Cerf Pension Term & Change Form

train employeeSjmay receive pay from the county N urse s/C oun ty H e a lth -
l3!lK ||t be e d ib le for ■ ERF if they are covered under Employees o f a health unit established pursuant to
J H B a t e r e t i l ^ ^ g ® ' « r a i n established by the State Chapter 205, RSM o. However, Nurses who are controlled
o f Missouri. The following positions are not eligible: by the County Commission, rather than a Chapter 205 unit,
are eligible.
C irc u it Clerks -
Circuit Clerks or any Deputy Circuit Clerks who P ro se cu tin g A tto rn e y s -
are members of M O SE R S. However, Deputy Section 50.1000(8), RSM o 1994,
Circuit Clerks who do not provides that Prosecuting Attorneys
participate in MOSERS and are not eligible because they are
work at least 1,000 hours members of a separate retirement
per year for the county arc system. However, other employees of
eligible. ■ the Prosecuting Attorney's office are
. eligible.
C o u rt E m ployees - 1
Employees who are hired, 1 S h e riff -
fired, or whose work Section 50.1000(8), RSM o 1994,
and responsibilities are provides that Sheriffs are not
controlled by a Circuit Judge eligible because they are members
or Associate Circuit Judge. of a separate retirement system.
However, employees who are However, other employees of the
hired and/or fired Iry the county t Sheriffs department are eligible.
and are directly compensated from
county funds are eligible. 911/E m ergency
( M anagem ent -
E le c tio n E m ployees - ■ ft 911 and Emergency Management
Directors and employees of inde­ I ft employees who are controlled
pendent election boards. I I by an independent board.
II
JBk ^
However, 9 I I and Emergency
E x te n s io n E m ployees - ■ ™ ft Majiagement employees who are
Missouri law states that cxtcn- m w RU f i WB* hired and/or fired directly by the
sion employees are employed by County Commission are eligible.
the University, which is a political
subdivision of the State of Missouri. State employees In addition, employees o f counties that are statutorily
are not eligible. excluded from the County Employees’ Retirement Fund
are not eligible for this plan.
J u v e n ile E m ployees -
Missouri courts have consistently ruled that Juvenile

IgfCERF
employees are employees of the C ircuit Court.
Additionally, H B 971, effective August 28, 1998,
states that Juvenile employees are not eligible for
C o u n t y E m ployees’
CERF.
R e t ir e m e n t F u n d
How to reach us...
C o u n ty E m p lo ye es' R etirem ent Fund
2121 S c h o tth ill W ood s D rive
Jefferson C ity , M O 65101
Toll-free: (8 7 7) 632-2373
Fax: (573) 761-4404
E-mail: adm in@ m ocerf.org
Website: www.mocerf.org

G reat-W est R etirem en t Services
100 N . Tucker, S uite 100
St. Louis, M O 63101
Toll-free: (8 7 7) 895-1394
Fax: (314) 241-2181
E-mail: iames.ellison@gwrs.com
Website: www.gwrs.com

The purpose of this brochure is to enable a member to
more easily understand benefits provided under the CERF
Pension Plan. If we have omitted or misstated any of the
plan’s provisions when explaining the topics covered by
this brochure, the official plan rules contained in the Code
of State Regulations will remain the final authority.

OTHER AVAILABLE
BROCHURES:
“C re ditable Service in the C E R F Pension P lan”

“Benefits for your Survivors in the C E R F
Pension P la n ”

“W h e n You Retire in the C E R F Pension P lan”

“W h e n You T erm inate Non-Vested in the C E R F
Pension P lan”

“P articipating in the C E R F 401(a) Savings P lan”

“P articipating in the C E R F 457 Savings P la n ”

10/08
 I
. : r ' ..'J*.i ’ ' . . ' " . " f ' : —l4.i~.JSSi«*?£•- •r*‘-'‘tv■.><

• If you reach 1,000 hours o n or before Ju n e 30, you
w ill enroll o n July 1 o f the current year.
P a rtic ip a tio n • If you reach 1,000 hours after June 30, you w ill
P a rtic ip a tio n in the C E R F P ension P lan is
enroll o n January 1 o f the follow in g year.
m a n d ato ry for eligible employees hired o n or after
Jan u a ry 1, 2000 and w orking at least 1,000 hours • If you are hired in a full-time position, th e n change
d u rin g th e year. to part-time status, you w ill rem ain in C E R F
and c ontinue to m ake the required contributions
I f you are an eligible employee w ho is scheduled regardless o f the num ber o f hours you work. T his
to w ork at least 1,000 hours du rin g the year, you part-time service w ill be calculated using the 91-
w ill becom e a pa rtic ipa nt a uto m atically on your hour rule. A s a participant, w hether full-time
date o f hire. If you are hired in to an eligible part- or part-time, you w ill rem ain in C E R F u n til you
tim e p o sitio n, but w ill w ork a t least 1,000 hours terminate county em ploym ent for a period greater
in a cale nd ar year, you w ill e n ro ll im m ediately than 30 days. Please keep your address updated
u p o n h ire as well. w ith C E R F in order to contin ue to receive
im portant inform ation regarding your benefits.

