Age for public safety employees (as defined in Code §72(t)(1)) (leave blank if not applicable) d. [ ] Age (may not be less than 50 for a Money Purchase Pension Plan or 40 for a Profit Sharing Plan) 20. NORMAL RETIREMENT DATE (Plan Section 1.34) means, with respect to any Participant, the: a. [X] date on which the Participant attains "NRA" b. [ ] first day of the month coinciding with or next following the Participant's "NRA" c. [ ] first day of the month nearest the Participant's "NRA" d. [ ] Anniversary Date coinciding with or next following the Participant's "NRA" e. [ ] Anniversary Date nearest the Participant's "NRA" f [ ] Other: (e.g., first day of the month following the Participant's "NRA"). 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Non -Standardized Governmental 401(a) 21. EARLY RETIREMENT DATE (Plan Section 1.15) a. [X] N/A (no early retirement provision provided) b. [ ] Early Retirement Date means the: 1. [ ] date on which a Participant satisfies the early retirement requirements 2. [ ] first day of the month coinciding with or next following the date on which a Participant satisfies the early retirement requirements 3. [ ] Anniversary Date coinciding with or next following the date on which a Participant satisfies the early retirement requirements Early retirement requirements 4. [ ] Participant attains age AND, completes.... (leave blank if not applicable) a. [ ] at least Years (or Periods) of Service for vesting purposes b. [ ] at least Years (or Periods) of Service for eligibility purposes c. [ ] Early Retirement Date means: (must be definitely determinable) COMPENSATION 22. COMPENSATION with respect to any Participant is defined as follows (Plan Sections 1.10 and 1.23). Base definition a. [X] Wages, tips and other compensation on Form W-2 b. [ ] Code §3401(a) wages (wages for withholding purposes) c. [ ] 415 safe harbor compensation NOTE: Plan Section 1.10(c) provides that the base definition of Compensation includes deferrals that are not included in income due to Code §§401(k), 125, 132(f)(4), 403(b), 402(h)(1)(13)(SEP), 414(h)(2), & 457. Determination period. Compensation will be based on the following "determination period" (this will also be the Limitation Year unless otherwise elected at option f. under Section B of Appendix A): d. [X] the Plan Year e. [ ] the Fiscal Year coinciding with or ending within the Plan Year f. [ ] the calendar year coinciding with or ending within the Plan Year Adjustments to Compensation (for Plan Section 1.10). Compensation will be adjusted by: g. [ ] No adjustments (skip to Question 23. below) h. [X] Adjustments. Compensation will be adjusted by (select all that apply): 1. [ ] excluding salary reductions (401(k), 125, 132(f)(4), 403(b), SEP, 414(h)(2) pickup, & 457) 2. [X] excluding reimbursements or other expense allowances, fringe benefits (cash or non -cash), moving expenses, deferred compensation (other than deferrals specified in 1. above) and welfare benefits. 3. [ ] excluding Compensation paid during the "determination period" while not a Participant in the Plan. 4. [ ] excluding Military Differential Pay 5. [ ] excluding overtime 6. [ ] excluding bonuses 7. [ ] other: (e.g., describe Compensation from the elections available above or a combination thereof as to a Participant group (e.g., no exclusions as to Division A Employees and exclude bonuses as to Division B Employees); and/or describe another exclusion (e.g., exclude shift differential pay)). 23. POST -SEVERANCE COMPENSATION (415 REGULATIONS) 415 Compensation (post -severance compensation adjustments) (select all that apply at a.; leave blank if none apply) NOTE: Unless otherwise elected under a. below, the following defaults apply: 415 Compensation will include (to the extent provided in Plan Section 1.23), post -severance regular pay, leave cash -outs and payments from nonqualified unfunded deferred compensation plans. a. [ ] The defaults listed above apply except for the following (select one or more): 1. [ ] Leave cash -outs will be excluded 2. [ ] Nonqualified unfunded deferred compensation will be excluded 3. [ ] Disability continuation payments will be included for all Participants and the salary continuation will continue for the following fixed or determinable period: 4. [ ] Other: (must be definitely determinable) Plan Compensation (post -severance compensation adjustments) b. [X] Defaults apply. Compensation will include (to the extent provided in Plan Section 1.10 and to the extent such amounts would be included in Compensation if paid prior to severance of employment) post -severance regular pay, leave cash -outs, and payments from nonqualified unfunded deferred compensation plans. (skip to Question 24) c. [ ] Exclude all post -severance compensation. Exclude all post -severance compensation for allocation purposes. d. [ ] Post -severance adjustments. The defaults listed at b. apply except for the following (select one or more): 1. [ ] Exclude all post -severance compensation 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Non -Standardized Governmental 401(a) 2. [ ] Regular pay will be excluded 3. [ ] Leave cash -outs will be excluded 4. [ ] Nonqualified unfunded deferred compensation will be excluded 5. [ ] Military Differential Pay will be included 6. [ ] Disability continuation payments will be included for all Participants and the salary continuation will continue for the following fixed or determinable period: e. [ ] Other: (must be definitely determinable) CONTRIBUTIONS AND ALLOCATIONS 24. EMPLOYER CONTRIBUTIONS (OTHER THAN MATCHING CONTRIBUTIONS) (Plan Section 4.1(b)(3)) (skip to Question 26 if Employer contributions are NOT selected at Question 1 Lb.) CONTRIBUTION FORMULA (select one or more of the following contribution formulas:) a. [ ] Discretionary contribution (no groups). (may not be elected if this Plan is a Money Purchase Pension Plan) The Employer may make a discretionary contribution, to be determined by the Employer. Any such contribution will be allocated to each Participant eligible to share in allocations in the same ratio as each Participant's Compensation bears to the total of such Compensation of all Participants. b. [ ] Discretionary contribution (Grouping method). (may not be elected if this Plan is a Money Purchase Pension Plan) The Employer may designate a discretionary contribution to be made on behalf of each Participant group selected below (only select 1. or 2.). The groups must be clearly defined in a manner that will not violate the definite predetermined allocation formula requirement of Regulation § 1.40 1 - I (b)(1)(ii). The Employer must notify the Trustee in writing of the amount of the Employer Contribution being given to each group. 1. [ ] Each Participant constitutes a separate classification. 2. [ ] Participants will be divided into the following classifications with the allocation methods indicated under each classification. Definition of classifications. Define each classification and specify the method of allocating the contribution among members of each classification. Classifications specified below must be clearly defined in a manner that will not violate the definitely determinable allocation requirement of Regulation §1.401-1(b)(1)(ii). Classification A will consist of The allocation method will be: [ ] pro rata based on Compensation [ ] equal dollar amounts (per capita) Classification B will consist of The allocation method will be: [ ] pro rata based on Compensation [ ] equal dollar amounts (per capita) Classification C will consist of The allocation method will be: [ ] pro rata based on Compensation [ ] equal dollar amounts (per capita) Classification D will consist of The allocation method will be: [ ] pro rata based on Compensation [ ] equal dollar amounts (per capita) Additional Classifications: (specify the classifications and which of the above allocation methods (pro rata or per capita) will be used for each classification). NOTE: If more than four (4) classifications, the additional classifications and allocation methods may be attached as an addendum to the Adoption Agreement or may be entered under Additional Classifications above. Determination of applicable group. If a Participant shifts from one classification to another during a Plan Year, then unless selected below, the Participant is in a classification based on the Participant's status as of the last day of the Plan Year, or if earlier, the date of termination of employment. If selected below, the Administrator will apportion the Participant's allocation during a Plan Year based on the following: a. [ ] Beginning of Plan Year. The classification will be based on the Participant's status as of the beginning of the Plan Year. b. [ ] Months in each classification. Pro rata based on the number of months the Participant spent in each classification. c. [ ] Days in each classification. Pro rata based on the number of days the Participant spent in each classification. d. [ ] One classification only. The Employer will direct the Administrator to place the Participant in only one classification for the entire Plan Year during which the shift occurs. c. [X] Fixed contribution equal to (only select one): 1. [X] 10 % of each Participant's Compensation for each: a. [ ] Plan Year b. [ ] calendar quarter c. [ ] month 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Non -Standardized Governmental 401(a) d. [X] pay period e. [ ] week 2. [ ] $ per Participant. 3. [ ] $ per Hour of Service worked while an Eligible Employee a. [ ] up to hours (leave blank if no limit) 4. [ ] other: (the formula described must satisfy the definitely determinable requirement under Regulation § 1.401-1(b)) NOTE: Under Question 24.c.4., the Employer may only describe the allocation of Nonelective Contributions from the elections available under Question 24.c of this Adoption Agreement and/or a combination thereof as to a Participant group (e.g., a monthly contribution applies to Group A). d. [ ] Sick leave/vacation leave conversion. The Employer will contribute an amount equal to an Employee's current hourly rate of pay multiplied by the Participant's number of unused accumulated sick leave and/or vacation days (as selected below). Only unpaid sick and vacation leave for which the Employee has no right to receive in cash may be included. In no event will the Employer's contribution for the Plan Year exceed the maximum contribution permitted under Code §415(c). The following may be converted under the Plan: (select one or both): 1. [ ] Sick leave 2. f 1 Vacation leave Eligible Employees. Only the following Participants shall receive the Employer contribution for sick leave and/or vacation leave (select 3. and/or 4; leave blank if no limitations provided, however, that this Plan may not be used to only provide benefits for terminated Employees) 3. [ ] Former Employees. All Employees terminating service with the Employer during the Plan Year and who have satisfied the eligibility requirements based on the terms of the Employer's accumulated benefits plans checked below (select all that apply; leave blank if no exclusions): a. [ ] The Former Employee must beat least age (e.g., 55) b. [ ] The value of the sick and/or vacation leave must beat least $ (e.g., $2,000) c. [ ] A contribution will only be made if the total hours is over (e.g., 10) hours d. [ ] A contribution will not be made for hours in excess of (e.g., 40) hours 4. [ ] Active Employees. Active Employees who have not terminated service during the Plan Year and who meet the following requirements (select all that apply; leave blank if no exclusions): a. [ ] The Employee must be at least age (e.g., 55) b. [ ] The value of the sick and/or vacation leave must be at least $ (e.g., $2,000) c. [ ] A contribution will only be made if the total hours is over (e.g., 10) hours d. [ ] A contribution will not be made for hours in excess of (e.g., 40) hours e. [ ] Social Security Replacement Plan. Except as provided below, the Employer will contribute an amount equal to 7.5% of each eligible Participant's Compensation for the entire Plan Year, reduced by mandatory Employee contributions that are picked -up under Code §414(h) and Employer contributions to this Plan actually contributed to the Participant's Account during such Plan Year. (may only be selected if Question 1 Lb. 1. has also been selected) AND, only the following Employees will NOT be eligible for the Social Security Replacement Plan contribution: (select all that apply) 1. [ ] Part-time Employees who are not otherwise covered by another qualifying public retirement system as defined for purposes of Regulation §31.3121(b)(7)-2. A part-time Employee is an Employee whose regularly scheduled service is less than Hours of Service in the relevant eligibility computation period (as defined in Plan Section 1.55). 2. [ ] Seasonal Employees who are not otherwise covered by another qualifying public retirement system as defined for purposes of Regulation §31.3121(b)(7)-2. A seasonal Employee is an Employee who is categorized as a seasonal Employee on the Employer's payroll records. 3. [ ] Temporary Employees who are not otherwise covered by another qualifying public retirement system as defined for purposes of Regulation §31.3121(b)(7)-2. A temporary Employee is an Employee who is categorized as a temporary Employee on the Employer's payroll records. 4. [ ] Employees in elective positions (filled by an election, which may be by legislative body, board or committee, or by a jurisdiction's qualified electorate) 5. [ ] Other: (any other group of Employees that is defmitely determinable and not eligible for the Social Security Replacement Plan contribution). The minimum contribution of 7.5% stated above will be satisfied by: a. [ ] the Employee only (specify the contribution at the mandatory Employee contributions Question 30) b. [ ] the Employer only c. [ ] both the Employee and the Employer. The Employee shall contribute the amount specified in Question 30 for mandatory Employee contributions) and the Employer shall contribute % of each eligible Participant's Compensation. NOTE: If a. or c. above is selected, then the mandatory Employee contribution must be picked -up by the Employer at Question 30. Also, if b. or c. above is selected, then the allocation conditions in Question 25 © 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) 10 Non -Standardized Governmental 401(a) below do not apply to the Employer contribution made pursuant to this provision. f [ ] Other: (the formula described must satisfy the definitely determinable requirement under Regulation §1.401-1(b) and if this is a Money Purchase Pension, it must not be a discretionary contribution formula). NOTE: Under Question 24.f., the Employer may only describe the allocation of Nonelective Contributions from the elections available under Question 24 and/or a combination thereof as to a Participant group or contribution type (e.g., pro rata allocation applies to Group A; contributions to other Employees will be allocated in accordance with the classifications allocation provisions of Plan Section 4.3 with each Participant constituting a separate classification). 25. ALLOCATION CONDITIONS (Plan Section 4.3). If 24.a., b., c., or f, is selected above, indicate requirements to share in allocations of Employer contributions (select a. OR b. and all that apply at c. - e.) a. [X] No conditions. All Participants share in the allocations regardless of service completed during the Plan Year or employment status on the last day of the Plan Year (skip to Question 26). b. [ ] Allocation conditions apply (select one of 1. - 5. AND one of 6. - 9. below) Conditions for Participants NOT employed on the last day of the Plan Year 1. [ ] A Participant must complete at least (not to exceed 500) Hours of Service if the actual hours/equivalency method is selected (or at least (not to exceed 3) months of service if the elapsed time method is selected). 2. [ ] A Participant must complete a Year of Service (or Period of Service if the elapsed time method is selected). 3. [ ] Participants will NOT share in the allocations, regardless of service. 4. [ ] Participants will share in the allocations, regardless of service. 5. [ ] Other: (must be definitely determinable and not subject to Employer discretion) Conditions for Participants employed on the last day of the Plan Year 6. [ ] No service requirement. 7. [ ] A Participant must complete a Year of Service (or Period of Service if the elapsed time method is selected). 