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Home My Public Portal AboutC-92-003 - Public Agency Retirement System (PARS), Retirement PlanRe: PARS Implementation Packet Dear PARS Administrator; This is to confirm your agency's interest in the Public Agency Retirement System (PARS) and to provide you with the documents and information necessary for the next steps of implementation. The checklist below shows what is needed to implement PARS. We require all outstanding fees and documents before we can begin to process your file. FEFS All PARS lees may be paid by a single check made out to Imperial Trust Co -PARS Account Received Not Yet Received (send as_soon „as possible), ❑ 0 $750 PARS Implementation Fee ❑ 0 $825 IRS application fee ($700 if fewer than 100 participants) ❑ 0 $1,000 Initial Hartford Deposit (credited to Employer Contributions) DOCUMENTS Received Not Yet Received (copy or sam le enclosed- send as soon as ssible ❑ F_x� A Signed PARS Engagement Letter ❑ P Public A Agency R Retirement S System Re: PARS Implementation Packet Dear PARS Administrator; This is to confirm your agency's interest in the Public Agency Retirement System (PARS) and to provide you with the documents and information necessary for the next steps of implementation. The checklist below shows what is needed to implement PARS. We require all outstanding fees and documents before we can begin to process your file. FEFS All PARS lees may be paid by a single check made out to Imperial Trust Co -PARS Account Received Not Yet Received (send as_soon „as possible), ❑ 0 $750 PARS Implementation Fee ❑ 0 $825 IRS application fee ($700 if fewer than 100 participants) ❑ 0 $1,000 Initial Hartford Deposit (credited to Employer Contributions) DOCUMENTS Received Not Yet Received (copy or sam le enclosed- send as soon as ssible ❑ F_x� A Signed PARS Engagement Letter ❑ Q A Signed Hartford Application ❑ A Completed and Signed PARS Adoption Agreement ❑ 0 A Completed IRS Data Form ❑ 0 A Signed Resolution from your governing board adopting PARS for your agency Q A Completed and Signed IRS 2848 Power of Attorney Form appointing the firm of Grant Thornton to represent your agency and File your application for an IRS Determination Letter in order to implement the plan in a timely manner, we will need to receive all PARS fees and documents at the address below as soon as possible. As questions arise now or in the future, please do not hesitate to call us. If you are outside the (714) area, please use the toll—free number listed below. We look forward to working with you. Cordially, Karen Zfaty, M.B.A. Director, Marketing Services 350 E. 171h St_. Suire 212 Cosa Mcsa. CA 92627 (714) 631.6369 (800) 540-6369 fax (714) 631-2063 taralparslimp Subject: Engagement Lester for Adaption of the Public Agency Rctirerneat System (PARS) Phase H Systems is prepared to implement PARS which is intended to be an alternative to mandatory Social Security coverage effective 1/1/92 for public agency employees not eligible for a current public agency pension plan. Phase II will be available for ongoing consultations with staff and governing body representatives concerning mandatory Social Security coverage and related matters. The Implementation Fee, payable to Imperial Trust Company - PARS Account, will be $1,575: $825 ($700 if fewer than 100 participants) is a non-refundable fee for a Letter of Determination from the IRS (to establish IRS approval of the tax status of your plan), payable upon the return of this signed Engagement Letter, and $750 is payable upon adoption of PARS by the governing body. This Implementation Fee is specifically for those services described in this letter. If the terms expressed in this letter are in accordance with your understanding of this engagement, sign this Ietter and return it to Phase H. Sincerely, PHASE U SYSTEMS 350 E. 17th St., Suite 212 Costa Mesa, CA 92627 The foregoing letter fully describes the services desired. Autho ' by: n (� City of Carson signatilm Public Agency Lawrence G. Olson City Administrator Name - i or Type t ,TWO i __... 