If you are hired o n a part-time basis to work less
th a n 1,000 hours du rin g the year, you w ill n ot be
e n ro lle d in C E R F at the tim e o f hire. However,
Em ployee C o n trib u tio n s
Effective w ith the signing o f H B 1455, all participants
if you reach 1,000 hours in a calendar year, you
hired o n or after February 25, 2002, are required
be co m e eligible for C E R F and w ill enroll as
to contribute an a dditio na l 4 % o f their gross
follows:
com pensation to C ERF, starting January 1, 2003.
These employees are n o t required to m ake up the
a dditio na l 4 % contrib ution s for the period o f
February 25 through D ecem ber 31, 2002.

A n y part of the a d d itio n a l 4 % c o n trib u tio n can
be paid by the county on b e h a lf o f an employee,
or it can be paid by the employee. Each county is
responsible for d e te rm in in g how it w ill be paid.

To further explain -
• A n o n - L A G E R S participant hired o n or after
February 25, 2002, w ill c ontrib ute 6 % o f gross
salary.

• A n active n o n - L A G E R S participant w ho
was employed w ith the county prior to
February 25, 2002, w ill c o n tin u e m aking 2%
contributions. However, if he terminates
em ploym ent for more th a n 30 days, and is
later rehired in an eligible position, he will
be required to m ake a 6 % c o n trib u tio n .
• A d d itio n ally , n o n - L A G E R S participants are
required to m ake a .7% c o n trib u tio n to the Becoming Vested
401(a) plan.
in Your
• A L A G E R S participant hired o n or after February
25, 2002, will contribute 4 % o f gross salary.
C ontributions
“Vesting” means that you have
• A n active L A G E R S participant w ho was a permanent right to your
employed w ith the county prior to February 25, pension benefit. In the CERF Pension
2002, is n o t required to make contributions. Plan, you are entitled to a benefit after eight years of
However, if he terminates em ploym ent for more continuous creditable service during which you have
than 30 days, and is later rehired in an eligible received pay for 1,000 hours in each of those eight years.
position, he w ill be required to contribute 4% .
Once you become vested, you are eligible to receive a
NOTE: Contributions are required on all compensation, full benefit at age 62, or an actuarially-reduced benefit
which includes regular wages, vacation, sick leave, as early as age 55.
overtime and bonuses.

Changing LAGERS Status Required M in im u m
If your status as a L A G E R S or n o n - L A G E R S D istrib u tio n Rule
participant changes, the follow ing w ill occur:
As a vested member, you must begin receiving a
• You w ill receive the full benefit for those required m inimum distribution of your pension benefit
years o f creditable service in w h ic h you were
on April 1 of the calendar year following the later
a n o n - L A G E R S participant and made the of the year in which you reach age 70'/2, or the year
required c ontributions.
in which you separate from service. If you have not
• You w ill receive two-thirds o f the full benefit applied for pension benefits prior to this deadline, the
for those years o f creditable service in w hich only option available to you will be a single life annuity
you were a L A G E R S participant and made the with no survivor benefit.
required contributions. If you leave county employment before you become
• If you receive a refund o f contrib ution s from vested, you will receive a refund of the contributions you
L A G E R S , you w ill be required to make up the made to the plan. Your contributions will be refunded
m andatory contrib ution s you w ould have paid in a lump-sum payment either directly to you or you may
to C E R F had you n ot been in L A G E R S . Your elect to have your contributions rolled over to an eligible
benefit for the period you were in L A G E R S , retirement plan. The refund will be made as soon as
for w hich you later received a refund, will be administratively possible. In order to elect a rollover to
calculated at the n o n - L A G E R S rate. another plan, the full amount of distribution must equal
$200 or more. You may also elect a partial rollover if
• If you retire from L A G E R S a n d return to work
that portion of your distribution is at least $500 or more.
in the county but are n ot accruing a dditional
Any refund of pre-tax contributions paid directly to you
service credit in L A G E R S , you are considered
require tax withholding at a rate of 20%.
a n o n - L A G E R S participant for this period
o f time. In this case, you must m ake the
mandatory contributions to CERF. A g a in , for
this period o f tim e, your C E R F benefit w ill be
msm
m CERF C o u n t y E m plo yees’
calculated at the n on - L A G E R S benefit rate. R e t ir e m e n t F u n d
 Submit completed form to: Version 5.7
County Employees’ Retirement Fund
2121 Schotthill W oods Drive
CERF COUNTY EMPLOYEES'
Jefferson City, MO 65101
Toll Free: 877-632-2373 FORM 2V
RETIREMENT FUND
Fax: 573-761-4404 TERMINATION VESTED

