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ICM/�C <br />Building Reriremen[ Seazairy <br />Vantage(are Retirement Health Savings Plan <br />Implementation Data Form — Page 2 <br />Default Investment The default fund will be used if a participant does not provide valid allocation instmctions. <br />Option <br />f you do not make an election in this section, the Milestone Fund with the target date closest to a purticipant's 60th birthday will be <br />used us your plan's default option. <br />You may select the "Altemative Default" option if you would like to use a fund (or funds) other than the Milestone Funds as your plan's <br />default option. Please see ICMA-RC's Standard Plan Fund lineup at www.icmoo.mg to complete this section. <br />Nate: Prior to selecting the "Alternative Default" option, employers should carefully review the Department of tabor's final <br />regulations an qualified default investment alternatives (ODIAs). More information is available online at www.dol.gov or <br />www.icmarc.org/ppa. <br />Default Fund for Investment Allocations (Select one option): <br />El The Milestone Funds (Default) with a target retirement age of: . <br />❑ Age 60 (Default) <br />VJ Age 55 (Input the Target Retirement Age to he used for your plan) <br />❑ Alternative Default <br />(Input the fund name that will be used as the plan's default investment option) <br />Claims Contact <br />Plan Contacts <br />Information <br />(Complete item <br />#18. If item #14-17 and 19 are left blank, the Primary Contact in #4 will receive mailings.) <br />Please indicate <br />14. PTOI <br />Contact Signature: <br />alternate addresses <br />(200) <br />Contact Name: Kathleen Crook <br />in Comments <br />(210) <br />Benefits & Compensation Su ervisor <br />Contact Title: P P <br />Section <br />(420) <br />Telephone: ( 714) 647-6967 (421) Fax: (714 ) 647-5321 <br />15. PT08 <br />Contact Signature: <br />(200) <br />Contact Name: <br />(210) <br />Contact Title: <br />(420) <br />Telephone: ( 1 _ (421) Fax: I—) <br />16. PT09 <br />Contact Signature: <br />(200) <br />Contact Name: <br />(210) <br />Contact Title: <br />(420) <br />Telephone: ( 1 __ (421) Fax: ( I <br />Contribution Contact I 17. PT02 (200) Contact Nome: Kathleen Crook — <br />Information Benefits & Com ensation e Su rvisor <br />(210) Contact Title: p p <br />(4201 Telephone: ( 714 ) 647-6967 (421) Fax: ( 714 ) 647-5321 <br />ICMA Retirement Corporation • P.O. Box 96220 • Washington, DC 20090-6220 • Tall Free 1-BOO 669-7400 <br />