8. [ ] A Participant must complete at least Hours of Service during the Plan Year. 9. [ ] Other: (must be definitely determinable and not subject to Employer discretion) Waiver of conditions for Participants NOT employed on the last day of the Plan Year. If b. L, 2., 3., or 5. above is selected, Participants who are not employed on the last day of the Plan Year in which one of the following events occur will be eligible to share in the allocations regardless of the above conditions (select all that apply; leave blank if none apply): c. [ ] Death d. [ ] Total and Permanent Disability e. [ ] Termination of employment on or after Normal Retirement Age 1. [ ] or Early Retirement Date 26. EMPLOYER MATCHING CONTRIBUTIONS (Plan Section 4.1(b)(2) and Plan Section 4.12). (skip to Question 29 if matching contributions are NOT selected at Question 1 l.c.) The Employer will (or may with respect to any discretionary contribution) make the following matching contributions: A. Employee contributions taken into account. For purposes of applying the matching contribution provisions below, the following amounts are being matched (hereafter referred to as "matched Employee contributions" (select one or more): Elective deferrals to a 457 plan. Enter Plan name(s): _ Elective deferrals to a 403(b) plan. Enter Plan name(s): Voluntary Employee Contributions Other: Adoption Agreement) B. Matching Formula. (select one) (specify amounts that are matched under this Plan and are provided for within this e. [ ] Fixed - uniform rate/amount. The Employer will make matching contributions equal to % (e.g., 50) of the Participant's "matched Employee contributions" 1. [ ] that do not exceed % of a Participant's Compensation (leave blank if no limit) Additional matching contribution (choose 2. if applicable): 2. [ ] plus an additional matching contribution of a discretionary percentage determined by the Employer, a. [ ] but not to exceed % of Compensation. Such contribution is subject to the Instructions and Notice requirement of Section 4.12. © 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) 11 Non -Standardized Governmental 401(a) f [ ] Fixed - tiered. The Employer will make matching contributions equal to a uniform percentage of each tier of each Participant's "matched Employee contributions", determined as follows: NOTE: Fill in only percentages or dollar amounts, but not both. If percentages are used, each tier represents the amount of the Participant's applicable contributions that equals the specified percentage of the Participant's Compensation (add additional tiers if necessary): Tiers of Contributions (indicate $ or %) First Next Next Next Matching Percentage g. [ ] Fixed - Years of Service. The Employer will make matching contributions equal to a uniform percentage of each Participant's "matched Employee contributions" based on the Participant's Years of Service (or Periods of Service if the elapsed time method is selected), determined as follows (add additional tiers if necessary): Years (or Periods) of Service Matching Percentage For purposes of the above matching contribution formula, a Year (or Period) of Service means a Year (or Period) of Service for: 1. [ ] vesting purposes 2. [ ] eligibility purposes h. [ ] Flexible Discretionary Match. (may not be elected if this Plan is a Money Purchase Pension Plan) "Flexible Discretionary Match" means a Matching Contribution which the Employer in its sole discretion elects to make to the Plan. Except as specified below, the Employer retains discretion over the formula or formulas for allocating the Flexible Discretionary Match, including the Discretionary Matching Contribution rate or amount, the limit(s) on Elective Deferrals or Employee Contributions subject to match, the per Participant match allocation limit(s), the Participants or categories of Participants who will receive the allocation, and the time period applicable to any matching formula(s) (collectively, the "Flexible Discretionary Matching Formula"), except as the Employer otherwise elects in its Adoption Agreement. Such contributions will be subject to the Instructions and Notice requirement of Section 4.12, reproduced below, unless the Employer elects to use a "Rigid Discretionary Match" in Election 26.B.h.1. below. The discretionary matching contribution under this Question 26.B.h. is a "Flexible Discretionary Match" unless the Employer elects to use a "Rigid Discretionary Match." (Choose 1. if applicable.) 1. [ ] Rigid Discretionary Match. A "Rigid Discretionary Match" means a Matching Contribution which the Employer in its sole discretion elects to make to the Plan. Such discretion will only pertain to the amount of the annual contribution. The Employer must select the allocation method for this Contribution by selecting among those Adoption Agreement options which confer no Employer Discretion regarding the allocation of such discretionary amount, for example, the limit(s) on Elective Deferrals or Employee Contributions subject to match, the per Participant match allocation limit(s), the Participants who will receive the allocation, and the time period applicable to any matching formula(s). This "Rigid Discretionary Match" is not subject to the Instructions and Notice requirement of Section 4.12. Section 4.12 provides: INSTRUCTIONS TO ADMINISTRATOR AND NOTIFICATION TO PARTICIPANTS. For Plan Years beginning after the end of the Plan Year in which this document is first adopted, if a "Flexible Discretionary Match" contribution formula applies (i.e., a formula that provides an Employer with discretion regarding how to allocate a matching contribution to Participants) and the Employer makes a "Flexible Discretionary Match" to the Plan, the Employer must provide the Plan Administrator or Trustee written instructions describing (1) how the "Flexible Discretionary Match" formula will be allocated to Participants (e.g., a uniform percentage of Elective Deferrals or a flat dollar amount), (2) the computation period(s) to which the "Flexible Discretionary Match" formula applies, and (3) if applicable, a description of each business location or business classification subject to separate "Flexible Discretionary Match" allocation formulas. Such instructions must be provided no later than the date on which the "Flexible Discretionary Match" is made to the Plan. A summary of these instructions must be communicated to Participants who receive an allocation of the "Flexible Discretionary Match" no later than 60 days following the date on which the last "Flexible Discretionary Match" contribution is made to the Plan for the Plan Year. i. [ ] Discretionary - tiered. (may not be elected if this Plan is a Money Purchase Pension Plan) The Employer may make matching contributions equal to a discretionary percentage of a Participant's "matched Employee contributions," to be determined by the Employer, of each tier, to be determined by the Employer. Such discretion will only pertain to the © 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) 12 Non -Standardized Governmental 401(a) amount of the contribution. The tiers may be based on the rate of a Participant's "matched Employee contributions" or Years of Service. Such contribution is subject to the Instructions and Notice requirement of Section 4.12. NOTE: Fill in only percentages or dollar amounts, but not both. If percentages are used, each tier represents the amount of the Participant's applicable contributions that equals the specified percentage of the Participant's Compensation (add additional tiers if necessary): Tiers of Contributions Matching Percentage (indicate $ or %) First % Next % Next % Next % j. [ ] Other: (the formula described must satisfy the definitely determinable requirement under Regulation § 1.401-1(b) and if this is a Money Purchase Pension Plan, it must not be a discretionary contribution formula. NOTE: Under Question 26.13 J., the Employer may only describe the allocation of Matching Contributions from the elections available under Question 26 and/or a combination thereof as to a Participant group or contribution type (e.g., fixed — uniform rate applies to Group A; contributions to other Employees will be allocated as a tiered contribution.) 27. MATCHING CONTRIBUTION PROVISIONS A. Maximum matching contribution. The total matching contribution made on behalf of any Participant for any Plan Year will not exceed: a. [ ] N/A (no Plan specific limit on the amount of matching contribution) b. [ ] $ c. [ ] % of Compensation. B. Period of determination. Any matching contribution other than a "Flexible Discretionary Match" will be applied on the following basis (and "matched Employee contributions" and any Compensation or dollar limitation used in determining the matching contribution will be based on the applicable period. Skip if the only Matching Contribution is a Flexible Discretionary Match.): d. [ ] the Plan Year (potential annual true -up required) e. [ ] each payroll period (no true -up) f. [ ] each month (potential monthly true -up required) g. [ ] each Plan Year quarter (potential quarterly true -up required) h. [ ] each payroll unit (e.g., hour) (no true -up) i. [ ] Other (specify): The time period described must be definitely determinable under Treas. Reg. § 1.401-1(b). This line may be used to apply different options to different matching contributions (e.g., Discretionary matching contributions will be allocated on a Plan Year period while fixed matching contributions will be allocated on each payroll period.) Such contribution period is subject to the Instructions and Notice requirement of Section 4.12. 28. ALLOCATION CONDITIONS (Plan Section 4.3) Select a. OR b. and all that apply of c. - h. a. [ ] No conditions. All Participants share in the allocations regardless of service completed during the Plan Year or employment status on the last day of the Plan Year (skip to Question 29). b. [ ] Allocation conditions apply (select one of 1. - 5. AND one of 6. - 9. below) Conditions for Participants NOT employed on the last day of the Plan Year. 1. [ ] A Participant must complete more than Hours of Service (or months of service if the elapsed time method is selected). 2. [ ] A Participant must complete a Year of Service (or Period of Service if the elapsed time method is selected). 3. [ ] Participants will NOT share in the allocations, regardless of service. 4. [ ] Participants will share in the allocations, regardless of service. 5. [ ] Other: (must be definitely determinable) Conditions for Participants employed on the last day of the Plan Year 6. [ ] No service requirement. 7. [ ] A Participant must complete a Year of Service (or Period of Service if the elapsed time method is selected). 8. [ ] A Participant must complete at least Hours of Service during the Plan Year. 9. [ ] Other: (must be definitely determinable and not subject to Employer discretion) Waiver of conditions for Participants NOT employed on the last day of the Plan Year. If b. 1., 2., 3., or 5. is selected, Participants who are not employed on the last day of the Plan Year in which one of the following events occur will be eligible to share in the allocations regardless of the above conditions (select all that apply; leave blank if none apply): c. [ ] Death d. [ ] Total and Permanent Disability e. [ ] Termination of employment on or after Normal Retirement Age 1. [ ] or Early Retirement Date © 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) 13 Non -Standardized Governmental 401(a) Conditions based on period other than Plan Year. The allocation conditions above will be applied based on the Plan Year unless otherwise selected below. If selected, the above provisions will be applied by substituting the term Plan Year with the specified period (e.g., if Plan Year quarter is selected below and the allocation condition is 250 Hours of Service per quarter, enter 250 hours (not 1000) at b.8. above). f. [ ] The Plan Year quarter. g. [ ] Payroll period. h. [ ] Other: (must be definitely determinable and not subject to Employer discretion and may not be longer than a twelve month period). 29. FORFEITURES (Plan Sections 1.21 and 4.3(e)) Timing of Forfeitures. Except as provided in Plan Section 1.21, a Forfeiture will occur: a. [ ] N/A (may only be selected if all contributions are fully Vested (default provisions at Plan Section 4.3(e) apply)) b. [X] As of the earlier of (1) the last day of the Plan Year in which the former Participant incurs five (5) consecutive 1-Year Breaks in Service, or (2) the distribution of the entire Vested portion of the Participant's Account. c. [ ] As of the last day of the Plan Year in which the former Participant incurs five (5) consecutive 1-Year Breaks in Service. d. [ ] As soon as reasonably practical after the date the Participant severs employment. Use of Forfeitures. (skip if this is NOT a Money Purchase Pension Plan; for Profit Sharing Plans, Forfeitures are disposed of in accordance with Employer direction that is consistent with Section 4.3(e)). Forfeitures will be (select one): e. [ ] added to the Employer contribution and allocated in the same manner f. [ ] used to reduce any Employer contribution g. [ ] allocated to all Participants eligible to share in the allocations of Employer contributions or Forfeitures in the same proportion that each Participant's Compensation for the Plan Year bears to the Compensation of all Participants for such year h. [ ] other: (describe the treatment of Forfeitures in a manner that is definitely determinable and that is not subject to Employer discretion) 30. MANDATORY EMPLOYEE CONTRIBUTIONS (Plan Section 4.8) (skip if mandatory Employee contributions NOT selected at Question 1 Ld.) Type of mandatory Employee Contribution. The mandatory Employee contribution is being made in accordance with the following: (select one) a. [ ] The mandatory Employee contribution is a condition of employment. b. [ ] The Employee must make, on or before first being eligible to participate under any Plan of the Employer, an irrevocable election to contribute the mandatory Employee contribution to the Plan. No Eligible Employee will become a Participant unless the Employee makes such an irrevocable election. Amount of mandatory Employee Contribution (select one) c. [ ] An Eligible Employee must contribute to the Plan % (not to exceed 25%) of Compensation. d. [ ] An Eligible Employee must, prior to his or her first Entry Date, make a one-time irrevocable election to contribute to the Plan from % (not less than 1 %) to % (not to exceed 25%) of Compensation. Conditions of Mandatory Employee Contributions e. [ ] Additional provisions and conditions: determinable; e.g., Only full-time Employees must make mandatory Employee contributions) (must be definitely Employer pick-up contribution. The mandatory Employee contribution is "picked -up" by the Employer under Code §414(h)(2) unless elected below. (select if applicable) f. [ ] The mandatory Employee contribution is not "picked -up" by the Employer. DISTRIBUTIONS 31. FORM OF DISTRIBUTIONS (Plan Sections 6.5 and 6.6) Distributions under the Plan may be made in (select all that apply; must select at least one): a. [X] lump -sums b. [X] substantially equal installments c. [X] partial withdrawals, provided the minimum withdrawal is S (leave blank if no minimum) d. [ ] partial withdrawals or installments are only permitted for Participants or Beneficiaries who must receive required minimum distributions under Code §401(a)(9) except for the following (leave blank if no exceptions): 1. [ ] Only Participants (and not Beneficiaries) may elect partial withdrawals or installments 2. [ ] Other: (e.g., partial is not permitted for death benefits. Must be definitely determinable and not subject to Employer discretion.) e. [ ] annuity: (describe the form of annuity or annuities) © 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) 14 Non -Standardized Governmental 401(a) f [ ] other: (must be definitely determinable and not subject to Employer discretion) NOTE: Regardless of the above, a Participant is not required to request a withdrawal of his or her total Account for an in-service distribution, a hardship distribution, or a distribution from the Participant's Rollover Account. Cash or property. Distributions may be made in: g. [X] cash only, except for (select all that apply; leave blank if none apply): 1. [ ] insurance Contracts 2. [ ] annuity Contracts 3. [ ] Participant loans 4. [ ] all investments in an open brokerage window or similar arrangement h. [ ] cash or property, except that the following limitation(s) apply: (leave blank if there are no limitations on property distributions): I. [ ] (must be definitely determinable and not subject to Employer discretion) Joint and Survivor Annuity provisions. (Plan Sections 6.5(e) and 6.6(e) (select one) The Joint and Survivor Annuity provisions do not apply to the Plan unless selected below (choose if applicable) i. [ ] Joint and Survivor Annuity applicable as normal form of distribution. The Joint and Survivor annuity rules set forth in Plan Sections 6.5(e) and 6.5(f) apply to all Participants (if selected, then annuities are a form of distribution under the Plan even if e. above is not selected) j. [ ] Joint and Survivor Annuity rules apply based on Participant election. Plan Section 6.5(f) will apply and the joint and survivor rules of Code §§401(a)(11) and 417 (as set forth in Plan Sections 6.5(e) and 6.6(e) will apply only if an annuity form of distribution is selected by a Participant. AND, if i. or j. is selected above, the one-year marriage rule does not apply unless selected below (choose if applicable). 1. [ ] The one-year marriage rule applies. Spousal consent requirements. Spousal consent is not required for any Plan provisions (except as otherwise elected in i. above for the joint and survivor annuity rules) unless selected below (choose if applicable) k. [ ] Required for all distributions. A Spouse must consent to all distributions (other than required minimum distributions). 1. [ ] Beneficiary designations. A married Participant's Spouse will be the Beneficiary of the entire death benefit unless the Spouse consents to an alternate Beneficiary. AND, if k. or 1. is selected, the one-year marriage rule does not apply unless selected below (choose if applicable). 1. [ ] The one-year marriage rule applies. 