How to Roll Your Money into Your Employer Sponsored Retirement Plan with Walgreen Profit-Sharing
Retirement Plan
In this packet, you will find information and a form necessary to roll over your Individual Retirement Account (IRA) or employer
sponsored retirement plan to your current employer sponsored retirement plan with Walgreen Profit-Sharing Retirement
Plan.
It’s easy! All you have to do is follow the Rollover Checklist. The checklist items are required to complete your rollover.
Rollover Checklist
Complete and sign the Incoming Rollover form included in this packet.
A copy of the original distribution check stub must be attached if you are sending in the check and this form together.
If you are rolling over from an IRA, please provide a copy of the most recent account statement. If you are rolling over
from an employer sponsored retirement plan, please provide a copy of the most recent account statement showing the
Internal Revenue Code ("Code") plan type, plan name, and if applicable, Roth first contribution date and Roth contribution
amounts.
Questions?
Please call our Rollover Services Team at 1-866-360-1192, Opt 3. We are available to assist you 9 a.m. to 8 p.m. Eastern
time, Monday through Friday.
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Incoming Rollover Election
How to Roll Your Money into Your Employer Sponsored Retirement Plan with Walgreen Profit-Sharing
Retirement Plan
In
this packet,
you will find information
and aPlan
form necessary to roll over your Individual Retirement Account (IRA) 150103-01
or employer
Walgreen
Profit-Sharing
Retirement
sponsored retirement plan to your current employer sponsored retirement plan with Walgreen Profit-Sharing Retirement
If
you have already received a rollover check, send this form and the check together to the address shown in the Payment
Plan.
Instructions section. Please see the Step-by-Step Instructions for Rollover Contributions for important details about the
It’s
easy!toAllcomplete
you haveyour
to do
is followrollover
the Rollover
checklist
items
are required to complete your rollover.
process
incoming
beforeChecklist.
submittingThe
your
form and
check.
If
your previous
provider has not already issued a rollover check, and you would like assistance with contacting your
Rollover
Checklist
previous provider or to learn more about your account consolidation options, please call 1-866-360-1192, Option 3. A
dedicated
specialist
you initiate
yourform
incoming
rollover
the phone.
Complete
and signcan
thehelp
Incoming
Rollover
included
in thisover
packet.
A copy of the original distribution check stub must be attached if you are sending in the check and this form together.
Participant Information
If you are rolling over from an IRA, please provide a copy of the most recent account statement. If you are rolling over
from an employer sponsored retirement plan, please provide a copy of the most recent account statement showing the
Internal
Revenue
Code ("Code")
plan
type, plan name,
contribution
date and Roth contribution
Last
Name
First
Name
MI and if applicable, Roth first Social
Security Number
amounts.
Questions?
Address - Number & Street
E-Mail Address
Please call our Rollover Services Team at 1-866-360-1192, Opt 3. We are available to assist you 9 a.m. to 8 p.m. Eastern
time, Monday through
Friday.
City
State
Zip Code
Mo
Day
Year
(
)
Daytime Phone
Date of Birth
Rollover Information - A copy of the original distribution check stub must be attached if you are sending
in the check and this form together.
All required documentation must be received in good order and we must review and confirm that the rollover
contribution can be accepted into your Plan, before your rollover contribution will be invested in the Plan. If the
rollover contribution cannot be accepted into the Plan, it will be returned to the issuer. See attached Step-by-Step
Instructions for Rollover Contributions. If you have any questions about your Plan’s rollover contribution options,
please call 1-866-360-1192, Option 3.
I am choosing a Direct Rollover from a:
Qualified 401(a) plan (Profit Sharing or Money Purchase)
Qualified 401(k) plan
Non-Roth
Pre-tax: $
(all contributions and earnings, excluding Roth contributions and earnings)
After-tax: $
Roth (employee contributions and earnings)
403(b) plan
Non-Roth
Pre-tax: $
(all contributions and earnings, excluding Roth contributions and earnings)
After-tax: $
Roth (employee contributions and earnings)
Governmental 457(b) plan
Traditional IRA (Only pre-tax amounts may be rolled over)
Instructions and Authorization from the Owner/Account-holder to Current Trustee or Custodian
As owner of the account referenced below, I hereby authorize you,
(Company Name) to liquidate:
100% (Approximate transfer amount $
) OR
Part ($
) of my account and transfer the proceeds to my new employer sponsored plan:
Immediately
At Maturity (if applicable)
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Incoming Rollover Election
How to Roll Your Money into Your Employer Sponsored Retirement Plan with Walgreen Profit-Sharing
Retirement Plan
Last Name
First Name
MI
Social Security Number
In this packet, you will find information and a form necessary to roll over your Individual Retirement Account (IRA) or employer
sponsored retirement plan to your current employer sponsored retirement plan with Walgreen Profit-Sharing Retirement
I am choosing an In-direct 60-Day Rollover from a (if an exception(s) applies, please indicate reason(s) for late
Plan.
contribution below the plan type):
It’s easy! All you have to do is follow the Rollover Checklist. The checklist items are required to complete your rollover.
Plan Type
Qualified
401(a) plan (Profit Sharing or Money Purchase)
Rollover
Checklist
Qualified 401(k) plan
Complete and sign the Incoming Rollover form included in this packet.
Non-Roth
A copy of the original distribution check stub must be attached if you are sending in the check and this form together.
Pre-tax: $
(all contributions and earnings, excluding Roth contributions and earnings)
If you are rolling over from an IRA, please provide a copy of the most recent account statement. If you are rolling over
from anAfter-tax:
employer$ sponsored retirement plan, please provide a copy of the most recent account statement showing the
Internal
Revenue
Code
("Code") plan
plan name, and if applicable, Roth first contribution date and Roth contribution
Roth (employee
contributions
andtype,
earnings)
amounts.
