Registered DCP (457) NEW BUSINESS AGREEMENT
Full Plan Support (FS) /Institutional (SP Option 4 (rmg 5/31/2017)/ Takeover: Conversion of G73239
Contract Number: G76721
Contract Effective Date: _______________
Initial Contract Effective Date: 1/01/1992
OneSolution 6D1D - Choose one:  Governmental  501(c)(3)/Top Hat  Governmental/Top Hat
AUL Retirement Services Representative's Name: Juani Briones
General Information - please complete all fields in their entirety
Contractholder: CITY OF FISHERS
Plan Name: CITY OF FISHERS DEFERRED COMPENSATION PLAN
Employer's Identification Number(EIN): 35-1361390
Trust EIN: _______________
Business Code: _______________
Fiscal Year End: 12/31
Executive Contact Name: Cecelie Conover
Title: ____________________
E-mail: [email protected]
Phone: 317-595-3111
Address: One Municipal Drive
Fax: _________________
City: Fishers
State: IN
Daily Contact Name:Cecelie Conover
Title: ___________________
E-mail: [email protected]
Phone: 317-595-3111
Address: One Municipal Drive
Fax: 317-595-3110
City: Fishers
State: IN
Zip: 46038
Zip: 46038
Primary Producer Information
Primary Producer Name: Anthony Gutwein
Primary B/D: Edward Jones
E-mail: [email protected]
Phone: 317-842-3645
Address: ________________________________________
Fax: _______________
City: ______________________________
State: ___________
Zip: __________
Multi-Plan Information
Are you now maintaining or have you ever maintained any other qualified plan?  Yes
 No
If yes, provide the information (below) for each of the plan(s) you are maintaining or have maintained.
Plan Name: _____________________________________________________________________________________
Has it been terminated?  Yes
 No
If yes, Date: ____________________________
Plan Type: ___________ Plan Form (prototype/individually designed): ______________ Plan Number: ____________
For AUL to provide tracking of service eligibility and vesting, you must provide the following:
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Basic Plan Document
Adoption Agreement
Subsequent Amendments
Summary Plan Description
Trust Agreement, if separate from Basic Plan Document
Investment Option Selection - See your AUL representative for any limitations
Please refer to Exhibit B of your Services Agreement and Fee Disclosure to select your investments.
PLAN-LEVEL DEFAULT INVESTMENT OPTIONS: The plan-level default option is the investment option into which we
will allocate participant contributions when we are missing the participant's investment option direction.
Select only one of the plan-level default investment options below:
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100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
AUL Fixed Interest Account (FIXD) - not QDIA-compliant
GoldmanSachs Money Mkt Gvt ADM (GSGA) - not QDIA-compliant
AmerCent Strat Alloc: Mod Inv (ASM2) - QDIA-compliant
Russell LP Balanced R1 (FRLB) - QDIA-compliant
Fidelity Advisor Freedom Target Date (F1 Series) - QDIA-compliant
Russell Lifepoints Target Date (R1 Series) - QDIA-compliant
American Century One Choice Target Date (L1 Series) - QDIA-compliant
TIAA-CREF Lifecycle Index Target Date (C1 Series) - QDIA-compliant
T. Rowe Price Retirement Target Date (T1 Series) - QDIA-compliant
AllianzGI Retirement Target Date (Z1 Series) - QDIA-compliant
IVY Balanced Y (IVBY) - QDIA-compliant
Franklin Income Adv (FTIA) - QDIA-compliant
MFS Conservative Alloc R3 (MCA3) - QDIA-compliant
MFS Growth Alloc R3 (MGA3) - QDIA-compliant
MFS Moderate Alloc R3 (MMA3) - QDIA-compliant
AmerFds American Balanced R4 (AFA4) - QDIA-compliant
AmerFds Target Date Ret R4 (M2 Series) - QDIA-compliant
QUALIFIED DEFAULT INVESTMENT ALTERNATIVE: As Plan Sponsor, you may elect a plan-level default investment
option that is a "Qualified Default Investment Alternative" (QDIA) as defined under applicable law and regulations. If certain
conditions are satisfied, plan fiduciaries can rely on safe harbor relief from fiduciary liability related to investment outcomes
experienced in connection with contributions defaulted into the default investment option for those participants who failed
to provide investment direction. However, fiduciaries are not relieved of their obligation to prudently select and monitor the
default investment option, or from any liability that results from failure to do so. The investment options directly above have
all been reviewed by the related fund company and determined by it to meet the definition of a QDIA under applicable law,
except for the Fixed Interest Account and the Money Market investment option. If you intend for the plan-level default
investment option you have chosen above for your plan to be QDIA-compliant, please mark the box below.
