[date] [participant name participant address1 …date] [participant name participant address1...

[Date] [Participant Name Participant Address1 Participant City ST Zip] Dear Participant: RE: Request for Hardship Distribution under the Plan (“Request for Distribution”) [Account Number – Plan Name] MassMutual has received your request for a hardship distribution from your retirement account. Please complete the enclosed Application for Hardship Withdrawal, provide supporting documentation for your request as outlined in the attached Appendix IV, and return it to:

MassMutual Retirement Services PO Box 219062 Kansas City MO 64121-9062 For Overnight Mail: MassMutual Retirement Services 430 W 7th St Kansas City MO 64105

To expedite your request, please fax documentation to (816) 701-3923. In applying for a hardship distribution, there are a few things to keep in mind: • If your hardship application is approved, you will not be permitted to make any

contributions to your plan for six months from the time of the distribution. • In order to receive a hardship distribution, you must provide documentation to

support the reason for your need. A list of the appropriate forms of documentation is included with the Application for Hardship Withdrawal. If the supportable documentation that is provided is less than the amount requested, the amount of the distribution will be processed based on the approved documentation.

MassMutual Financial Group is the fleet name for Massachusetts Mutual Life Insurance Company (MassMutual) [of which Retirement Services is a division] and affiliates

• As part of your application process, you must certify that you have obtained all nontaxable loans from the Plan (if applicable) and all other plans maintained by your employer that are reasonably available to you. By completing the attached Application for Hardship Withdrawal and returning it for processing, you are certifying that there are no other loans reasonably available to you through your employer. A loan is considered “reasonably available” as long as it does not have the effect of increasing your need. Consider the following examples in which receiving a loan would increase the need:

o Taking out a loan in order to purchase a principal residence would disqualify

you from obtaining other financing. o The amount of the loan repayments would cause you to default on the loan.

If you feel that loans are reasonably available to you, or if you have any questions regarding your application for a hardship distribution, please contact the Participant Information Center at (800) 743-5274, 8:00 AM EST to 8:00 PM EST. In addition, you can contact the Participant Information Center by email through the RetireSMARTSM participant website. Log into RetireSMARTSM and then, in the upper right corner, click on “Contact Us”; this will send an email directly to the Participant Information Center. Sincerely, MassMutual RS-07478-01 08/18/2008

Documentation Required For Hardship Approvals The documentation/information below is needed to complete, approve and process your hardship withdrawal request. Note: All requests require proper documentation, and can not be approved or processed unless it is provided. If MassMutual requests additional information and the required documentation is not received, the hardship request will be closed and you may be charged for the review. For additional details please refer to the Explanation of Hardship and Supporting Documentation that was enclosed in your package. Please pay close attention to the required information that must be included with your specific hardship submission, to ensure your request can be completed in a timely manner.

Medical Expenses A copy of the bill for services, current within 60 days, that shows the outstanding balance due.

If the medical procedure has not yet occurred, please provide: A letter from the physician stating that pre-payment is necessary AND A letter from the insurance provider with the amount to be covered by insurance-if no insurance the estimate/treatment plan must state no

insurance coverage. An Explanation of Benefits (EOB) (from your insurance provider) for each bill, showing what services/procedures were provided, what portion

of the expense was covered by insurance OR documentation indicating that the expense is not reimbursable from insurance Documentation for each bill, explaining what services were provided AND the service dates. (Commonly, these are found on the Explanation

of Benefits.) This is needed in place of an EOB. If the bill lists the details of the services/procedures provided, an EOB is not needed.

Prevention of Eviction or Foreclosure A copy of the Notice of Eviction. The Notice of Eviction by the landlord, apartment complex, or court must state:

The amount due to prevent eviction. A future date for eviction (at least 5 business days in the future from the date you submit to MassMutual) that states that you “will” be

evicted (not “may”), if the amount due is not made current. If you pay the amount stated, you will be allowed to stay at the property. A signature of the landlord must be present on the Notice.

o If Notice of Eviction is issued by a landlord or court, you must also provide the Lease Agreement for the property. The property address.

A copy of the Notice of Foreclosure. The foreclosure notice must be issued by a bank, or a mortgage company and state: The amount due to bring the mortgage current Foreclosure proceedings will commence if the amounts owed are not paid by a future date. The property address.

Purchase of Primary Residence

A good faith estimate (GFE) issued by a bank or mortgage company that contains closing costs, date of closing, and the address of the property. If the requested amount is more than the settlement charges on the GFE, a sales contract/agreement is required.

For a land purchase only: Evidence from the contractor of the immediate building of the primary residence. For the construction of a primary residence: An executed contract between the builder and yourself (which may include dates and amounts of

periodic disbursements to the builder), a copy of the construction loan, and a commitment letter from a bank or mortgage company.

Tuition and Related Education Fees A current tuition bill indicating the name of the student and the semester or term, with the institution name present on the bill. The bill must indicate the current outstanding amount due for the student, not simply list the cost of attending the institution. The tuition must be for accredited secondary education resulting in a degree or certificate.

