CalPERS Supplemental Contributions Plan 452001
IRC 415(c) LIMIT WORKSHEET
(Estimate for Calendar Year 2014)
1. PERSONAL INFORMATION
(please print clearly)
NAME: ____________________________________________________________
SOCIAL SECURITY NUMBER: ______________________
CalPERS ID:
__________
ADDRESS: __________________________________________________________ APT:________________________________________
CITY:______________________________________________________________ STATE:_________ ZIP CODE: ______________________
WORK PHONE: ________________ HOME PHONE: ____________________ E-MAIL: ____________________________________________
2. 415(c) LIMIT WORKSHEET (with estimates and example column)
GENERAL INSTRUCTIONS1
1. Enter your estimated gross pay for the calendar year, before deductions
Enter Your Estimates
in This Column
$
2. Enter estimates for the following amounts for the calendar year:
Note: The IRC 415(c) limit does not apply to medical, dental or 457 pre-tax deductions
$
168,000.00
Pre-Tax Salary Adjustments
a. CalPERS pre-tax Member Retirement Contributions to the defined benefit plan
$
$
8,320.00
b. Member Service Credit purchase contributions (Pre-tax deductions for purchase
of additional service credit, except redeposits)
$
$
3,000.00
c. Employer pre-tax contributions to the State Alternate Retirement Program for
new employees hired after 8/11/2004
$
$
d. Mandatory pre-tax contributions to the other retirement plans that are picked up
by your employer (do not include your own salary deferral contributions, if any)
$
$
e. Add Lines 2a and 2d
3. Section 415 Compensation – Subtract Line 2e from Line 1
$
$
$
$
11,320.00
156,680.00
4. IRC Section 415(c) maximum limit for 2014
$
$
52,000.00
5. If your Section 415 Compensation for the year (Line 3) is less than $52,000 enter
that amount on line 5. If greater, enter $52,000.
$
$
52,000.00
6. Enter your employer and/or employee contributions to a 401(a) defined contribution
plan (including 401(k) plans), 403(a) and 403(b) plans, and Simplified Employee
Pension Plans (SEPs)
52,000.00
Contributions to Retirement Plans
a. Enter after-tax payments to CalPERS (such as purchases of additional service credit
except redeposits)
$
$
.00
b. Enter after-tax payments to another employer’s Defined Benefit Plan for purchase of
additional service credit except redeposits
$
$
.00
c. Enter pre-tax employer contributions to 401(a) defined contribution plan, including
pre-tax contributions to 401(k) plan and the State Alternative Retirement Program
for new employees hired after 8/11/2004
$
$
3,360.00
d. Enter pre-tax emplyee contributions to a Section 401(a) defined contribution plan
(including a 401(k) plan), 403(a) and 403(b) plans, and SEPs
$
$
2,400.00
e. Enter the amount of Employee Roth Contributions (after-tax) to a Section 401(k)
or 403(b) plan
$
$
f. Add lines 6a through 6e
$
$
5,760.00
$
$
46,240.00
7. Maximum SCP Contribution for the calendar year. Subtract Line 6f from line 5
1
Example: SMITH
The information provided in this worksheet is not intended to serve as legal, tax, or investment advice. Please consult a qualified professional for such advice.
PAGE 1 of 3
CalPERS Supplemental Contributions Plan 452001
IRC 415(c) LIMIT WORKSHEET
3. SIGNATURE REQUIRED
PARTICIPANT’S SIGNATURE: __________________________________________________________ DATE: ______________________
Please submit your completed form by fax or mail:
FAX
FAXDELIVERY:
DELIVERY:
ING,
Plan
Administration
Voya,
Plan
Administration
Attn:
Attn:CalPERS
CalPERS
1-888-228-6185
1-888-228-6185
US
DELIVERY:
USMAIL
MAIL
DELIVERY:
ING,
Plan
Administration
Voya,
Plan
Administration
Attn:
Attn:CalPERS
CalPERS
P.O.