403(b) plan
Non-Roth
Questions?
Pre-tax:
$
contributions
and earnings,
contributions
Please call
our Rollover
Services(all
Team
at 1-866-360-1192,
Optexcluding
3. We areRoth
available
to assistand
youearnings)
9 a.m. to 8 p.m. Eastern
time, Monday
through
Friday.
After-tax: $
Roth (employee contributions and earnings)
Governmental 457(b) plan
Traditional IRA (Only pre-tax amounts may be rolled over)
Instructions and Authorization from the Owner/Account-holder to Current Trustee or Custodian
As owner of the account referenced below, I hereby authorize you,
(Company Name) to liquidate:
100% (Approximate transfer amount $
) OR
Part ($
) of my account and transfer the proceeds to my new employer sponsored plan:
Immediately
At Maturity (if applicable)
Reasons for Late Contribution
I intended to make the rollover within 60 days after receiving the distribution but was unable to do so for the following
reason(s). Check all that apply:
An error was committed by the financial institution making the distribution or receiving the contribution.
The distribution was in the form of a check and the check was misplaced and never cashed.
The distribution was deposited into and remained in an account that I mistakenly thought was a retirement plan or IRA.
My principal residence was severely damaged.
One of my family members died.
I or one of my family members was seriously ill.
I was incarcerated.
Restrictions were imposed by a foreign country.
A postal error occurred.
The distribution was made on account of an IRS levy and the proceeds of the levy have been returned to me.
The party making the distribution delayed providing information that the receiving plan or IRA required to complete the
rollover despite my reasonable efforts to obtain the information.
Previous Provider Information:
Company Name
Account Number
Mailing Address
(
)
Phone Number
City/State/Zip Code
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Incoming Rollover Election
How to Roll Your Money into Your Employer Sponsored Retirement Plan with Walgreen Profit-Sharing
Retirement Plan
Last Name
First Name
MI
Social Security Number
In this packet, you will find information and a form necessary to roll over your Individual Retirement Account (IRA) or employer
sponsored retirement plan to your current employer sponsored retirement plan with Walgreen Profit-Sharing Retirement
Plan.
Required Documentation
If
are All
rolling
anisIRA,
please
provide a
copy of the
most
recentitems
account
you are rolling
over from a
It’syou
easy!
youover
havefrom
to do
follow
the Rollover
Checklist.
The
checklist
are statement.
required toIfcomplete
your rollover.
previous employers plan, please provide a copy of the most recent account statement showing the Internal Revenue Code
("Code")
type, plan name, and if applicable, Roth first contribution date and Roth contribution amounts.
Rolloverplan
Checklist
If you do not have this information on the statement, please have your Previous Plan Administrator complete the
Completefields
and sign
the Incoming
Rollover
form included
in this
packet.employer as Plan Administrator.
applicable
below.
Also provide
the signature
of the
previous
A
copy
of
the
original
distribution
check
stub
must
be
attached
if you are sending in the check and this form together.
The name of the distributing plan is
If you are referred
rolling over
IRA, The
please
provide
a copy of
recent account
statement.
If you are rolling
(hereinafter
to asfrom
the an
"Plan").
Plan
Administrator
of the
the most
Plan certifies
to the best
of their knowledge
that: over
from an employer sponsored retirement plan, please provide a copy of the most recent account statement showing the
(1) The
Plan is Code
designated
or intended
be tax
qualified
the Code
the requirements
of acontribution
Internal
Revenue
("Code")
plan type,toplan
name,
and if under
applicable,
Rothand
firstmeets
contribution
date and Roth
amounts.Qualified 401(a) or 401(k) plan
403(b) plan
Questions?
for governmental
plansat 1-866-360-1192, Opt 3. We are available to assist you 9 a.m. to 8 p.m. Eastern
Please call457(b)
our Rollover
Services Team
time,(2)
Monday
through are
Friday.
The amounts
eligible for rollover as described in Code section 402(c).
(3) Employer/employee before-tax contribution and earnings: $
(4) After-tax contributions:
After-tax cost basis: $
After-tax earnings: $
12/31/86 after-tax cost basis $
Note: Unless otherwise indicated, all amounts received will be considered employee before-tax contributions and
earnings.
(5) For Rollovers from designated Roth accounts:
Roth first contribution date:
Roth contributions (no earnings):
Roth earnings:
(6) For In-plan Roth Transfers/Rollovers:
Roth recapture amount:
Roth recapture date(s):
Roth contributions (no earnings):
Roth earnings:
(7) Signature of previous employer:
I am authorized to sign as Plan Administrator of the previous employer.
Signature of "Plan Administrator"
Printed Name of "Plan Administrator"
Title
Company Name
Date
Phone Number
Email Address
Amount of Direct Rollover: $
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(Enter approximate amount if exact amount is not known.)
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Incoming Rollover Election
Incoming Rollover Election
How to Roll Your Money into Your Employer Sponsored Retirement Plan with Walgreen Profit-Sharing
First Name
MI
Social Security Number
Retirement PlanLast Name
Last Name
First Name
MI
Social Security Number
In this packet, you will find information and a form necessary to roll over your Individual Retirement Account (IRA) or employer
sponsored
retirement
to your current
employer
retirement
with Walgreen
Profit-Sharing Retirement
Investment
Option plan
Information
- Please
refer to sponsored
your Plan materials
forplan
investment
option designations.
Plan.