12/12/91 Date 701 E. Carson Street Address Carson, CA 90745 sty, state Phan R Sydems it not lieamsed to provide and doom nit offer W. accounting or legal advice. The public ageoq is urged to coasuh with appropriate pnXcasionala regarding the tax, accounting aad kgal 6nPucations of adopting a PARS Pension Pun 350 E. 17th St., Suite 212, Cortes Mea, CA 92627 (114) 631-6369 (SM 540-6369 fax (114) 631-2063 R S Public Agency retirement System Subject: Engagement Lester for Adaption of the Public Agency Rctirerneat System (PARS) Phase H Systems is prepared to implement PARS which is intended to be an alternative to mandatory Social Security coverage effective 1/1/92 for public agency employees not eligible for a current public agency pension plan. Phase II will be available for ongoing consultations with staff and governing body representatives concerning mandatory Social Security coverage and related matters. The Implementation Fee, payable to Imperial Trust Company - PARS Account, will be $1,575: $825 ($700 if fewer than 100 participants) is a non-refundable fee for a Letter of Determination from the IRS (to establish IRS approval of the tax status of your plan), payable upon the return of this signed Engagement Letter, and $750 is payable upon adoption of PARS by the governing body. This Implementation Fee is specifically for those services described in this letter. If the terms expressed in this letter are in accordance with your understanding of this engagement, sign this Ietter and return it to Phase H. Sincerely, PHASE U SYSTEMS 350 E. 17th St., Suite 212 Costa Mesa, CA 92627 The foregoing letter fully describes the services desired. Autho ' by: n (� City of Carson signatilm Public Agency Lawrence G. Olson City Administrator Name - i or Type t ,TWO i __... 12/12/91 Date 701 E. Carson Street Address Carson, CA 90745 sty, state Phan R Sydems it not lieamsed to provide and doom nit offer W. accounting or legal advice. The public ageoq is urged to coasuh with appropriate pnXcasionala regarding the tax, accounting aad kgal 6nPucations of adopting a PARS Pension Pun 350 E. 17th St., Suite 212, Cortes Mea, CA 92627 (114) 631-6369 (SM 540-6369 fax (114) 631-2063 Application for Group Annuity Contract 4t THE HARTFORD ITTThe husarxe People of Application Is Hereby Made to 11 HARTFORD LIFE INSURANCE COMPANY Hartford, Connecticut (Contractholder) by Whose Main Office Address is for a Group Annuity Contract. Separate Account Contributions: ® Not Applicable ❑ To be Included Plan Assets may be deposited in Separate Account IVA /, Dated at City of Carson on (Agent or Broker) (witness) Amount of Binding Payment S 1, 000 Form PAL -1879-0 Printed in U.S.A. Received by December 17, -19 91 Lawrence G. Olson (Le4el a f Applicant) by ��'"'u Crt Administrator (Signature and Tide) HARTFORD LIFE INSURANCE COMPANY Hartford, Connecticut RECEIPT dollars to be applied as a credit towards the payment of the first contribution under the contract for which application is made. If the application is not accepted, the payment evidenced by this receipt shall be returned. Date Agent or Broker (Detach this receipt when payment is mads) ADOPTION AGREEMENT Version 7 Deeeinbwa 9, 1991 Copyright c 1991 PHASE 11 SYSTEMS. All rights reserved. Reproduction in part or whole is prohibited. P A R S Public Agency Retirement System ADOPTION AGREEMENT Version 7 Deeeinbwa 9, 1991 Copyright c 1991 PHASE 11 SYSTEMS. All rights reserved. Reproduction in part or whole is prohibited. ADOPTION AGREEMENT TO THE PUBLIC AGENCY RETIREMENT SYSTEM (PARS) AND TRUST AGREEMENT EMPLOYER City of Carson FEDERAL I.D. # 95-2513547 ADMINISTRATOR Lawrence G. Olson (Name) City Administrator (Title) — — ADDRESS City Administrator (Department) 701 E. Carson Street (Number •and Street) Carson, California 90745 (City) (State and Zip Code) NAME OF PLAN PUBLIC AGENCY RETIREMENT SYSTEM (PARS)-- City of Carson City of Carson______ (Agency Name) INTRODUCTION This Adoption Agreement, the provisions of the Public Agency Retirement System (PARS), and the provisions of the PARS Trust of which this Agreement is a part, are hereby adopted by the Employer executing this Agreement for the benefit of Eligible Employees and their Beneficiaries. This Adoption Agreement is part of the adoption of a new Plan, as provided in Section 2.5 of the PARS Trust. Item 1: EFFECTIVE DATE ,DAT.&rshalLM-e n Item 2: ELIGIBLE EMPLOYEE A. ELIGIBLE EMPLOYEE shall mean only those Employees who, at any time during which the Employer maintains this Plan, are not accruing a benefit under Social Security or another Retirement System provided and maintained by the Employer which meets the minimum requirements of IRS Regulations of IRC Section 3121 (b)(7)(1). B. ELIGIBLE EMPLOYEE shall include all active employees until termination of employment and inactive employees until their interest in the Plan is distributed. C. ELIGIBLE EMPLOYEE shall exclude all employees exempted under IRC Section 3121 (b)(7)(0. D. ELIGIBLE EMPLOYEE shall include the following: Item 3: ELIGIBILITY REQUIREMENTS A. SERVICE REQUIREMENT: An Employee who qualifies as an ELIGIBLE EMPLOYEE under Item 2 above shall be eligible to participate immediately. B. EMPLOYMENT REQUIREMENT: An Employee who terminates employment