 I intend for my plan-level default investment option to be a Qualified Default Investment Alternative. As a non-ERISA
plan, I understand that ERISA Title I requirements do not apply and that an annual notice is not required.
INCOMPLETE PARTICIPANT ACCOUNT INFORMATION: If AUL has all the information necessary to establish a
participant account, but has not received investment direction for the account, any contributions received on behalf of that
participant will be deposited into the Default Option. Any money allocated to the Default Option will remain there until the
participant transfers monies out of the Default Option.
REVENUE SHARING STATEMENT: AUL receives revenue from the investment management companies that provide the
underlying investments. This revenue can be in the form of 12-b(1) fees, Sub T-A Fees, Shareholder Service Fees or other
types of fees. This revenue offsets AUL's expenses related to the services it provides under and in connection with the
group annuity contract(s) that serve as the funding vehicle(s) for a retirement plan. A full description of this revenue is found
in Exhibit B of your Services Agreement and Fee Disclosure.
COMMON, COLLECTIVE, COMMINGLED OR GROUP TRUST USE CERTIFICATION: In order to select the State St
Eqty 500 Indx R as an available investment option for plan participants through the applied for AUL group annuity contract,
the employer/plan sponsor (or contractholder) must make the certification below. By signing this New Business Agreement,
the employer/plan sponsor (or contractholder) does so make the certification.
I certify that the plan and trust (for which this applied for group annuity contract is to serve as a funding vehicle) may
invest its trust assets in a group annuity contract issued by an insurance company, any part of the assets of which can
be invested in any common, collective, commingled or group trust fund that is maintained solely for the collective
investment of funds of tax-qualified pension or profit sharing plans, individual retirement accounts, and/or funds of or
for certain governmental retirement plans, which common, collective, commingled or group trust fund is exempt from
federal taxation under Internal Revenue Code Section 501(a).
AUL FIXED INTEREST ACCOUNT (FIA) TRANSFER RESTRICTIONS: If the AUL FIA is selected, there will be a transfer
restriction that applies to FIA transfers depending on whether the competing investment option is an available investment
option for participant accounts. Please refer to Exhibit B of your Services Agreement and Fee Disclosure for competing
investment options.
If you –
1. select the competing investment option, then the following transfer rules will apply –
For participants who have $2,500 or more in the FIA at the beginning of the contract year, up to 20% of that amount may
be transferred during that contract year. For participants who have less than $2,500 in the FIA at the beginning of the
contract year, any amount may be transferred from the FIA for that participant during that contract year.
2. do NOT select the competing investment option, then the following transfer rules will apply –
One-hundred percent (100%) may be transferred from the FIA at any time. However, once a transfer has been made from
the FIA for a participant, transfers back into the FIA are allowed only after 90 days have elapsed since the last transfer
from the FIA for that participant.
FIXED INTEREST ACCOUNT LUMP-SUM PAYMENTS/INSTALLMENTS: Upon contract termination, the Fixed Interest
Account funds will be paid in six annual installments over five years if "i" is greater than "j", but will be paid in a lump-sum
if "j" is greater than or equal to "i". For these purposes:
"i" = the Guaranteed Rate AUL credits to new contributions and
"j" = the dollar-weighted average rate of interest AUL credits to amounts withdrawn from each affected participant
account.