Investment
Option
Information
- Please refer to your Plan materials for investment option designations.
I understand that funds may impose redemption fees on certain transfers, redemptions or exchanges if assets are held less
It’s
easy!
All you
have
do
followprospectus
the Rolloveror
Checklist.
Thetransfers,
checklist
items are
complete
yourare
rollover.
I understand
than
the period
thatstated
fundsto
in
may
theis
impose
fund's
redemption
fees
other
on certain
disclosure
documents.
redemptions
I willrequired
refer
or exchanges
to to
the
fund's
if assets
prospectus
held
and/or
less
than the period
disclosure
documents
stated for
in the
more
fund's
information.
prospectus or other disclosure documents. I will refer to the fund's prospectus and/or
disclosure Checklist
documents for more information.
Rollover
Select either existing ongoing allocations (A) or your own investment options (B).
Select
either and
existing
allocations
(A)form
or your
own investment
options (B).
sign ongoing
the
Incoming
Rollover
included
in this packet.
(A)Complete
Existing
Ongoing
Allocations
(A)AExisting
Ongoing
Allocations
copytoofallocate
the
original
distribution
check as
stub
be attached
you are sending in the check and this form together.
I wish
this rollover
the same
mymust
existing
ongoing ifallocations.
you are
rolling over
from anthe
IRA,
please
provide
a copy
of the
most recent account statement. If you are rolling over
IIfwish
to allocate
this rollover
same
as my
existing
ongoing
allocations.
(B)from
Select
Your Ownsponsored
Investment
Optionsplan, please provide a copy of the most recent account statement showing the
an employer
retirement
(B)Internal
Select Revenue
Your Own
Investment
Code
("Code") Options
plan type, plan name, and if applicable, Roth first contribution date and Roth contribution
INVESTMENT OPTION
INVESTMENT OPTION
amounts.
INVESTMENT OPTION
INVESTMENT OPTION
NAME
TICKER CODE %
NAME
TICKER CODE %
Questions?
NAMERetirement Income Fund.................TICKER
CODE _____
%
NAME
CODE _____
%
Target
N/A
WLGTRI
S&P
500 Index Fund............................ TICKER
N/A
WLGSP5
Fund................. N/A
WLGTRI _____ S&P
500Small
Index
Fund............................
WLGSP5 _____
Target Retirement Income
2010 Fund...................
WLGT10
Russell
Cap
Completeness Index Fnd.. N/A
WLGRSC
Please call our Rollover Services Team at 1-866-360-1192, Opt 3. We are available to assist you 9 a.m. to 8 p.m. Eastern
2010 Fund................... N/A
WLGT10 _____ Bond
Russell
Small
Cap Completeness Index Fnd.. N/A
WLGRSC
Target Retirement 2015
WLGT15
Index
Fund.................................
WLGBDI _____
time, Monday through
Friday.
Target
Target
Target
Target
Target
Target
Target
Target
Target
Retirement
Retirement
Retirement
Retirement
Retirement
Retirement
Retirement
Retirement
Retirement
2015
2020
2020
2025
2025
2030
2030
2035
2035
2040
2040
2045
2045
2050
2050
2055
2055
Fund...................
Fund...................
Fund...................
Fund...................
Fund...................
Fund...................
Fund...................
Fund...................
Fund...................
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
WLGT15
WLGT20
WLGT20
WLGT25
WLGT25
WLGT30
WLGT30
WLGT35
WLGT35
WLGT40
WLGT40
WLGT45
WLGT45
WLGT50
WLGT50
WLGT55
WLGT55
_____
_____
_____
_____
_____
_____
_____
_____
_____
Bond Index Fund.................................
International
Stock Index Fund................. N/A
International
Index Fund................. N/A
Stable Value Stock
Fund...............................
Stable
Value Fund...............................
..................................... N/A
Bond Fund...
Bond
Large Fund.................
Company Stock Fund....................
....................... N/A
Large Company
International
Stock
Stock
Fund........................
Fund.................... N/A
International Stock
Small/Mid-Size
Company
Fund........................
Stock Fund......... N/A
Small/Mid-Size
WBA Stock Fund.................................
Company Stock Fund......... N/A
WBA
WBA
Real Asset
Stock Fund.................................
Fund................................. WBA
N/A
Real Asset
Fund.................................
MUST
INDICATE
WHOLE PERCENTAGES N/A
WLGBDI
WLGISI
WLGISI
WLGSVF
WLGBND
WLGSVF
WLGBND
WLGLCS
WLGLCS
WLGITS
WLGSMS
WLGITS
WLGSMS
WBASTK
WBASTK
WLGRLA
WLGRLA
MUST INDICATE WHOLE PERCENTAGES
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=100%
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Incoming Rollover Election
How to Roll Your Money into Your Employer Sponsored Retirement Plan with Walgreen Profit-Sharing
Retirement Plan
Last Name
First Name
MI
Social Security Number
In this packet, you will find information and a form necessary to roll over your Individual Retirement Account (IRA) or employer
sponsored retirement plan to your current employer sponsored retirement plan with Walgreen Profit-Sharing Retirement
Plan.
Required
Signature - My signature indicates that I have read, understand the effect of my election and agree to all pages of
this
Incoming
Rollover
form, including
the Participant
Acknowledgements.
I affirm
that to
all complete
information
provided
is true
It’s easy!