during the Plan Year shall still be eligible to participate during such Plan Year. Item 4: COMPENSATION A. COMPENSATION shall mean all compensation for the Plan Year paid or payable in cash by the Employer for personal services by the Eligible Employee. This definition of COMPENSATION shall be subject to the provisions of Article 1.06 of the Plan as well as the turther provisions of this Item. B. If elected in this Item, the term COMPENSATION shall be defined as follows: W-2 Wages j ] YES [ ] NO Base Salary [ ] YES j ] NO CALIF. PERS Compensation j ] YES [ ] NO CALIF. STRS Compensation [ ] YES [ ] NO 9901P YES [ ] NO (define below) Item 5: NORMAL RETIREMENT AGE NORMAL RETIREMENT AGE shall mean sixty (60) years of age. 2 Item 6: NORMAL RETIREMENT DATE NORMAL RETIREMENT DATE shall mean the first of the month coincident with or next following the date on which the Participant attains NORMAL RETIREMENT AGE. Item 7: DEATH AND TOTAL DISABILITY PROVISION A Participant's Vesting and distribution rights on the date of his death or 'Permanent and Total Disability" will be the same as the Vesting and distribution rights applicable on the date of his attainment of Normal Retirement Age. Item 8: ALLOCATION AND AMOUNT OF CONTRIBUTIONS A. The Employer shall make Employer Contributions in the amount of I—% of each Participant's Compensation. Employer Contributions shall be forwarded to the Trustee to be allocated to each Participant's Employer Contribution Account. Employer will pay plan administrator expenses. Plan expenses shall be paid out of Pian assets, and shall be allocated as follows: We'] mployorConrributtbtf°A'ccocFntsi,�if6d '0'I % to the Employee Contribution Accounts, D. A Participant shall not be permitted to direct the investment of his Employer Contribution Account or his Employee Contribution Account. Item 9: INVESTMENT OF CONTRIBUTIONS A. Pursuant to Section 4.1(2) of the Trust, the funding policy and method of this plan shall be as follows: Yrs- A No�'AII C'.uiitrt'iifiii�wilQbe:deposited.in Imperial,Trust,Company's_. _ Pariptlo�r _ :tnsur IT {J is lsi Yes No All Contributions will be deposited in Imperial Trust Company's Money Market Fund guaranteed by the Federal Deposit Insurance Corporation. B. Yes No Pursuant to Section 4. l(b)(2) of the Trust, the Plan Administrator hereby names the Trustee as the Fiduciary with respect to the investment and management of all Trust assets. Item 10: VALUATION DATE VALUATION DATE shall mean the date as of which a valuation is completed. Valuations are done at least monthly and more frequently, at the discretion of the Trustee. Item II: METHOD OF FUNDING The Plan shall be funded as provided under Section 4.1 of the PARS Plan Document. Item 12: VESTING A. The Participant's Employee Contribution Account shall be 100% Vested at all times. The Participant's Employer Contribution Account shall be 100% Vested at Normal Retirement Age, Total Disability or Death. However, notwithstanding anything to the contrary in this Plan, the Participant shall be Vested in his Employer Contribution Account to such a degree and at such a time as to meet the minimum requirements for a retirement system under Section 3121(b)(7)(F) of the Code. B. Yes No Years of Service with the Employer completed before the Employer maintained this Plan shall be counted to determine the nonforfcitable percentage in such Employee's benefit from Employer Contributions. C. Yes No Years of Service completed prior to termination of employment shall not be credited to an Employee who terminates employment before satisfying the eligibility requirements in Item 3 of the Adoption Agreement. D. For Vesting purposes, a Participant will be credited with a Year of Participation or Service only if he or she completes at least one Hour of Service during the computation period. E. Benefits shall be vested in accordance with the following: Yes No A participant transferring to an eligible retirement plan with the same employer shall be 100% vested. Yes No The schedule shown below shall be used: Years of Service Percent Completed Vested Item 13: PLAN YEAR months coiismenciiig on Item la: MISCELLANEOUS This Adoption Agreement shall be used only in conjunction with the Public Agency Retirement System (PARS) and the PARS Trust. Executed this day of , 1991, at California. City Administrator _ Title Sample Board Resolution WHEREAS it is determined to be in the best interest of the (AGENCY) and its employees to provide a Qualifying Retirement System ("Qualifying System") to all employees not currently eligible for such a Qualifying System, thereby meeting the requirements of Section 11332 of the Omnibus Budget