Funeral Expenses Need a current itemized bill for burial and/or funeral expenses incurred that indicates the name of the funeral home, mortuary, crematorium,

monument company and/or religious establishment. Bill for funeral expenses must indicate the name of the spouse, child, parent or other dependent on whose behalf the services were furnished.

Expenses for Repair of Damage on a Principal Residence (Internal Revenue Code Section 165 Casualty)

Must be as a result of a loss that arises from fire, storm, or other casualty, or from theft. A statement from the insurance carrier evidencing a denial of coverage for the cost of repairs.

For prepayment of costs; need an estimate from the contractor. For building a principal residence destroyed by a casualty; an executed contract between you and the contractor.

In addition to obtaining the proper documentation located in the above checklist, please review your Hardship Withdrawal Request to ensure that you have:

signed the form indicated the amount of withdrawal request (net or gross) completed the withholding section returned all pages of the distribution form.

RS-18073-01

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COMPLETE ALL PAGES MassMutual Retirement Services (MMRS) is a division of Massachusetts Mutual Life Insurance Company (MassMutual) and affiliates.

APPLICATION FOR HARDSHIP WITHDRAWAL

To be Completed by the Participant: Participant's Name ___________________ __________________ ______________________ first middle last Social Security No. _____________________ Address ___________________________________________________________________________ street ___________________________________________________________________________ city state zip Legal State of Residence _________________________________ If the Legal State of Residence is not provided, MassMutual will use the state provided in the Mailing Address for state tax purposes.

Check if Mailing Address or Legal State of Residence has changed. Marital Status: Married Not Married or Legally Separated If there is a question about my request, I prefer to be contacted by:

E-mail Address: ________________________________________

Phone Number #: _______________________________________

To be Completed by MassMutual: Account Number _____________________ Sponsor Name ______________________________________________________________________ Plan Name ______________________________________________________________________________

HARDSHIP REQUEST 1. I request a withdrawal due to hardship in the following amount:

Gross Amount: Withdraw $__________ from my vested account balance. I understand that any income tax withholding will be deducted from this amount.

Net Amount: Withdraw $__________ from my vested account balance plus withdraw any income

tax withholding.

I understand that: 1) My distribution will be limited to the amount available or the amount that can be approved based on

the documentation provided, and 2) If I do not elect a Gross or Net amount, I will receive the distribution as a Net amount, and 3) If I do not specify an amount, the distribution will be processed for the lesser of the approved amount

or the amount available. 2. I certify that the amount of hardship in item (1) above is for the following reason(s): Expenses for Medical Care for myself, my spouse, my children, my other dependent(s), or, if

permitted by the Plan, my primary beneficiary. Purchase of My Principal Residence (excluding mortgage payments). Tuition and Related Education Fees including room and board expenses, for the next 12 months

for post-secondary education for myself, my spouse, my children, my other dependent(s) or, if permitted by the Plan, my primary beneficiary.

Prevention of Eviction from or Foreclosure on the mortgage on my principal residence. I certify that I am currently living at the address stated in the submitted hardship documentation.

Expenses for the Repair of Damage on my principal residence that would qualify for the casualty deduction under §IRC 165.

Payment for Burial or Funeral Expenses for my deceased parent, spouse, children, dependents or, if permitted by the Plan, my primary beneficiary.


To receive the hardship withdrawal requested above, I certify that the following requirements have been or will be satisfied:

1. The withdrawal amount requested will not be in excess of the amount of the financial need. 2. I previously have obtained all distributions and nontaxable loans from this Plan and all other plans

maintained by my employer that are reasonably available to me (i.e., the loan(s) will not increase my level of need). A loan is considered “reasonably available” so long as it does not have the effect of increasing your need, such as

• Taking out a loan in order to purchase a principal residence that would disqualify you from obtaining other financing; or

• The amount of the loan repayments would cause you to default on the loan. 3. I will not be able to make any contributions to any qualified or non-qualified plan maintained by my

employer, including a cash or deferred arrangement that is part of a cafeteria plan within the meaning of section 125 (but excluding a health or welfare benefit plan) for at least 6 months after I receive the hardship withdrawal; and

Failure to produce the substantiating documentation will mean denial of my hardship request. (For a list of approved forms of documentation, please see the “Permissible Hardship Expenses and Supporting Documentation” included with this application.).

INCOME TAX WITHHOLDING You may elect to have federal and state taxes withheld from your hardship distribution. The amount that you elect to withdraw may not exceed the amount of federal and state taxes that would apply as a result of the hardship distribution. If you do not make any tax withholding election for Federal or State taxes related to your hardship distribution, 10% will automatically be withheld for Federal taxes and the amount of State taxes that will be withheld will be based on the applicable withholding requirements of your State. FEDERAL WITHHOLDING: Distributions of pre-tax contributions plus earnings on all contributions are subject to federal income tax. Hardship withdrawals are not eligible to be rolled over, and you have the option whether or not to have federal income tax withheld. If you elect to have withholding, 10% will automatically be withheld for federal income tax. I elect to have federal income tax: � withheld � not withheld. In addition to this federal income tax withholding, I want an additional amount withheld of $_________. Please read the Special Tax Notice(s). Contact your tax advisor or the IRS if you have any questions concerning tax withholding. STATE WITHHOLDING: Contact your tax advisor or your state’s tax department if you have any questions concerning state tax withholding. Refer to the State Tax Information document for important information regarding State Withholding in your Legal State of Residence. If you make an election that is not in compliance with your state’s regulations, MassMutual will default to your state’s requirements.