All you
have Election
to do is follow
the Rollover
Checklist. The
checklist items are
required
your
rollover.
and correct. If a rollover is requested, I certify that: 1) I was entitled to a rollover distribution as a participant; 2) the distribution
was not a: series of periodic payments, required minimum distribution, hardship distribution, excess contribution(s) or Roth
Rollover
IRA
assets;Checklist
3) if an In-direct 60-day rollover, the rollover contribution is being made to the Plan within 60 days from the
date
I
received
distribution;
andRollover
4) that the
entire
amount
is being
rolled over from an "eligible retirement plan" within
Complete andmy
sign
the Incoming
form
included
in this
packet.
the meaning of Code Section 402.
A copy of the original distribution check stub must be attached if you are sending in the check and this form together.
I am encouraged to discuss rolling money from one account to another with my financial advisor/planner and to consider
If potential
you are rolling
over from
an IRA,
provide
a copyoptions.
of the most recent account statement. If you are rolling over
any
fees and/or
limitations
of please
available
investment
from an employer sponsored retirement plan, please provide a copy of the most recent account statement showing the
I understand
that anCode
election
to rollover
thisplan
Planname,
from another
plan or IRA
may
in significant
tax consequences
to
Internal Revenue
("Code")
plan to
type,
and if applicable,
Roth
firstresult
contribution
date and
Roth contribution
me.
I am responsible for any income tax or penalties for the election I made in this form. I acknowledge that Service Provider
amounts.
has not provided any tax or investment advice. I acknowledge that if I need financial or tax advice related to this rollover
election,
it is my responsibility to consult with my personal financial and/or tax advisor.
Questions?
IPlease
understand
that
Service
Provider
is required
to comply with
regulations
and requirements
the to
Office
of Eastern
Foreign
call our
Rollover
Services
Team
at 1-866-360-1192,
Optthe
3. We
are available
to assist you 9ofa.m.
8 p.m.
Assets
Control,
Department
of
the
Treasury
("OFAC").
As
a
result,
Service
Provider
cannot
conduct
business
with
persons
time, Monday through Friday.
in a blocked country or any person designated by OFAC as a specially designated national or blocked person. For more
information, please access the OFAC Web site at:
http://www.treasury.gov/about/organizational-structure/offices/Pages/Office-of-Foreign-Assets-Control.aspx.
Participant Signature
Date
A handwritten signature is required on this form. An electronic signature will not be accepted and will result in a
significant delay.
Participant forward or fax as shown above in the
Payment Instructions section
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 Retirement refers to the products and services offered in the retirement markets by Great-West Life & Annuity Insurance Company, Corporate
Headquarters: Greenwood Village, CO; Great-West Life & Annuity Insurance Company of New York, Home Office: NY, NY; and their subsidiaries and
affiliates. The trademarks, logos, service marks, and design elements used are owned by their respective owners and are used by permission.
Participant Acknowledgements
General Information - I understand that only certain types of distributions are eligible for rollover treatment and that it is
solely my responsibility to ensure such eligibility. By signing below, I affirm that the funds I am rolling over are in fact eligible
for such treatment.
I authorize these funds to be allocated into my employer's Plan and to be invested according to the information specified
in the Investment Option Information section.
I understand that I am permitted to direct the investment of my accounts in the Plan. I acknowledge that I have received
and reviewed the information about my investment choices and have had an opportunity to freely choose how my accounts
are invested. I understand and agree that my employer and other plan fiduciaries will not be liable for the results of my
investment directions. All funds rolled in the Walgreen Profit-Sharing Retirement Plan are subject to the terms of the
Walgreen Profit-Sharing Retirement Plan.
If the investment option information is missing or incomplete, I authorize Service Provider to allocate the rollover assets
("assets") the same as my most recent investment election on file (if I have an account established) or to the default
investment option selected by my Plan (if I do not have an account established). If no default investment option is selected
by my Plan, the funds will be returned to the payor. If additional assets from the same source are received more than 180
calendar days after Service Provider receives the initial assets, I authorize Service Provider to allocate all monies received
the same as my most recent investment election on file with Service Provider. I understand I must call 1-866-360-1192,
Option 3 or access the Web site in order to make changes or transfer monies from the default investment option. If my initial
rollover assets are received more than 1 year after Service Provider receives and approves this Incoming Rollover Election
form, I understand Service Provider will require the submission of a new form for approval. Assets will not be invested until
after approval is granted. Forms and documentation received after market close will be reviewed for approval the following
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Incoming Rollover Election
How to Roll Your Money into Your Employer Sponsored Retirement Plan with Walgreen Profit-Sharing
Retirement Plan
Last Name
First Name
MI
Social Security Number
In this packet, you will find information and a form necessary to roll over your Individual Retirement Account (IRA) or employer
sponsored
retirement
plan to
your
employer
sponsored
retirement
plan with
Walgreen
Retirement
business day.
I understand
that
thiscurrent
completed
form must
be received
by Service
Provider
at theProfit-Sharing
address indicated
in the
Plan.
Required Signature section of this form.
It’s
easy! All you
have to do- isI follow
the Rollover
Checklist.
checklist
items
are required
to complete
rollover.may
Withdrawal
Restrictions
understand
that the
Internal The
Revenue
Code
and/or
my employer’s
Planyour
Document
impose restrictions on rollovers and/or distributions. I understand that I must contact the Plan Administrator, if applicable, to
Rollover
determine Checklist
when and/or under what circumstances I am eligible to receive distributions or make rollovers.
Investment
Options
- I Incoming
understand
that byform
signing
and insubmitting
this form for processing, I am requesting to have
Complete and
sign the
Rollover
included
this packet.
investment options established under the Plan as specified on this form. I understand and agree that this account is subject
copy
of the
original
stub must
attached if you
in and
the check
and
this form
together.
to A
the
terms
of the
Plan distribution
Document. check
I understand
andbe
acknowledge
thatare
all sending
payments
account
values,
when
based on
you are rolling
over
from an IRA,
please
provide
copy of theand
most
recent
account
statement.