Reconciliation Act (the "Act") and Section 3121(b)(7)(F) of the Internal Revenue Code (the "Code"); WHEREAS it is the intent of the governing Board of the (AGENCY) to adopt such a Qualifying System as an alternative system to Social Security for employees not currently covered under a Qualifying System; Now therefore, be it resolved that: (1) The governing board of the AGENCY does hereby intend to adopt such a Qualifying System effective January 1, 1992, for the benefit of employees employed on that date and hired thereafter; and, �-�• �w-� �''" "'� Lawrence G. Olson Thegoveinin .bo�dof'the A e hereby, authorizes. ads 'stratoLto-select,.adopdand hnplement.a.Quaiifying.Pl4n tionPfor--Sec,3121(b)(7 M of the Internal Revenuc Code whm issued'brtlte:`InlerWRevenud Service; } (3) The AGENCY Plan Administrator is hereby authorized to take whatever additional actions are necessary to maintain the participation of the AGENCY in the Qualifying Plan and to take whatever other actions are necessary to comply with Section 11332 of the Act, Section 3121(b)(7)(F) of the Code, and relevant regulations issued or as may be issued. DATE: BY: MUc /germy Rzd mcat sr%U= (PMM f:wursU&=Iq n%d6e=cd%bdrtsV= I.R.S. Data Form INSTRUCTIONS: The IRS Letter of Plan Determination Application requires the following information: • A list of the 25 highest paid employees eligible for PARS in order of compensation, starting with the highest paid, including Name, Date of Birth, Years of Service, and 1990 W-2 Income • The information requested at the bottom of this page • The information may be submitted on another page --you need not use this form. Partici ts' Last Name and Initials Date of Birth Hire Date 1990 W-2 Income Name of Agency Person to whom correspondence relating to PARS should be addressed Mailing Address City, State ZIP Phone Number Year Agency was Founded (approximate) Agency or District's Federal Tax ID Number Total Number Employees Eligible for PARS Employees Participating in PERS Employees Participating in SIRS Total 1990 W-2 Payroll 350 E. 17th St., Suite 212, Cast& Mesa, CA 92627 (114) 631-6369 (1100) 540.6364 fax (714) 631-2063 P A R S Public Agency Retirement System I.R.S. Data Form INSTRUCTIONS: The IRS Letter of Plan Determination Application requires the following information: • A list of the 25 highest paid employees eligible for PARS in order of compensation, starting with the highest paid, including Name, Date of Birth, Years of Service, and 1990 W-2 Income • The information requested at the bottom of this page • The information may be submitted on another page --you need not use this form. Partici ts' Last Name and Initials Date of Birth Hire Date 1990 W-2 Income Name of Agency Person to whom correspondence relating to PARS should be addressed Mailing Address City, State ZIP Phone Number Year Agency was Founded (approximate) Agency or District's Federal Tax ID Number Total Number Employees Eligible for PARS Employees Participating in PERS Employees Participating in SIRS Total 1990 W-2 Payroll 350 E. 17th St., Suite 212, Cast& Mesa, CA 92627 (114) 631-6369 (1100) 540.6364 fax (714) 631-2063 Form 2848 Power of Attorney/ OMB No 1545.0150 (Rev March 1991) Department of the Treasury and Declaration of Representative Expues 5.31.93 internal Revenue service ► For Paperwork Reduction and Privacy Act Notice. met the Instruclions. Power of Attorney 1 Taxpayer Information Taxpayer name(s) and address (Please type or print.) Social security number(s) Employer identification number City of Carson Attention City Administrator 95-2513547 701 E. Carson St./P.O. Box 6234 Plan number (if applicable) Carson, CA 90749 Daytime telephone number ( 310 ) 830-7600 2 hereby appoint(s) the following representative(s) as attorneys) -in -fact. 2 Representative(s) (Please type or print.) Name and address Myles Margady CAF No.. .. - - - 20.05-'284.54R .............. CIO GRANT THORNTON Telephone No. ( 213 ) ,,,-„ 627-1717..._ 1000 Wilshire Blvd., Ste 700 Fax No. ( 213 )- 624-679...., Los Angeles. CA 90017 Check if new: Address ❑ Telephone No ❑ Name and address CAF No. ......................................... N/A Telephone No. ( ) ............... FaxNo. ()................................ Check if new: Address - . ❑ Telephone No- ❑ Name and address CAF No ........................................... N/A Telephone No. ( ) ........................ FaxNo. ( )................................ Check if new: Address . - . ElTeleohone No. ❑ to represent the taxpayer(s) before the Internal Revenue Service for the following tax matters: 3 Tax Matters Type of Tax (income. Employment, Excise, etc.) Tax Form Number (1040.941.720, etc.) Year(s) or Penod(s) Application for Determination of RetirementPlan - Sion Form 5300 5300 1991 N/A N/A 4 Specific Use Not Recorded on Centralized Authorization File (CAF).