ENROLLING IN THE
P L A N I S V E RY E A S Y ! !
To better serve your needs when enrolling please complete the form as shown.
Section 1: Always include your Social Security
Section 2: Please print the Employer (Entity)
Number, Name, Home Address and all other identifyNumber, Name and Address of your department
ing and contact information to help us correctly
and payroll contact information to ensure that
establish your new account. If you are reporting a
your form will be sent to the proper payroll
change in your name, acceptoffice. If you need assistance with this
able legal proof of the
information, please call us at 1-866-827change must accompany this
NMEX(6639).
form. (E.g., Copy of marSection 5: Please check
PARTIC
IPATIO
N
riage certificate, driver’s
the box that
AGREE
and SE
ME
RVICE
REQUE NT, PAYROLL
ST for
license, order of legal name
applies to
PLEAS
DEFER DEDUCTION
E REA
A
RED C
D THE
OMPEN UTHORIZAT
REVER
IO
S
N
A
change from court).
1. Soc
TION P
SE SID
how often
ial Secur
E OF T
LAN
2. EN
Numbe
HIS FO
ity
TITY N
r
RM PR
UMBER
IOR TO
:
E
you
are
m
pl
oyer Nam
COMPL
State ID
Date
e ____
ETION Agenc
Numbe
______
Birth of
y Name
r ______
__
__
__
______
______
Employ
______
Section 3 & 4: Mark the
Name
paid.
____
__
er Addre
______
____
ss ____ ____________
Sex r
______
Salary
____
______
______
r
$_____
______
______
Payroll
______
“Type of Request” and list
__
______
____
Center
______
______
Address
Name
____
Payroll
______
______
Center
__
______
Phone
______
# (_____
the dollar amount you
Section 6:
__
) ______
______
wish to change from
If you want
Home
r
Phone
(under “OLD”) and the
to
establish
Occupat
Work
ion __
______
P
__
ho
__
ne
______
dollar amount you wish
-an annual
r
3. TY
______
PE OF
______
REQUE
Email A
______
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______
dd
New r
Ext. __ ress ______
______
4. DE
to change to (under
automatic
______
______
__
Change
FERRA
______ __________
____
L SUM
r Reins
__
______
MARY
tatemen
Hire Dat
______
t
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_
“NEW”). Also, you
deferral
______
______
______
____
6.
AUTOM
may write in the date
increase,
ATIC IN
CREAS
E
you wish to have your
please
first deferral take
complete this
7. CA
TCH-U
5. PA
P Provi
YROLL
effect. (Generally,
section.
check
sion Util
FREQU
ized:
ENCY:
deferrals can start or
with your payroll
8. r
9.
be boun Enroll me in
FUNDIN
d
as
G OPT
increase no earlier
center for
restrictio by the term set rebalan
IONS –
Only fo
obtain m ns imposed s and conditi cing. I agre
r New
by the
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ore info
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than the first day of
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RS Ser
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rvice, itsns. I understa ing any
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terms an nd I can
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le % an
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100%
ing the month this
Section 7: Not
application is
sure about the
signed.)
“Catch-Up”?
Check with your
Section 9: The
Retirement
Fund Section is
Specialist for
only for new
provisions or call us
10. r
Check
here if
th
is
is
enrollments.
a chan
at 1-866-827
ge of b
eneficia
ry. (
We can help
NMEX(6639) for
you select
assistance.
your fund
Note: You may
r
choices.
consolidate other
Call us at 1pre-tax
retirement plan
866-827assets into your Deferred
NMEX
______
______
______
Compensation
Plan.For
______
(6639).
______
______
______
______
______
______
more
______
______
______
______
__
____
______
information,check the box
______
______
Section
______
______
____
to
have a Retirement
______
10.
______
______
______
______
Specialist contact you to
__
Beneficiary Selection:
discuss
your options.