If you are shares
rolling over
theIf experience
of the
investment
options,
may
not beaguaranteed
may
fluctuate,
and,
upon redemption,
may
anmore
employer
sponsored
plan,I acknowledge
please providethat
a copy
of the most
recent
accountincluding
statement
showing the
befrom
worth
or less
than theirretirement
original cost.
investment
option
information,
prospectuses,
Internal Revenue
Code
plan type,
plan
name,
and
if applicable,
first
contribution
datethe
and
Roth
disclosure
documents
and("Code")
Fund Profile
sheets,
have
been
made
availableRoth
to me
and
I understand
risks
ofcontribution
investing. I
amounts. and agree that Service Provider will not be liable for the results of my investment directions.
understand
Account Corrections - I understand that it is my obligation to review all confirmations and quarterly statements for
Questions?
discrepancies or errors.
Please call ourLoan
Rollover
Services
at 1-866-360-1192,
3. We
available
to rollover.
assist you
9 a.m. toyou
8 p.m.
Outstanding
Balance
- AnTeam
outstanding
loan balance Opt
cannot
be are
included
in the
However,
mayEastern
pay off
time,
Monday through
Friday.before this rollover is submitted. After the loan is paid off, you may submit this rollover request.
the outstanding
loan balance
If you do not pay off the outstanding loan balance, you may rollover only the cash value (not including the loan) from the
Plan that has the outstanding loan.
Certification for Late Rollover Contribution - Pursuant to Internal Revenue Service Revenue Procedure 2016-47, I certify
that my contribution which I have described on this form missed the 60-day rollover deadline for the reason(s) listed under
Reasons for Late Contribution Section. I am making this contribution as soon as practicable after the reason or reasons I
indicated no longer prevent me from making the contribution. I understand that this certification concerns only the 60-day
requirement for a rollover and that, to complete the rollover, I must comply with all other tax law requirements for a valid
rollover and with your rollover procedures.
Pursuant to Revenue Procedure 2016-47, unless you have actual knowledge to the contrary, you may rely on this certification
to show that I have satisfied the conditions for a waiver of the 60-day rollover requirement for the amount identified on this
form. You may not rely on this certification in determining whether the contribution satisfies other requirements for a valid
rollover.
I declare that the representations made with respect to my certification for late rollover contribution on this form are true and
that the IRS has not previously denied a request for a waiver of the 60-day rollover requirement with respect to a rollover
of all or part of the distribution to which this contribution relates. I understand that in the event I am audited and the IRS
does not grant a waiver for this contribution, I may be subject to income and excise taxes, interest, and penalties. If the
contribution is made to an IRA, I understand you will be required to report the contribution to the IRS. I also understand that
I should retain a copy of this signed certification with my tax records.
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Incoming Rollover Election
How to Roll Your Money into Your Employer Sponsored Retirement Plan with Walgreen Profit-Sharing
First Name
MI
Social Security Number
Retirement PlanLast Name
In this packet, you will find information and a form necessary to roll over your Individual Retirement Account (IRA) or employer
sponsored
retirement plan to your current employer sponsored retirement plan with Walgreen Profit-Sharing Retirement
Payment Instructions
Plan.
If you have already contacted your previous provider to initiate your rollover distribution, or have already received a rollover
It’s
easy!
Allthe
youpayment
have to and
do ismailing
follow instructions
the Rolloverbelow.
Checklist.
The
areonly,
required
complete below.
your rollover.
check,
use
If you
arechecklist
mailing items
this form
see to
instructions
Make check payable to:
Regular mail address for the
Rollover
Great-WestChecklist
Trust Company, LLC
check and form (if mailed together):
Great-West
Complete
and sign the
Incoming Rollover
form included in this
packet. Trust Company, LLC
Include
the following
information
on the check:
PO Box 561215
Participant
Name,
Social
Security
Number,
A copy of the original distribution check stub must be attached
if youCO
are80256-1215
sending in the check and this form together.
Denver,
Plan Number, Plan Name
If you are rolling over from an IRA, please provide a copy of the most recent account statement. If you are rolling over
Wire
instructions:
Overnight
for the
from
an employer sponsored retirement plan, please provide
a copy ofmail
the address
most recent
account statement showing the
Account
of: Great-West
Trust Company,
LLCname,
FBOand check
and form
mailed
together):
Internal Revenue
Code ("Code")
plan type, plan
if applicable,
Roth(if
first
contribution
date and Roth contribution
Walgreen
Profit Sharing Plan
US Bank
amounts.
10035 East 40th Avenue Suite 100
Bank: US Bank
Attn Lockbox # 561215 DN-CO-OCLB
Account
no: 103690395621
Questions?
Denver, CO 80238
Routing transit no: 102000021
Please call Financial
our Rollover
Services Team at 1-866-360-1192, Opt
3. WeEmpower
are available
to assist you 9 a.m. to 8 p.m. Eastern
Contact:
Retirement
Attention:
Control
time,
MondayParticipant
through Friday.
Phone: 1-877-924-7763
Reference:
Name, Social Security Number,
Plan Number, Plan Name
Mailing/Fax Instructions if sending this form only
If you have not received a rollover check or initiated your rollover distribution with your previous provider, send this form only
to us. Please fax this form to 1-888-241-8614 or mail to the address above.
After your request has been received and processed, we will contact you to initiate your distribution from the other provider.
You can also call a dedicated specialist at 1-866-360-1192, Option 3, if you have any questions about the status of your
incoming rollover request.