—If the power of attorney is for a specific use not recorded on CAF, please check this box. (See the Instructions for Specific Use Not Recorded on CAF on page 4.) . . . . . . . . ► ❑ 5 Acts Authorized.—The representatives are authorized to receive and inspect confidential tax information and to perform any and all acts that f can perform with respect to the tax matters described in line 3, for example, the authority to sign any agreements, consents. or other documents. The authority does not include the power to receive refund checks or the power to sign certain returns. (See instructions.) List any specific additions or deletions to the acts otherwise authorized in this power of attorney: ......... NA(L@.......................... ....-----------------•---- ..,._...--------------------------------------------------------------------------------------... Note: In general, an unenrolled preperer of tax returns cannot sign any document for a taxpayer. See Revenue Procedure 81-38, Printed as Pub. 470, for more information. Note: The tax matters partner/person of a partnership or S corporation is not permitted to authorize representatives to Perform certain acts. See the instructions for more information. 6 Receipt of Refund Checks.—If you want to authorize a representative named in line 2 to receive, BUT NOT TO ENDORSE OR CASH, refund checks, initial here NIA and list the name of that representative below. Name of representative to receive refund check(s) ► NIA Cat. N0, 119801 Form 2848 (Rev 3.91) Myl Fwm28A8(Rev 3.41) Fade x 7 Notices and Communications, Notices and other wntten communications will be sent to the first representative listed in line 2. a If you want the second representative listed to receive such notices and communications, check this box . . . . . . . ► ❑ b If you do not want any notices or communications sent to your representative, check this box . . . . . . . . . . . ► ❑ 8 Retention/Revocation of Prior Power(s) of Attorney.—The filing of this power of attorney automatically revokes all earlier power(s) of attorney on file with the Internal Revenue Service for the same tax matters and years or periods covered by this document, If you do not want to revoke a prior power of attorney, check here . . . . . . . . . . . . . . . . . ► ❑ YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT. 9 Signature of Taxpayer(s).—If a tax matter concerns a pint return, both husband and wife must sign if joint representation is requested. otherwise, see the instructions. If signed by a corporate officer, partner, guardian, tax matters partner/person, executor, receiver, administrator. or trustee on behalf of the taxpayer. I certify that I have the authority to execute this form on behalf of the taxpayer. ► If this power of attorney Is not signed, It will be returned. ................................Y : .. •'--- '----------- .................. ..1.2.-.17-.9..1. .... ..City Administrator ....... Signature pate iitie(itappl,pble) #ii Lawrence G. Olson ...................................t .............................---- PanName ................................5.na.ur.e....................................... -------.Da.t.e........ ------------- ^--------' -----^............................Prn.Mam-e ................................ Declaration of Representative Under penalties of perjury, I declare that: • I am not currently under suspension or disbarment from practice before the Internal Revenue Service; • I am aware of regulations contained in Treasury Department Circular No. 230 (31 CFR, Part 10), as amended, concerning the practice of attorneys, certified public accountants. enrolled agents, enrolled actuaries, and others; • I am authorized to represent the taxpayer(s) identified in Part I for the tax matter(s) specified there; and • I am one of the following: a Attorney—a member in good standing of the bar of the highest court of the jurisdiction shown below. b Certified Public Accountant—duly qualified to practice as a certified public accountant in the jurisdiction shown below. c Enrolled Agent—enrolled as an agent under the requirements of Treasury Department Circular No. 230. d Off icer—a bona fide officer of the taxpayer organization. e Full -Time Employee—a full-time employee of the taxpayer. f Family Member—a member of the taxpayer's immediate family (i.e., spouse, parent, child, brother, or sister). g Enrolled Actuary --enrolled as an actuary by the Joint Board for the Enrollment of Actuaries under 29 U.S.C. 1242 (the authority to practice before the Service is limited by section 10.3(dx1) of Treasury Department Circular No. 230). h Unenrolled Return Preparer—an unenrolled return preparer under section 10.7(a)(7) of Treasury Department Circular No. 230. ► If this power of attorney is not signed, K will be returned. Designation --Insert above letter (a- h) Jurisdiction (state) or Enrollment Card No. Signature Date les Margady (a) ' .'