Qualified Domestic Relations Order

This Qualified Domestic Relations Order ("Order") is entered pursuant to section 414(p) of the Internal Revenue Code of 1986, as amended ("Code"), and section 206(d)(3) of the Employee Retirement Income Security Act of 1974, as amended ("ERISA"), and is intended to satisfy the requirements of a "qualified domestic relations order" as defined therein. This Order assigns to [Alternate Payee Name] ("Alternate Payee") a portion of the retirement benefits of [Participant Name] ("Participant") under the [Plan Name] (the "Plan"), sponsored by [Employer Name] ("Plan Sponsor"), Plan Number [____________], EIN [____________]. This Order is issued in connection with the property division effected by the [divorce decree / separation agreement / property settlement agreement] entered in the case captioned [____________], [Court Name], Case No. [____________].

The Participant's last known mailing address is [____________]. The Alternate Payee's last known mailing address is [____________]. Each Party shall promptly notify the Plan Administrator in writing of any change of address. This Order applies to benefits payable under the Plan as currently maintained and as it may be amended from time to time, provided that no amendment to the Plan shall reduce the Alternate Payee's rights under this Order below the amounts and benefits assigned herein. The Plan Administrator is hereby directed to separately account for the Alternate Payee's assigned interest as described in Article II.

Alternate Payee is hereby assigned [____]% of the Participant's accrued benefit under the Plan as of [the date of the [divorce decree / separation agreement], i.e., [____________] / the [____________] valuation date used by the Plan] (the "Determination Date"), plus [any earnings, losses, and investment adjustments attributable to the assigned portion from the Determination Date to the date of distribution / no post-Determination-Date adjustments, the assigned amount being fixed as of the Determination Date]. The method of division chosen reflects the Parties' intention to [share equally in the marital portion of Participant's accrued benefit / divide benefits under the time rule formula as set forth in Exhibit A / other agreed method].

The Alternate Payee shall be entitled to receive distribution of the assigned benefit at the time and in the form elected by the Alternate Payee from among the distribution options available under the Plan, subject to Plan rules regarding the earliest permissible distribution date. The Alternate Payee may elect to receive distribution as early as [the date the Participant attains the earliest retirement age under the Plan / the date the Participant separates from service with the Plan Sponsor], even if the Participant has not separated from service or elected to commence benefits. The assigned benefit shall be paid in any form permitted under the Plan for the Participant, other than a qualified joint and survivor annuity unless the Alternate Payee consents.

To the extent permitted under the Plan, Alternate Payee shall be treated as the Participant's surviving spouse for purposes of the pre-retirement survivor annuity with respect to the assigned portion of the benefit. In the event the Participant dies before the commencement of benefit payments and before the Alternate Payee has received full distribution of the assigned benefit, the Alternate Payee shall be entitled to receive the pre-retirement survivor benefit attributable to the assigned portion of the Participant's accrued benefit. If the Plan does not provide a pre-retirement survivor annuity, Participant shall maintain Alternate Payee as a beneficiary to the extent of the assigned benefit pending full distribution to Alternate Payee.

If the Participant is eligible for, or elects to receive, early retirement benefits or subsidized benefits under the Plan, the Alternate Payee shall be entitled to receive the early retirement or subsidized benefits attributable to the assigned percentage, calculated as if the Participant retired on the date distribution to the Alternate Payee commences, to the extent such treatment is required under section 414(p)(4)(B) of the Code. The Alternate Payee shall not, however, receive benefits in excess of the present value of the Participant's total accrued benefit, and the Participant's remaining benefit under the Plan shall be reduced by the full amount of the benefit assigned to the Alternate Payee under this Order.

The Plan Administrator is directed to: (a) promptly notify the Participant and Alternate Payee of receipt of this Order; (b) determine whether this Order constitutes a "qualified domestic relations order" within the meaning of Code section 414(p) and ERISA section 206(d)(3) within a reasonable period and in accordance with the Plan's established QDRO procedures; (c) segregate the amount or portion of the Participant's benefit that would be payable to the Alternate Payee if the Order is determined to be qualified; and (d) pay the segregated amounts to the Alternate Payee upon a determination that this Order is qualified. The Plan Administrator shall notify both Parties in writing of its qualification determination.

To the extent any provision of this Order is inconsistent with the terms of the Plan, the terms of the Plan shall control, except where the inconsistency is required to satisfy the QDRO requirements of the Code and ERISA, in which case the Plan shall be deemed amended as necessary solely with respect to the Alternate Payee's assigned interest. The Parties agree to cooperate in executing any amendments, corrections, or supplements to this Order as may be required by the Plan Administrator to achieve qualification. Each Party shall bear his or her own attorneys' fees and costs in connection with any proceeding to qualify or enforce this Order, except as otherwise ordered by the court.