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Acceptance of Assets - to the Sending Custodian/Trustee
completed
by Empower
Retirement
How to Roll Your Money To
into be
Your
Employer Sponsored
Retirement
Plan with Walgreen Profit-Sharing
Retirement Plan
Participant's Name:
In this packet, you will find information and a form necessary to roll over your Individual Retirement Account (IRA) or employer
Receiving Plan
Name:plan
Walgreen
Profit-Sharing
Retirement
Plan retirement plan with Walgreen Profit-Sharing Retirement
sponsored
retirement
to your
current employer
sponsored
Plan.
Receiving
Plan Number: 150103-01
It’s
All you
have to do Social
is follow
the Rollover
Checklist. The checklist items are required to complete your rollover.
Lasteasy!
4 digits
of Participant's
Security
Number:
Prior Provider Policy/Account Number:
Rollover Checklist
To Whom it May Concern
Complete and sign the Incoming Rollover form included in this packet.
Great-West Life & Annuity Insurance Company and its affiliates Empower Retirement provide recordkeeping and asset
A copyservices
of the original
distribution
check stub
must beplan
attached
if you on
arethe
sending
in the
check and
this form
together.
custody
to the employer
sponsored
retirement
referenced
attached
Incoming
Rollover
Form.
The plan’s
records
reflect
a
beneficial
account
for
the
participant
requesting
a
rollover
of
assets
from
your
institution
into
the over
plan
If you are rolling over from an IRA, please provide a copy of the most recent account statement. If you are rolling
account.
from an employer sponsored retirement plan, please provide a copy of the most recent account statement showing the
Revenue
Code
("Code")
plan type,the
plan
name,
and if applicable,
firsttocontribution
and Roth
contribution
At Internal
the direction
of the
employer
sponsoring
plan,
Empower
RetirementRoth
agrees
accept the date
transferred
funds
from the
amounts.
sending
institution and allocate them to the participant’s beneficial account under the plan in accordance with the applicable
provisions of the Internal Revenue Code.
Questions?
Please call our Rollover Services Team at 1-866-360-1192, Opt 3. We are available to assist you 9 a.m. to 8 p.m. Eastern
time,
Monday
through Friday.
Authorized
Signature
Date
Empower Retirement
A handwritten signature is required on this form. An electronic signature will not be accepted and will result in a
significant delay.
Empower Retirement Internal Event ID:
On behalf of the plan and the participant, we ask that you please complete this requested transaction, as soon as possible.
Please make check payable to: Great-West Trust Company, LLC
FBO:
Regular mail address for the check and form (if mailed together):
Great-West Trust Company, LLC
PO Box 561215
Denver, CO 80256-1215
Overnight mail address for the check and form (if mailed together):
US Bank
10035 East 40th Avenue Suite 100
Attn Lockbox # 561215 DN-CO-OCLB
Denver, CO 80238
Contact: Empower Retirement
Phone: 1-877-924-7763
When completing the request, please include the following:
• Participant’s Social Security Number
• An itemized record of the distribution, outlining any and all surrender penalties
• Breakdown by money source (i.e. Employee and Employer contributions)
We appreciate your prompt attention regarding this matter. If you have any questions or require additional information,
please feel free to contact our Client Service Department at 1-866-360-1192, Option 3.
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Step-by-Step Instructions for Rollover Contributions
How
to Roll
Your Money
into Your
Sponsored
Retirement
with Walgreen
Profit-Sharing
Walgreen
Profit-Sharing
Retirement
PlanEmployer
offers you the
opportunity
to "roll over"Plan
the distribution
you receive
from your
Retirement
Plan
previous employer's plan or IRA. The following information and instructions are designed to help you through this process.
If
any
questions,
please contact
dedicated
specialist
1-866-360-1192,
3. Account (IRA) or employer
Inyou
this have
packet,
you
will find information
and aaform
necessary
to rollat
over
your Individual Option
Retirement
sponsored
retirement
plan
to
your
current
employer
sponsored
retirement
plan
with
Walgreen
Determine Whether Your Contribution Is a Direct Rollover or an In-direct 60-Day Rollover. Profit-Sharing Retirement
Plan.
• Direct Rollover: Your previous plan or annuity makes the distribution check payable directly to Great-West Trust
It’s easy!
All youLLC.
have to do is follow the Rollover Checklist. The checklist items are required to complete your rollover.
Company,
• In-direct
60-Day Rollover: Your previous plan or annuity makes the distribution check payable to you.
Rollover
Checklist
If You Are Electing a Direct Rollover
Complete and sign the Incoming Rollover form included in this packet.
• Complete the Participant Information section of the Incoming Rollover Election form.
A copy of the original distribution check stub must be attached if you are sending in the check and this form together.
• Complete the Rollover Information section choosing Direct Rollover and the applicable Internal Revenue Code ("Code")
If you
rolling
over
from an IRA, please provide a copy of the most recent account statement. If you are rolling over
planare
type
on the
form.
from an employer sponsored retirement plan, please provide a copy of the most recent account statement showing the
• If you
are rolling
after-tax
please
the amount
the after-tax
cost
Internal
Revenue
Codeover
("Code")
plan contributions,
type, plan name,
and ifindicate
applicable,
Roth firstofcontribution
date
andbasis
Roth(contribution
contribution
amount not including earnings).
amounts.
• Complete the Previous Provider Information section.
Questions?
• Complete the Required Documentation section. Please attach a copy of most recent account statement to the Incoming
Please
call ourElection
Rollover
Services
1-866-360-1192,
Opt 3. does
We are
to assist
a.m.and
to 8Plan
p.m.Name
Eastern
Rollover
form.