32. CONDITIONS FOR DISTRIBUTIONS UPON SEVERANCE OF EMPLOYMENT. Distributions upon severance of employment pursuant to Plan Section 6.4(a) will not be made unless the following conditions have been satisfied: A. Accounts in excess of $5,000 a. [X] Distributions may be made as soon as administratively feasible following severance of employment. b. [ ] Distributions may be made as soon as administratively feasible after the last day of the Plan Year coincident with or next following severance of employment. c. [ ] Distributions may be made as soon as administratively feasible after the last day of the Plan Year quarter coincident with or next following severance of employment. d. [ ] Distributions may be made as soon as administratively feasible after the Valuation Date coincident with or next following severance of employment. e. [ ] Distributions may be made as soon as administratively feasible after months have elapsed following severance of employment. f. [ ] No distributions may be made until a Participant has reached Early or Normal Retirement Date. g. [ ] Other: (must be objective conditions which are ascertainable and may not exceed the limits of Code §401(a)(14) as set forth in Plan Section 6.7) B. Accounts of $5,000 or less h. [X] Same as above i. [ ] Distributions may be made as soon as administratively feasible following severance of employment. j. [ ] Distributions may be made as soon as administratively feasible after the last day of the Plan Year coincident with or next following severance of employment. k. [ ] Other: (must be objective conditions which are ascertainable and may not exceed the limits of Code §401(a)(14) as set forth in Plan Section 6.7) © 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) 15 Non -Standardized Governmental 401(a) C. Timing after initial distributable event. If a distribution is not made in accordance with the above provisions upon the occurrence of the distributable event, then a Participant may elect a subsequent distribution at any time after the time the amount was first distributable (assuming the amount is still distributable), unless otherwise selected below (may not be selected with 321 and 32.h.): 1. [ ] Other: (e.g., a subsequent distribution request may only be made in accordance with 1. above (i.e., the last day of another Plan Year); must be objective conditions which are ascertainable and may not exceed the limits of Code §401(a)(14) as set forth in Plan Section 6.7) D. Participant consent (i.e., involuntary cash -outs). Should Vested Account balances less than a certain dollar threshold be automatically distributed without Participant consent (mandatory distributions)? NOTE: The Plan provides that distributions of amounts of $5,000 or less are only paid as lump -sums. m. [ ] No, Participant consent is required for all distributions. n. [X] Yes, Participant consent is required only if the distribution is over: 1. [ ] $5,000 2. [X] $1,000 3. [ ] $ (less than $1,000) NOTE: If 2. or 3. is selected, rollovers will be included in determining the threshold for Participant consent. Automatic IRA rollover. With respect to mandatory distributions of amounts that are $1,000 or less, if a Participant makes no election, the amount will be distributed as a lump -sum unless selected below. 4. [ ] If a Participant makes no election, then the amount will be automatically rolled over to an IRA provided the amount is at least $ (e.g., $200). E. Rollovers in determination of $5,000 threshold. Unless otherwise elected below, amounts attributable to rollover contributions (if any) will be included in determining the $5,000 threshold for timing of distributions, form of distributions, or consent rules. o. [ ] Exclude rollovers (rollover contributions will be excluded in determining the $5,000 threshold) NOTE: Regardless of the above election, if the Participant consent threshold is $1,000 or less, then the Administrator must include amounts attributable to rollovers for such purpose. In such case, an election to exclude rollovers above will apply for purposes of the timing and form of distributions. 33. DISTRIBUTIONS UPON DEATH (Plan Section 6.8(b)(2)) Distributions upon the death of a Participant prior to the "required beginning date" will: a. [X] be made pursuant to the election of the Participant or "designated Beneficiary" b. [ ] begin within 1 year of death for a "designated Beneficiary" and be payable over the life (or over a period not exceeding the "life expectancy") of such Beneficiary, except that if the "designated Beneficiary" is the Participant's Spouse, begin prior to December 31 st of the year in which the Participant would have attained age 70 1/2 c. [ ] be made within 5 (or if lesser ) years of death for all Beneficiaries d. [ ] be made within 5 (or if lesser ) years of death for all Beneficiaries, except that if the "designated Beneficiary" is the Participant's Spouse, begin prior to December 31 st of the year in which the Participant would have attained age 70 1/2 and be payable over the life (or over a period not exceeding the "life expectancy") of such "surviving Spouse" NOTE: The elections above must be coordinated with the Form of distributions (e.g., if the Plan only permits lump -sum distributions, then options a., b. and d. would not be applicable). 34. OTHER PERMITTED DISTRIBUTIONS (select all that apply; leave blank if none apply) A. IN-SERVICE DISTRIBUTIONS (Plan Section 6.11) In-service distributions will NOT be allowed (except as otherwise permitted under the Plan without regard to this provision) unless selected below (if applicable, answer a. - e.; leave blank if not applicable): a. [ ] In-service distributions may be made to a Participant who has not separated from service provided the following has been satisfied (select one or more) (options 2. - 5. may only be selected with Profit Sharing Plans): 1. [ ] Age. The Participant has reached: (select one) a. [ ] Normal Retirement Age b. [ ] age 62 c. [ ] age 59 1/2 (may not be selected if a Money Purchase Pension Plan) d. [ ] age (may not be less than age 62 for Money Purchase Pension Plans) 2. [ ] the Participant has been a Participant in the Plan for at least years (may not be less than five (5)) 3. [ ] the amounts being distributed have accumulated in the Plan for at least 2 years 4. [ ] other: (must satisfy the definitely determinable requirement under Regulations §401-1(b); may not be subject to Employer discretion; and must be limited to a combination of items a. 1. — a.3. or a Participant's disability).) More than one condition. If more than one condition is selected above, then a Participant only needs to satisfy one of the conditions, unless selected below: 5. [ ] A Participant must satisfy each condition NOTE: Distributions from a Transfer Account attributable to a Money Purchase Pension Plan are not permitted prior to age 62. © 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) 16 Non -Standardized Governmental 401(a) Account restrictions. In-service distributions are permitted from the following Participant Accounts: b. [ ] all Accounts c. [ ] only from the following Accounts (select one or more): 1. [ ] Account attributable to Employer matching contributions 2. [ ] Account attributable to Employer contributions other than matching contributions 3. [ ] Rollover Account 4. [ ] Transfer Account Permitted from the following assets attributable to (select one or both): a. [ ] non -pension assets b. [ ] pension assets (e.g., from a Money Purchase Pension Plan) 5. [ ] Mandatory Employee Contribution Account 6. [ ] Other: (specify Account(s) and conditions in a manner that satisfies the definitely determinable requirement under Regulation § 1.401-1(b) and is not subject to Employer discretion) Limitations. The following limitations apply to in-service distributions: d. [ ] N/A (no additional limitations) e. [ ] Additional limitations (select one or more): 1. [ ] The minimum amount of a distribution is $ 2. [ ] No more than distribution(s) may be made to a Participant during a Plan Year. 3. [ ] Distributions may only be made from Accounts which are fully Vested. In-service distributions may be made subject to the following provisions: (must satisfy the definitely determinable requirement under Regulation § 1.401-1(b) and not be subject to Employer discretion). HARDSHIP DISTRIBUTIONS (Plan Sections 6.12) (may not be selected if this is a Money Purchase Pension Plan) Hardship distributions will NOT be allowed (except as otherwise permitted under the Plan without regard to this provision) unless selected below (leave blank if not applicable): f. [X] Hardship distributions are permitted from the following Participant Accounts: 1. [X] all Accounts 2. [ ] only from the following Accounts (select one or more): a. [ ] Account attributable to Employer matching contributions b. [ ] Account attributable to Employer contributions other than matching contributions c. [ ] Rollover Account (if not available at any time under Question 36) d. [ ] Transfer Account (other than amounts attributable to a money purchase pension plan) e. [ ] Mandatory Employee Contribution Account f. [ ] Other: (specify Account(s) and conditions in a manner that is definitely determinable and not subject to Employer discretion) NOTE: Hardship distributions are NOT permitted from a Transfer Account attributable to pension assets (e.g., from a Money Purchase Pension Plan). Additional limitations. The following limitations apply to hardship distributions: 3. [X] N/A (no additional limitations) 4. [ ] Additional limitations (select one or more): a. [ ] The minimum amount of a distribution is $ b. [ ] No more than distribution(s) may be made to a Participant during a Plan Year. c. [ ] Distributions may only be made from Accounts which are fully Vested. d. [ ] A Participant does not include a Former Employee at the time of the hardship distribution. e. [ ] Hardship distributions may be made subject to the following provisions: (must satisfy the definitely determinable requirement under Regulation § 1.401-1(b) and not be subject to Employer discretion). Beneficiary Hardship. Hardship distributions for Beneficiary expenses are NOT allowed unless otherwise selected below. 5. [ ] Hardship distributions for expenses of Beneficiaries are allowed Special effective date (may be left blank if effective date is same as the Plan or Restatement Effective Date; select a. and, if applicable, b.) a. [ ] effective as of b. f 1 eliminated effective as of © 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) 17 Non -Standardized Governmental 401(a) MISCELLANEOUS 35. LOANS TO PARTICIPANTS (Plan Section 7.4) a. [X] New loans are NOT permitted. b. [ ] New loans are permitted. NOTE: Regardless of whether new loans are permitted, if the Plan permits rollovers and/or plan -to -plan transfers, then the Administrator may, in a uniform manner, accept rollovers and/or plan -to -plan transfers of loans into this Plan. 36. ROLLOVERS (Plan Section 4.6) (skip if rollover contributions are NOT selected at l l .f ) Eligibility. Rollovers may be accepted from all Participants who are Employees as well as the following (select all that apply; leave blank if not applicable): a. [ ] Any Eligible Employee, even prior to meeting eligibility conditions to be a Participant b. [ ] Participants who are Former Employees Distributions. When may distributions be made from a Participant's Rollover Account? c. [X] At any time d. [ ] Only when the Participant is otherwise entitled to any distribution under the Plan 37. HEART ACT (Plan Section 4.11) (select one or more) a. [X] HEART ACT Continued benefit accruals. Continued benefit accruals will apply b. [ ] Distributions for deemed severance of employment. The Plan permits distributions for deemed severance of employment. © 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) 18 Non -Standardized Governmental 401(a) Reliance on Provider Opinion Letter. The Provider has obtained from the IRS an Opinion Letter specifying the form of this document satisfies Code §401 as of the date of the Opinion Letter. An adopting Employer may rely on the Provider's IRS Opinion Letter only to the extent provided in Rev. Proc. 2017-41 or subsequent guidance. The Employer may not rely on the Opinion Letter in certain other circumstances or with respect to certain qualification requirements, which are specified in the Opinion Letter and in Rev. Proc. 2017-41 or subsequent guidance. In order to have reliance in such circumstances or with respect to such qualification requirements, the Employer must apply for a determination letter to Employee Plans Determinations of the IRS. An Employer who has ever maintained or who later adopts an individual medical account, as defined in Code §415(1)(2)) in addition to this Plan may not rely on the opinion letter issued by the Internal Revenue Service with respect to the requirements of Code§415. This Adoption Agreement may be used only in conjunction with the basic Plan document 903. This Adoption Agreement and the basic Plan document will together be known as Empower Retirement, LLC Non -Standardized Governmental 401(a) Pre -Approved Plan #002. The adoption of this Plan, its qualification by the IRS, and the related tax consequences are the responsibility of the Employer and its independent tax and legal advisors. Execution for Page Substitution Amendment Only. If this paragraph is completed, this Execution Page documents an amendment to Adoption Agreement Election(s) effective , by substitute Adoption Agreement page number(s) . The Employer should retain all Adoption Agreement Execution Pages and amended pages. (Note: The Effective Date may be retroactive or may be prospective.) The Provider, Empower Retirement, LLC will notify the Employer of any amendment to this Pre -approved Plan or of any abandonment or discontinuance by the Provider of its maintenance of this Pre -approved Plan. In addition, this Plan is provided to the Employer either in connection with investment in a product or pursuant to a contract or other arrangement for products and/or services. Upon cessation of such investment in a product or cessation of such contract or arrangement, as applicable, the Employer is no longer considered to be an adopter of this Plan and Empower Retirement, LLC no longer has any obligations to the Employer that relate to the adoption of this Plan. For inquiries regarding the adoption of the Pre -approved Plan, the Provider's intended meaning of any Plan provisions or the effect of the Opinion Letter issued to the Provider, please contact the Provider or the Provider's representative. Provider Name: Empower Retirement, LLC Address: Greenwood Village Colorado 80111 Telephone Number: (877) 694-4015 Email address (optional): The Employer, by executing below, hereby adopts this Plan (add additional signature lines as needed). NOTE: If more than one Plan type is adopted, the Plan Provider must provide multiple plan documents for Employer signature. EMPLOYER: Cit� of Clermont By: CDocuSigne by: am_,,"S 43l F57D413554D6... 7/11/2024 DATE SIGNED © 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) 19 Non -Standardized Governmental 401(a) APPENDIX A SPECIAL EFFECTIVE DATES AND OTHER PERMITTED ELECTIONS A. Special effective dates (leave blank if not applicable): a. [X] Special effective date(s): Special Effective Date October 10, 2023: The Employer elects to no longer apply Break -in - Service rules for Rehired Employees. Rehired Employees are to be treated as new hires, in accordance with Sections 3.2 and 3.5 of the base plan document. For the period prior to October 10, 2023, beginning July 1, 2022, the Employer applied Break -in -Service rules for rehired employees in compliance with selections in Appendix A, Section B, Subsection c. La and c. Lb, related to the application of "rule of parity" provisions for eligibility and vesting purposes. Any Former Employee who had been a Participant and was reemployed by the Employer, that Employee was treated as a Participant as of their reemployment date. . For periods prior to the specified special effective date(s), the Plan terms in effect prior to its restatement under this Adoption Agreement will control for purposes of the designated provisions. A special effective date may not result in the delay of a Plan provision beyond the permissible effective date under any applicable law. (The Employer has reliance on the IRS Opinion Letter only if the features described in the preceding sentence constitute protected benefits within the meaning of Code Section 411(d)(6) and the regulations thereunder, and only if such features are permissible in a "Cycle 3" preapproved plan, i.e., the features are not specifically prohibited by Revenue Procedure 2017-41 (or any superseding guidance) B. Other permitted elections (the following elections are optional): a. [ ] No other permitted elections The following elections apply (select one or more): b. [X] Deemed 125 compensation (Plan Section 1.23). Deemed 125 compensation will be included in Compensation and 415 Compensation. c. [ ] Break -in -Service Rules. The following Break -in -Service rules apply to the Plan.(select 1. or 2.) 1. [ ] Reemployed after five (5) 1-Year Breaks in Service ("rule of parity" provisions) (Plan Section 3.5(e)). The "rule of parity" provisions in Plan Section 3.5(d) will apply for (select one or both): a. [ ] eligibility purposes b. [ ] vesting purposes 2. [ ] Break -in -Service rules for rehired Employees. The following Break -in -Service rules set forth in Plan Sections 3.2 and 3.5 apply: (select one or both) a. [ ] all Break -in -Service rules set forth in such Sections. b. [ ] only the following: (specify which provisions apply to the Plan) d. [X] Beneficiary if no beneficiary elected by Participant (Plan Section 6.2(f)). In the event no valid designation of Beneficiary exists, then in lieu of the order set forth in Plan Section 6.2(f), the following order of priority will be used: First to the Participant's spouse, then to the Participant's estate (specify an order of beneficiaries; e.g., children per stirpes, parents, and then step -children). e. [ ] Joint and Survivor Annuity/Pre-Retirement Survivor Annuity. If the Plan applies the Joint and Survivor Annuity rules, then the normal form of annuity will be a joint and 50% survivor annuity (i.e., if 31.i. or 31.j. is selected) and the Pre -Retirement Survivor Annuity will be equal to 50% of a Participant's interest in the Plan unless selected below (select 1. and/or 2.) 