ENROLLMENT/CHANGE FORM Kent Companies, Inc. Profit

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ENROLLMENT/CHANGE FORM Kent Companies, Inc. Profit
ENROLLMENT/CHANGE FORM
Kent Companies, Inc. Profit Sharing and 401(k) Savings Plan
(Refer to instructions before completing form)
INITIAL ENROLLMENT
A.
CHANGE
PERSONAL INFORMATION
Name:
Address:
Date of Hire or Service:
Date of Rehire:_________________________________
Have you been a full-time employee since your date of hire?
E-mail address:
B.
Marital Status:
Single
Social Security #:
Date of Birth:
Date of Eligibility:
Married
-
Yes
No
Division # (if applicable):
YOUR CONTRIBUTIONS
Note: you may not exceed certain limits. For details, see second page.
Check the appropriate box and, if applicable, fill in the percentage/amount that you elect to contribute each
pay period to the plan through payroll deductions.
Yes, I elect to make pre-tax contributions:
Percentage:_______% (up to maximum permitted by plan)
OR
Whole dollar amount per pay period:
Yes, I elect to make after-tax (Roth) Contributions:
Percentage:_______% (up to maximum permitted by plan)
OR
Whole dollar amount per pay period:
No, I elect NOT to participate, nor make contributions at this time.
C.
INVESTMENTS
I understand that:
D.
1)
In order to make my investment elections, I must call 1-866-401-5425 Monday through Friday between
8:00 a.m and 6:00 p.m. or go to www.huntington.com on the web (see instructions on the next page
under section E - Accessing the Web.)
2)
If I do not enter any investment elections my total account balance and all future contributions will be
invested in the age appropriate Target Retirement Fund (based on my year of birth)
AUTHORIZATION/WAIVER
I understand that the contributions I have authorized will remain in effect until I elect to change them in
writing by completing a new Enrollment/Change Form. I also understand that my account is subject to all
the terms and conditions of the plan.
Participant Signature:
Date Signed:_______________
Sponsor Signature:__________________________________________ Date Signed:_______________
Submit the completed form to your Human Resources Department.
Retain a copy for your records.
ENROLLMENT/CHANGE FORM
Kent Companies, Inc. Profit Sharing and 401(k) Savings Plan
First indicate whether you are enrolling in the Plan or making a change in your participation by checking the
appropriate item. Complete the sections indicated.
A. PERSONAL INFORMATION
Complete all information as indicated.
B. YOUR CONTRIBUTIONS
You are authorizing your payroll department to deduct a certain percentage or whole dollar amount from each
paycheck and deposit this amount into the plan.
The limits for these contributions depend on several things, including:
- the dollar limit established by law
- the dollar or percentage limit established in your plan
- the maximum amount you may contribute according to government regulations.
The total combined contributions may not exceed the Code Section 402(g) limit, as indexed. The limit for 2012 is
$17,000.00. Your Employer may also limit the maximum combined percentage limit of before tax and after-tax
(Roth) contributions.
Still uncertain? Consult your written materials about the plan and/or ask your employer.
C. INVESTMENTS
If I choose not to visit the website or call 1-866-401-5425, I understand that my account balance will be invested in
the age appropriate Target Retirement Fund (based on my year of birth) .
D. AUTHORIZATION/WAIVER
After reading this section, please sign and date your Enrollment/Change Form and return it to the Human Resource
Department at least two (2) weeks before the elections are to be effective.
E. ACCESSING THE WEB
Access the Huntington Retirement Web Site by visiting www.huntington.com. Select “Home” from the row under
the Huntington logo (if “Home” is not already green). Note the green banner that says “Welcome to your Online
Banking” (left column), and select “Other” from the row below. From the drop down box called “Select a
Service”, select “Retirement Connection”.
The first time you log in:
Select “New to the system? Enroll Now!” Type in your Social Security Number without dashes. Type in the
Enrollment Password: KC352548. Select Begin.