Be sure to complete this area. If you
have more than two beneficiaries, you may include a
Signature Section: To
signed attachment.
eliminate processing delays, please be sure to
sign and date this form before mailing it. All
Please keep the last copy of this form for your records.
unsigned forms will be returned to you for your
Month
Last
Numbe
r & Stre
et
Day
M
Year
F
First
City
Additio
nal Mai
State
Amount
to Fund
ing Opt
ions
Univers
al Life
SUB TO
SPECIAL
TOTAL SPECIAL
Start __
TAL
DEFERR
PAY PER
______
IOD
DATES
______
r Wee
kly (W)-5
2
r Bi-W
eekly (Z
)-26
ASSET A
LLOCAT
ION
______
______
%
______
______
%
______
______
%
______
______
%
______
______
%
______
______
%
SPECIAL
TY
______
______
%
INTERNA
TIONA
L
______
______
%
______
______
%
______
______
%
______
______
%
AL
ENDING
______
___
OLD
$ ____
NEW
______
____
$ ____
$ ____
______
______
____
____
$ ____
$ ____
______
______
____
____
$ ____
$ ____
______
______
____
____
$ ____
$ ____
______
______
____
____
$ ____
______
____
Stop __
______
______
______
___
r Mon
thly (M)-1
2
r Oth
er ____
______
__
r Sem
i-Month
ly (X)-2
______
4
______
______
___
MI
ling Info
rmation
Check
here if
this is a
name
change
(p
name ch roof of
ange mu
st
be attac
hed).
Check
here if
this is a
new
addres
s
Zip Code
General
ly, defe
rrals ca
ing the
n start
month
or increa
this appl
se no ea
ication
rlier than
is signe
the first
d. Star
t Deferra
day of
the mon
l on: __
Percent
th follow______
age or
______
Dollar In
______
*If sele
cr
____
ease*:
cted,
______
this perc
__% O
annually
entage
R $___
or dolla
in July.
______
r increa
This op
Please
se will
tion is no
check w
automat
t availa
ith your
ically oc
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payroll
cur
h all pa
center
prior to
yroll ce
nters.
selectin
r Yes,
g
th
is
3-year
option.
r Yes,
Normal
Age 50
Retirem
+
ent Age
: ____
r No
______
______
______
______
______
__
Life Cy
cle Cons
er
Life Cy
cle 2015 vative Portfolio
Portfolio
Life Cy
cle 2025
MID CAP
Portfolio
(CONTIN
Life Cy
UE
cle 2035
______
______ D)
Portfolio
Life Cy
%
cle 2045
Portfolio
Life Cy
T. Rowe
cle 2055
LARGE
Portfolio
CAP
Fund (In Price Institutio
nal
______
stitutiona
______
l Shares Mid-Cap Equi
Invesco
%
ty Growt
______
)
Global
______
h
Real Es
%
Calvert
______
tate Fu
Social In
nd (Inst
______
vestmen
%
itutiona
Dodge
Aberde
______
l Shares
& Cox
en
______
Stock Fu t Equity Portfol
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(Institutio Emerging M
%
Fi
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arkets Eq
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nal Clas
rafund
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uity Fund
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America
BALANCE
Vangua
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rd Institu
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Fidelity ®
tional In
______
cific Gro
dex Fu
Diversifie
______
SMALL C
nd
wth Fund ®
%
Va
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ng
In
__
ua
®
ternatio
AP
______
rd Tota
(Class
nal Fund
__%
______
l Intern
Oakmar
R6)
(Signal
ational
______
Shares
k Equity
Stock In
%
)
Income
BONDS
Princip
MID CAP
dex Fu
al Di
Institutio
nd
DFA U.
nal
(Institutio versified Real
______
______
S.
Sm
______
Asset Fu Fund (Class I)
nal Clas
all Cap
______
%
s)
nd
Fu
%
__
______
nd (Cla
______
______
ss I)
____%
Bl
ackrock
%
Fidelity
______
______
Low Pr
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Templet
Princip
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FIXED/C
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or
1. IF TH
Fund (A Fund
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______
L INVE
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______
STMENT
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p Blend
%
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nd
N ALLO
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PLEASE
PERCEN
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exico St
TAGE
% Tota
IS GREA
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R THAN
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100%,
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YOUR
to
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WILL BE
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. The re
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The redu
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its pa
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rstand the front an
Particip
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that th
d
ating Em
designat continue until
trator in
ese stat back of this
tages in
ployee’s
ed inve
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conjunct
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Signatur
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not cove
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set-up
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time
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DC-406
Da
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P
lan or
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Nationw
8-0314
produc e with the In
ide Retir
ternal
ts.
ement
Solu
ORIGIN
tions •
Sales Di
P. O. Bo
AL - Pr
rector ’s
x 28
ocessin
Signatur
g • COPY 580 • Santa Fe
e/Numbe
, NM 87
2 - Payr
r
592-99
oll Cent
00 • 1-86
er • CO
6-827-NM
PY 3 Particip
Princip
ant • CO EX(6639) • ww
al’s Sign
PY 4 ature
Retirem w.newmexico
457dc.co
ent Spec
m
ialist
Call us at 1-866-827-NMEX(6639) for assistance.