No State Tax Withholding Election I have read the State Tax Information document and I elect to have no state income tax withheld from my

payment(s).

Voluntary State Income Tax Withholding I have read the State Tax Information document and I elect to have the following voluntary state income tax

withheld from my payment(s) (choose one): ____% $________ (whole dollar amount) ___ based on my state's tax table formula, if applicable (MassMutual will apply the default tax allowance) Note: MassMutual will not withhold more than your State’s personal income tax rate.

METHOD OF PAYMENT

Direct deposit to a bank account of which I am an account holder - Deposited within 3 business days from date of processing.

This option is NOT available for Rollovers.

To elect Direct Deposit, you must select either Checking or Savings and you must provide a voided check or copy of a pre-printed, account-specific deposit slip or a bank specification sheet from your bank for validation.

Checking Savings

___________________________________ __________________________________________ _______________________________________ Bank Name Bank ABA/Routing (9 digits) Bank Account No.

Please note that we can only send funds via direct deposit to banks with a valid U.S. routing number.


I understand that if I do not fully complete this section or the bank account information I have provided is invalid, a check will be mailed. I understand that a reprocessing fee may be charged to my account if the direct deposit is declined by my financial institution. Subsequent withdrawals will be processed in the same manner (up to 180 days from the date of the original distribution) unless I notify MassMutual in writing to distribute the money differently. I also authorize MassMutual to initiate a debit to my account for any overpayment or payments made in error.

Send payment by check - Allow up to 10 business days for postal service delivery.

SIGNATURE I understand there may be a charge deducted from my account for each distribution processed for the hardship review service, whether my request is approved or not. If all required items are not completed on this form along with proper supporting documentation, payment will be delayed. If electing direct deposit, by signing below I certify that I am an account holder on the bank account listed above. By signing this form, I certify that the information I have provided is accurate, to the best of my knowledge. I also certify that I have read and understand the Explanation of Hardship and Supporting Documentation document. I also certify that I have obtained, and will provide upon request by MassMutual, the documentation necessary to support my hardship withdrawal request, including a completed Waiver of Preretirement Survivor Annuity form if the Plan requires spousal consent and I am married. _____________________ Participant Signature Date

Please return this form to: MassMutual Retirement Services PO Box 219062 Kansas City MO 64121-9062 OR

For Overnight Mail: MassMutual Retirement Services 430 W 7th St Kansas City MO 64105 OR

Fax to: (816) 701-3923, Attn: RS CSO Processing OR

Email to: [email protected]

Appendix IV

Explanation of Hardship and Supporting Documentation Definition of “Dependent,” as defined by Sections 152(c) and 152(d) of the Internal Revenue Code shall mean with respect to a participant:

A qualifying child: An individual who (i) is a child of the participant (or a descendent of such a child), a brother, sister, stepbrother, or stepsister of the participant or any such descendent of any such relative; (ii) who has not attained age 19 as of the close of the calendar year in which the taxable year of the participant (taxpayer) begins or is a student who has not attained age 24 as of the close of such calendar year. The age requirement in (ii) shall be treated as met in the case of a dependent who is permanently and totally disabled at any time during such calendar year.

A qualifying relative: An individual (i) who is a child (or a descendant of a child), brother, sister, stepbrother, stepsister, father, mother (or ancestor of father or mother), stepfather, stepmother, son or daughter of a brother or sister of the participant, brother or sister of the father or mother of the taxpayer, son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, sister-in-law, or an individual who, for the taxable year of the participant, has the same principal place of the abode as the participant and is a member of the participant's household; (ii) with respect to whom the taxpayer provides over one-half of the individual's support for the calendar year taxable year begins; and (iii) who is not a qualifying child of such participant or of any other taxpayer for any taxable year beginning in the calendar year in which such taxable year begins.

