OSU FOUNDATION 403(b) PLAN
Contribution Election Form

¨ NEW ENROLLMENT / ¨ STOP ENROLLMENT / ¨ CHANGE ELECTIONS
Employee Name: ______
By executing this Contribution Election Form (Election Form), I authorize Oregon State University Foundation (the Foundation) to deduct from my pay the amount indicated in Section1 below and to contribute that amount to the OSU Foundation 403(b) Plan. I designate the contributions as Traditional Elective Contributions and/or Roth Elective Contributions in the proportions indicated in Section 1 and direct the contribution amount to be deposited in the investment options specified in Section 2.
I understand that this Election Form will be effective the date I specify in Section 3, but not earlier than the first day of the payroll period beginning after I sign this Election Form and submit it to the Foundation’s payroll department together with the properly completed Vendor-provided forms necessary to facilitate my investment directions. I understand that this Election Form will remain in effect until I either terminate employment or submit a replacement Election Form.
SECTION 1: CONTRIBUTION AMOUNT AND TYPE
I elect the following contribution amount in A or B, and if I choose and am eligible, a catch-up contribution amount in C. I designate my contributions as Traditional Elective Contributions and Roth Elective Contributions as indicated below. I understand that my elections below are subject to other amounts being withheld from my pay and to the applicable statutory limits on contributions.
Elect A or B; and
Elect C if you have attained age 50 and want to elect a catch-up contribution / Traditional
Elective Contribution / Roth
Elective Contribution
A. Percent of my annual salary, a proportional amount to be paid each pay period, with adjustments made for changes in rate of pay. / % / %
B. A flat dollar amount each pay period. / $ / $
C. Catch-up contribution: A flat dollar amount each pay period.
*If you have attained age 50, you may make a “catch-up contribution” in excess of the statutory limits on regular elective contributions. / $ / $
SECTION 3: CONTRIBUTION AND VENDOR DESIGNATION
Contribution Designation / Vendor / Contribution Amount or Percent
¨ Traditional
/ ¨ Fidelity
¨ TIAA-CREF
¨ VALIC / $ or % of total
$ or % of total
$ or % of total
¨ Roth
Note: Not an available option through TIAA-CREF / ¨ Fidelity
¨ VALIC / $ or % of total
$ or % of total


SECTION 4. EFFECTIVE DATE:

This Election Form shall be effective for the payroll period* beginning ______, 20___.

(*Payroll periods begin on the 1st and 16th day of each month.)

Employee Signature:

Signed this day of , 20

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