5166
P.O.Box
Box
5166
Boston,
02206-5166
Boston,MAMA
02206-5166
OVERNIGHT
DELIVERY:
OVERNIGHT DELIVERY:
Voya,
Plan
Administration
ING, Plan
Administration
Attn:
CalPERS
Attn: CalPERS
30
BraintreeHillHill
Office
30 Braintree
Office
ParkPark
Braintree,
MA
02184
Braintree, MA
02184
If you
haveany
anyquestions,
questions,you
you
may
call
Help
Line
1-800-260-0659,orortotoobtain
obtain
additional
plan
or account
If
you have
may
call
thethe
Help
Line
at at
1-800-260-0659,
additional
plan
or account
information,
please
access please
your account
https://calpers.ingplans.com.
Customer Service Representatives
are available
Monday through
information,
accessatyour
account at https://calpers.voyaplans.com.
Customer Service
Representatives
are Friday,
6:00
A.M.Monday
to 5:00 P.M.
Pacific
Time6:00
(excluding
holidays).
available
through
Friday,
A.M. tostock
5:00 market
P.M. Pacific
Time (excluding stock market holidays).
IRC 415(c) LIMIT WORKSHEET / PAGE 2 of 3
09/01/2014
PR452001CALEAFN
CalPERS Supplemental Contributions Plan 452001
IRC 415(c) LIMIT WORKSHEET
4. EXAMPLE
M.R. Smith has a gross monthly salary of $14,000 and no other compensation. His monthly pre-tax deductions are:
• CalPERS member contribution to a defined benefit plan $693.33 (2a)
• Pre-tax contributions to purchase Additional Retirement Service Credit $250.00 (2b)
• Pre-tax medical savings deduction $25.00 (not applicable)
• Deferred compensation (457 Plan) contributions $300.00 (not applicable)
• Mandatory pre-tax contributions to the State Alternate Retirement Program $280.00 (6c)
• 401(k) contributions $200.00 (6d)
GENERAL INSTRUCTIONS
1. Enter your estimated gross pay for the calendar year, before deductions
Example: M.R. Smith’s Data
$ 14,000 month x 12 =
2. Enter estimates for the following amounts for the calendar year:
Note: The IRC 415(c) limit does not apply to medical, dental or 457 pre-tax deductions
$
168,000.00
Pre-Tax Salary Adjustments
a. CalPERS pre-tax Member Retirement Contributions to the defined benefit plan
$
693.33 x 12 =
$
8,320.00
b. Member Service Credit purchase contributions (Pre-tax deductions for purchase
of additional service credit, except redeposits)
$
250.00 x 12 =
$
3,000.00
c. Employer pre-tax contributions to the State Alternate Retirement Program for
new employees hired after 8/11/2004
$
$
d. Mandatory pre-tax contributions to the other retirement plans that are picked up
by your employer (do not include your own salary deferral contributions, if any)
$
$
e. Add Lines 2a and 2d
$
$
11,320.00
3. Section 415 Compensation – Subtract Line 2e from Line 1
$168,000 - 11,320 =
$
156,680.00
4. IRC Section 415(c) maximum limit for 2014
$
$
52,000.00
5. If your Section 415 Compensation for the year (Line 3) is less than $52,000 enter
that amount on line 5. If greater, enter $52,000.
$
$
52,000.00
6. Enter your employer and/or employee contributions to a 401(a) defined contribution
plan (including 401(k) plans), 403(a) and 403(b) plans, and Simplified Employee
Pension Plans (SEPs)
Contributions to Retirement Plans
a. Enter after-tax payments to CalPERS (such as purchases of additional service credit
except redeposits)
$
$
.00
b. Enter after-tax payments to another employer’s Defined Benefit Plan for purchase of
additional service credit except redeposits
$
$
.00
c. Enter pre-tax employer contributions to 401(a) defined contribution plan, including
pre-tax contributions to 401(k) plan and the State Alternative Retirement Program
for new employees hired after 8/11/2004
$
280.00 x 12 =
$
3,360.00
d. Enter pre-tax emplyee contributions to a Section 401(a) defined contribution plan
(including a 401(k) plan), 403(a) and 403(b) plans, and SEPs
$
200.00 x 12 =
$
2,400.00
e. Enter the amount of Employee Roth Contributions (after-tax) to a Section 401(k)
or 403(b) plan
$
$
f. Add lines 6a through 6e
$3,360.00 + 2,400 =
$
5,760.00
$
$
46,240.00
7. Maximum SCP Contribution for the calendar year. Subtract Line 6f from line 5
IRC 415(c) LIMIT WORKSHEET / PAGE 3 of 3
09/01/2014
PR452001CALEAFN