The County Clerk completes this form if the participant terminates em ployment with the county on o r after 01/01/2000 and has completed a
m inimum o f 8 continuous years in an eligible position. The Clerk should also complete and attach Form SI/, “Verification o f
P articipant’s Salary, Hours, and Contributions,” if the participant worked p rio r to January 2003 an d /o r had a service period where
no contributions were made. The participant is eligible to draw a retirem ent benefit at age 62 o r a reduced retirem ent benefit as early as
age 55, when these requirem ents are fulfilled. The clerk and participant M U ST sign page 2 o f this form. This form and Form 2B m ust
be completed, signed, dated, and returned to the CERF Administrative Office 30-90 days p rio r to the com m encem ent o f benefits if
the participant is going to retire im m ediately upon termination o f county employment.

Note: As a vested member, you must begin receiving a required minimum distribution o f your pension benefit on April 1 o f the calendar year following the later
o f the year in which you reach age 70-1/2, o r the year in which you separate from service. If you have not applied for pension benefits prior to this deadline, the
only option available to you will be a single life annuity with no survivor benefit.

PARTICIPANT INFORMATION

Social Security Num ber________ - ______- _________ County of Employment _____________________________________________

First N am e_______________________Initial ________ Last N am e________________________________________ Suffix

Address ____________________________________________ City __________________________ State ________ Zip _

Home Phone/Cell (______ }___________________________ Date of Birth ______/______/_______

Work Phone j ______ )______________________________

EMPLOYMENT INFORMATION

Original Date of Hire / / CERF Eligibility Date / / □ LAGERS □ Non-LAGERS
Note: In some cases the Original Date o f Hire precedes the CERF Eligibility Date.

If Original Date of Hire and CERF Eligibility Date are different, please explain

Date of Termination / / D ep artm en t___________________________________Position ___________________________

Is Termination Due to Death? Y / N (Circle One)
Check one of the following boxes:
□ Employee has terminated employment/eligibility with at least eight vested years of service but is not within 30-90 days of
retirement age (62 or older for full benefits, 55-61 for reduced benefits).
□ Employee is eligible for retirement benefits (62 or over for full benefits, 55-61 for reduced benefits), or is already 62 or older,
has eight vested years of service and is within 30-90 days of retirement age. Employee hereby makes application to
receive retirement benefits from the County Employees’ Retirement Fund.

You will be advised whether any purchase of prior service is required before your benefits begin. Participants who terminated
employment prior to January 1, 2000 are required to make a purchase of prior service to draw a retirement benefit. Participants who
were employed on or before June 10, 1999 and remained employed through January 1, 2000, may not be required to make a purchase of
prior service.

FINAL COMPENSATION INFORMATION

Submit figures for final compensation. The average final compensation is calculated using the participant’s two highest calendar
years of compensation, and neither year can include a payment attributable to any prior year (including, but not limited to, a
payment of benefits, back pay, unused vacation days or sick leave). See 16 CSR 50-2.050(1).

1. $___________________________________ For the calendar year of _____________________

2. $___________________________________ For the calendar year of _____________________
Continue to Page 2 fo r REQUIRED Participant and County Clerk Signature

Form 2 V T erm Vested rev0311
Page 1 o f 2
If married, please provide the following information:

Name of Spouse Social Security # Date of Birth / I

REQUIRED SIGNATURES

I understand that by ending my employment, I am no longer eligible for the $10,000 death benefit. I further understand that I
cannot receive an immediate retirement benefit from the County Employees’ Retirement Fund if I return to county employment
within 30 days. If I return to county employment 31 days or more after the Date of Termination on this form and have elected to
begin receiving a CERF retirement benefit immediately, I understand that I must work less than 1,000 hours in a calendar year to
continue receiving a benefit from the County Employees’ Retirement Fund, otherwise my retirement benefit will be suspended
until I separate from service.

I understand any misrepresentation of fact will result in an adjustment of benefits and/or appropriate legal action.

