Plan Adoption Agreement Form - Church Benefits Board

If you have any questions regarding how to complete the Adoption Agreement form, please contact our team at helpdesk@churchbenefits.org. After submitting your signed Adoption Agreement form, Nicole Averette, Director of Benefits, will contact you to schedule your training on how to submit retirement contributions. During the initial training session, Nicole will review your completed Adoption Agreement form to ensure everything is completed correctly. If there is an error on the form, she will walk you through completing and submitting the form again.

A copy of your signed agreement will be sent to your principal contact via email.

403(b)(9) Plan and Trust Adoption Agreement

By executing this Adoption Agreement, the undersigned Employer elects to establish a 403(b)(9) Plan (“Plan”) for the benefit of its eligible Employees and make certain elections with respect to the provisions of the Plan. This Adoption Agreement accompanies the Church Benefits Board, Inc. 403(b)(9) Plan and Trust Document (“Plan Document”) and may only be used in conjunction with the Plan Document. The Plan is intended to be a church retirement income account described in section 403(b)(9) of the Internal Revenue Code. The Plan consists of the terms, provisions and conditions of the Plan Document, the Adoption Agreement and the Administrative Appendix which are annexed hereto and made a part hereof for all purposes, as the same may be from time to time amended and/or restated. All words and phrases defined in the Plan shall have the same meaning when used in this Adoption Agreement. The adopting Employer makes the following representations and elections:

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This field is for validation purposes and should be left unchanged.

Employer Information

Name of Employer:(Required)

Address of Employer:(Required)

Street Address City, State, ZIP

Principal Contact at Employer:(Required)

Email Address of Principal Contact:(Required)

Enter Email Confirm Email

Phone Number:(Required)

Fax Number:

Federal Employer Identification Number:(Required)

Eligible Employer Status. The Employer is:(Required)

A church (defined in section 2.05 of the Plan Document).

A church association (defined in section 2.06 of the Plan Document).

A qualified church-controlled organization (defined in section 2.30 of the Plan Document).

A nonqualified church-controlled organization** (defined in section 2.25 of the Plan Document).

A self-employed minister (i.e., a minister described in section 414(e)(5)(A)(i)(I) of the Internal Revenue Code.)

An employer of a chaplain (i.e., a minister described in section 414(e)(5)(A)(i)(II) of the Internal Revenue Code.)

** Nonqualified church-controlled organizations (non-QCCOs) must provide an annual notice to eligible employees notifying them of their right to participate in this Plan and must perform annual nondiscrimination testing with respect to any Employer contributions made to the Plan.

By checking this box, your organization affirms it shares common religious bonds and convictions with the Cooperative Baptist Fellowship.

The Church Benefits Board is a ministry of the Cooperative Baptist Fellowship (CBF). The Internal Revenue Service requires organizations that participate in the CBB 403(b)(9) Plan to be associated with CBF, evidenced by the sharing of common religious bonds and convictions. For more information, visit: cbf.net/who-we-are/

Yes

Are you a new participating employer?(Required)

If you recently started your benefits with CBB, please answer yes.

Yes

New Plan Initial Effective Date:

(This date cannot be earlier than the first day of the first Plan Year in which the Plan is adopted.)

MM slash DD slash YYYY

Amended/Restated Plan Effective Date:

If this is an amendment of a previous Adoption Agreement, the following effective dates apply:

MM slash DD slash YYYY

Employer Basic and Matching Contributions

The Employer is responsible for determining whether an individual meets any specified requirements.

Employer Basic Contributions

Employer Basic Contributions Eligibility:(Required)

No Employer Basic Contributions will be made.

Employees of the Employer will be eligible to receive Employer Basic Contributions when the following requirement(s) are met:

Length of Service:

No service required – Immediate eligibility

Have completed the following designated months of service (maximum of 12 months)

Months of service for Employer Basic Contributions eligibility (maximum of 12 months):

Please enter a number from 0 to 12.

Be regularly scheduled to work at least the following hours per week:

Employee Classifications (Please describe):

Amount of Employer Basic Contributions

The Employer will make the following Employer Basic Contributions for eligible Employees as described above. *Please enter fixed amount in the following field.

Fixed Percentage

Fixed Dollar Amount

Other

Fixed Percentage Amount:

The Employer will make contributions each Plan Year in an amount equal to _____% of each Participant’s Compensation. *NOTE* For purposes of calculating Employer Basic Contributions, Compensation includes a minister’s housing allowance.

Please enter a number from 0 to 100.

Fixed Dollar Amount:

The Employer will make Employer Basic Contributions for each eligible Participant each Plan Year in an amount equal to $____.

Please describe calculation and allocation of Employer Basic Contribution below:

Employer Matching Contributions

Employer Matching Contributions Eligibility:(Required)

No Employer Matching Contributions will be made.

Employer Basic Contributions are being paid, and Employer Matching Contributions will use the same eligibility requirements as outlined above.

Employees of the Employer will be eligible to receive Employer Matching Contributions when the following requirement(s) are met:

Length of Service

No service required – Immediate eligibility

Have completed the designated months of service (maximum of 12 months)

Months of service for Employer Matching Contributions eligibility (maximum of 12 months):

Please enter a number from 0 to 12.

Be regularly scheduled to work at least the following hours per week:

Employee Classifications (Please describe):

Amount of Employer Matching Contributions

The Employer will make the following Employer Matching Contributions for eligible Employees as described above. *Please enter fixed amounts in both of the following fields.

Fixed Amount (with percentage limit)

Fixed Amount (with dollar limit)

Other

Fixed Amount with Percentage Limit – Step 1

An amount equal to _____% of each Participant’s Employee Elective Deferral and Roth Contributions, not to exceed _____% of each Participant’s Compensation. *NOTE* For purposes of calculating Employer Matching Contributions, Compensation may include a minister’s housing allowance.