I. Medical Care A. You may receive a hardship distribution for amounts not covered by insurance for the

following medical care expenses permitted under section 213(d) of the Internal Revenue Code: • Operations/treatment affecting any part of the body (not for surgery solely for

cosmetic reasons) • Obstetrical expenses • Invitro fertilization • Vasectomy • Therapy • X-ray treatments • Hospital services • Nursing services • Medical services

• Laboratory services • Surgical services • Laparoscopic surgery (if deemed medically necessary by a doctor) • Dental services • Diagnostic services • Gastric by-pass surgery (if medically necessary as evidenced by a doctor) • Healing services • Prescribed drugs. Forecasting is allowed based on quantity of specified refills, up

to six months. Cost of medication and number of refills must be provided. • Artificial teeth • Artificial limbs • Ambulance hire • Lodging (while away from home primarily for and essential to medical care,

limited to $50 per night) • Transportation for and essential to receipt of medical care • Hearing aids (cost of hearing aid and batteries to operate device). Forecasting is

allowed, for a six month period, in cases where the device is being rented. • Reconstructive surgery as a result of mastectomy • Breast reduction (if deemed medically necessary by a doctor) • Eyeglasses • Laser eye surgery • Seeing eye dog • Wheelchair • Crutches • Inclinator • Capital expenditures, operation and maintenance for permanent improvement or

betterment of the property advised by a physician (example, an elevator for an afflicted individual), limited to the difference between the increase in property value due to the improvement and the cost of installing the improvement.

• Qualified long-term care services defined as: necessary diagnostic, preventative, therapeutic, curing, treating, mitigating, and rehabilitative services, and maintenance or personal care services, that are required by a chronically ill person as certified by a healthcare practitioner. An individual is “chronically ill” if he/she is as unable to perform at least 2 activities of daily living (e.g., eating, toileting, transferring, bathing, dressing, and continence); or requires substantial supervision to protect the individual’s health and safety due to severe cognitive impairment as indicated in writing by a health care professional stating that it is necessary for long term care.

• Costs (tuition, meals and lodging) of attending a school that furnishes special education to help a child to overcome learning disabilities caused by mental or physical impairments. A doctor must recommend that the child attend the school. Overcoming the learning disability must be a principal reason for attending the school, and any ordinary education received must be incidental to the special education provided. Special education includes but is not necessarily limited to:

- Teaching Braille to a visually impaired person,

- Teaching lip reading to a hearing-impaired person, or - Giving remedial language training to correct a condition caused by a

birth defect. • Medical insurance premiums • Premium payments under a qualified long-term care insurance contract.

Note that the payment of qualified long-term care premiums is limited to the following amounts:

Age before the Close of the Taxable Year The limitation is: 40 or less $340 More than 40 but not more than 50 $640 More than 50 but not more than 60 $1,270 More than 60 but not more than 70 $3,390 More than 70 $4,240 Note: Each of the above dollar amounts may be increased by the medical care cost adjustment (as prescribed by the Treasury Secretary) each calendar year. Any increase that is not a multiple of 10, shall be rounded to the nearest multiple of 10.

B. You cannot receive a hardship distribution for the following Medical Care expenses:

• Babysitting, childcare and nursing services for a normal, healthy baby • Contributions to, or expenses that would be covered by, your flexible spending

account or health savings account or medical savings account • Controlled substances (such as marijuana, laetrile, etc.) • Cosmetic surgery (amount you pay for unnecessary surgery) • Dancing lessons • Diaper service • Electrolysis or hair removal • Funeral expenses (cannot include in medical expenses amounts you pay for

funerals) • Future medical care (to be provided substantially beyond the end of the year) • Hair transplant • Health club dues • Health coverage tax credit • Household help (not including nursing-type services) • Illegal operations and treatments • Insurance policies providing indemnity against loss of income or for loss or life,

limb, sight • Maternity clothes • Medicines and drugs from other countries • Nonprescription drugs and medicines (except insulin) • Nutritional supplements • Personal use items (toiletries, cosmetics, or sundry items) • Swimming lessons

• Teeth whitening • Veterinary fees • Weight-loss program Please see Internal Revenue Service Publication 502 for additional details regarding what will, and what will not, constitute a medical expense that is eligible to be covered by a hardship distribution.

C. If you request a hardship distribution for medical expenses, you must have

documentation to support your request. If you cannot produce the documentation to substantiate your hardship request, your application will be denied. The following documentation is acceptable:

1. Some Medical Care expenses are paid for by the insurance company. Others

are not. For the portion of those Medical Care expenses that the insurance company will not pay (unreimbursed qualifying Medical Care expenses):

• Current bill for service, and • Explanation of Benefits* for each bill submitted indicating:

• Service rendered that qualifies as a Medical Care expense; • Date of such service; • Amount of coverage paid; and • Amount currently owed. • If you cannot produce an Explanation of Benefits, you must

obtain a copy from the insurance company. If the company cannot provide a copy, you may submit a copy of the medical history with respect to the service rendered, including any amount paid by the insurance company.

*If the Bill for service outlines the services rendered, you do not need to provide the Explanation of Benefits documentation.

2. Some Medical Care expenses will not be covered at all by the insurance company.

For qualifying Medical Care expenses for treatment not covered by the insurance policy:

• A current bill for service that lists the information noted in item #1 above; • Explanation of Benefits evidencing a denial of coverage; or • A letter from the insurance company stating that no Explanation of Benefits is

available. 3. If prepayment of certain Medical Care expenses is required on or before the time

of treatment:

• Estimate of the cost for the procedure from the insurance company and/or medical professional

• Letter from the medical professional stating that payment is required either in advance or at the time of the procedure

An example of this would be were a dentist requires pre-payment for a treatment plan. Generally, you cannot include in medical expenses current payments for medical care (including medical insurance) to be provided substantially beyond the end of the year. This rule does not apply in situations where the future care is purchased in connection with obtaining lifetime care or long-term care.

