Item 19 - Agreement with Empower Annuity Insurance Company for the Employee Deferred Compensation Plan

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49 Model QDRO Language, which addresses all required issues, can be provided to assist you in preparing the DRO. 4.1. REQUIRED INFORMATION Generally, QC will reject a DRO that does not contain the required information listed below, or includes instructions that are not clear. However, if a DRO does not contain a party’s last known mailing address, social security number, and/or date of birth, and if QC otherwise receives the missing information, QDRO Consultants will review the DRO as if it contains the missing information. Also, if a DRO contains a retirement plan name that is not the Plan’s exact legal name, as identified below, and if it is clear that the plan referenced in the DRO is intended to be the Plan, QC will review the DRO as if it contains the Plan’s legal name. Names and Addresses: The DRO must include the names and last known mailing addresses of the Participant and Alternate Payee. Social Security Numbers: The DRO must include the social security numbers of the Participant and Alternate Payee. For privacy reasons, you may provide these in a separate document. Dates of Birth: The DRO must include the dates of birth for the Participant and Alternate Payee. For privacy reasons, you may provide these in a separate document. The Plan’s Legal Name: The DRO must identify the Plan by its legal name: City of Santa Ana Deferred Compensation Plan State Domestic Relations Law: The DRO must state that it is made pursuant to a state domestic relations law. Child Support / Alimony / Marital Property Rights: The DRO must indicate that it provides child support, spousal support, and/or marital property rights to the Alternate Payee. Alternate Payee’s Benefits: The DRO must clearly state the portion of the Participant’s Plan benefits that is assigned to the Alternate Payee, either as a lump-sum dollar amount OR a percentage of the Participant’s account balance, and must include the date as of which the assignment is effective (“Assignment Date”). The current recordkeeper cannot obtain account balance informa tion or calculate investment gains/losses on any Participant accounts for periods prior to the restriction date as determined by Empower Annuity Insurance Company, which is October 1, 2023 (“Restriction Date”). Therefore, the DRO must not contain an Assignment Date that is prior to the Restriction Date. Payment Date: The DRO must include language that permits the Alternate Payee to elect to begin receiving his/her benefits as soon as administratively possible after the date that QC determines that the DRO is a QDRO or, if later, at the earliest date permitted under the Plan. Payment Period: The DRO must include language that the Alternate Payee shall receive his/her benefits in a single lump-sum payment, or in any other form of payment that the Plan permits. 4.2. IMPORTANT INFORMATION / DEFAULT PROVISIONS