Existing Asset Transfer
Mapping to Like (similar) Options: This option keeps the plan assets invested in the market during the transition and
reconciliation process. . Select the AUL investment options that best mirror the existing investments in your current
contract. Transferred assets will be immediately invested as directed below at a plan-level. If no investment direction is
given for forfeitures and/or any other investment, the assets will be invested in the Fixed Interest Account.
Participants will have access to their takeover assets at the end of the transition process. It will be the participant's
responsibility to re-direct their existing balances using the transfer option via Account Services or the OneAmerica
TeleServe® system. Participants who do not take this action will remain invested as described above.
Instructions: Listed in the table below are your current Investment Options. In the right-hand column, titled "Mapping AUL
Investments," you must list the receiving Investment Option on the same row with the existing Investment Option from which
the money will be transferred. Be sure to include the four-digit investment ID immediately after the name of the Investment
Option.
You may transfer monies from more than one existing investment option into a given AUL investment; however, you may
not divide the monies of one existing investment into two or more AUL investments.
Existing Investments
Fixed Interest Account (FIXD)
Mapping AUL Investments
Fixed Interest Account (FIXD)
GoldmanSachs Money Mkt Govt Ad (GSGA)
Pioneer Bond Y (PBYA)
Fidelity VIP High Income Init (HHIB)
Fidelity VIP Asset Manager Init (HMGD)
Janus Balanced S (JASS)
Russell LifePoints Equity Growth Strategy R1 (RTES
Russell LifePoints Balanced R1 (RTBS)
Russell LifePoints Conservative R1 (RTCS)
Russell LifePoints Growth Strategy R1 (RTGS)
Russell LifePoints Moderate R1 (RTMS)
Fidelity VIP Equity Income Init (HEQI)
Pioneer Equity Income Y (PEIY)
TRowe Price Equity Income Ins (TRP2)
State Street Equity 500 Index Adm (FINX)
Alger LrgCap Growth Portfolio I-2 (AAG2)
Fidelity VIP Contrafund Init (HOPP)
Fidelity VIP Growth Init (HEQU)
Ariel Inv (ARL2)
Calvert VP SRI MidCap Growth Prt (CCA2)
Vanguard VIF Sm Company Growth Ins (VSG2)
Fidelity VIP Oversears Init (HINL)
Preliminary Agreement for American United Life Insurance Company® Group
Annuity Contract
1. The Contractholder hereby authorizes AUL to allocate any contribution made to the Contract before the earlier of:
(A) the date AUL receives, at its Home Office, an acceptance of the Contract signed by the Contractholder or
(B) the date a contribution is made to the Contract following the Contractholder's receipt of the Contract (but no earlier than
60 days after the Contract Date of Issue as it appears on the face page of the Contract), among participant accounts and
investment options offered under the Contract according to the allocation instructions and investment option elections
received by AUL at its Home Office from the Contractholder. However, if applicable state law requires in this situation that
the Contractholder not bear the market risk in allocating these contributions among the investment options offered under
the Contract, AUL shall allocate such contributions to its general asset account in lieu of any AUL separate account,
notwithstanding the Contractholder's investment option elections. Such contributions shall be administered by AUL pursuant
to the terms of the Contract and any accompanying amendment to the Contract, except as otherwise provided below.
2. Upon the date a contribution is made to the Contract following the Contractholder's receipt of the Contract (but no earlier
than 60 days after the Contract Date of Issue), if AUL does not receive a signed acceptance of the Contract at its Home
Office by that date, the Contractholder shall be deemed to have accepted the Contract and any accompanying amendment
to the Contract by the making of such contribution. The Contract and any accompanying amendment shall be effective as
of the effective dates shown on the Contract and amendment.