4. If Medical Care expenses will be paid in installments:

• Explanation of Benefits evidencing the service rendered and that the lifetime

maximum permitted by the insurance company has been reached for the applicable medical expense

• A current bill showing the remaining amount to be paid. If the current bill does not show the details of the specific service provided, please also provide the original bill that provides that information.

D. Examples: Past-due medical expenses: Past-due medical expenses may be eligible for hardship treatment if the participant can produce bills for service dating back from the original date of services to the current date that the participant is requesting the hardship. For example, a participant incurs eligible medical care expenses on January 1st and has been unable to pay them. On April 1st, the participant requests a hardship distribution to pay the medical expenses. The participant will be required to produce documentation indicating that the services were rendered and the amount is past due. Past due medical expenses without proof that they are still owed will not be considered an immediate and heavy financial need.

Important note: A bill shall be considered current if issued within 60 days from the date of the hardship request. Medical Credit Cards: Amounts owed on medical credit cards used to pay eligible medical expenses are eligible for a hardship distribution. The amount of hardship shall be limited to the amount necessary to satisfy payment of the eligible medical expenses charged to the credit card.

Note: An Explanation of Benefits must be provided along with a copy of the medical credit card bill.

Other Credit Cards: Balances for eligible medical expenses charged to all other credits cards shall NOT be eligible for a hardship distribution.

II. Purchase of a Principal Residence A. Principal Residence includes:

• Principal Residence • The purchase of land upon which the principal residence shall be immediately

built • Building a residence with a service contract • Purchase of a housing cooperative or condominium

B. Principal Residence DOES NOT include:

• Vacation homes • Rental properties • Mortgage payments. Note: The property may NOT be a rent-to-own residence or “lease with an option to buy” residence.

C. If you request a hardship distribution for the purchase of a principal residence, you

must have documentation to support your request. If you cannot produce the documentation to substantiate your hardship request, your application will be denied. Any one of the following types documentation is acceptable:

• Good Faith Estimate: Issued by a bank or mortgage company. The Good Faith

Estimate must include the estimated total closing costs, any down payments, prepaid expenses and signature, excluding any contributions from the seller. The Good Faith Estimate cannot be issued by a realty company (unless the real estate agent is acting as the lender) and must be prepared and signed within 60 days of the request. *A contract is needed along with the Good Faith Estimate if the requested withdrawal amount is more than the funds necessary to close indicated on the Good Faith Estimate.

• Contract: Must include a closing date (or, alternatively, written certification from

the mortgage company of the closing date); it must be issued no more than 60 days prior to the closing date; it must be signed by you and the seller. *If the property is being financed by the owner, a Good Faith Estimate is not required. A copy of the contract will suffice.

• Service Contract: Must provide an estimated completion date; and it must be signed by you and the contractor.

• Purchase of land: For the construction of a principal residence, you must provide MassMutual with an executed Contract between you and the seller (which may include dates and amounts of periodic disbursements to the builder), a copy of the construction loan and a commitment letter from a bank or mortgage company.

D. Examples: Purchase of Land for Motor Home/Trailer: The purchase of land for purposes of maintaining a motor home/trailer as the primary residence shall be eligible for a hardship distribution when accompanied by one of the applicable documents noted in Section C above.

Rent-to-Own Arrangements: Rental payments or “lease with an option to buy” payments applied towards home ownership shall NOT be considered hardship eligible. However, such payments may qualify for hardship if they are necessary to prevent eviction from principal residence.

Building Ones Own Primary Residence: Hardship distributions will NOT be eligible if you are building your own primary residence and are requesting a distribution to purchase materials/services without a service contract.

Credit Card Expenses: A hardship distribution will NOT be allowed for expenses that are charged to a credit card.

III. Payment of Tuition and Related Educational Fees A. You may receive a hardship distribution for the following fees and expenses:

• Tuition • Related educational fees, including books • Room and board expenses

A hardship distribution may be permitted to cover expenses related to the current semester or to cover past overdue balances from previous semesters (provided the balance is still outstanding and a current bill is provided). The above bulleted expenses may be forecasted out up to the next 12 months of post-secondary education. B. The fees and expenses must be incurred by one of the following accredited

institutions which must also require a high school diploma or recognized equivalent for admission:

• State-sponsored university • State-sponsored college • State-sponsored vocational school • State-sponsored technical school

• Private university • Private college • Private vocational school (examples: tractor trailer, cosmetology, escalator

technician) • Private technical school

C. Tuition and related educational expenses shall not include:

• Non-academic-related expenses • Courses designed to sell products (ex. real estate courses) • Random courses that are not part of, or result in completion of, a program that

provides a certification or degree. D. If you request a hardship distribution for tuition and related educational fees, you

must have documentation to support your request. MassMutual may require that you produce this documentation at any time. If you cannot produce the documentation to substantiate your hardship request, your application will be denied. The following documentation is acceptable:

For initial, ongoing enrollment and summer sessions:

• A current tuition bill listing the school name indicating:

- Name of the student - Total amount currently outstanding (not just the cost of attending the school) - The semester or term the charges are for - Whether expenses for room and board are included in the hardship request

• The tuition bill may also be used to calculate anticipated financial need for the remainder of the academic year.