Mail completed form to:
Nationwide Retirement Solutions, P. O. Box 28580, Santa Fe, NM 87592-9900
DC-4068-0314
Nationwide Retirement Solutions • P. O. Box 28580 • Santa Fe, NM 87592-9900 • 1-866-827-NMEX(6639) • www.newmexico457dc.com
PARTICIPATION AGREEMENT, PAYROLL DEDUCTION AUTHORIZATION
and SERVICE REQUEST for DEFERRED COMPENSATION PLAN
2.
ENTITY NUMBER:
Employer Name ________________________
PLEASE READ THE REVERSE SIDE OF THIS FORM PRIOR TO COMPLETION Agency Name ________________________
Employer Address ______________________
______________________________________
M
F
1. Social Security
Date of
Number
Birth
Sex r r
Payroll Center Name ____________________
Month
Day
Year
Payroll Center Phone # (_____) ____________
State ID Number ________________________
Salary $_____________________
Name
Last
First
MI
r Check here if
this is a name
change (proof of
name change must
be attached).
Address
Number & Street
Additional Mailing Information
City
State
r Check here if
this is a new
address
-Home
Phone
Work
Phone
Zip Code
Email Address _______________________________
Ext. ________________
Occupation __________________________________________________________
Hire Date
________________________
3.
TYPE OF REQUEST: r New r Change r Reinstatement
Generally, deferrals can start or increase no earlier than the first day of the month following the month this application is signed. Start Deferral on: ________________________
4.
DEFERRAL SUMMARY
6.
OLD
NEW
Amount to Funding Options
$ ______________
$ ______________
Universal Life
$ ______________
$ ______________
$ ______________
$ ______________
SUB TOTAL
SPECIAL
TOTAL DEFERRAL
$ ______________
$ ______________
$ ______________
$ ______________
AUTOMATIC INCREASE
Percentage or Dollar Increase*: ________% OR $_________
*If selected, this percentage or dollar increase will automatically occur
annually in July. This option is not available through all payroll centers.
Please check with your payroll center prior to selecting this option.
7.
CATCH-UP Provision Utilized:
SPECIAL PAY PERIOD ENDING DATES
r Yes, 3-year
Start _______________________
Normal Retirement Age: ____________________________________
5.
Stop _______________________
PAYROLL FREQUENCY:
r Weekly (W)-52
r Bi-Weekly (Z)-26
9.
r Monthly (M)-12
r Semi-Monthly (X)-24
r Other _________________________________
r Yes, Age 50+
r No
8. r Enroll me in asset rebalancing. I agree to comply with and
be bound by the terms and conditions of the service including any
restrictions imposed by the investment options. I understand I can
obtain more information about the service, its terms and conditions by
contacting the NRS Service Center.
FUNDING OPTIONS – Only for New Business or Allocation Changes – Must be in Whole % and Total 100%
ASSET ALLOCATION
____________%
____________%
____________%
____________%
____________%
____________%
Life
Life
Life
Life
Life
Life
SPECIALTY
____________%
Invesco Global Real Estate Fund (Institutional Shares)
INTERNATIONAL
____________%
____________%
____________%
____________%
SMALL CAP
____________%
MID CAP
____________%
____________%
1. IF
Cycle
Cycle
Cycle
Cycle
Cycle
Cycle
MID CAP(CONTINUED)
____________%
Conservative Portfolio
2015 Portfolio
2025 Portfolio
2035 Portfolio
2045 Portfolio
2055 Portfolio
LARGE CAP
____________%
____________%
____________%
____________%
Aberdeen Emerging Markets Equity Fund
(Institutional Class)
American Funds-EuroPacific Growth Fund® (Class R6)
Fidelity® Diversified International Fund
Vanguard® Total International Stock Index Fund
(Signal Shares)
DFA U.S. Small Cap Fund (Class I)
Fidelity Low Priced Stock Fund
Principal Investors Fund Inc. - Principle MidCap Blend
Fund (Institutional Class)
THE TOTAL INVESTMENT OPTION ALLOCATION PERCENTAGE IS GREATER THAN
BALANCED
____________%
____________%
BONDS
____________%
____________%
____________%
FIXED/CASH
____________%
T. Rowe Price Institutional Mid-Cap Equity Growth
Fund (Institutional Shares)
Calvert Social Investment Equity Portfolio (Class I)
Dodge & Cox Stock Fund
Fidelity Contrafund
Vanguard Institutional Index Fund
Oakmark Equity Income Institutional Fund (Class I)
Principal Diversified Real Asset Fund
(Institutional Class)
Blackrock Inflation Protected Bond Fund
Templeton Global Bond Fund (Advisor Class)
Vanguard Total Bond Market Index Fund
(Institutional Shares)
New Mexico Stable Value Fund
____________% Total for both columns must equal 100%1
100%, YOUR APPLICATION
WILL BE REJECTED AND YOUR ALLOCATIONS WILL NOT BE PROCESSED.