3. Any investment option elections received by AUL at its Home Office in acceptable form prior to the date the Contract is
accepted or deemed accepted by the Contractholder shall remain in effect for the Contract once the Contract has been
accepted or deemed accepted until such time as new investment option elections are received by AUL in acceptable form
at its Home Office pursuant to the terms of the Contract.
4. If the Contract is not accepted or deemed accepted, and if the Contractholder notifies AUL at its Home Office in writing
that it will not accept the Contract, the following amount shall be paid in a single sum to the Contractholder on a mutually
agreed-upon date:
(A) any contributions to the Contract which have been allocated to AUL's general asset account, plus interest credited
thereon as determined pursuant to the Contract, which remain in AUL's general asset account as of such date of payment,
plus
(B) the value, as determined by AUL pursuant to the Contract as of such date of payment, of any accumulation units in any
AUL separate account which were purchased with contributions to the Contract and which are held on such date of payment,
minus
(C) the sum of:
(1) the same Withdrawal Charge (if sales compensation has been paid) that would be applied to single-sum Contract
termination payments under the Contract as of such date of payment; plus
(2) any non-refundable application/installation fee and any other non-refundable initial expense(s) payment(s)
submitted by the Contractholder for the Contract, plus
(3) any other administrative services fees or Contract charges owed by the Contractholder to AUL as of the date of
payment, plus or minus
(4) the same Market Value Adjustment applicable to AUL's general asset account that would be applied to single-sum
Contract termination payments under the Contract as of such date of payment.
AUL shall make such payment only upon receipt at its Home Office of a proper form signed by the Contractholder and, if
applicable, by the employer sponsoring the retirement plan for which the Contract is to be a funding vehicle, releasing AUL,
its agents, and its employees from any and all liability arising out of such payment by AUL.
Notwithstanding the above provisions of this Section 4, if the Contractholder makes a contribution to the Contract in the
form of a rollover from another AUL group annuity contract (the original contract), if the new Contract is not accepted or
deemed accepted, and if the Contractholder notifies AUL at its Home Office in writing that it will not accept the Contract,
then the Contractholder hereby directs AUL to reinstate the original contract between the Contractholder and AUL. The
amount calculated above in this Section 4 (but without reduction for the Withdrawal Charge and without adjustment for the
Market Value Adjustment) shall be rolled back into the original contract and into the available investment options according
to the provisions of that contract, in lieu of being paid to the Contractholder. However, notwithstanding the previous
sentence, amounts held in the general asset account in the original contract which were rolled into, and remain in, the
general asset account in the new Contract shall be rolled back into the general asset account in the original contract,
together with interest earned thereon in the new Contract, and those interest rate pockets applicable to such amounts in
the original contract shall be maintained for those amounts and the interest earned thereon.
5. This Preliminary Agreement shall terminate when:
(A) the signed Contract acceptance is received by AUL at its Home Office; or
(B) the Contract is deemed accepted under Section 2 above; or
(C) payment is made by AUL pursuant to Section 4 above.
Participant Fees
Distribution Fees
A distribution fee will be applied to a participant's account in the event of a lump-sum distribution.
 Check here if you elect to have the distribution fee billed to the Plan Sponsor.
Please refer to Exhibit C of your Services Agreement and Fee Disclosure for information relating to this fee.
Fiduciary Acceptance
I, the undersigned Plan Fiduciary, have received information describing the costs that may occur in connection with buying,
maintaining or terminating this contract. I have read and understand the Sales Compensation Disclosure found in the
Services Agreement and Fee Disclosure and approve this transaction on behalf of the plan.