1. [ ] Normal form of annuity. Instead of a joint and 50% survivor annuity, the normal form of the qualified Joint and Survivor Annuity will be: (select one) a. [ ] joint and 100% survivor annuity b. [ ] joint and 75% survivor annuity c. [ ] joint and 66 2/3% survivor annuity 2. [ ] Pre -Retirement Survivor Annuity. The Pre -Retirement Survivor Annuity (minimum Spouse's death benefit) will be equal to 50% of a Participant's interest in the Plan unless a different percentage is selected below: (select one) a. [ ] 100% of a Participant's interest in the Plan. b. [ ] % (may not be less than 50%) of a Participant's interest in the Plan. f. [ ] Limitation Year (Plan Section 1.30). The Limitation Year for Code §415 purposes will be (must be a consecutive twelve month period) instead of the "determination period" for Compensation. g. [ ] 415 Limits when 2 defined contribution plans are maintained (Plan Section 4.4). If any Participant is covered under another qualified defined contribution plan maintained by the Employer or an Affiliated Employer, or if the Employer or an Affiliated Employer maintains a welfare benefit fund, as defined in Code §419(e), or an individual medical account, as defined in Code §415(1)(2), under which amounts are treated as "annual additions" with respect to any Participant in this Plan, then the provisions of Plan Section 4.4(b) will apply unless otherwise specified below: 1. [ ] Specify, in a manner that precludes Employer discretion, the method under which the plans will limit total "annual additions" to the "maximum permissible amount" and will properly reduce any "excess amounts": 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Non -Standardized Governmental 401(a) h. [ ] Recognition of Service with other employers (Plan Sections 1.40 and 1.55). Service with the following employers (in addition to those specified at Question 15) will be recognized as follows (select one or more): 11 J Contribution Eligibility Vesting Allocation 1. [ ] Employer name: a. [ ] b. [ ] c. [ ] 2. [ ] Employer name: a. [ ] b. [ ] c. [ ] 3. [ ] Employer name: a. [ ] b. [ ] c. [ ] 4. [ ] Employer name: a. [ ] b. [ ] c. [ ] 5. [ ] Employer name: a. [ ] b. [ ] c. [ ] 6. [ ] Employer name: a. [ ] b. [ ] c. [ ] Limitations 7. [ ] The following provisions or limitations apply with respect to the a. [ ] b. [ ] c. [ ] recognition of prior service: (e.g., credit service with X only on/following 1/l/19) [X] Other vesting provisions. The following vesting provisions apply to the Plan (select one or more): 1. [X] Special vesting provisions. The following special provisions apply to the vesting provisions of the Plan: Pre -amendments vesting schedule is as follows: 0-4 years of service - 0%, 5 years of service - 50%, 6 years of service - 60%, 7 years of service - 70%, 8 years of service - 80%, 9 years of service - 90% and 10 years of service - 100% (must be definitely determinable and satisfy the parameters set forth at Question 17) 2. [X] Pre -amendment vesting schedule. (Plan Section 6.4(b)). If the vesting schedule has been amended and a different vesting schedule other than the schedule at Question 17 applies to any Participants, then the following provisions apply (must select one of a. — d.): Applicable Participants. The vesting schedules in Question 17 only apply to: a. [ ] Participants who are Employees as of (enter date). b. [X] Participants in the Plan who have an Hour of Service on or after October 10, 2023 (enter date). c. [ ] Participants (even if not an Employee) in the Plan on or after (enter date). d. [ ] Other: (e.g., Participants in division A. Must be definitely determinable.) [ ] Minimum distribution transitional rules (Plan Section 6.8(e)(5)) NOTE: This Section does not apply to (1) anew Plan, (2) an amendment or restatement of an existing Plan that never contained the provisions of Code §401(a)(9) as in effect prior to the amendments made by the Small Business Job Protection Act of 1996 (SBJPA), or (3) a Plan where the transition rules below do not affect any current Participants. The "required beginning date" for a Participant is: 1. [ ] April 1 st of the calendar year following the year in which the Participant attains age 70 1/2. (pre-SBJPA rules continue to apply) 2. [ ] April 1st of the calendar year following the later of the year in which the Participant attains age 70 1/2 or retires (the post-SBJPA rules), with the following exceptions (select one or both; leave blank if both applied effective as of January 1, 1996): a. [ ] A Participant who was already receiving required minimum distributions under the pre-SBJPA rules as of (may not be earlier than January 1, 1996) was allowed to stop receiving distributions and have them recommence in accordance with the post-SBJPA rules. Upon the recommencement of distributions, if the Plan permits annuities as a form of distribution then the following apply: 1. [ ] N/A (annuity distributions are not permitted) 2. [ ] Upon the recommencement of distributions, the original Annuity Starting Date will be retained. 3. [ ] Upon the recommencement of distributions, anew Annuity Starting Date is created. b. [ ] A Participant who had not begun receiving required minimum distributions as of (may not be earlier than January 1, 1996) may elect to defer commencement of distributions until retirement. The option to defer the commencement of distributions (i.e., to elect to receive in-service distributions upon attainment of age 70 1/2) applies to all such Participants unless selected below: 1. [ ] The in-service distribution option was eliminated with respect to Participants who attained age 70 1/2 in or after the calendar year that began after the later of (1) December © 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) 2 Non -Standardized Governmental 401(a) 31, 1998, or (2) the adoption date of the restatement to bring the Plan into compliance with the SBJPA. k. [ ] Other spousal provisions (select one or more) 1. [ ] Definition of Spouse. The term Spouse includes a spouse under federal law as well as the following: 2. [ ] Automatic revocation of spousal designation (Plan Section 6.2(g)). The automatic revocation of a spousal Beneficiary designation in the case of divorce does not apply. 3. [ ] Timing of QDRO payment. A distribution to an Alternate Payee shall not be permitted prior to the time a Participant would be entitled to a distribution. 1. [ ] Applicable law. Instead of using the applicable laws set forth in Plan Section 9.4(a), the Plan will be governed by the laws of m. [ ] Total and Permanent Disability. Instead of the definition at Plan Section 1.50, Total and Permanent Disability means: (must be definitely determinable). n. [ ] Inclusion of Reclassified Employees (Plan Section 1.17(a)). The Employer does not exclude Reclassified Employees subject to the following provisions: (leave blank if not applicable): o. [ ] Claims procedures (Plan Section 2.10). The claims procedures forth in Plan Section 2.10(a) — (b) apply unless otherwise elected below or unless the Administrator has operationally adopted alternative procedures. 1. [ ] The claims procedures set forth in Plan Section 2.10(c) — (g) apply instead of Plan Section 2.10(a). 2. [ ] The claims procedures set forth in Plan Section 2.10(c)-(g) apply as follows: (specify which provisions apply and/or modified) p. [ ] Age 62 In -Service Distributions For Transferred Money Purchase Assets (Plan Section 6.11) In-service distributions will be allowed for Participants at age 62. (applies only for Transfer Accounts from a Money Purchase Pension Plan) (skip this question if the Plan is a Money Purchase Pension Plan or if in-service distributions are already permitted for Transferred Accounts at Question 34) Limitations. The following limitations apply to these in-service distributions: 1. [ ] The Plan already provides for in-service distributions and the restrictions set forth in the Plan (e.g., minimum amount of distributions or frequency of distributions) are applicable to in-service distributions at age 62. 2. [ ] N/A (no limitations) 3. [ ] The following elections apply to in-service distributions at age 62 (select one or more): a. [ ] The minimum amount of a distribution is $ (may not exceed $1,000). b. [ ] No more than distribution(s) may be made to a Participant during a Plan Year. c. [ ] Distributions may only be made from Accounts which are fully Vested. d. [ ] In-service distributions may be made subject to the following provisions: (must be definitely determinable and not subject to discretion). q. [ ] QLACs. (Plan Section 6.8(e)(4) A Participant may elect a QLAC (as defined in Plan Section 6.8(e)(4)) or any alternative form of annuity permitted pursuant to a QLAC in which the Participant's Account has been invested. 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Non -Standardized Governmental 401(a) ADMINISTRATIVE PROCEDURES The following are optional administrative provisions. The Administrator may implement procedures that override any elections in this Section without a formal Plan amendment. In addition, modifications to these procedures will not affect an Employer's reliance on the Plan. A. Loan Limitations. (complete only if loans to Participants are permitted; leave blank if none apply) a. [ ] Limitations (select one or more): 1. [ ] Loans will be treated as Participant directed investments. 2. [ ] Loans will only be made for hardship or financial necessity as specified below (select a. or b.) a. [ ] hardship reasons specified in Plan Section 6.12 b. [ ] financial necessity (as defined in the loan program). 3. [ ] The minimum loan will be $ 4. [ ] A Participant may only have (e.g., one (1)) loan(s) outstanding at any time. 5. [ ] All outstanding loan balances will become due and payable in their entirety upon the occurrence of a distributable event (other than satisfaction of the conditions for an in-service distribution (including a hardship distribution), if applicable). 6. [ ] The home loan term will be years. (if not selected, the Administrator establishes the term for repayment of a home loan) 7. [ ] Account restrictions. Loans will only be permitted from the following Participant Accounts (select all that apply or leave blank if no limitations apply): a. [ ] Account(s) attributable to Employer matching contributions b. [ ] Account attributable to Employer contributions other than matching contributions c. [ ] Rollover Account d. [ ] Transfer Account e. [ ] Other: AND, if loans are restricted to certain accounts, the limitations of Code §72(p) will be applied: f. [ ] by determining the limits by only considering the restricted accounts. g. [ ] by determining the limits taking into account a Participant's entire interest in the Plan. Additional Loan Provisions (select all that apply; leave blank if none apply) b. [ ] Loan payments. Loans are repaid by (if left blank, then payroll deduction applies unless Participant is not subject to payroll (e.g., partner who only has a draw)): 1. [ ] payroll deduction 2. [ ] ACH (Automated Clearing House) 3. [ ] check a. [ ] Only for prepayment C. [ ] Interest rate. Loans will be granted at the following interest rate (if left blank, then 3. below applies): 1. [ ] percentage points over the prime interest rate 2. [ ] % 3. [ ] the Administrator establishes the rate at the time the loan is made d. [ ] Refinancing. Loan refinancing is allowed. B. Life Insurance. (Plan Section 7.3) a. [X] Life insurance may not be purchased. b. [ ] Life insurance may be purchased... 1. [ ] at the option of the Administrator at the option of the Participant Limitations 3. [ ] N/A (no limitations) 4. [ ] The purchase of initial or additional life insurance will be subject to the following limitations (select one or more): a. [ ] Each initial Contract will have a minimum face amount of $ b. [ ] Each additional Contract will have a minimum face amount of $ c. [ ] The Participant has completed Years (or Periods) of Service. d. [ ] The Participant has completed Years (or Periods) of Service while a Participant in the Plan. e. [ ] The Participant is under age on the Contract issue date. f. [ ] The maximum amount of all Contracts on behalf of a Participant may not exceed $ g. [ ] The maximum face amount of any life insurance Contract will be $ C. Plan Expenses. Will the Plan assess against an individual Participant's Account certain Plan expenses that are incurred by, or are attributable to, a particular Participant based on use of a particular Plan service? a. [ ] No b. [X] Yes 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Non -Standardized Governmental 401(a) Use of Forfeitures Forfeitures of Employer contributions other than matching contributions will be: C. [ ] added to the Employer contribution and allocated in the same manner d. [ ] used to reduce any Employer contribution e. [ ] allocated to all Participants eligible to share in the allocations of Employer contributions or Forfeitures in the same proportion that each Participant's Compensation for the Plan Year bears to the Compensation of all Participants for such year f. [ ] other: (describe the treatment of Forfeitures in a manner that is definitely determinable and not subject to Employer discretion) Forfeitures of Employer matching contributions will be: g. [ ] N/A. Same as above or no Employer matching contributions. h. [ ] used to reduce the Employer matching contribution. i. [ ] used to reduce any Employer contribution. j. [ ] other: (describe the treatment of Forfeitures in a manner that is definitely determinable and not subject to Employer discretion) D. Directed investments a. [ ] Participant directed investments are NOT permitted. b. [X] Participant directed investments are permitted from the following Participant Accounts: 1. [X] all Accounts 2. [ ] only from the following Accounts (select one or more): a. [ ] Account attributable to Employer contributions b. [ ] Rollover Account c. [ ] Transfer Account d. [ ] Other: (specify Account(s) and conditions in a manner that is definitely determinable and not subject to Employer discretion) E. Rollover Limitations. Will the Plan accept rollover contributions and/or direct rollovers from the sources specified below? a. [ ] No, Administrator determines in operation which sources will be accepted. b. [ ] Yes Rollover sources. Indicate the sources of rollovers that will be accepted (select one or more) 1. [ ] Direct Rollovers. The Plan will accept a direct rollover of an eligible rollover distribution from (select one or more): a. [ ] a qualified plan described in Code §401(a) (including a 401(k) plan, profit sharing plan, defined benefit plan, stock bonus plan and money purchase plan), excluding after-tax employee contributions b. [ ] a qualified plan described in Code §401(a) (including a 401(k) plan, profit sharing plan, defined benefit plan, stock bonus plan and money purchase plan), including after-tax employee contributions c. [ ] a plan described in Code §403(a) (an annuity plan), excluding after-tax employee contributions d. [ ] a plan described in Code §403(a) (an annuity plan), including after-tax employee contributions e. [ ] a plan described in Code §403(b) (a tax-sheltered annuity), excluding after-tax employee contributions f. [ ] a plan described in Code §403(b) (a tax-sheltered annuity), including after-tax employee contributions g. [ ] a plan described in Code §457(b) (eligible deferred compensation plan) Direct Rollovers of Participant Loan. The Plan will NOT accept a direct rollover of a Participant loan from another plan unless selected below (leave blank if default applies) h. [ ] The Plan will accept a direct rollover of a Participant loan i. [ ] The Plan will only accept a direct rollover of a Participant loan only in the following situation(s): (e.g., only from Participants who were employees of an acquired organization). 2. [ ] Participant Rollover Contributions from Other Plans (i.e., not via a direct plan -to -plan transfer). The Plan will accept a contribution of an eligible rollover distribution (select one or more): a. [ ] a qualified plan described in Code §401(a) (including a 401(k) plan, profit sharing plan, defined benefit plan, stock bonus plan and money purchase plan) b. [ ] a plan described in Code §403(a) (an annuity plan) c. [ ] a plan described in Code §403(b) (a tax-sheltered annuity) d. [ ] a governmental plan described in Code §457(b) (eligible deferred compensation plan) 3. [ ] Participant Rollover Contributions from IRAs: The Plan will accept a rollover contribution of the portion of a distribution from a traditional IRA that is eligible to be rolled over and would otherwise be includible in gross income. Rollovers from Roth IRAs or a Coverdell Education Savings Account (formerly known as an Education IRA) are not permitted because they are not traditional IRAs. A rollover from a SIMPLE IRA is allowed if the amounts are rolled over after the individual has been in the SIMPLE IRA for at least two years. F. Trustee(s) or Insurer(s). Information regarding Trustee(s)/Insurer(s) (required for the Summary Plan Description and, if requested, the Trust Agreement) (Note: Select a. if not using provided trust. MUST select b and following questions as applicable): a. [ ] Do not produce the trust agreement 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Non -Standardized Governmental 401(a) b. [X] Complete the following UNLESS not selecting supporting forms: Trustee/Insurer (select a. OR one or more of d. - e) c. [ ] Insurer. This Plan is funded exclusively with Contracts (select one or more of 1. - 4) Name of Insurer(s) 1. [ ] 2. [ ] 3. [ ] Use Employer address/telephone number/email 4. [ ] Use following address/telephone number/email a. Street: b. City: c. State: d. Zip: e. Telephone: f. Email: d. [ ] Individual Trustee(s) e. [ ] Corporate Trustee Name of Trust f. Specify name of Trust (required for FIS trust): Individual Trustees (if d. selected above, complete g. - j.) Directed/Discretionary Trustees. The individual Trustee(s) executing this Adoption Agreement are (select g. or h.) g. [ ] Select for each individual Trustee (skip to next question) h. [ ] The following selections apply to all individual Trustee(s) (select 1. - 4. as applicable) 1. [ ] A discretionary Trustee over all plan assets (may not be selected with 2. - 4.) 2. [ ] A nondiscretionary (directed) Trustee over all plan assets (may not be selected with L, 3. or 4.) 