If yourTeam
most at
recent
account statement
notavailable
indicate the
Codeyou
plan9type
of
time,your
Monday
through
Friday. plan, you must ALSO have your previous employer sign the Incoming Rollover Election form.
previous
employer's
For an IRA, please verify the account statement indicates the account is an IRA.
• For a Direct Rollover from an IRA please note: The maximum amount eligible for rollover is the total amount of your
taxable IRA contributions plus earnings. Non-taxable IRA contributions may not be rolled over. If your rollover amount
was held in a conduit IRA and you were born before January 1, 1936, you may be eligible for capital gains treatment.
In this instance, you may want to track these rollover amounts in order to be eligible for favorable tax treatment. If the
amounts were from a SIMPLE IRA, you would have had to participate in the SIMPLE IRA for a minimum of two years.
• If you have already received a rollover check, send this form, the check and the check stub together to the
appropriate address shown in the Payment Instructions section.
• If you do not have a rollover check, and have not initiated a distribution from the other provider,
1. Send this form with appropriate documentation described on this form.
2. In order to complete the rollover, the previous provider must be contacted and instructed to distribute the
assets. If you would like assistance with contacting the other carrier, please contact a dedicated specialist
at 1-866-360-1192, Option 3.
• Send your completed Incoming Rollover Election form with required documentation attached to:
Regular mail address for the
check and form (if mailed together):
Great-West Trust Company, LLC
PO Box 561215
Denver, CO 80256-1215
Overnight mail address for the
check and form (if mailed together):
US Bank
10035 East 40th Avenue Suite 100
Attn Lockbox # 561215 DN-CO-OCLB
Denver, CO 80238
Contact: Empower Retirement
Phone: 1-877-924-7763
Or fax to 1-888-241-8614
• Service Provider will review your request and required documentation to determine if your rollover can be accepted
into the Plan. If information is missing, we will contact you for more information.
• After your request has been received and processed, we will contact you to initiate your distribution from the other
carrier.
If You Are Electing an In-direct 60-Day Rollover
• Complete the Participant Information section of the Incoming Rollover Election form.
• Complete the Rollover Information section choosing an In-direct 60-Day Rollover and the applicable Code. Please send
a copy of the check stub, showing the amount of the distribution and withholding, from the previous provider.
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• If you are rolling over after-tax contributions, please indicate the amount of the after-tax cost basis (contribution
amount not including earnings).
• Complete
the Previous
Information
section.
How
to Roll Your
MoneyProvider
into Your
Employer
Sponsored Retirement Plan with Walgreen Profit-Sharing
Retirement
Plan
• Complete the Required Documentation section. Attach a copy of most recent account statement to the Incoming
form.
If your most
statement
does
notIndividual
indicate the
Code plan
type and
Plan
Name of
In thisRollover
packet, Election
you will find
information
andrecent
a formaccount
necessary
to roll over
your
Retirement
Account
(IRA)
or employer
your previous
employer's
plan, current
you must
ALSO have
your previous
employer
sign Walgreen
the Incoming
Rollover Election
form.
sponsored
retirement
plan to your
employer
sponsored
retirement
plan with
Profit-Sharing
Retirement
Plan.For an IRA, please verify the account statement indicates the account is an IRA.
To avoid
any
income
consequences,
you
must rollThe
overchecklist
your entire
gross
distribution
(includingyour
anyrollover.
income tax
It’s• easy!
All you
have
to dotax
is follow
the Rollover
Checklist.
items
are required
to complete
withholding). If you roll over less than your gross distribution, the amount not rolled over will be subject to income tax
and may
be subject to excise tax.
Rollover
Checklist
• Send the Incoming Rollover Election form to:
Complete and sign the Incoming Rollover form included in this packet.
Regular mail address for the
A copy
of and
the original
check stub must be attached if you are sending in the check and this form together.
check
form (ifdistribution
mailed together):
Great-West
Trust
LLC please provide a copy of the most recent account statement. If you are rolling over
If you
are rolling
overCompany,
from an IRA,
POanBox
561215sponsored retirement plan, please provide a copy of the most recent account statement showing the
from
employer
Denver,
CO 80256-1215
Internal
Revenue
Code ("Code") plan type, plan name, and if applicable, Roth first contribution date and Roth contribution
amounts.
Overnight mail address for the
check and form (if mailed together):
Questions?
US Bank
10035
EastRollover
40th Avenue
Suite
100 at 1-866-360-1192, Opt 3. We are available to assist you 9 a.m. to 8 p.m. Eastern
Please
call our
Services
Team
Lockbox
# 561215
time, Attn
Monday
through
Friday.DN-CO-OCLB
Denver, CO 80238
Contact: Empower Retirement
Phone: 1-877-924-7763
Or fax to 1-888-241-8614
• If you have already received a rollover check, send this form, the check and the check stub together to the
appropriate address shown in the Payment Instructions section.
• Service Provider will review your request and required documentation to determine if your rollover can be accepted
into the Plan. If information is missing, we will contact you for more information.
Endorse the rollover check to:
Great-West Trust Company, LLC,
OR
If your rollover check has already been cashed, please consider sending in a cashier's check or certified check made
payable to Great-West Trust Company, LLC.
Some Important Rollover Facts
• If any documentation is missing, your request will not be processed until you have submitted the required documentation
for review.
• In the event that a rollover contribution is made that cannot be accepted, the rollover contribution will be made payable
and returned to the issuer. Please contact a dedicated specialist at 1-866-360-1192, Option 3, if you have any questions
about your incoming rollover options for this Plan.