Fixed Amount with Percentage Limit – Step 2

An amount equal to _____% of each Participant’s Employee Elective Deferral and Roth Contributions, not to exceed _____% of each Participant’s Compensation.

I elect to INCLUDE a minister’s housing allowance when calculating Employer Matching Contributions.

By checking this box, I elect to INCLUDE a minister’s housing allowance when calculating Employer Matching Contributions. To maximize Employer Matching Contributions that take housing allowance into account, Employees must contribute a larger percentage of their Compensation to the Plan because Employee elective deferral contributions can only be made on taxable Compensation (excluding housing allowance amounts).

Yes

Fixed Amount with Dollar Limit – Step 1

An amount equal to ____% of each Participant’s Employee Elective Deferral and Roth Contributions, with total Matching Contributions for the year not to exceed $_______ (next field).

Fixed Amount with Dollar Limit – Step 2

An amount equal to ____% of each Participant’s Employee Elective Deferral and Roth Contributions, with total Matching Contributions for the year not to exceed $_______ (next field).

Please describe calculation and allocation of Employer Matching Contribution below:

Amendment and Termination

Except as otherwise provided in the Plan, including this Adoption Agreement, it is agreed that the Plan will be amended only by the Church Benefits Board (“CBB”). CBB will inform all Employers of any amendments made to the Plan; provided, however, that the Employer is also permitted to add overriding plan language, if necessary, to satisfy Code Section 415 because of the required aggregation of multiple plans. CBB reserves the right to discontinue or terminate the Plan. Written advance notification of any such discontinuance or termination will be provided. The Employer reserves the right to change any of the elections in this Adoption Agreement as they relate to future contributions by proper resolution and by completion and execution of a revised Adoption Agreement. The Employer has the right to terminate its participation in the Plan at any time by taking appropriate action through its Board of Directors; provided, however, that if applicable, it first provides 60 days’ written notice to CBB and the Employer’s Participants in the Plan of such action.

Authorized Employer Representatives

Until otherwise advised in writing by the Employer, CBB may accept the instructions of, or documents signed by, any of the following persons on behalf of the Employer (if more than two people, please attach another sheet with the following information):

Name:(Required)

Title/Position:(Required)

Signature(Required)

Name:

Title/Position:

Signature

Limitation of Liability

Neither CBB nor the Employer shall be liable to any person or entity for any of its acts carried out hereunder in good faith and based upon the information available at the time. Only the assets and properties of the Plan shall be liable for the debts, obligations, and liabilities under this Plan, and in no event shall CBB or any of its properties or assets, or the properties or assets of the Employer, be liable for or subject to any debts or claims of any kind arising under the Plan. IN WITNESS WHEREOF, the Employer and CBB hereby agree to the provisions of the Plan, including the stipulations set out in this Adoption Agreement.

Authorized Representative(Required)

Title/Position(Required)

Date Signed by Employer(Required)

MM slash DD slash YYYY

Church Benefits Board, Inc. 403(b)(9) Plan and Trust Administrative Appendix

This Administrative Appendix lists duties and responsibilities allocated to the Employer adopting the Church Benefits Board, Inc. 403(b)(9) Plan and Trust (“Plan”). Capitalized terms in this Appendix shall be defined in accordance with the terms of the Plan document. For purposes of this Appendix, “Plan” means the 403(b)(9) plan created by the individual Employer by adopting the 403(b)(9) Plan and Trust document.

Duties and Responsibilities of the Employer

The following administrative functions have been delegated by CBB to all Employers adopting the Plan: 1. Determining whether an Employee is eligible to participate in the Plan. 2. Timely enrolling of all eligible Employees in the Plan. 3. Promptly submitting to CBB (or its designee) completed enrollment forms following receipt of the relevant information from Employees. 4. Notifying CBB (or its designee) of a termination of employment, the granting and termination of leaves of absence, the commencement of and return to work after periods of Disability, and other facts or events which may be relevant in the operation of the Plan. 5. Promptly distributing to Participants any notice or other communication from CBB (or its designee), to the extent such notice or communication pertains to the Plan or its operation and CBB (or its designee) indicates is for the attention of such Employees. 6. Forwarding all Contributions to CBB (or its designee) as follows: • Elective Deferrals – by the 15th day of the month following the month in which the deferral was made • Employer Basic and/or Matching Contributions – no later than 15 days following the end of each pay period upon which the contribution was based • All other Contributions – within a period that is not longer than reasonable for the proper administration of the Plan 7. Determining the Participant’s Includible Compensation for purposes of monitoring the maximum Employee Contributions that a Participant may contribute. 8. Providing CBB (or its designee) with all information necessary to perform contribution limits testing under Code Sections 402(g), 414(v) and 415(c). (Note: CBB (or its designee) will assist the Employer in performing annual limits testing but will not be responsible for monitoring limits throughout the year.) 9. Determining the Employer’s status, including whether it is an Internal Revenue Code section 501(c)(3) organization, a qualified church-controlled organization or nonqualified church-controlled organization, and/or a member of a controlled group; and immediately notifying CBB of a status change in case it becomes ineligible to participate in a church plan. 10. If the Employer is a nonqualified church-controlled organization, providing annual notices to eligible employees, notifying them of their right to participate in and make employee elective deferral contributions to the Plan in accordance with Article XV of the Plan document. 11.If the Employer is a nonqualified church-controlled organization, conducting annual nondiscrimination testing with respect to employer contributions made to the Plan in accordance with Article XV of the Plan document. 12. Providing CBB with information on clergy status for purposes of designating applicable distributions from the Plan as eligible for the housing allowance exclusion from federal gross income as described in Code section 107 and the corresponding regulations.