E. Examples: Off-campus Housing: Off campus housing is eligible for a financial hardship, provided that the housing is affiliated with the educational institution the student is attending. A copy of the rental agreement or lease agreement is required with the student’s name or a letter from the landlord stating the student will reside there. If there is more than one leasee it must specify how much each party is responsible to pay. Expenses outside of the lease agreement, such as internet, phone and cable service bills, are not reimbursable.

Secondary Education Fees: Preschool, elementary, middle or high school tuition and related educational expenses are not hardship eligible.


IV. Prevention of Eviction or Foreclosure A. You may receive a hardship if the distribution is necessary for the following:

• To prevent eviction from the employee’s principal residence • To prevent foreclosure on the mortgage on that residence. • The amount of the hardship may be in an amount sufficient to bring all payments

current as of the date such funds are received. B. If you request a hardship distribution to prevent eviction or foreclosure, you must

have documentation to support your request. If you cannot produce the documentation to substantiate your hardship request, your application will be denied. The following documentation is acceptable:

1. Eviction from the principal residence:

• Eviction notice issued by the landlord, apartment complex, court, or any other authorized entity which states the amount to be paid to prevent eviction and that such amount is past due.

If the eviction notice is issued by an individual rather than a rental organization, you must also supply MassMutual with a copy of the lease agreement and a signed statement from the landlord confirming the pending eviction. If there is no written lease agreement involved, a signed statement from the landlord confirming the pending eviction will be required, and such statement must also specify the residential address of the property, the monthly rental amount and that there is no lease agreement.

2. Foreclosure on the principal residence:

• Notice of foreclosure (stating that proceedings have commenced or will

commence either immediately or on a specified date), which must: - Be issued by a bank, mortgage company, or other qualified lending institution - State the amount due to bring the mortgage current, and - State that foreclosure proceedings will commence immediately if the amounts owed are not paid.

C. Examples: Eviction from Land: Evicted from the lot upon which your trailer is located and the trailer is your primary residence.

Timely Hardship Application: The eviction or foreclosure notice must not be past the eviction/foreclosure date. The eviction deadline must allow time for review and processing – MassMutual requests that requests are submitted at least five business days before the eviction date on the notice.

Cure of Foreclosure: If foreclosure proceedings have begun, a letter from the mortgage company stating the amount that is required to cure the foreclosure shall be considered to

be evidence of an immediate and heavy financial need. A hardship distribution will not be permitted beyond the amount necessary to cure the foreclosure.

If foreclosure or the immediate threat of foreclosure is due to non-payment of property taxes then a hardship distribution will be permitted if the required supporting documentation is provided.

Note: If the mortgage is not in the participant’s name but the deed is and has the same address or if the mortgage and the deed are in the spouse’s name and the address is the participant’s address then a hardship distribution will be permitted if the required supporting documentation is provided.


V. Burial and/or Funeral Expenses A. You may receive a hardship distribution for the following items:

• Purchase of grave • Burial fees • Monument fees (headstone) • Crematory fees • Casket • Casket fittings • Burial containers • Urn • Nameplates • Memorial plaque • Book of remembrance • Memorial cards • Church fees • Press notices • Cemetery fees • Services for funeral director, staff and overhead • Hearse and funeral vehicle rentals necessary to transport the deceased (does not

include transportation of family members) • Collection of the body and transference to hospital, funeral home/mortuary or

other location • Preparation of the body • Embalming • Memorial service • Graveside service • Funeral service

B. You cannot receive a hardship distribution for the following burial and/or funeral expenses:

• Reception • Flowers • Donations • Pre-payment of a (future) funeral • Transportation (other than the modes of transportation not included in Section A

above). C. If you request a hardship distribution for the payment of funeral or burial expenses,

you must have documentation to support your request. If you cannot produce the documentation to substantiate your hardship request, your application will be denied. The following documentation is acceptable:

• A current bill for burial and/or funeral expenses indicating:

° Name of the funeral home, mortuary, crematorium, cemetery, monument company and/or religious establishment (church, synagogue, chapel or other place of worship)

° Name of the parent, spouse, child or other dependent on whose

behalf the services were furnished. If the decedent’s name is not included in the bill for service, additionally, the participant must provide a death certificate indicating the decedent’s name. Unless the person is a dependent (as described at the beginning of this document), the following relationships would not qualify for reimbursement: brother or sister in-law, mother or father in-law.