The Huntington National Bank - Retirement Plan Services
Fair Credit Reporting Act Opt-Out Notice
This Fair Credit Reporting Act Opt-Out Notice (“Notice”):
·
Is provided by the Retirement Plan Services division of The Huntington National Bank (“Huntington”).
·
Explains how we disclose consumer information for individuals participating in retirement plans issued through Huntington (“Participants”)
to Huntington’s affiliated securities broker and investment advisor, The Huntington Investment Company (“HIC”).
·
Gives you choices about how your Participant information is shared with HIC and whether HIC may use your Participant information to
market its products or services to you.
·
Does not apply to financial products and services that you apply for or obtain from Huntington outside of your retirement plan relationship
or from other Huntington companies.
Information We May Share with HIC
We may disclose information we collect on Participants to HIC.
you with HIC, including:
·
·
However, you have the right to ask us not to share certain information about
Information you give us on retirement plan enrollment forms, such as your income or marital status.
Information we obtain from others regarding their relationships or transactions with you or to verify what you tell us, such as account
balances or employment history.
Please be aware, however, that this right is limited. It does not cover sharing of information with HIC as permitted by law, such as identifying
information and information about our experiences and transactions with you.
Also, if you ask us not to share certain information about you
with HIC, our ability to provide you with brokerage and investment advisory services, relating to your retirement plan or otherwise, may be
limited.
Marketing by HIC
Federal law gives you the right to limit some but not all marketing from HIC.
about your choice to limit marketing from HIC.
Federal law also requires us to give you this Notice to tell you
You may limit HIC from marketing its products or services to you based on your personal information that it receives from Huntington.
information includes your income, marital status, retirement plan balance, investment history, and plan termination date.
This
Please be aware, however, that this right is limited. It does not cover situations where the law permits HIC to use your personal information
from Huntington to market its products or services to you, such as if you have a business relationship with HIC or if you request or authorize
HIC to market its products or services to you. Also, if you ask us to limit marketing as described above, our ability to offer you beneficial
brokerage and investment advisory services, relating to your retirement plan or otherwise, may be limited.
Your Choice to Limit Information Sharing and Marketing
You may complete and mail the Participant Preference Form attached to this Notice to ask us not to share Participant information about
you with HIC and to limit marketing by HIC as described above. If you make this choice, it will apply only to your retirement plan
relationship with Huntington. Your choice will apply until you tell us to change your choice. If you have previously told us your choice, you
do not need to do so again.
Effective Date
This Notice is effective as of 02/23/2009.
Cut here to detach Form. Keep Notice for your records.
Participant Preference Form
You may use this Form to limit information sharing by Huntington with HIC and to limit use of your information by HIC for marketing purposes.
complete this Form and mail it to us at: Huntington Retirement Plan Services, Participant Preference Form, 1 Financial Plaza, MI026, Holland, Michigan 49423.
To do this,
About You
Please provide the information requested so that we can properly process this Form and match you to the correct retirement plan (please print):
Name:
Address:
Phone number:
Last 4-digits of your Social Security Number:
Your employer’s name: Kent Companies, Inc.
Your Choice to Limit Participant Information Sharing and Marketing
If you do not want Huntington to share information about you with HIC, or HIC to market products or services to you using Participant information about you
from Huntington, you can opt-out. Please be aware, however, that this opt-out choice is limited. Your choice does not cover sharing of information with HIC as
permitted by law. Examples of this are identifying information like your name and address and information about our experiences and transactions with you
such as your retirement plan balance and investment history. Your choice also does not cover situations where the law permits HIC to use your personal
information from Huntington to market products or services to you. Examples of this are if you have a business relationship with HIC, you request product or
service information from HIC, or you authorize HIC to market its products or services to you.
By signing below, you authorize us to rely on the choices you are indicating on this Form.
Signature
Date
CHECK THIS BOX IF YOU WANT TO OPT-OUT

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