Signature of Participant Date* Social Security Number

‘ Form 2V and Designation of Survivor Form 2B must be completed and dated at least 30, but not more than 90, days prior to the
commencement of benefits if the participant is going to retire immediately upon termination of county employment.

I hereby certify that the above information regarding the participant and his/her county compensation amounts are true and
correct. Attached to this form are copies of the participant’s county income documentation.**

Signature of County Clerk Date

‘ ‘ ACCEPTABLE DOCUMENTATION OF COUNTY INCOME

■ W-2s. If the W-2s do not reflect gross wages, a printout from county payroll records must accompany the W-2s,
along with an explanation of any difference.
■ A federal tax return (Form 1040) with supporting W-2s.
■ A printout from county payroll records, accompanied by the Clerk’s certification and seal.
■ Other supporting documentation as approved by the Board of Directors.

REQUIRED ATTACHMENT(S)_________________________________________________________________________________
* Form SV, if applicable.

Form 2 V T erm Vested rev0311
Page 2 o f 2
 Submit completed form to: Version 5.7
County Employees' Retirement Fund
2121 Schotthill W oods Drive FORM 1A
Jefferson City, MO 65101 BENEFICIARY DESIGNATION
COUNTY EMPLOYEES' Toll Free: 877-632-2373 ($10,000 DEATH BENEFIT/
RETIREM ENT FUND
Fax: 573-761-4404 NON-VESTED REFUND OF CONTRIBUTIONS)

The participant completes and signs this form upon an employee’s commencement o f county employment in an eligible position to designate
beneficiaries of the $10,000 death benefit and, if applicable, non-vested refund of contributions through the County Employees' Retirement Fund.
PAGE 2 MUST BE SIGNED BY THE PARTICIPANT.

PARTICIPANT INFORMATION

Social Security Number________ - ______ - ______________ County of E m ploym e nt_________________________________________________

First Name _______________________ Initial ___________ Last Name Suffix

PRIMARY BENEFICIARIES OF $10,000 DEATH BENEFIT/NON-VESTED REFUND OF CONTRIBUTIONS
Percentage o f B enefit fo r ALL p rim ary beneficiaries m ust total 100%.

Social Security Number - Relation to Participant Percentage of Benefit

First Name Initial Last Name Suffix

Address City State Zip

Home Phone ( ) Cell ( ) G ender □ Male □ Female Date o f Birth / /

Social Security Number _ _ Relation to Participant Percentage o f Benefit

First Name Initial Last Name Suffix

Address City State Zip

Home Phone ( ) Cell ( ) G ender □ Male □ Female Date o f Birth / I

Social Security Number _ _ Relation to Participant Percentage of Benefit

First Name Initial Last Name Suffix

Address City State Zip

Home Phone ( ) Cell ( ) G ender □ Male □ Female Date o f Birth / 1

Social Security Number _ _ Relation to Participant Percentage of Benefit

First Name Initial Last Name Suffix

Address City State Zip

Home Phone ( ) Cell ( ) Gender □ Male □ Female Date o f Birth / 1

Social Security Number _ _ Relation to Participant Percentage of Benefit

First Name Initial Last Name Suffix

Address City State Zip

Home Phone ( ) Cell ( ) G ender □ Male □ Female Date of Birth / 1

Social Security Number _ _ Relation to Participant Percentage o f Benefit

First Name Initial Last Name Suffix

Address City State Zip

Home Phone ( ) Cell ( ) Gender □ Male □ Female Date o f Birth / I

Continue to Page 2 for Contingent Beneficiary Designation(s) and REQUIRED Participant Signature

Form lA Beneficiary Designation $10,000 Death Benefit and Non-vested Refund rev082012.doc
Page 1 o f 2
 CONTINGENT BENEFICIARIES OF $10,000 DEATH BENEFIT/NON-VESTED REFUND OF CONTRIBUTIONS
Percentage o f B enefit fo r ALL contingent beneficiaries m ust total 100%.