3. [ ] The individual Trustee(s) will serve as a discretionary Trustee over the following assets: (may not be selected with 1. or 2.) 4. [ ] The individual Trustee(s) will serve as a nondiscretionary (directed) Trustee over the following assets: (may not be selected with 1. or 2.) Individual Trustee(s) (complete if d. selected above) i. [ ] Individual Trustee(s) are (select one or more of a. - j.; enter address at j. below) a. Name Title/Email: 1. Title 2. Email (optional) Trustee is: (complete if g. selected above; select 3. - 6. as applicable) 3. [ ] Discretionary Trustee over all plan assets (may not be selected with 4. - 6.) 4. [ ] A discretionary Trustee over the following plan assets: (may not be select with 3. or 5.) 5. [ ] Nondiscretionary Trustee over all plan assets (may not be selected with 3., 4. or 6.) 6. [ ] A nondiscretionary (directed) Trustee or Custodian over the following plan assets (may not be selected with 3. or 5.) b. Name Title/Email: 1. Title 2. Email (optional) Trustee is: (complete if g. selected above; select 3. - 6. as applicable) 3. [ ] Discretionary Trustee over all plan assets (may not be selected with 4. - 6.) 4. [ ] A discretionary Trustee over the following plan assets: (may not be select with 3. or 5.) 5. [ ] Nondiscretionary Trustee over all plan assets (may not be selected with 3., 4. or 6.) 6. [ ] A nondiscretionary (directed) Trustee or Custodian over the following plan assets (may not be selected with 3. or 5.) c. Name Title/Email: 1. Title 2. Email (optional) Trustee is: (complete if g. selected above; select 3. - 6. as applicable) 3. [ ] Discretionary Trustee over all plan assets (may not be selected with 4. - 6.) 4. [ ] A discretionary Trustee over the following plan assets: (may not be select with 3. or 5.) 5. [ ] Nondiscretionary Trustee over all plan assets (may not be selected with 3., 4. or 6.) 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Non -Standardized Governmental 401(a) 6. [ ] A nondiscretionary (directed) Trustee or Custodian over the following plan assets (may not be selected with 3. or 5.) d. Name Title/Email: 1. Title 2. Email (optional) Trustee is: (complete if g. selected above; select 3. - 6. as applicable) 3. [ ] Discretionary Trustee over all plan assets (may not be selected with 4. or 6.) 4. [ ] A discretionary Trustee over the following plan assets: (may not be selected with 3. or 5.) 5. [ ] Nondiscretionary Trustee over all plan assets (may not be selected with 3., 4. or 6.) 6. [ ] A nondiscretionary (directed) Trustee or Custodian over the following plan assets (may not be selected with 3. or 5.) e. Name Title/Email: 1. Title 2. Email (optional) Trustee is: (complete if g. selected above; select 3. - 6. as applicable) 3. [ ] Discretionary Trustee over all plan assets (may not be selected with 4. or 6.) 4. [ ] A discretionary Trustee over the following plan assets: (may not be selected with 3. or 5.) 5. [ ] Nondiscretionary Trustee over all plan assets (may not be selected with 3., 4. or 6.) 6. [ ] A nondiscretionary (directed) Trustee or Custodian over the following plan assets (may not be selected with 3. or 5.) f. Name Title/Email: 1. Title 2. Email (optional) Trustee is: (complete if g. selected above; select 3. - 6. as applicable) 3. [ ] Discretionary Trustee over all plan assets (may not be selected with 4. or 6.) 4. [ ] A discretionary Trustee over the following plan assets: (may not be selected with 3. or 5.) 5. [ ] Nondiscretionary Trustee over all plan assets (may not be selected with 3., 4. or 6.) 6. [ ] A nondiscretionary (directed) Trustee or Custodian over the following plan assets (may not be selected with 3. or 5.) g. Name Title/Email: 1. Title 2. Email (optional) Trustee is: (complete if g. selected above; select 3. - 6. as applicable) 3. [ ] Discretionary Trustee over all plan assets (may not be selected with 4. or 6.) 4. [ ] A discretionary Trustee over the following plan assets: (may not be selected with 3. or 5.) 5. [ ] Nondiscretionary Trustee over all plan assets (may not be selected with 3., 4. or 6.) 6. [ ] A nondiscretionary (directed) Trustee or Custodian over the following plan assets (may not be selected with 3. or 5.) h. Name Title/Email: 1. Title 2. Email (optional) Trustee is: (complete if g. selected above; select 3. - 6. as applicable) 3. [ ] Discretionary Trustee over all plan assets (may not be selected with 4. or 6.) 4. [ ] A discretionary Trustee over the following plan assets: (may not be selected with 3. or 5.) 5. [ ] Nondiscretionary Trustee over all plan assets (may not be selected with 3., 4. or 6.) 6. [ ] A nondiscretionary (directed) Trustee or Custodian over the following plan assets (may not be selected with 3. or 5.) Name Title/Email: 1. Title 2. Email (optional) Trustee is: (complete if g. selected above; select 3. - 6. as applicable) 3. [ ] Discretionary Trustee over all plan assets (may not be selected with 4. or 6.) 4. [ ] A discretionary Trustee over the following plan assets: (may not be selected with 3. or 5.) 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Non -Standardized Governmental 401(a) 5. [ ] Nondiscretionary Trustee over all plan assets (may not be selected with 3., 4. or 6.) 6. [ ] A nondiscretionary (directed) Trustee or Custodian over the following plan assets (may not be selected with 3. or 5.) j. Name Title/Email: 1. Title 2. Email (optional) Trustee is: (complete if g. selected above; select 3. - 6. as applicable) 3. [ ] Discretionary Trustee over all plan assets (may not be selected with 4. or 6.) 4. [ ] A discretionary Trustee over the following plan assets: (may not be selected with 3. or 5.) 5. [ ] Nondiscretionary Trustee over all plan assets (may not be selected with 3., 4. or 6.) 6. [ ] A nondiscretionary (directed) Trustee or Custodian over the following plan assets (may not be selected with 3. or 5.) j. [ ] Individual Trustee Address (complete if d. selected above) 1. [ ] Use Employer address/telephone number/email 2. [ ] Use following address/telephone number/email a. Street: b. City: c. State: d. Zip: e. Telephone: f Email: Corporate Trustee Name/Type/Address (complete if e. selected above) k. [ ] Name Address/telephone number/email 1. [ ] Use Employer address/telephone number/email 2. [ ] Use following address/telephone number/email a. Street: b. City: c. State: d. Zip: e. Telephone: f. Email: Directed/Discretionary. The Corporate Trustee is (select 3. - 6. as applicable) 3. [ ] A discretionary Trustee over all plan assets (may not be selected with 4. - 6.) 4. [ ] A nondiscretionary (directed) Trustee over all plan assets (may not be selected with 3., 5. or 6.) 5. [ ] A discretionary Trustee over the following plan assets over the following assets: (may not be selected with 3. - 4.) 6. [ ] A nondiscretionary (directed) Trustee over the following plan assets (may not be selected with 3. - 4.) Signee (optional): 7. [ ] Name of person signing on behalf of the corporate Trustee 8. [ ] Email address of person signing on behalf of the corporate Trustee Special Trustee for collection of contributions. The Employer appoints the following Special Trustee with the responsibility to collect delinquent contributions (optional) 1. [ ] Name Title: 1. Address/telephone number/email 2. [ ] Use Employer address/telephone number/email 3. [ ] Use following address/telephone number/email a. Street: b. City: c. State: d. Zip: e. Telephone: f. Email: Custodian(s) Name/Address . The Custodian(s) are (optional) m. [X] Name(s) Empower Trust Company, LLC 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Non -Standardized Governmental 401(a) Address/telephone number/email 1. [ ] Use Employer address/telephone number/email 2. [X] Use following address/telephone number/email a. Street: 8515 East Orchard Road b. City: Greenwood Village c. State: Colorado d. Zip: 80111 e. Telephone: (877) 694-4015 f Email: Investment in common, collective or pooled trust funds. The nondiscretionary Trustee, as directed or the discretionary Trustee acting without direction (and in addition to the discretionary Trustee's authority to invest in its own funds), may invest in any of the following trust funds: (optional) n. [ ] (Specify the names of one or more trust funds in which the Plan can invest) Choice of law o. [ ] This trust will be governed by the laws of the state of: 1. [ ] State in which the Employer's principal office is located 2. [ ] State in which the corporate trustee or insurer is located 3. [ ] Other 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Non -Standardized Governmental 401(a) EMPOWER RETIREMENT, LLC NON -STANDARDIZED GOVERNMENTAL 401(A) MODIFICATIONS 401(A) CITY OF CLERMONT DEFINED CONTRIBUTION PLAN The enclosed Plan is being submitted for expedited review as a Non -Standardized Plan. No modifications from the approved specimen plan have been made to this Plan. 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) AMENDMENT TO IMPLEMENT HARDSHIP DISTRIBUTION PROVISIONS OF THE BIPARTISAN BUDGET ACT OF 2018 401(A) CITY OF CLERMONT DEFINED CONTRIBUTION PLAN ARTICLE I PREAMBLE 1.1 Adoption and effective date of Amendment. The Document Provider, on behalf of the Employer, hereby adopts this Amendment to the Employer's Plan. Except as otherwise specified in this Amendment, this Amendment is effective ("the Effective Date") on the first day of the first Plan Year beginning after December 31, 2018, or as soon as administratively feasible thereafter, and in no event later than the Latest Effective Date. If the Plan, prior to this Amendment, does not provide for hardship distributions, then this Amendment will be void and of no effect. 1.2 Superseding of inconsistent provisions. This Amendment supersedes the provisions of the Plan to the extent those provisions are inconsistent with the provisions of this Amendment. Except as otherwise provided in this Amendment, terms defined in the Plan will have the same meaning in this Amendment. 1.3 Construction. Except as otherwise provided in this Amendment, any "Section" reference in this Amendment refers only to this Amendment and is not a reference to the Plan. The Article and Section numbering in this Amendment is solely for purposes of this Amendment, and does not relate to the Plan article, section, or other numbering designations. 1.4 Effect of restatement of Plan. If the Employer restates the Plan using the Document Provider's pre -approved plan based on The Cumulative List of Changes in Plan Qualification Requirements for Pre -approved Defined Contribution Plans for 2017 (Notice 2017-37) or any earlier Cumulative List, then this Amendment shall remain in effect after such restatement unless the provisions in this Amendment are restated or otherwise become obsolete (e.g., if the Plan is restated onto a plan document which incorporates these provisions). 1.5 Adoption by Document Provider. The Document Provider hereby adopts this Amendment on behalf of all of the Document Provider's plans adopted by its adopting employers. The adoption by the Document Provider becomes applicable with respect to an Employer's Plan on the Effective Date (or, if later, the Effective Date of the Plan), unless the Employer individually adopts this Amendment, or an alternative amendment, prior to the expiration of the remedial amendment period relating to this Amendment. ARTICLE H ELECTIONS Instructions: Complete the elections at Sections 2.1 and 2.2. Unless this Amendment is signed by the Employer, the default elections Section 2.3 will apply. If the Employer is satisfied with those defaults and the Document Provider's elections in Sections 2.1 and 2.2, the Employer does not need to execute this Amendment. Otherwise, the Employer must complete the elections at Sections 2.1 and 2.2, may complete one or more of Sections 2.4 through 2.7 in order to override the default elections in Amendment Section 2.3, and must execute the amendment. 2.1 Termination of deferral suspension. Hardship distributions made on or after the Effective Date will not trigger a suspension of Elective Deferrals, pursuant to Section 3.1(c). If a Participant received a hardship distribution before the Effective Date, and therefore Elective Deferrals were suspended, will the Participant be able to resume deferrals as soon as practical after the Effective Date? a. [ ] YES. Beginning on the Effective Date, Elective Deferrals will not be suspended on account of a hardship distribution, regardless of the date of the distribution. b. [X] NO. The Participant's suspension of Elective Deferrals begun before the Effective Date will continue as originally scheduled. 2.2 Expansion of sources available for a hardship distribution. Pursuant to Amendment Section 3.2, are QNECs and QMACs available for hardship distributions? a. [ ] YES. QNECs and QMACs are available for hardship distributions. b. [X] NO. QNECs and QMACs are not available for hardship distributions. 2.3 Default Provisions. The following provisions apply except to the extent the Employer makes a different election in one or more of Sections 2.4 through 2.7 and executes the Amendment. a. After the Effective Date, Participants do not need to take plan loans before taking hardship distributions. b. After the Effective Date, earnings on Elective Deferrals may be withdrawn on account of a hardship. C. Hardship needs include residential casualty losses (without regard to whether the casualty was in a federally declared disaster area) and Disaster Losses, effective January 1, 2018 or as soon as practical thereafter. d. The Effective Date is the first day of the first Plan Year beginning after December 31, 2018, or as soon as administratively feasible thereafter, and in no event later than the Latest Effective Date. 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Skip Sections 2.4 through 2.7 if you accept the default provisions listed in Section 2.3. Any entry in Sections 2.4 through 2.7 will override those defaults. 2.4 Loan Requirement. The provisions of Amendment Section 3.1(b), requiring recipients of hardship distributions to take available nontaxable loans, will NOT apply unless selected below: a. [ ] Amendment Section 3.1(b) APPLIES (i.e., Participants are required to obtain a Plan loan) indefinitely, unless and until the Plan is further amended. 2.5 Expansion of sources available for a hardship distribution. Earnings on amounts attributable to Elective Deferrals are available for hardship distribution, unless selected below: a. [ ] Earnings on amounts attributable to Elective Deferrals are NOT available for hardship distributions. 2.6 Hardship needs/events. The provisions of Amendment Sections 3.3 (relating to residential casualty losses) and 3.4 (relating to Disaster Losses) apply as of January 1, 2018, or as soon as practical thereafter, unless otherwise elected below. a. [ ] Amendment Section 3.3 will NOT apply (and so casualty losses are limited to federally declared disasters, pursuant to Code § 165(h)). b. [ ] Amendment Section 3.4 will NOT apply (and so the Plan will not make hardship distributions on account of Disaster Losses). 2.7 Effective Dates. Unless otherwise selected below, the Effective Date is the first day of the first Plan Year beginning after December 31, 2018, or as soon as administratively feasible thereafter, and in no event later than the Latest Effective Date. Except as otherwise specified in this Amendment, all provisions are effective on the Effective Date. a. [ ] Other general Effective Date: (may not be earlier than the first day of the first Plan Year beginning on or after January 1, 2019 or after the Latest Effective Date). b. [ ] Special Effective Date for Amendment Section 2.2a: [Enter a special effective date, no sooner than the first day of the 2019 Plan Year.] C. [ ] Special Effective Date for Amendment Section 2.3a: [Enter a special effective date, no sooner than the first day of the 2019 Plan Year.] d. [ ] Special Effective Date for Amendment Section 2.3b: [Enter a special effective date no sooner than the first day of the 2019 Plan Year.] e. [ ] Special Effective Date for Amendment Section 2.3c: [Enter a special effective date for the expansion of hardship needs/events, no sooner than January 1, 2018.1 ARTICLE III DISTRIBUTION BASED ON HARDSHIP 3.1 Modification of hardship necessity provisions. a. The Necessity Provisions of the Plan are repealed. Except as otherwise provided in this Section 3.1, the Plan will not make a hardship distribution to a Participant unless the Participant has obtained all other currently available distributions (including distributions of ESOP dividends under section Code §404(k), but not hardship distributions) under the plan and all other plans of deferred compensation, whether qualified or nonqualified, maintained by the Employer. In addition, for a distribution that is made on or after the Latest Effective Date (or such earlier date as the Plan Administrator has implemented the procedure), the Participant must certify (in writing, by an electronic medium as defined in Treas. Reg. § 1.40 1 (a)-2 I (e)(3), or in such other form as authorized in IRS guidance) that he or she has insufficient cash or other liquid assets reasonably available to satisfy the need. b. If and only if elected in Amendment Section 2.4, before a hardship distribution may be made, a Participant must obtain all nontaxable loans (determined at the time a loan is made) available under the plan and all other plans maintained by the Employer. C. The Plan will not suspend the Participant from making Elective Deferrals on account of receipt of a hardship distribution. This provision will apply to hardship distributions made after the Effective Date. Under Amendment Section 2.1, it may also apply, as of the Effective Date, to certain suspensions of Elective Deferrals on account of receipt of a hardship distribution prior to the Effective Date. 3.2 Modification of amounts that may be withdrawn on account of a hardship. Except as otherwise elected in Amendment Sections 2.2 and 2.5, earnings on Elective Deferrals, QNECs, and QMACs (and the earnings thereon) may be withdrawn on account of a hardship. The hardship provisions set forth in the Plan, except as modified by this Amendment, continue to apply. 