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EMPOWER ANNUITY INSURANCE COMPANY
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EMPOWER ANNUITY INSURANCE COMPANY
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Last modified
8/19/2024 4:00:40 PM
Creation date
10/9/2023 9:49:41 AM
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Contracts
Company Name
EMPOWER ANNUITY INSURANCE COMPANY
Contract #
A-2023-164
Agency
Finance & Management Services
Council Approval Date
9/19/2023
Expiration Date
9/30/2023
Insurance Exp Date
12/1/2024
Destruction Year
2028
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EXHIBIT A-1: <br />APPROVED QDRO PROCEDURES AND MODEL FORM FOR QUALIFIED PLANS <br />Forthe <br />City of Santa Ana Deferred Compensation Plan, 960140 <br />1. INTRODUCTION. Empower has arranged for QDRO Consultants to review domestic relations orders <br />(DROs) related to the Plan, and to determine whether they are qualified domestic relations orders <br />(QDROs). The Plan is a defined contribution plan that provides a Participant with a benefit equal to the <br />vested portion of the Participant's account balance. <br />1.1. These QDRO Procedures help Plan Participants and other interested parties prepare QDRQS <br />more effectively and efficiently. Among other things, these QDRO Procedures explain: <br />• Who to contact for relevant information or Plan documents; <br />• The required information that must be in a DRO; <br />• The important information that should be in a DRO, and how the DRO will be interpreted if such <br />information is not included; <br />• Model or sample language to assist the parties in preparing a DRO; <br />• Where to send a draft or Executed DRO for review; <br />• How the Alternate Payee's interests will be protected during the DRO review process, including <br />any time or other limits on the review period; <br />• The opportunity to revise a rejected DRO; <br />• Who the Alternate Payee should contact to begin benefit payments; and <br />• What happens when the Participant or Alternate Payee dies. <br />2. CONTACT INFORMATION. If you have questions or requests related to the review or determination of <br />a QDRO, please contact QDRO Consultants at: <br />QDRO Consultants <br />www.qdros.com/contact <br />If you need a Participant's benefit statement, Plan documents (such as a summary plan description), <br />or if you have other questions or requests related to the Plan or a Participant, please contact the Plan <br />Recordkeeperat: <br />Empower <br />P.O. Box 173764 <br />Denver, CO 80217-3764 <br />Phone:1-800-338-4015 <br />Fax:1-866-633-5212 <br />47 <br />City Council 19 — 50 9/19/2023 <br />
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