• Examples of Contributions Which Cannot Be Rolled Over:
• Any "required minimum distribution" (i.e., amount being paid to you because you are age 70 1/2 or older).
• Distributions that are a series of periodic payments (made at least annually) and paid to you over your life expectancy
(or the life expectancy of you and your beneficiary) or for a period of at least 10 years.
• Hardship Distributions
• Unforeseeable Emergency Distributions
• Excess Contributions
• Roth IRA Assets
• Please Note: If you are making a "Regular 60-Day Rollover" under Federal Regulations, you have 60 (sixty) days from
the date of your distribution to make a rollover contribution. It is your responsibility to ensure that Service Provider
receives all required documentation AND your rollover contribution prior to the expiration of the 60-day period. After 60
days, Service Provider can only accept a rollover on behalf of the Plan if you certify a reason for late contribution. You
will be responsible for any income tax or tax penalties for failure to meet the 60-day rule for rollover contributions when
information is not provided and the rollover contribution is not made within the 60-day period. If you provide a reason
for late contribution, you will be responsible for maintaining the documentation.
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• An election to rollover to this Plan from another plan or IRA may result in significant tax consequences to you. You are
responsible for any income tax or penalties for the election made in this form.
• Review
related into
to your
qualified
plan distribution
with Retirement
your financial Plan
advisor
or tax
advisor. Profit-Sharing
How
to Rolldecisions
Your Money
Your
Employer
Sponsored
with
Walgreen
Retirement Plan
Read this information carefully.
In this packet, you will find information and a form necessary to roll over your Individual Retirement Account (IRA) or employer
sponsored retirement plan to your current employer sponsored retirement plan with Walgreen Profit-Sharing Retirement
Plan.
It’s easy! All you have to do is follow the Rollover Checklist. The checklist items are required to complete your rollover.
Rollover Checklist
Complete and sign the Incoming Rollover form included in this packet.
A copy of the original distribution check stub must be attached if you are sending in the check and this form together.
If you are rolling over from an IRA, please provide a copy of the most recent account statement. If you are rolling over
from an employer sponsored retirement plan, please provide a copy of the most recent account statement showing the
Internal Revenue Code ("Code") plan type, plan name, and if applicable, Roth first contribution date and Roth contribution
amounts.
Questions?
Please call our Rollover Services Team at 1-866-360-1192, Opt 3. We are available to assist you 9 a.m. to 8 p.m. Eastern
time, Monday through Friday.
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Using Visual Aids
With Your Speech
Tips for the best presentations
Reasons to Use Visual Aids
Improves audience understanding and memory
Serves as notes
Provides clearer organization
Facilitates more eye contact and motion by the speaker
Contributes to speaker credibility
Source: University of Pittsburgh
Presentation Technology
Too often speakers allow technology to dominate, while losing their
message.
• Prezi
• Death by PowerPoint
• More PowerPoint tips
• Tips for visual aids (video)
Visual Aids Checklist
To make the best use of visual aids,
I will:
✓Prepare visual aids well in
advance
✓Keep visual aids simple
✓Make sure visuals are large
enough
✓Use limited text
✓Use fonts effectively
✓Use color effectively
✓Use images strategically
✓Explain visual aids clearly
✓Talk to my audience, not my
visual aid
✓Practice with my visual aids
Links to Prepare You
• https://www.youtube.com/watch?v=99JcXlzVxug
• https://youtu.be/jOWdZmurQoU
Creating a Speech Using an Outline Format
Before you Begin:
Identify your purpose. (Is it to persuade? Inform? Explain?)
The purpose statement expresses the goal of the speech and formulating it
lets you know precisely what you want the speech to accomplish.
__________________________________________________________________
Developing the Body:
The body presents main points intended to fulfill the purpose and support
the thesis.
Identify three main points:
1. ______________________________________________________
2. ______________________________________________________
3. ______________________________________________________
Supporting points
The evidence and material used to justify the main points
Lead the audience to accept the speech’s purpose(s)
Should be at least two supporting points for every main point
UNCG University Speaking Center, (336)256-1346, speakingcenter.uncg.edu
2 of 2
Should cite where the evidence was found in order to establish
credibility and should give credit where credit is due (Another, title,
and date are typically sufficient)
Developing the Introduction:
The introduction is important because it prepares the audience, gets their
attention, makes the topic relevant to them, and previews what’s to come.
Attention Getter:
Part of the introduction specifically designed to grab the audience’s
attention
Examples:
1.
2.
3.
4.
5.
Quotations
Stories (real of hypothetical)
Rhetorical questions
Startling statements
Humor
Choose an attention getter:
__________________________________________________________________
__________________________________________________________________
The thesis statement expresses the theme or central idea of the speech. It
concisely lays out what the speech is about.
Overall, the introduction should include:
1. Attention Getter
2. Motivation
UNCG University Speaking Center, (336)256-1346, speakingcenter.uncg.edu
3 of 2
3. Credibility
4. Preview of Main Points
5. Thesis Statement
Developing the Conclusion:
The purpose of a conclusion is to:
Signal the conclusion
Summarize the main points and goals of the speech
Tie back to the attention getter in the introduction
Leave the audience with something to reflect upon
Transitions:
Words, phrases, or sentences that tie together the main points of
the speech
Allow the speaker to move smoothly from one idea to the next
o Examples:
First, second, third
In addition to (restate the previous main point one or
two)
Phrases that include next, we now turn to, finally, let’s
consider, similarly…
UNCG University Speaking Center, (336)256-1346, speakingcenter.uncg.edu
Purchase answer to see full
attachment