10. r Check here if this is a change of beneficiary. (Any changes in the beneficiary designations supersede any prior beneficiary designations).
PLEASE NOTE: Percentage split must total 100%, and must be in whole percentages. If you have more than one primary or contingent beneficiary, you must attach those
designations on a separate sheet. r Check here if you have attached additional beneficiaries.
Beneficiary Name
Social Security Number
%Split
r Primary
r Contingent
Address
Date of Birth
Phone #
r Primary
r Contingent
Beneficiary Name
Social Security Number
Address
%Split
Date of Birth
%Split
r Please contact me regarding transferring my other pre-tax retirement plans.
I authorize my Employer to reduce my salary by the above amount which will be credited to the State of New Mexico Plan. The reduction will continue until
otherwise authorized in accordance with the Plan. The withholding of my deferred amount by my Employer and its payment to the designated investment
option(s) will be reflected in the first pay period contingent on the processing of this application by the Plan Administrator in conjunction with the set-up time
required by my payroll center. The reduction is to be allocated to the funding options in the percentages indicated above.
I have read and understand each of the statements on the front and back of this form, which have been drafted in compliance with the Internal
Revenue Code. I accept these terms and understand that these statements do not cover all the details of the Plan or products.
__________________________________________
Participating Employee’s Signature
__________________________________
Retirement Specialist’s Signature/Number
DC-4068-0314
______________
Date
__________________________________
Sales Director’s Signature/Number
________________________________
Principal’s Signature
Nationwide Retirement Solutions • P. O. Box 28580 • Santa Fe, NM 87592-9900 • 1-866-827-NMEX(6639) • www.newmexico457dc.com
ORIGINAL - Processing • COPY 2 - Payroll Center • COPY 3 - Participant • COPY 4 - Retirement Specialist
THE STATE OF NEW MEXICO DEFERRED COMPENSATION PLAN
MEMORANDUM OF UNDERSTANDING
The purpose of this memo is to ensure that you fully understand the major terms, restrictions and costs of the State of New Mexico
Deferred Compensation Plan. However, it does not cover all the details of the Plan. Please refer to the Plan Document for specific
details.
I understand and acknowledge the following:
1.
I understand that my participation in the Plan is governed by the terms and conditions of the Plan Document.
The product information brochure and fund prospectuses are available upon request at at www.newmexico457dc.com or by calling
1-866-827-NMEX(6639).
2.
The total annual deferral amount to all 457 plans is the lesser $17,500 or 100% of includible compensation. Under certain
circumstances, additional amounts above the limit may be deferred into the Plan if (1) I will obtain age 50 or older during the calendar
year, or (2) I am within three years of Normal Retirement Age and did not defer the maximum amount in prior years. The Plan
Document provides additional details about deferral limits. Deferrals in excess of maximum amounts are not permitted and will be considered taxable income when refunded. It is my responsibility to ensure my deferrals do not exceed the annual limit. Contributions to
other Section 457 plans may limit the maximum amount I may defer under the Plan.
I understand that by selecting the automatic increase option, my payroll contributions will automatically increase by the dollar or percentage amount selected annually in July.
