Plan Adoption Agreement Form

If you have any questions regarding how to complete the Adoption Agreement form, please contact our operations team at helpdesk@churchbenefits.org. After submitting your signed Adoption Agreement form, the next step for the Guided Payroll process is to schedule your initial training session with Nicole Averette, Benefits Services Manager. You will be redirected to the online scheduler once you complete the form. A copy of your signed agreement will be sent to your principal contact via email. 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.

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:

Step 1 of 3

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.)

Are you a new participating employer?(Required)

If you have an account number with CBB and have received invoices, your answer will be no.

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.)

Amended/Restated Plan Effective Date:

If this is an amendment of a previous Adoption Agreement, the following effective dates apply (USE PLACEHOLDER DATE):

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)

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. 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.

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