.:c.. rx4'� �:Gr•.sq,2-nry�>.n.:.b�`.,�C�' ...'Y�Sr.... ..y.� � .. r �v S; P A R Public Agency Retirement +t 'rn,WY: Re: PARS Administration Packet Dear PARS Administrator; Enclosed are several revised documents for your use in administering PARS. Please use diem to replace earlier versions. 1. PARS Contribution and Data Submission Instructions Please read this document carefully and call Phase II if you have any questions or problems in submitting data or contributions in the manner described. 2. Participant Enrollment Form* (optional form) This form is provided for your convenience in administering PARS. You may choose instead to use your payroll database or other personnel records to maintain this information. The purpose of maintaining the data is to expedite distribution of PARS benefits when an employee becomes eligible. The use of this form is optional. 3. Request for Distribution Form* This form sets in motion the distribution process for employees who are leaving PARS for any reason (i.e., death, disability, termination of employment or retirement). 4. Change of Name, Address, or Beneficiary Form* Under PARS, the spouse is automatically the beneficiary. For an unmarried participant, the estate is the beneficiary. This form may be used to designate a beneficiary other than the spouse or the estate. This form may also be used to indicate a change of name or address. 5. Sample Employee Announcement It is essential that you inform eligible employees of the adoption of PARS and of the impending payroll deduction before the first payroll deduction is made. A sample Employee Announcement is enclosed for this purpose. 6. General Information for PARS Participants* This brief description of PARS is suitable for distribution to employees. We are in the process of preparing other documents for you (such as the Summary Plan Description, PARS PIan Document, and IRS Application for Determination of Employee Benefit Plan). Please call us at Phase II if you have any questions or concerns with any aspect of PARS administration. We look forward to bearing from you. Sincerely, Karen Zfaty, M.B.A. Director, Marketing Services * For your convenience, a master copy and a file copy have been enclosed. f: lusersUara%parsWminu 350 E. 17th St., Suite 212 Costa Mesa, CA 92627 (800) 540-6369 (714) 631-6369 fax (714) 631-2063 �vt?Xti�4 'ai'!:.iFti..v. Y'e't?:: :.')[O''A"Y.:^". r .. 1%:.'i'fi}.4 ,�a(.O,t:4i: iry:7 �> t^�S,oi. r�;iG:h v' c`rJ.L�, ��; �. '- :..' .. :{...r t ... r.. ;r ]i:{.;` -' \ A4 ?Si' r :t'.A. /:KSv'. ivv: :turf- i ...i.:..i -....t 11sa:'•:'S�• +'4{"+Sth ? '\'4: t::0 .i M -: NO Yyqq � t. . .- 1J. .. . • :S.-». '.'t .. 4)n%'J:�.S.,....:i"`.'v'-r u t .... Number wager P A R 5 400.00 15.001 15.00 Jones, Jane B. 111223332 573.33 21.50 21.50 Smith, Robert C. MIX 1000.00 37.50 1 37.50 Public Agency Retirement System rw:or9. .4> J� n'�a`;a"K:O "04. � ' � � .. .A:..,: - - :: ;� vi;e s.:• . � -" k -�4� ^Ka;.i�op}��02;� _ �, IS: t \M1.,T`:,Ckt.Ft¢T a v at:t' ....i}`nS%O.011 µ{C S .AS.. :9i K Q:S\... •h- f-._�. v..?:. .F'S.. YO O ti ' a PARS Contribution and Data Submission Instructions 1. DATA Data should be transmitted to PARS on an IBM formatted disk (360K, 1.2Mb or 1.44 Mb) or on magnetic tape, (see attached specifications) in ASCII code, and should include the information shown below. A paper copy of the report and a COPY OF THE PARS CONTRIBUTION CHECK should be seat to: Phase Q Systema - PARS Administration 350 E. 17th St., Suite 212 Costa Mess, CA 92627 alta: Mark Powley, Manager, Plans Administration QtH Marr Powley at (714) 631-069 or (8010) 540-6369 ifyou have any problems with transmittal of data. Name Payroll Daic [field width = 401 191 1101 191 191 Public Agency Name 011592 Participants' Last Name, Social Security Employer Employee First Name and Initial Number wager Contribution Contribution Doe, John A. 111223331 400.00 15.001 15.00 Jones, Jane B. 111223332 573.33 21.50 21.50 Smith, Robert C. 111223333 1000.00 37.50 1 37.50 Total Total Total Employer Employee Total Participants wages Contribution Contribution Totals 1 3 1 1973.33 1 74.001 74.00 header record detail record (1 per participant) trailer record Initial Contribution Credit 1,000.00 0.00 Contribution Totals 74.00 74.00 Amount due to