The undersigned, as Plan Administrator of the CITY OF FISHERS DEFERRED COMPENSATION PLAN ("Plan"), hereby
appoints American United Life Insurance Company® ("AUL"), as the Plan Administrator's agent for the sole purpose of
executing Plan participants' investment instructions through the OneAmerica TeleServe® system or the OneAmerica Web
site at www.OneAmerica.com. It is understood that AUL will execute Plan participants' investment instructions received
through the OneAmerica TeleServe® system or the OneAmerica Web site effective as of the close of business on the
valuation date, as referenced in your contract, in which AUL receives the request. It is further understood that AUL has no
discretion or authority to alter or decline to execute any Plan participant investment instructions received through the
OneAmerica TeleServe® system or the OneAmerica Web site, unless such instructions are impossible to execute. If any
such instructions are impossible to execute, AUL will so notify the participant before the instructions are accepted by
OneAmerica TeleServe® system or the OneAmerica Web site. All investment instructions received and executed through
the OneAmerica TeleServe® system or the OneAmerica Web site will be confirmed in writing to the Plan participant within
ten business days. AUL may rely on the information provided by the funding entity (or entities) who is (are) holding plan
assets listed in this document.
The Contractholder, Plan Administrator, and AUL hereby agree by signing below, that they will be bound by the terms of
this New Business Agreement as of the date of AUL's acceptance. This agreement shall continue in effect from the date it
is accepted by AUL and from year to year thereafter, unless terminated by AUL or the Plan Administrator by written
notification to the other party at least 30 days prior to the date termination is effective. Except for any annual contract
administrative fee provision of the Preliminary Agreement, the terms of the Preliminary Agreement are superseded by the
terms of the applied-for Contract as of the date the applied-for Contract is issued by AUL, and the Contract is accepted or
is deemed accepted under the provisions of the Preliminary Agreement. The Contractholder must sign and date the
Amendment which accompanies the issued Contract, and return a copy to AUL. AUL will accept non-original paper copies
or faxed copies of the properly executed original New Business Agreement. The Contractholder hereby certifies that such
non-original copies are true and accurate copies of the original document and that no changes deviating from the language
in the copies have been made or will be made to the original.
CONTRACTHOLDER
and PLAN FIDUCIARY
AUL RETIREMENT SERVICES SALES REPRESENTATIVE
American United Life Insurance Company®
Signature:
Signature:
Printed Name:
Printed Name: Matthew Shanks
Title:
Title: Regional Sales Director, Retirement Services
Date:
Date:
PLAN ADMINISTRATOR (if other than Applicant)
SALES PRODUCER
Signature:
Signature:
Printed Name:
Printed Name:
Title:
Title:
Date:
Date:
For licensing purposes, please indicate the state in which this agreement is being signed: Indiana.
Electronic acceptance of this New Business Agreement by American United Life (AUL) Indianapolis, Indiana indicates that
AUL has reviewed its contents along with all other required materials and has accepted its terms, and is equivalent to AUL's
written signature.
Advisor / Producer / Retirement Services Representative Information Sheet – AUL Use Only
Contract #:
G76721
Contract Name: City of Fishers
RSR/RSD Production Bonus Assignment(s)*
Name
(Sales Role)
Investment Advisor – Advice Only
Investment Advisor – Models
Special Marketing
Broker Dealer
TPA
% Split
Direct Broker
AUL# (AA######)
OA General Agent
Advisor/Producer Name
OA Career Agent
Select One
RC/RM/RE Default Bonus Assignment^
% Amount
**100%
Name
(Service Role) – RC/RM/RE assigned to case
% Amount
**100%
* Includes name(s) and %(s) of those the Sales Rep desires to receive split. This includes Relationship Management Personnel and
Group Reps (Cross Selling Agreements).
* Any Relationship Management or Group Sales personnel entered in Production Bonus will receive bonus from premium received
from 1st year only.
* There must be at least one Sales Rep entered with a minimum of 1% assigned.
** All entry percents must add up to 100%.
^ Any sales offices having at least one Relationship Management Personnel present must assign the appropriate RC/RM/RE.
^ Individual entered for Service Role is the defined RC/RM/RE of the case.