° List of expenses incurred

D. Examples: Credit Card Expenses: A hardship distribution will NOT be allowed to pay for burial or funeral expenses that are charged to a credit card.

VI. Expenses for the Repair of Damage to the Employee’s Principal Residence that would Qualify for the Casualty Deduction A. You may receive a hardship distribution to repair damage to your principal residence

that arose from any of the following sudden, unexpected or unusual events:

• Electrical storms • Tree damage (ex. Limb punctures roof) • Earthquakes

• Fires • Floods (such as riverbanks overflowing or floods that impact a community) • Government-ordered demolition or relocation of a home that is unsafe to use

because of a disaster • Hail • Landslides • Mine cave-ins • Shipwrecks • Sonic booms • Hurricanes and tornadoes • Terrorist attacks • Vandalism • Volcanic eruptions • Disasters occurring in an area subsequently determined by the President of the

United States to warrant assistance by the Federal Government

Note: Your insurance deductible amount may qualify for a hardship.

This list contains examples of casualties that qualify for a hardship, but this list is not all-inclusive of every casualty that may be covered.

B. The following items do not qualify for hardship treatment:

Progressive deterioration:

• The steady weakening of a building due to normal wind and weather conditions; • A burst water heater (however, the rust and water damage to rugs and drapes

caused by the bursting of a water heater does qualify as a casualty) • Losses caused by droughts • Termite or moth damage • The damage or destruction of trees, shrubs and other plans by a fungus, disease,

insects, worms or similar pests C. If you request a hardship distribution for the repair or construction of your principal

residence due to damage caused by a qualifying casualty, you must have documentation to support your request. If you cannot produce the documentation to substantiate your hardship request, your application will be denied. The following documentation is acceptable:

1. For the payment of unreimbursed costs of qualifying casualties to repair a

damaged principal residence:

• Bill for services from the contractor. The contractor should state the cause of the casualty and provide a breakdown of the cost on the bill

• Statement from the insurance carrier evidencing a denial of coverage* of the cost of repairs

2. If you are required to prepay certain repairs/construction:

• Estimate from the contractor. The contractor should state the cause of the

casualty on the estimate. • Statement from the insurance carrier evidencing the coverage* or the denial of

coverage of the costs of repair

3. For the building of a principal residence destroyed by the casualty:

• Executed contract between you and the contractor (which may include dates and amounts of periodic disbursements to the contractor). The contractor should state the cause of the casualty on the contract.

• Statement from the insurance carrier evidencing the coverage or the denial of coverage* of the cost of construction

*Insurance claims that are denied because the insurance carrier has labeled the loss due to “normal wear and tear” or because it deems the loss to be the result of an incident outside the definition of casualty as defined in Section A. above will not qualify as a hardship.

Credit Card Expenses: A hardship distribution will NOT be allowed for expenses that are charged to a credit card. RS-07480-09 Exp. 01/01/14

Distributions Forms – Defined Contribution Plans

RS‐31234‐00

SPECIAL TAX NOTICE (For Payments Not From a Designated Roth Account)

YOUR ROLLOVER OPTIONS You are receiving this notice because all or a portion of a payment you are receiving from your retirement plan is eligible to be rolled over to an IRA or an employer plan. This notice is intended to help you decide whether to do such a rollover. This notice describes the rollover rules that apply to payments from the Plan that are not from a designated Roth account (a type of account with special tax rules in some employer plans). If you also receive a payment from a designated Roth account in the Plan, you will be provided a different notice for that payment, and the Plan administrator or the payor will tell you the amount that is being paid from each account. Rules that apply to most payments from a plan are described in the “General Information About Rollovers” section. Special rules that only apply in certain circumstances are described in the “Special Rules and Options” section.

GENERAL INFORMATION ABOUT ROLLOVERS How can a rollover affect my taxes? You will be taxed on a payment from the Plan if you do not roll it over. If you are under age 59½ and do not do a rollover, you will also have to pay a 10% additional income tax on early distributions (unless an exception applies). However, if you do a rollover, you will not have to pay tax until you receive payments later and the 10% additional income tax will not apply if those payments are made after you are age 59½ (or if an exception applies). Where may I roll over the payment? You may roll over the payment to either an IRA (an individual retirement account or individual retirement annuity) or an employer plan (a tax-qualified plan, section 403(b) plan, or governmental section 457(b) plan) that will accept the rollover. The rules of the IRA or employer plan that holds the rollover will determine your investment options, fees, and rights to payment from the IRA or employer plan (for example, no spousal consent rules apply to IRAs and IRAs may not provide loans). Further, the amount rolled over will become subject to the tax rules that apply to the IRA or employer plan. How do I do a rollover? There are two ways to do a rollover. You can do either a direct rollover or a 60-day rollover.

If you do a direct rollover, the Plan will make the payment directly to your IRA or an employer plan. You should contact the IRA sponsor or the administrator of the employer plan for information on how to do a direct rollover.