PARS 0.00 74.001 00 Initial PARS Contribution Credit Remaining 926.00 0.00 A COPY of the PARS Contribution Check in the amount of $74.00 is enclosed with this data report 2. CONTRIBUTIONS PARS contribution checks made out for the total amoumt of contributions should be seat (and made payable) to: Imperial Trust U mipauy F/B/O: PARS 01797-W 201 N. Figueroa St, Suite 610 Los Angeles, CA 90012 Attn: John Henry, Vice President Cal! John Henry at (213) 580-1515 ifyou have any problems with transmittal of coub ibudow. Funds may be electronically transferred to: Imperial Bank, Inglewood, California ABA No. 122201444 For Credit to Imperial Trust Company Settlement Account No. 09-042-326 (Further Credit to Account No. 01797-M PARS) L• lusersUualparslparsdata Public Agency Retimment Sy t m 350 E. 17th St., Suite 212 Coda Moa, CA 92627 (714) 631-6369 (800) 540-6369 fax (714) 631-2063 ] Nil A R S { Public Agency Retirement System K 5�;vyv . - ..ego........... PARS Magnetic Tape Specifications Phase lI can process data in-house on all types of IBM PC -formatted diskettes and on DC2000 mini data cartridges formatted for the Mountain TD4000 Tape Backup System. We must take other magnetic tapes off-site to have them converted to diskettes and the fee for this is charged to the PARS plan expenses. Therefore, it is to the advantage of PARS Participants that we receive the data on diskettes or data cartridges. If data is sent on magnetic tape, however, the tape and data should be formatted in the following way: 1. TAPE 2. DATA header record detail record (1 per participant) trailer record 3 112" DC2000 mini data cartridge or 112" magnetic tape at 1600 bpi formatted for Mountain TD4000 Non -labeled ASCII or EBCDIC Tape Backup System Unblocked or Specify Blocking Factor Record Layout: Record Length = 100; No Packed Numeric Data; No Implied Decimal Field Name Starting Position Field Length Type Comments Employee/Agency Name 1 40 AIN Doe, John A. or Public Agency Name Social Security Number 41 9 N 111223333 Wages 50 10 N 573.33 No Implied Decimal Employer Contribution 60 8 N 21.50 No Implied Decimal Employee Contribution 68 8 N 21.50 No Implied Decimal Filler 76 24 AN 74.00 Record Type 100 1 1 1 N 1=header record; 2=detail record; 3=trailer record Report Format Participants' Last Name, First Name and Initial [field width = 401 Date or Soc Sec #* 191 Wages [101 Employer Contribution (8) Employee Contribution [a] Data Filler Type [24] [1] Public Agency Name 011592 1 Doe, John A. 111223331 400.00 15.00 15.00 1 2 Jones, Jane B. 111223332 573.33 21.50 21.50 2 Smith, Robert C. 111223333 1000.00 37.50 1 37.50 2 Totals 3* 1973.33 74.001 74.00 3 *Please enter the total number of detail records in this field on the trailer record. The diskette or tape AND a hardcopy of the report should be sent to. Phase II Systems - PARS Administration 350 E. 17th St., Suite 212 Costa Mesa, CA 92627 attn: Mark Powley, Manager, Plans Administration Call Mark Powley or Karen Zfaty at the numbers below if you have any questions or problems with transmittal of data. f-%usersUuu=1parsladminlmag,tape Public Ageocy Retirement System 350 E. 17th St., Suite 212 Costa Meas, CA 92627 (114) 631-6369 (800) 540-6369 fax (114) 631-2063 Participant Enrollment Form Public Agency Retirement System {PARS} Name of Participant Social Security Number Address of Participant City State Zip Phone Res { ) Phone Bus ( } Birthdate Sex Date of Hire Date Terminated Date Signature cwyfi& 1991 PMW 13 SY5L=S Request for Distribution Public Agency Retirement System (PARS) To: Phase II, PARS Trust Administrator 350 E. 171h St., Suite 212 Costa Mesa, CA 92627 (714) 631-6369 (800) 540-6369 (outside 714) fax (714) 631-2063 From: This is to advise you that our employee Legal Name of Participant Address of Participant City State Zip Phone ) Birthdate Social Security Number Sex Terminated employment with us effective , 19 Retired on '19 - Became 19Became totally disabled on , 19 Died on , 19 (There is an executed beneficiary statement in favor of Please determine the benefits due the above employee/beneficiary and arrange for payment of such benefits. Signature of Administrator Date Revised November 25, 1991 Copyright 199! Public Agcocy Ruin Sym lars►panlFog4dist Change of Name, Address, or Beneficiary Form Public Agency Retirement System (PARS) Pare r o12 Use this form to indicate a change of name or address or to designate a beneficiary other than your spouse if you are married, or your estate if you are unmarried. Section IA: Personal Information Old Name of Participant New Name of Participant Name of Employer Address of Participant City State Zip Phone Res ( ) Bus ( ) Birthdate