I understand that all funds held pursuant to the Plan are held in a custodial account for my exclusive benefit or the benefit of my
beneficiaries. I may withdraw funds from the Plan only upon severance from employment; at age 70 1/2 (if deferrals have stopped);
upon an unforeseeable emergency approved by the Plan; or I may take a one time in-service withdrawal if my account value is $5,000
or less (as adjusted) and I have not deferred into the Plan for two or more years. In some cases withdrawal for purchase or repayment
of service credits in a governmental defined benefit plan (pension) may be permitted. Additionally, funds may be withdrawn upon my
death. All withdrawals of funds must be in compliance with the Internal Revenue Code and applicable regulations, some of which are
expressed in the Plan Document. Amounts rolled into the Plan from another eligible retirement plan that are maintained in a separate
Rollover Account may be distributed at any time, upon request.
3.
4.
5.
Generally, my distributions must begin no later than April 1st following the year I reach age 70 1/2. If I work beyond age 70 1/2, generally, my distributions must begin no later than April 1st following the year I have a severance from employment or retire. Please consult
your plan document for further details. All distributions are taxable as ordinary income and subject to income tax in the year received.
My distributions must be made in a manner that satisfies the minimum distribution requirements of IRC Sec. 401(a)(9), which currently
requires benefits to be paid at least annually over a period not to extend beyond my life expectancy. Failure to meet minimum distribution requirements may result in the payment of 50% federal excise tax.
6.
The funds in my account may be eligible for rollover to a traditional IRA or to an eligible retirement plan. The “Special Tax Notice
Regarding Plan Payments” provides detailed information about my options. Due to important tax consequences related to distributions,
I have been advised to consult a tax advisor. I expressly assume the responsibility for tax consequences relating to any distribution,
and I agree that neither the Plan nor the Plan Administrator shall be responsible for those tax consequences.
7.
No more than 25% of deferrals can be used to purchase life insurance.
8.
I understand that all products are optional.
9.
If an allocation is made to a closed or unavailable investment option, the allocation will be made to the default option, the New Mexico
Stable Value Fund. If the total investment option allocation percentage equals less than 100%, the difference will be invested in the
default option, the New Mexico Stable Value Fund. If the total investment option allocation percentage is greater than 100%, my
application will be rejected and my allocations will not be processed.
ASSET ALLOCATION OPTIONS
The LifeCycle portfolios are comprised of underlying investment strategies available in the Plan on a stand alone basis. The Portfolios
themselves are not registered investment options. The LifeCycle portfolios are administered by Nationwide Retirement Solutions
according to direction provided by the Board of the Public Employees Retirement Association of New Mexico based on advice from
Mercer Investment Consulting, Inc.
The LifeCycle portfolios are designed to provide diversification and asset allocation across several types of investments and asset
classes, primarily by investing in underlying investment strategies that are made available in the Plan on a stand alone basis. Asset
allocation does not guarantee returns or insulate you from potential losses. There are no additional fees associated with the LifeCycle
portfolios, but you are indirectly paying a proportionate share of the applicable fees and expenses of the underlying investment
strategies in each portfolio.
STABLE VALUE OPTION
1.
The State of New Mexico Stable Value Fund is composed of investments with Galliard Capital Management.
2.
These assets, and all new money (effective July 1, 2012), will be invested with Galliard Capital Management.
3.
The projected performance for the Galliard contracts will be combined to provide a blended return.
MUTUAL FUND OPTIONS
1.
I understand that the Net Asset Value of a mutual fund changes on a daily basis and that there is no guarantee of principal or
investment return.
2.
The value of amounts allocated to mutual fund options will vary depending upon the value of the chosen mutual funds and could result
in either a gain or loss. I have received and reviewed the participating fund prospectuses. Some mutual funds may impose a short term
trade fee. Please read the underlying prospectuses carefully.
3.
I understand that pursuant to the Plan Document, deferred amounts will be invested per my selection of funding options specified on the
Participation Agreement or as otherwise amended.
ADMINISTRATION FEE
An annualized $52.00 administration fee, billed quarterly, is charged and would reduce your account value. For new participants, this fee
is waived for the first two quarters or until your account balance has reached $1,000; whichever occurs sooner.
DC-4068-0314
Nationwide Retirement Solutions • P. O. Box 28580 • Santa Fe, NM 87592-9900 • 1-866-827-NMEX(6639) • www.newmexico457dc.com