3.3 Residential casualty loss. Except as otherwise provided in Amendment Section 2.6, effective January 1, 2018 or as soon as practical thereafter, to the extent the Plan permits hardship distributions for expenses to repair damage to the Participant's principal residence that would qualify for a casualty loss deduction under Code § 165, such amounts will be determined without regard to Code §165(h)(5). 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) 3.4 Disaster loss. If the Plan is a Deemed Need Plan, then except as otherwise provided in Amendment Section 2.6, effective January 2018 or as soon as practical thereafter, the financial needs which can justify a hardship distribution to a Participant are expanded to include Disaster Losses. ARTICLE IV DEFINITIONS 4.1 Suspensions of Elective Deferrals. Any reference to suspension of Elective Deferrals means and includes a suspension of Elective Deferrals and/or Employee Contributions to this Plan or any other qualified plan, a 403(b) plan, or an eligible governmental plan (described in Treas. Reg. § 1.457-2(f)) of the Employer. 4.2 QNECs. A "QNEC" is a Qualified Nonelective Contribution, described in Code §401(m)(4)(C) or a safe harbor nonelective contribution described in Code §401(k)(12)(C). For purposes of this Amendment only, a QACA nonelective contribution described in Code §401(k)(13)(D)(i)(II) will also be treated as though it were a QNEC. 4.3 QMACs. A "QMAC" is a Qualified Matching Contribution, described in Code §401(k)(3)(D)(ii)(I), or a safe harbor matching contribution described in Code §401(k)(12)(B). For purposes of this Amendment only, a QACA matching contribution described in Code §401 (k)(1 3)(D)(i)(I) will also be treated as though it were a QMAC. 4.4 Necessity Provisions. The "Necessity Provisions" of the Plan are those provisions which implement the provisions of Treas. Reg. § 1.401(k)-1(d)(3)(iv)(B), (C), (D), and (E), as in effect prior to April 1, 2019. These provisions may either reflect the safe harbor "deemed necessary" standards of subparagraph (E) of that regulation, or the non -safe harbor "no alternative means" standards of subparagraphs (B), (C), and (D) of that regulation. 4.5 Deemed Need Plan. The Plan is a "Deemed Need Plan" to the extent the Plan limits eligibility for a hardship distribution to the deemed immediate and heavy financial needs described in Treas. Reg. §1.401(k)-1(d)(3)(ii)(B), (as revised effective April 1, 2019). 4.6 Disaster Losses. Disaster Losses are expenses and losses (including loss of income) incurred by the Participant on account of a disaster declared by the Federal Emergency Management Agency (FEMA) under the Robert T. Stafford Disaster Relief and Emergency Assistance Act, Pub. L. 100-707, provided that the Participant's principal residence or principal place of employment at the time of the disaster was located in an area designated by FEMA for individual assistance with respect to the disaster. 4.7 Document Provider. The Document Provider means the Sponsor of a Prototype Plan or VS Practitioner of a Volume Submitter Plan as defined in Rev. Proc. 2015-36, or the Provider of a Pre -approved Plan, as defined in Rev. Proc. 2017-41. References to the Document Provider's plans or to pre -approved plans refer to the Prototype Plans, Volume Submitter Plans, and/or Pre -approved Plans sponsored by the Document Provider for use by adopting employers, as the case may be. 4.8 Latest Effective Date. The "Latest Effective Date" is the latest of January 1, 2020, the Effective Date of the Plan, or the effective date of any amendment adding hardship distributions to the Plan. Except with respect to any election made by the employer in Article II, this Amendment is hereby adopted by the prototype sponsor/volume submitter practitioner on behalf of all adopting employers. Signature and date on file (signature and date) Sponsor/Practitioner Name: Empower Retirement, LLC NOTE: The Employer only needs to execute this Amendment if an election has been made in one or more of Sections 2.4 through 2.7, or the Employer has made a different selection from the Document Provider's selection in Sections 2.1 or 2.2. This Amendment has been executed this 7/11/2024 Name of Plan: 401(a) City of Clermont Defined Contribution Plan Name of Employer: City of Clermont DocuSigned by: B y Sty Un ex 431F57D413554D6"MP DYER day of 0 2020 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) AMENDMENT FOR CARES ACT ARTICLE 1 PREAMBLE; DEFINITIONS 1.1 Adoption of Amendment. The Document Provider, on behalf of the Employer, hereby adopts this Amendment to the Employer's Plan to implement provisions of the Act which affect the Plan. All references to the Plan include the Plan's loan program, policy, or procedure to the extent applicable. 1.2 Superseding of inconsistent provisions. This Amendment supersedes the provisions of the Plan to the extent those provisions are inconsistent with the provisions of this Amendment. 1.3 Construction. Except as otherwise provided in this Amendment, any Article or Section reference in this Amendment refers only to this Amendment and is not a reference to the Plan. The Article and Section numbering in this Amendment is solely for purposes of this Amendment and does not relate to the Plan article, section, or other numbering designations. 1.4 Effect of restatement of Plan. If the Employer restates the Plan then this Amendment shall remain in effect after such restatement unless the provisions in this Amendment are restated or otherwise become obsolete (e.g., if the Plan is restated onto a plan document which incorporates these provisions). 1.5 Definitions. Except as otherwise provided in this Amendment, terms defined in the Plan will have the same meaning in this Amendment. The following definitions apply specifically to this Amendment: A. The "Act" is the Coronavirus Aid, Relief, and Economic Security Act, also known as the CARES Act. This Amendment shall be interpreted and applied to comply with the Act. B. A "Qualified Individual" means any individual who meets one or more of the criteria described in paragraphs (1), (2), (3), or (4). Participants, alternate payees and beneficiaries of deceased participants can be treated as Qualified Individuals. The Plan Administrator may rely on an individual's certification that the individual satisfies a condition to be a Qualified Individual unless the Plan Administrator has actual knowledge to the contrary. In applying the criteria, "COVID-19" means either the virus SARS—CoV-2 or coronavirus disease 2019; "an approved test" means a test approved by the Centers for Disease Control and Prevention (including a test authorized under the Federal Food, Drug, and Cosmetic Act); and a "member of the individual's household" means someone who shares the individual's principal residence. The criteria are as follows: (1) The individual was diagnosed with COVID-19 by an approved test; (2) The individual's spouse or dependent (as defined in Code § 152) was diagnosed with COVID- 19 by an approved test; (3) The individual has experienced adverse financial consequences because: (a) the individual or the individual's spouse, or a member of the individual's household was quarantined, furloughed or laid off, or had work hours reduced due to COVID-19; (b) the individual, the individual's spouse, or a member of the individual's household was unable to work due to lack of childcare due to COVID-19; (c) A business owned or operated by the individual, the individual's spouse, or a member of the individual's household closed or reduced hours due to COVID-19; or (d) the individual, the individual's spouse, or a member of the individual's household had a reduction in pay (or self-employment income) due to COVID-19 or had a job offer rescinded or start date for a job delayed due to COVID-19; or (4) The individual satisfies any other criteria determined by the Treasury or the IRS. © 2021 FIS Business Systems LLC 100474-02 (effective June 26, 2024) Page 1 of 6 1.6 Adoption by Document Provider. The Document Provider hereby adopts this Amendment on behalf of all of the Document Provider's plans adopted by its adopting employers. The adoption by the Document Provider becomes applicable with respect to an Employer's Plan on March 27, 2020 (or, if later, the Effective Date of the Plan), unless the Employer individually adopts this Amendment, or an alternative amendment, prior to the expiration of the remedial amendment period relating to this Amendment. The Document Provider means the Sponsor of a Prototype Plan or Volume Submitter Practitioner of a Volume Submitter Plan as defined in Rev. Proc. 2013-22 or 2015-36, or the Provider of a Pre -approved Plan, as defined in Rev. Proc. 2017-41. References to the Document Provider's plans or to pre -approved plans refer to the Prototype Plans, Volume Submitter Plans, and/or Pre -approved Plans sponsored by the Document Provider for use by adopting employers, as the case may be, except as limited in Section 2.1. ARTICLE 2 IDENTIFYING INFORMATION; EMPLOYER ELECTIONS Instructions: The Document Provider should complete the elections at Sections 2.1 (if applicable), 2.3, and 2.4. If the Employer is satisfied with those choices, the Employer does not need to execute this Amendment. Otherwise, the Employer must complete the information at Section 2.2 and may complete one or more of Sections 2.3 through 2.5 to indicate the Employer's preferences. 2.1 Application to Document Provider plans: This Amendment will apply to all preapproved plans (including Prototype and Volume Submitter plans) of the Document Provider except the following: (Optional. List plan types, such as Defined Benefit Plans or 403(b) Plans, which the Document Provider does not wish to amend): 2.2 Employer identifying information. (Complete only if Employer is separately adopting this Amendment.) A. Name of Employer: City of Clermont B. Name of Plan: 401(a) City of Clermont Defined Contribution Plan C. Type of Plan (check one; optional) (1) [ ] 401(k) Plan (2) [ ] Profit -Sharing Plan (other than a 401(k) plan) (3) [ ] Money Purchase Pension Plan (4) [ ] Defined Benefit Plan (including a cash balance plan) (5) [ ] 403(b) Plan 2.3 Relief for Qualified Individuals. Will the Plan provide any or all of the following relief for Qualified Individuals: (1) Coronavirus-Related Distributions described in Article 3, (2) increased loan limits described in Section 4.2, (3) the loan repayment extension described in Section 4.3. (Select one of (a), (b), or (c). If (c) is selected, then select one or more of (d), (e), and/or (9) (a) [ ] No. The Plan will not provide any of these relief provisions. (b) [ ] Yes. The Plan will provide all of these relief provisions. The limitations on distributions described in Sections 2.3(d)(1) — (4) and the limitations on loans in Section 2.3(e)(1) — (3) and Section 2.3(f)(1) — (3) do not apply. (c) [X] Some. The Plan will provide those relief provisions selected in (d), (e), or (f) below. (d) [X] The Coronavirus-Related Distribution provisions described in Article 3 (If (d) is selected, the Employer or Document Provider may optionally select one or more of (1), (2), (3), or (4).) (1) [ ] Coronavirus-Related Distributions are not available from an account in which the Participant is not 100% vested. (2) [ ] Coronavirus-Related Distributions may be made only from the following accounts: (3) [ ] The maximum amount of Coronavirus-Related Distributions from the Plan to a Qualified Individual will not exceed: $ . (Enter amount less than $100, 000.) © 2021 FIS Business Systems LLC 100474-02 (effective June 26, 2024) Page 2 of 6 (4) [X] The following additional provisions apply to Coronavirus-Related Distributions: The provisions of Article 3 of this Amendment apply only to the extent a Coronavirus-Related Distribution has been made to a Qualified Individual. To the extent the Plan does not operationally apply the rules of Article 3 of this Amendment, it does not apply to the Plan. The Plan Administrator shall document through administrative procedures or otherwise the manner in which the Plan operationally pplied the rules under Article 3 of this Amendment. (Enter limitations or restrictions which are nondiscriminatory and not subject to Employer discretion) (e) [X] The increased loan limit described in Section 4.2 (If (e) is selected, the Employer or Document Provider may optionally select one or both of (1), (2), or (3).) (1) [ ] The maximum dollar amount of loans pursuant to Section 4.2 will not exceed: $ . (Enter amount less than $100, 000.) (2) [ ] The maximum percentage of the present value of the nonforfeitable accrued benefit that may be loaned pursuant to Section 4.2 will not exceed: %. (Enter percentage less than 100%.) (3) [X] The following additional provisions apply to the increased loan limit: The increased loan limits described in Section 4.2 of this Amendment apply only to the extent a loan has been made to a Qualified Individual in excess of the limits otherwise available under the Plan. To the extent the Plan does not operationally apply the increased loan limits described in Section 4.2 of this Amendment, it does not apply to the Plan. The Plan Administrator shall document through administrative procedures or otherwise the manner in which the Plan operationally pplied the increased loan limits described in Section 4.2 of this Amendment. (Enter limitations or restrictions which are nondiscriminatory) (f) [X] The loan repayment extension described in Section 4.3 (If 19 is selected, the Employer or Document Provider may optionally select one or more of (1), (2), or (3).) (1) [ ] The Suspension Period will begin (Enter date not before March 27, 2020) and end . (Enter date not later than December 31, 2020.) (2) [ ] The Extension Period will be . (Enter period, up to one year, the due date of the loan will be extended, such as "six months.') (3) [X] The following additional provisions apply to the loan repayment extension: The loan repayment extension described in Section 4.3 of this Amendment applies only to the extent the due date to repay a loan has been extended for a Qualified Individual. To the extent the Plan does not operationally extend the due date for loan repayment as described in Section 4.3 of this Amendment, it does not apply to the Plan. The Plan Administrator shall document through administrative procedures or otherwise the manner in which the Plan operationally extended the due date for loan repayment as described in Section 4.3 of this Amendment. (Enter limitations or restrictions which are nondiscriminatory) 2.4 RMD waivers for 2020. Unless otherwise elected below, the provisions of Section 5.2 apply and a Participant or Beneficiary who would have been required to receive a 2020 RMD or Extended 2020 RMD will receive the distribution unless the Participant or Beneficiary chooses not to receive the distribution. (a) [ ] No RMDs without request. The provisions of Section 5.2 apply and a Participant or Beneficiary who would have been required to receive a 2020 RMD or Extended 2020 RMD will not receive the distribution unless the Participant or Beneficiary chooses to receive the distribution. (b) [X] Split. The provisions of Section 5.2 apply. A Participant or Beneficiary who would have been required to receive a 2020 RMD will not receive the distribution unless the Participant or Beneficiary chooses to receive the distribution. A Participant or Beneficiary who would have been required to receive an Extended 2020 RMD will receive the distribution unless the Participant or Beneficiary chooses not to receive the distribution. (c) [ ] No change to RNIDs. Payment of RMDs or Extended 2020 RMDs will be governed by the terms of the Plan without regard to this Amendment (i.e., no election is available to Participants or Beneficiaries). (d) [ ] Describe: For purposes of Section 5.3, the Plan will also treat the following as eligible rollover distributions in 2020: (Choose one or none of (e), 19, (g), or (h): If no election is made, then a direct rollover will be offered only for distributions that would be eligible rollover distributions without regard to Code §401(a)(9)(1)): (e) [X] 2020 RMDs. © 2021 FIS Business Systems LLC 100474-02 (effective June 26, 2024) Page 3 of 6 (f) [ ] 2020 RMDs and Extended 2020 RMDs. (g) [ ] 2020 RMDs but only if paid with an additional amount that is an eligible rollover distribution without regard to Code §401(a)(9)(I). (h) [ ] Describe: The provisions of Article 5, and the elections in this Section 2.4, will be effective on the date specified in Section 2.5. unless a different date is entered here: (Optional. Enter a date between March 27, 2020 and December 31, 2020. RMD distributions before the selected effective date should have followed plan terms in effect before this Amendment.) 2.5 Effective Date. This Amendment is effective March 27, 2020 (or as soon as practical thereafter), or, if later, the following date: (Optional. Enter a date not later than December 31, 2020.) ARTICLE 3 CORONAVIRUS-RELATED DISTRIBUTIONS 3.1 Application. This Article 3 will apply if Section 2.3(b) or Section 2.3(d) is selected. 3.2 Coronavirus-Related Distribution(s). Subject to the provisions described in Section 2.3(d)(4), if any, a Qualified Individual may take one or more Coronavirus-Related Distributions. The accounts from which the amount may be distributed shall be limited if selected in Sections 2.3(d)(1) and (2). However, if the Plan is a Defined Benefit Plan, and the Qualified Individual has not separated from service, the Qualified Individual may not take a Coronavirus-Related Distribution prior to attaining the earlier of Normal Retirement Age or age 59'/2. The provisions of this Section will apply notwithstanding any limitation in the Plan on partial distributions or any otherwise applicable plan or administrative limits on the number of allowable distributions. 