Sex SS# Date of Hire Section 1B: Beneficiary Designation Unless you choose otherwise, your beneficiary is your spouse (or your estate if you are not married) If you are married and you designate a beneficiary other than your spouse, your spouse must sign the waiver in Section 2 below. Name of Beneficiary Address City State ZIP Relationship Phone Res( ) Bus( ) Participant Signature Date Employer Signature Date Section 2: Spousal Waiver I hereby consent to the beneficiary designation of my spouse, a participant in this plan. I understand that in consenting to the designation of anyone except myself, I am waiving rights to a survivor benefit that I would be legally entitled to at a later date. Spouse's Signature Notary or Plan Representative Copyright 1991 Phase 11 Systems Date Date Change of Name, Address, or Beneficiary Form Public Agency Retirement Plan (PARS) Page 2 of 2 Section 3A: General Rules for Designation of Beneficiary 1. It is your responsibility to keep the Designation of Beneficiary current. 2. You reserve the right to revoke or change your Designation of Beneficiary, subject to the other provisions of this Section 3. 3. If, upon your death, there is no valid Designation of Beneficiary on file with the Plan Administrator, any death benefits which become due will be paid in accordance with the Plan Document. 4. YOU ARE CONSIDERED MARRIED if you are under decree of separate maintenance or decree of legal separation. (See "Special Rules for Married Participants" below.) Section 3B: Special Rules for Married Participants 1. IN ORDER TO COMPLY WITH FEDERAL LAW, THE PLAN REQUIRES THAT IF YOU ARE MARRIED, YOUR SURVIVING SPOUSE WILL BE YOUR SOLE PRIMARY BENEFICIARY. 2. If you wish to designate a person or persons other than your spouse, or in addition to your spouse, you must obtain the notarized consent of your spouse in writing on this form. Failure to obtain your spouse's consent in these instances renders this designation invalid. 3. ANY CONSENT BY A SPOUSE APPLIES ONLY TO THAT SPOUSE AND NOT TO ANY FUTURE SPOUSE. Therefore, if a new marriage occurs, a new Designation of Beneficiary should be completed and, if necessary, the new spouse's consent must be obtained. 4. IF THE LOCATION OF YOUR SPOUSE IS UNKNOWN, you must attach to this Designation of Beneficiary form, a notarized statement to the effect that the spouse cannot be located I have read and understood this document. Participant's Signature Name (printed) Date Copyright 1991 phase U systema fAuwrs%karcaV&raladmiu%beoerulc OTHER TYPES OF RETIREMENT SYSTEMS (Continued) ARS 1. Plan operated by trustee with fiduciary liability for Investments 2. Employee contributions can be mandatory per §401 a and per California Government Code 14h allows pre=tax contribution§ 3 I .ry 4. Rollovers allowed to other qualified pians §401 a, §401k 5 IRA's 5. Qualified pians offered by both public and private sector S. Tax qualified plan 7. Assets owned by trust 8. FDIC Insurance (if applicable) up to $100,000 per PARTICIPANT 457 Defeffed rem9ngation 1. Plan operated by employer with employer liability for investments 2. No specific federal or state laws provide for mandatory deferral of employee's Income under §457 5 3. ELECTIVE deferrals are pre-tax within certain limits 4. Rollover only to some other §457 plans S. §457 available only to not-for-profit employers 8. Non-qualified plan 7. Assets owned by employer 8. FDIC Insurance (if applicable) up to $100,000 per EMPLOYER THE TRUST ADMINISTRATOR: PHASE 11 SYSTEMS Our Mission Phase tl Systems is committed to providing the highest -quality financial products and administrative services to Its clients, with consistent responsiveness and attention to detail. The key to our success is our ability to attract, develop and retain highly -motivated professionals who are dedicated to attaining the company's goals. As part of that process, and to assist our clients in achieving their retirement plan goals. each member of Phase II Systems holds himself or herself personally accountable for fulfilling his or her responsibilities to each individual client. Sipecialists: Retirement Plan. iQr Public Agencies Phase fl Systems specializes in the design, Implementation and administration of retirement plans for public agencies. Since our incorporation in 1984, we have implemented upwards of 80 such plans for over two dozen Southern California school districts and community colleges. Although a relatively young company, we have deep roots In the industry. Our founder and president, M. C. Johnson, Jr., CLU, has been In the employee benefits business for more than forty years. Prior to forming Phase 11 in 1984, he was a