Social Security Number Relation to Participant Percentage of Benefit

First Name Initial Last Name Suffix

Address City State Zip

Home Phone ( ) Cell ( ) G ender □ Male □ Female Date of Birth / /

Social Security Number _ _ Relation to Participant Percentage of Benefit

First Name Initial Last Name Suffix

Address City State Zip

Home Phone ( ) Cell ( ) G ender □ Male □ Female Date of Birth / /

Social Security Number
_ _ Relation to Participant Percentage of Benefit

First Name Initial Last Name Suffix

Address City State Zip

Home Phone ( ) Cell ( ) G ender □ Male □ Female Date of Birth / /

Social Security Number _ _ Relation to Participant Percentage of Benefit

First Name Initial Last Name Suffix

Address City State Zip

Home Phone ( ) Cell ( ) Gender □ Male □ Female Date of Birth / /

Social Security Number _ _ Relation to Participant Percentage of Benefit

First Name Initial Last Name Suffix

Address City State Zip

Home Phone ( ) Cell ( ) Gender □ Male □ Female Date of Birth / /

Social Security Number________ - ______ - ______________ Relation to Participant ____________________ Percentage of Benefit _____________

First Name ______________________ Initial _____________ Last Name ______________________________________________Suffix ____________

Address __________________________________________________ City ______________________________ State __________ Zip _____________

Home Phone ( ) Cell ( ) G ender □ Male □ Female Date of Birth / /

REQUIRED SIGNATURE - See Below
I am designating the above person(s) as my primary and contingent beneficiaries of my $10,000 death benefit and, if applicable, non-vested
refund of contributions through the County Em ployees’ Retirement Fund. If none of these persons are alive when I die, my benefit will be
distributed in the manner provided by law. I revoke all prior designations regarding these funds. I understand that any dissolution or annulment
o f marriage following the execution of this form shall have no effect on the designation of my spouse or relative of my spouse as beneficiary
hereunder. I reserve the right to revoke any designation by making another written designation. I agree that unless and until I submit another
written designation, any and all designations made hereunder shall remain in full force and effect. Unless otherwise stated by me, my
beneficiaries’ interest in this benefit is as join t tenants with right of survivorship. The interest of any beneficiary (and related heirs)
term inates if he or she dies before I do. The indicated share of the other beneficiaries will increase on a pro rata basis. I understand
these beneficiary designations will become void once I terminate from county employment.

Signature of Participant Date Social Security Number

Form lA Beneficiary Designation $10,000 Death Benefit and Non-vested Refund rev082012.doc
Page 2 o f 2
 Submit completed form to: Version 5.4
County Em ployees’ Retirem ent Fund
2121 Schotthill W oods Drive
Jefferson City, MO 65101
CERF Toll Free: 877-632-2373 FORM 4
Fax: 573-761-4404 CHANGE OF INFORMATION

The County Clerk com pletes and signs this form upon a participant's change in contact information, m arital status, o r employment status.
The em ployee IS N O T required to sign this form.

Note: This form will not be accepted as a change in beneficiary designation. Please use the appropriate beneficiary form(s), to submit a
change to the participant's beneficiaries.
PREVIOUS PARTICIPANT INFORMATION

Social Security Number County of Employment

First Name Initial Last Name Suffix

Address City State Zip

W ork Phone ( ) Home Phone/Cell ( )

Gender □ Male □ Female Marital Status □ Married □ Single Date of Birth / /

Date of Hire / / Employee’s Dept. Employee’s Position

Employment Status
County C ontribution____ % □ Full-Time
(cann ot exceed 4% ) Q Seasonal, >1,000 hours □ Part-time, >1,000 hours □ Non-LAGERS
Employee C ontribution____ % □ Seasonal, <1,000 hours □ Part-time, <1,000 hours □ LAGERS
(within range o f 2% - 6%)

UPDATED PARTICIPANT INFORMATION (Enter only information that has changed.)

Social Security Number County of Employment

First N am e___________ Initial Last N am e__________ Suffix

Address _____ City ___________ State _ Zip

Work Phone j_ Date of Birth I /

G ender □ M ale M a rita l S ta tu s □ M a rrie d — Must attach copy o f marriage certificate, if reporting change in status.
□ F e m a le □ S in g le - Must attach copy o f divorce decree or death certificate, if reporting change in status.

Date of Hire / / Employee’s Dept. Employee’s Position

Employment Status
County C ontribution____ % □ Full-Time (contributions will continue to be withheld when changing from F/T to P/T, based on LAGERS status)
(c an n o t exceed 4% )
□ Seasonal, >1,000 hours □ Part-time, >1,000 hours □ Non-LAGERS

Employee C ontribution------- % □ S e a s o n a l, <1,000 hours □ P a rt-tim e , <1,000 hours □ LAGERS
(w ithin range of 2% - 6%)
| Check the box at the left if the updated participant address also affects beneficiaries who resided at the participant's previous address.

REQUIRED SIGNATURE - See Below

The above information for this participant has changed effective _ . (date). Please update all records for this participant. If this is for participant’s
change to part-time employment, I have notified the participant that they are eligible for the $10,000 death benefit only during the months in which they work.

Signature of County Clerk Date

Form4 Change o f Information rev0410 Page 1 o f 1