3.3 Repayment of distribution. If the Plan permits a Participant to make rollover contributions, then a such a Participant who received a Coronavirus-Related Distribution (from this Plan and/or another eligible retirement plan as defined in Code §402(c)(8)(13)), at any time during the 3-year period beginning on the day after receipt of the distribution, may make one or more contributions to the Plan, as rollover contributions, in an aggregate amount not to exceed the amount of such distribution. 3.4 Definition of Coronavirus-Related Distribution. A "Coronavirus-Related Distribution" means a distribution to a Qualified Individual during the period beginning January 1, 2020 and ending December 30, 2020. The total amount of Coronavirus-Related Distributions to a Qualified Individual pursuant to this Amendment from all plans maintained by the Employer, or any related employer described in Code §414(b), (c), (m), or (o), shall not exceed $100,000, (or such lesser amount specified in Section 2.3(d)(3)). The Coronavirus-Related Distributions from the Plan to a Qualified Individual will not exceed the amount of the individual's vested account balance or the present value of the individual's vested accrued benefit. ARTICLE 4 PARTICIPANT LOAN RELIEF 4.1 Application. This Article 4 will apply only if the Plan permits participant loans. Section 4.2 will apply if Section 2.3(b) or Section 2.3(e) is selected. Section 4.3 will apply if Section 2.3(b) or Section 2.3(f) is selected. 4.2 Increased loan limit. Notwithstanding the loan limitation that otherwise would apply, the Plan will determine the loan limit under Code §72(p)(2)(A) for a loan to a Qualified Individual, made during the period beginning March 27, 2020 and ending September 22, 2020, by substituting "$100,000" (or such lesser amount specified in Section 2.3(e)(1)) for "$50,000," and by substituting "100% (or such lesser percentage specified in Section 2.3(e)(2)) of the present value of the nonforfeitable accrued benefit of the © 2021 FIS Business Systems LLC 100474-02 (effective June 26, 2024) Page 4 of 6 employee under the Plan" for "one-half of the present value of the nonforfeitable accrued benefit of the employee under the Plan" (or its equivalent). The provisions described in Section 2.3(e)(3), if any, will apply in connection with loans to Qualified Individuals. 4.3 Extension of certain repayments. If a Qualified Individual has an outstanding loan from the Plan on or after March 27, 2020, then: (1) if the date for any repayment of such loan occurs during the Suspension Period, the due date is extended for the Extension Period; (2) the due date of the loan will be extended by the Extension Period; (3) the Plan will adjust any subsequent repayments to reflect the extension of the due date and any interest accrued during the Suspension Period; and (4) the Plan will disregard the Extension Period in determining the 5-year period and the loan term under Code §72(p)(2)(B) or (C). The provisions described in Section 2.3(f)(3), if any, will apply in connection with the suspension and extension described in this Section. The Suspension Period, unless otherwise specified in Section 2.3(f)(1), will begin March 27, 2020 and end December 31, 2020. The Extension Period, unless otherwise specified in Section 2.3(f)(2) will be one year. The provisions of this Section 4.3 will be applied in accordance with Section S.B. of Notice 2020-50, or any subsequent applicable guidance, and the adjustment described in (3) may reflect the "safe harbor" described therein. ARTICLE 5 WAIVER OF 2020 REQUIRED MINIMUM DISTRIBUTIONS (RMDs) 5.1 Application. This Article 5 will apply only to defined contribution plans, including 401(k) Plans, Profit - Sharing Plans, Money Purchase Pension Plans, and 403(b) Plans. The definitions in Section 5.4 will apply in interpreting Section 2.4. 5.2 Waiver; default provision. This Section 5.2 will apply unless Section 2.4(c) is selected or to the extent 2.4(d) overrides it. Notwithstanding the provisions of the Plan relating to RMDs, whether a Participant or Beneficiary who would have been required to receive 2020 RMDs, and who would have satisfied that requirement by receiving distributions that are (1) equal to the 2020 RMDs, or (2) Extended 2020 RMDs will receive those distributions is determined in accordance with the option chosen in Section 2.4. Notwithstanding the option chosen in Section 2.4, a Participant or Beneficiary will be given an opportunity to make an election as to whether or not to receive those distributions. If the Plan permits a Beneficiary of a deceased Participant to make the election to use the 5-year rule or the life expectancy rule, the deadline to make the election may be extended to reflect the adoption of Code §401(a)(9)(I). 5.3 Direct rollovers. Notwithstanding the provisions of the Plan relating to required minimum distributions under Code §401(a)(9), and solely for purposes of applying the direct rollover provisions of the Plan, certain additional distributions in 2020, as elected by the Employer in Section 2.4, will be treated as eligible rollover distributions. If no election is made by the Employer in Section 2.4, then a direct rollover will be offered only for distributions that would be eligible rollover distributions without regard to Code §401(a)(9)(I). 5.4 Definitions. "RMDs" means required minimum distributions described in Code §401(a)(9). "2020 RMDs" means required minimum distributions the Plan would have been required to distribute in 2020 (or permitted to pay in 2021 for the 2020 calendar year for a Participant with a required beginning date of April 1, 2021) but for the enactment of Code §401(a)(9)(I). "Extended 2020 RMDs" means one or more payments in a series of substantially equal distributions (that include the 2020 RMDs) made at least annually and expected to last for the life (or life expectancy) of the Participant, the joint lives (or joint life expectancy) of the Participant and the Participant's designated Beneficiary, or for a period of at least 10 years. 5.5 Installment payments. A Participant or Beneficiary receiving payment of 2020 RMDs or 2020 Extended RMDs pursuant to this Article 5 may receive them in any method (including installments or partial distributions) which would have been permitted under the terms of the Plan if the amounts would have been RMDs but for the enactment of Code §401(a)(9)(I). © 2021 FIS Business Systems LLC 100474-02 (effective June 26, 2024) Page 5 of 6 Document Provider Name: Empower Retirement, LLC The Document Provider executed this Amendment on January 19, 2023. By: Signature on file (Authorized signer for Document Provider) Employ: The Employer executed this Amendment on 7/11/2024 D�ocu,S{iggne"dby: `enter date) By. a"Ax'b 431 F57D413MWhorized Signer for Employer) © 2021 FIS Business Systems LLC 100474-02 (effective June 26, 2024) Page 6 of 6 AMENDMENT TO IMPLEMENT SECURE ACT AND OTHER LAW CHANGES 401(A) CITY OF CLERMONT DEFINED CONTRIBUTION PLAN ARTICLE 1 PREAMBLE 1.1 Adoption and effective date of Amendment. The Document Provider, on behalf of the Employer, hereby adopts this Amendment to the Employer's Plan. Each Article specifies the effective date of its provisions. Also see Section 1.5. 1.2 Superseding of inconsistent provisions. This Amendment supersedes the provisions of the Plan to the extent those provisions are inconsistent with the provisions of this Amendment. Except as otherwise provided in this Amendment, terms defined in the Plan will have the same meaning in this Amendment. Most Articles include definitions which are specific to that Article. Also see Section 1.6. 1.3 Numbering. Except as otherwise provided in this Amendment, any "Section" reference in this Amendment refers only to this Amendment and is not a reference to the Plan. The Article and Section numbering in this Amendment is solely for purposes of this Amendment, and does not relate to the Plan article, section, or other numbering designations. 1.4 Intention; Construction. The purpose of this amendment is to amend the Plan in accordance with pension -related provisions of the Further Consolidated Appropriations Act of 2019 ("FCAA") in general, and Division O of that Act, the Setting Every Community Up for Retirement Enhancement Act of 2019 ("SECURE"), in specific. It also addresses a provision of the Bipartisan American Miners Act ("BAMA"), which is also part of FCAA, as well as a section of the Coronavirus Aid, Relief, and Economic Security Act ("CARES"). The provisions of this Amendment shall be interpreted and applied to be consistent with FCAA and CARES and IRS guidance issued in connection therewith, whether such guidance is issued before or after the date of this amendment. 1.5 Effect of subsequent restatement or amendment of Plan. If the Employer restates the Plan, then this Amendment shall remain in effect after such restatement unless the provisions in this Amendment are restated or otherwise become obsolete (e.g., if the Plan is restated onto a plan document which incorporates these provisions). Some Articles in this amendment may not apply to a particular plan at the time the Amendment is executed but they will apply in the future based on subsequent amendments. 1.6 Preservation of prior amendments. If the Employer previously amended the Plan after December 20, 2019 to implement a provision contained in one or more Articles of this Amendment, that prior amendment shall remain in effect and will not be superseded by this Amendment, unless Section 1.6(a) is selected. For example, if the Employer previously adopted an amendment to implement the BAMA provisions of Article 10, that amendment remains in effect, notwithstanding the provisions of this Amendment, unless Section 1.6(a) is selected. (a) [ ] This amendment supersedes all prior inconsistent amendments of the Plan. 1.7 Adoption by Document Provider. The Document Provider hereby adopts this Amendment on behalf of all of the Document Provider's plans adopted by its adopting employers. The adoption by the Document Provider becomes applicable with respect to an Employer's Plan on the Effective Date (or, if later, the Effective Date of the Plan), unless the Employer individually adopts this Amendment, or an alternative amendment, prior to the expiration of the remedial amendment period relating to this Amendment. ARTICLE 2 INSTRUCTIONS; ELECTIONS 2.1 Instructions. Select 2.3a if all defaults are accepted at Provider level. Select 2.3b and as applicable 2.4 - 2.10 if the Document Provider wishes to select other than the default for a particular provision. If no changes are made by the Employer, the Employer does not need to sign. However, if the Employer wishes to make a change from the Provider's defaults, they may make selections below and the Employer must then execute the amendment. 2.2 Plan Type Definitions. "Qualified Plan" means a Profit -Sharing Plan or Money Purchase Pension Plan. 2.3 Operating Elections. Many subsequent Articles of this Amendment refer to elections appearing in this Article 2. Each of Sections 2.4 through 2.10 refers to a corresponding Article. For example, Section 2.4 has the elections related to Article 4. The definitions in those Articles apply to the elections in the corresponding Section of this Article 2, and those elections have the same effective date as the corresponding Article. Each Section of this Article lists the default provisions which will apply if no election is made. If you accept the default(s), there is no need to complete the Section. There are no elective provisions which apply to Article 3 or Articles 11 through 14. The following are the defaults and a summary of the Articles for which there are no elections. • Article 3. Reserved. • Article 4. QBADs are not permitted. • Article 5. Distributions of RMDs will not begin before a Participant turns 72. • Article 6. The Plan will apply its RMD provisions with respect to the 5-year rule in administering the 10-year rule. 0 2022 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) • Article 7. RMDs subject to 5-Year Rule for participants who died from 2015 through 2019 are extended one year unless the beneficiary objects. • Article 8. Reserved. • Article 9. Reserved. • Article 10. The amendment does not modify the minimum age for in-service distributions. • Article 11. Administrative policy can permit distributions of Discontinued Lifetime Income Investments. • Article 12. Updated RMD tables and 2022 transition. • Article 13. Permits retroactive plan adoption. • Article 14. Difficulty of care payments are compensation for purposes of Code §415 only. Check (a) or (b). (a) [X] All defaults apply. Skip the rest of Article 2 and sign the amendment. (b) [ ] One or more defaults do not apply. Complete those sections in Article 2 for which you do not accept the default; then sign the amendment. 2.4 Article 4 — Birth/Adoption Distributions. In the absence of an election below, Article 4 does NOT apply. To permit QBADs (Qualified Birth and Adoption Distributions), check (a). If QBADs are available, they apply to all accounts except as provided in Article 4 or in elections (b), (c), (d), or (e). (Select all that apply) (a) (b) (c) (1) (1) (2) (3) (4) Article 4 applies effective January 1, 2020, unless a different date is selected in (1) below. [ ] . (Enter date after December 31, 2019.) QBADs may only be made from accounts in which the Participant is fully vested. QBADs are only available from the following Accounts (select one or more): [ ] Employer matching contributions [ ] Employer contributions other than matching [ ] Rollover contributions [ ] Transferred accounts Permitted from the following assets attributable to (select one or both): a. [ ] non -pension assets b. [ ] pension assets (e.g., from a Money Purchase Pension Plan) [ ] Mandatory Employee Contributions [ ] Describe: (must be definitely determinable and not subject to discretion) QBADs are not available if the Participant has severed employment. Describe additional limitations: (must be definitely determinable and not subject to discretion) 2.5 Article 5 — RMD Timing. Unless Section 2.5(a) is selected, distribution of RMDs will begin for Affected Participants no sooner than April 1 of the calendar year following the year the Participant attains age 72. (a) [ ] Distribution of RMDs to Affected Participants will NOT be delayed on account of this Amendment (i.e., distributions will generally commence no later than April 1 of the calendar year following the year the Affected Participant attains age 70'h), in accordance with Section 5.5. This election is effective for distributions after December 31, 2019, except as specified below (Optional: select either or both of (1) or (2)): (1) [ ] Section 5.5 is effective for distributions after and prior to the earlier of January 1, 2022 or the date entered in 2.5(a)(2). (Enter date on or after December 31, 2019) (2) [ ] Section 5.5 is repealed for distributions after (enter date on or after the date entered in 2.5(a)(1) and before January 1, 2022), subject to the anti -cutback rule of Code §411(d)(6) to the extent applicable. 2.6 Article 6 — 10-Year Rule for Beneficiary RMDs. RMDs to an Eligible Designated Beneficiary of a Participant who dies prior to the Participant's RBD will be made as elected below. hi the absence of an election in Section 2.6, the Plan's provisions about Beneficiary elections with regard to the 5-Year Rule will apply, substituting the 10-Year Rule for the 5-Year Rule. (a) [ ] Beneficiary election. The Eligible Designated Beneficiary may elect application of the 10-Year Rule or the Life Expectancy rule. If the Beneficiary does not make a timely election (Select one of (1) or (2)): (1) [ ] 10-year rule. The 10-year rule applies to the Eligible Designated Beneficiary. (2) [ ] Life Expectancy Rule. The Life Expectancy rule applies to the Eligible Designated Beneficiary. (b) [ ] 10-year rule. The 10-year rule applies to the Eligible Designated Beneficiary. (c) [ ] Life Expectancy rule. The Life Expectancy rule applies to the Eligible Designated Beneficiary. (d) [ ] Shorter Period. The entire interest of the Eligible Designated Beneficiary will be distributed no later than December 31, (enter a number of years, not exceeding "10') year(s) following the year of the Participant's death. (e) [ ] Other: (Describe, e.g., the 10-Year Rule applies to all Beneficiaries other than a surviving spouse Beneficiary.) 0 2022 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) 2.7 Article 7 — CARES RMD Waivers; 5-Year Rule. Unless the Employer elects otherwise below, beneficiaries of Applicable Participant Accounts will have the option to extend distribution under the 5-Year Rule by one year, and in the absence of a beneficiary election the extension will apply. (a) [ ] No extension without request. The provisions of Section 7.2 apply but in the absence of a beneficiary election the extension will NOT apply. (b) [ ] Not Apply. Article 7 will NOT apply to this Plan. 2.8 Article 8 — Reserved. 2.9 Article 9 — Reserved. 2.10 Article 10 — In -Service Distributions. In the absence of an election below, Article 10 does NOT apply. To permit in-service distributions at age 59'/2 for pension plans, check (a). Check (b) to specify an age greater than 59%. If Article 10 applies, it applies to all Accounts except as limited in Article 10. (a) [ ] Article 10 applies effective on or after the first day of the first plan year beginning after December 31, 2019, unless a different date is selected in (1) below. (1) [ ] . (Enter date on or after the first day of the first plan year beginning after December 31, 2019.) (b) [ ] Age at which in-service distributions are permitted (Enter age greater than 59%.) This provision applies effective on or after the first day of the first plan year beginning after December 31, 2019, unless a different date is selected in (1) below. (1) [ ] . (Enter date on or after the first day of the first plan year beginning after December 31, 2019.) ARTICLE 3 RESERVED ARTICLE 4 BIRTH/ADOPTION DISTRIBUTIONS — SECURE Act §113 4.1 Application. This Article 4 will apply only if the Employer elects in Section 2.4(a) for this Article 4 to apply, effective on the date specified in Section 2.4(a). 4.2 Distribution Authorized. Except as limited by Section 2.4 (b), (c), (e), a Participant may request a distribution of up to $5,000 (per child or Eligible Adoptee) as a QBAD. The Participant may request the distribution whether or not the Participant has severed employment unless Section 2.4(d) is selected. This $5,000 limit shall be reduced by QBADs to the Participant made with respect to the same child or Eligible Adoptee by other plans maintained by the Employer or a related employer described in Code §414(b), (c), (m), or (o). However, if the Plan is a Money Purchase Pension Plan (or the account from which the distribution is withdrawn was transferred from a Money Purchase Pension Plan), and the Participant has not separated from service, the Participant may not take a QBAD prior to attaining the earlier of Normal Retirement Age or age 59'/z. The Plan Administrator may adopt a policy imposing frequency limitations or other reasonable administrative conditions for QBADs. 4.3 Definitions. The following definitions apply for this Article 4 and Section 2.4: (a) A "QBAD" is a Qualified Birth or Adoption Distribution described in Code §72(t)(2)(H)(iii). A QBAD must be made during the 1-year period beginning on the date on which a child of the Participant is born or on which the legal adoption of an Eligible Adoptee by the Participant is finalized. (b) An "Eligible Adoptee" is an individual, other than a child of the Participant's spouse, who has not attained age 18 or is physically or mentally incapable of self-support. An individual is considered physically or mentally incapable of self-support if that individual is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment that can be expected to result in death or to be of long -continued and indefinite duration. This provision shall be applied in a manner consistent with Part D of IRS Notice 2020-68. 4.4 Rollover. A Participant who received one or more QBADs from this Plan may, if the Plan then permits the Participant to make rollover contributions, make one or more contributions in an aggregate amount not to exceed the amount of such QBADs. The Plan will treat such a contribution as a rollover contribution made by direct trustee -to -trustee transfer within 60 days of distribution. 4.5 Reliance. The Plan Administrator may rely on an individual's reasonable representation that the individual is eligible to receive a QBAD unless the Plan Administrator has actual knowledge to the contrary. 4.6 Status. A QBAD is not an eligible rollover distribution for purpose of the obligation to permit a direct rollover under Code §401(a)(31), the notice requirement of Code §402(f), or the mandatory withholding rules of Code §3405(c)(1). 0 2022 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) ARTICLE 5 REQUIRED BEGINNING DATE — SECURE Act §114 5.1 Application. This Article 5 will apply to all plans, regardless of type. It is effective with regard to RMDs required to be made after December 31, 2019. 5.2 Delay of Required Beginning Date. An Affected Participant's RBD shall not be earlier than April 1 of the calendar year following the year the Affected Participant attains age 72. For purposes of determining an Affected Participant's RBD, an Affected Participant will be treated as a more than 5% owner if the Participant was a 5-percent owner (as defined in Code §416(i)(1)(B)) as to the Plan Year ending in the calendar year the Participant attains age 72. 5.3 Spousal Distributions. If an Affected Participant dies prior to the Participant's RBD, and the Participant's sole Designated Beneficiary is the Participant's surviving spouse, then the RMDs to the surviving spouse will begin by December 31 of the calendar year immediately following the calendar year in which the Participant died, or by December 31 of the calendar year in which the Participant would have attained age 72, if later. However, this Section will apply only if the Plan, prior to this Amendment, permitted a surviving spouse to delay RMD distributions to December 31 of the calendar year in which the Participant would have attained age 70'/z. 5.4 Definitions. The following definitions apply for this Article 5 and Section 2.5: (a) A Participant is an "Affected Participant" if the Participant was born after June 30, 1949. (b) An "RMD" is a Required Minimum Distribution as described in Code §401(a)(9). (c) A Participant's "RBD" is the Participant's Required Beginning Date as described in Code §401(a)(9)(C), as amplified by Section 5.2. 5.5 Optional Distribution Timing. If the Employer elects in Section 2.5(a) for this Section 5.5 to apply, the timing and form of distributions to an Affected Participant will be determined as though this Article 5 had not been adopted. Distributions pursuant to this paragraph, which are not RMDs, will be treated as eligible rollover distributions for purposes of the direct rollover provisions of Code §401(a)(31). This Section 5.5 will no longer be effective for distributions after December 31, 2021, or, if earlier, the date specified in Section 2.5(a)(2). ARTICLE 6 BENEFICIARY RMDS — SECURE Act §401 6.1 Application. This Article 6 will apply to all plans. This Article will not apply to qualified annuities described in SECURE Act §401(b)(4)(B). 6.2 Effective Date. Except as provided in Section 6.4, Article 6 will apply to Participants who die on or after the Effective Date of this Article. Generally, the Effective Date of this Article is January 1, 2022. The Effective Date of this Article 6 in the case of a collectively -bargained plan will be the date determined in SECURE Act §401(b)(2). See Section 6.5 regarding the limited application of this Article to certain accounts of Participants who died before the Effective Date of this Article. 6.3 Death before RBD. If the Participant dies before the Participant's RBD, the Plan will distribute or commence distribution of the Participant's Vested Accrued Benefit not later than as follows: (a) No Designated Beneficiary. If there is no Designated Beneficiary as of September 30 of the year following the calendar year of the Participant's death, the Beneficiary's entire interest will be distributed under the 5-Year Rule. (b) Eligible Designated Beneficiary. If the distributee of a Participant's account is an Eligible Designated Beneficiary, the Beneficiary's entire interest will be distributed under the Life Expectancy Rule unless the 10-Year Rule applies. The Employer may elect application of the Life Expectancy rule or the 10-Year Rule in Section 2.6. In the absence of an election in Section 2.6, the Plan's provisions with regard to election of the 5-Year Rule will apply, substituting the 10-Year Rule for the 5-Year Rule. A permitted Beneficiary election must be made no later than the earlier of December 31 of the calendar year in which distribution would be required to begin under the Life Expectancy Rule, or by December 31 of the calendar year which contains the tenth anniversary of the Participant's (or, if applicable, surviving spouse's) death. (c) Other Designated Beneficiaries. If the distributee of the Participant's account is a Designated Beneficiary who is not an Eligible Designated Beneficiary, then the Beneficiary's entire interest will be distributed under the 10-Year Rule. (d) 10-Year Rule. If distribution of a deceased Participant's account thereof is subject to the "10-Year Rule," then the Plan will distribute the account in full no later than December 31 of the tenth year following the year of the Participant's death. No RMDs are required to be distributed from the account prior to that date. 6.4 Death after RBD. If the Participant dies on or after the Participant's RBD, the Participant's remaining interest will be distributed at least as rapidly as under the method of distribution being used as of the date of the participant's death, using the Life Expectancy 0 2022 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Rule, as, and to the extent, provided by applicable guidance. If the Beneficiary is a Designated Beneficiary that is not an Eligible Designated Beneficiary, the Plan will distribute the remaining account in full no later than December 31 of the tenth year following the year of the Participant's death. 6.5 Beneficiary Death. If an Eligible Designated Beneficiary receiving distributions under the Life Expectancy Rule dies before receiving distribution of the Beneficiary's entire interest in the Participant's account, the Plan will distribute that interest in full no later than December 31 of the 10't' year following the year of the Eligible Designated Beneficiary's death. Similarly, if a Participant died before the Effective Date of this Article 6, and the beneficiary died after such Effective Date, but prior to receiving full distribution of the beneficiary's interest, the Plan will distribute that interest in full no later than December 31 of the tenth year following the year of the beneficiary's death. 6.6 Age of Majority. If a child of the Participant was receiving distributions under the Life Expectancy rule, when the child reaches the age of Majority, the Plan will distribute the child's account in full no later than 10 years after that date, provided the child is not otherwise an Eligible Designated Beneficiary, such as a disabled or chronically ill individual. 6.7 Definitions; operating rules. The following definitions and operating rules apply for this Article 6 and Section 2.6: (a) An "RMD" is a Required Minimum Distribution as described in Code §401(a)(9). (b) A Participant's "RBD" is the Participant's Required Beginning Date as described in Code §401(a)(9)(C) and the Plan. Also see Section 5.2. (c) A distributee of a Participant's account is a "Designated Beneficiary" if the distributee is an individual or trust who is a beneficiary of the account (whether pursuant to a designation by the Participant or application of the Plan terms) and who is a designated beneficiary under Code §401(a)(9) and Treas. Reg. § 1.40 1 (a)(9)-4, Q&As-4 and -5. (d) An individual is an "Eligible Designated Beneficiary" of a Participant if the individual qualifies as a Designated Beneficiary and is (1) the Participant's spouse, (2) the Participant's child who has not reached the age of Majority, (3) an individual not more than 10 years younger than the Participant, (4) a disabled individual, as defined in Code §72(m)(7), or (5) an individual who has been certified to be chronically ill (as defined in Code §7702B(c)(2)) for a reasonably lengthy period, or indefinitely. Certain trusts may be treated as Eligible Designated Beneficiaries pursuant to Code §40 1 (a)(9)(H)(iv) and (v). (e) Whether a child has reached the age of "Majority" is determined under Code §401(a)(9)(F) and applicable regulations and guidance issued thereunder. (f) The "Life Expectancy Rule" for distributing RMDs is described in Code §401(a)(9)(13)(iii) and is further described in the Plan. (g) The "5-Year Rule" for distributing RMDs is described in Code §401(a)(9)(B)(ii) and is further described in the Plan. (h) The "10-Year Rule" is described in Section 6.3(d). (i) Shorter period. Section 2.6(e) may specify a shorter period to be used in place of the tenth year after the death of a Participant or Beneficiary. (j) Separate share rule. All references in this Article to a Participant's Account and a Beneficiary's interest in that account will be applied separately to each separate account determined under Treas. Reg. § 1.401(a)(9)-8, Q&A 2 and 3, and Code §401(a)(9)(H)(iv). ARTICLE 7 EXTENSION OF 5-YEAR RULE FOR RMDS — CARES §2203 7.1 Application. This Article 7 does not apply if the Employer has selected Section 2.7(b); otherwise, it is effective January 1, 2020. 7.2 Waiver; default provision. The beneficiary of an Applicable Participant Account will have the option to extend the deadline to distribute the account for one year. The default in the absence of a beneficiary election will be to extend the distribution, unless the Employer elects in Section 2.7(a) for the default to be not to extend unless the beneficiary requests it. 7.3 Definitions. The following definitions apply for this Article 7 and Section 2.7: (a) "RMDs" means required minimum distributions described in Code §401(a)(9). (b) The "5-Year Rule" for distributing RMDs is described in Code §401(a)(9)(B)(ii) and is further described in the Plan. (c) "Applicable Participant Account" means the remaining account of a Participant who died during the years 2015-2019, to the extent the account is subject to the 5-Year Rule. 0 2022 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) ARTICLE 8 RESERVED ARTICLE 9 RESERVED ARTICLE 10 IN-SERVICE PENSION DISTRIBUTIONS — BAMA §104 10.1 Application. This Article 10 will apply only if the Plan is a Money Purchase Pension Plan or, as described in Section 10.3, a Profit - Sharing Plan, and the Employer elects in Section 2.10 for this Article 10 to apply, effective on the date specified in Section 2.10(a). 10.2 Distribution at 59%. A Participant can take an in-service distribution at age 59'h, or, if later, the age (if any) specified in Section 2.10(b). Such a distribution will be limited to the vested portion of the Participant's accrued benefit or account and will be subject to all Plan provisions related to in-service distributions. 10.3 Limited application to Profit -Sharing Plans. If the Employer elects in Section 2.10 for this Article 10 to apply, this Article 10 will apply to an account in a Profit -Sharing Plan which holds assets transferred from a Money Purchase Pension Plan or a Defined Benefit Plan. ARTICLE 11 DISTRIBUTIONS OF DISCONTINUED LIFETIME INCOME INVESTMENTS — SECURE §109 11.1 Application. This Article 11 is effective for Plan Years beginning after December 31, 2019. 11.2 Distributions authorized. The Plan Administrator may authorize Participants to request, and as soon as practical after a Participant makes a request the Plan will make, a distribution of a Discontinued Lifetime Income Investment. Distribution under this Article is limited to the 90-day period prior to the date on which the Lifetime Income Investment is no longer authorized to be held as an investment option under the Plan. Such distribution will be in the form of a Qualified Distribution, or in the form of a Qualified Plan Distribution Annuity Contract, as determined by the Plan Administrator. The Plan Administrator will administer this section in a reasonable, nondiscriminatory manner, and may authorize distributions of some Discontinued Lifetime Income Investments and not others. 11.3 Definitions. The terms "Lifetime Income Investment," "Qualified Distribution" and "Qualified Plan Distribution Annuity Contract" have the meanings set forth in Code §401(a)(38)(B). A "Discontinued Lifetime Income Investment" is a Lifetime Income Investment which will no longer be authorized to be held as an investment option under the Plan. ARTICLE 12 UPDATED LIFE EXPECTANCY TABLES — TREAS. REG. §1.401(a)(9)-9 12.1 Application. This Article 12 will apply to all plans and is effective for distribution calendar years beginning on or after January 1, 2022. 12.2 New RMD Tables. Any Plan reference to the life expectancy tables detailed in Treas. Reg. § 1.401(a)(9), such as the Uniform Life Table, the Single Life Table, or the Joint and Last Survivor Table, refers to these tables as published in Treas. Reg. § 1.401(a)(9)-9 from time to time, and is subject to adjustment as described in Treas. Reg. § 1.401 (a)(9)-9(f). ARTICLE 13 ADOPTION OF PLAN AFTER YEAR END — SECURE §201 13.1 Application. This Article 13 is effective for Plan Years beginning after December 31, 2019. 13.2 Retroactive Plan Adoption. If the Employer adopted the underlying Plan to which this Amendment relates after the close of a taxable year, but prior to the due date (including extensions) of the Employer's federal income tax return for that taxable year, the Plan is treated as having been adopted as of the last day of the taxable year if the Plan's initial effective date is any date within that taxable year. However, no Participant may make elective deferrals to the Plan prior to the date it was adopted. ARTICLE 14 DIFFICULTY OF CARE PAYMENTS — SECURE §116 14.1 Application. This Article 14 is effective for Plan Years beginning after December 31, 2015. 14.2 Inclusion in 415 Compensation. The amount of a Participant's Compensation for purposes of determining the annual addition limit under Code §415(c)(1)(B) is increased by the amount of Difficulty of Care Payments the Employer makes to the Participant. 14.3 Definition. A "Difficulty of Care Payment" is a payment described in Code §131(c)(1) made in connection with qualified foster individuals. 0 2022 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024) Except with respect to any election made by the employer in Article 2, this Amendment is hereby adopted by the prototype sponsor/volume submitter practitioner on behalf of all adopting employers. Signature and date on file (signature and date) Sponsor/Practitioner Name: Empower Retirement, LLC NOTE: The Employer only needs to execute this Amendment if the Employer has made different selections from the Document Provider's selections. This Amendment has been executed this 7/11/2024 day of Name of Plan: 401 (a) City of Clermont Defined Contribution Plan Name of Employer: City of Clermont Docu igned by: By: S 431F57D413554D6... EMPLOYER © 2022 Empower Retirement, LLC or its suppliers 100474-02 (effective June 26, 2024)