If you do not do a direct rollover, you may still do a rollover by making a deposit into an IRA or

eligible employer plan that will accept it. You will have 60 days after you receive the payment to make the deposit. If you do not do a direct rollover, the Plan is required to withhold 20% of the payment for federal income taxes (up to the amount of cash and property received other than employer stock). This means that, in order to roll over the entire payment in a 60-day rollover, you


104A-2 11/09

must use other funds to make up for the 20% withheld. If you do not roll over the entire amount of the payment, the portion not rolled over will be taxed and will be subject to the 10% additional income tax on early distributions if you are under age 59½ (unless an exception applies).

How much may I roll over? If you wish to do a rollover, you may roll over all or part of the amount eligible for rollover. Any payment from the Plan is eligible for rollover, except: • Certain payments spread over a period of at least 10 years or over your life or life expectancy (or the

lives or joint life expectancy of you and your beneficiary) • Required minimum distributions after age 70½ (or after death) • Hardship distributions • ESOP dividends • Corrective distributions of contributions that exceed tax law limitations • Loans treated as deemed distributions (for example, loans in default due to missed payments before

your employment ends) • Cost of life insurance paid by the Plan • Contributions made under special automatic enrollment rules that are withdrawn pursuant to your

request within 90 days of enrollment • Amounts treated as distributed because of a prohibited allocation of S corporation stock under an

ESOP (also, there will generally be adverse tax consequences if you roll over a distribution of S corporation stock to an IRA).

• If you are doing an In Plan Roth Rollover only vested amounts held in a plan account for a plan participant other than an amount held in a designated Roth account is eligible to be rolled over to the same plan.

The Plan administrator or the payor can tell you what portion of a payment is eligible for rollover. If I don’t do a rollover, will I have to pay the 10% additional income tax on early distributions? If you are under age 59½, you will have to pay the 10% additional income tax on early distributions for any payment from the Plan (including amounts withheld for income tax) that you do not roll over, unless one of the exceptions listed below applies. This tax is in addition to the regular income tax on the payment not rolled over. The 10% additional income tax does not apply to the following payments from the Plan: • Payments made after you separate from service if you will be at least age 55 in the year of the

separation • Payments that start after you separate from service if paid at least annually in equal or close to equal

amounts over your life or life expectancy (or the lives or joint life expectancy of you and your beneficiary)

• Payments from a governmental defined benefit pension plan made after you separate from service if you are a public safety employee and you are at least age 50 in the year of the separation

• Payments made due to disability • Payments after your death • Payments of ESOP dividends • Corrective distributions of contributions that exceed tax law limitations • Cost of life insurance paid by the Plan • Contributions made under special automatic enrollment rules that are withdrawn pursuant to your

request within 90 days of enrollment


RS‐31234‐00

• Payments made directly to the government to satisfy a federal tax levy • Payments made under a qualified domestic relations order (QDRO) • Payments up to the amount of your deductible medical expenses • Certain payments made while you are on active duty if you were a member of a reserve component

called to duty after September 11, 2001 for more than 179 days • Payments of certain automatic enrollment contributions requested to be withdrawn within 90 days of

the first contribution. If I do a rollover to an IRA, will the 10% additional income tax apply to early distributions from the IRA? If you receive a payment from an IRA when you are under age 59½, you will have to pay the 10% additional income tax on early distributions from the IRA, unless an exception applies. In general, the exceptions to the 10% additional income tax for early distributions from an IRA are the same as the exceptions listed above for early distributions from a plan. However, there are a few differences for payments from an IRA, including: • There is no exception for payments after separation from service that are made after age 55. • The exception for qualified domestic relations orders (QDROs) does not apply (although a special

rule applies under which, as part of a divorce or separation agreement, a tax-free transfer may be made directly to an IRA of a spouse or former spouse).

• The exception for payments made at least annually in equal or close to equal amounts over a specified period applies without regard to whether you have had a separation from service.

• There are additional exceptions for (1) payments for qualified higher education expenses, (2) payments up to $10,000 used in a qualified first-time home purchase, and (3) payments after you have received unemployment compensation for 12 consecutive weeks (or would have been eligible to receive unemployment compensation but for self-employed status).

Will I owe State, Local or U.S. possession income taxes? This notice does not describe any state, local or U.S. possession income tax rules (including withholding rules).

SPECIAL RULES AND OPTIONS If your payment includes after-tax contributions After-tax contributions included in a payment are not taxed. If a payment is only part of your benefit, an allocable portion of your after-tax contributions is generally included in the payment. If you have pre-1987 after-tax contributions maintained in a separate account, a special rule may apply to determine whether the after-tax contributions are included in a payment. You may roll over to an IRA a payment that includes after-tax contributions through either a direct rollover or a 60-day rollover. You must keep track of the aggregate amount of the after-tax contributions in all of your IRAs (in order to determine your taxable income for later payments from the IRAs). If you do a direct rollover of only a portion of the amount paid from the Plan and a portion is paid to you, each of the payments will include an allocable portion of the after-tax contributions. If you do a 60day rollover to an IRA of only a portion of the payment made to you, the after-tax contributions are treated as rolled over last. For example, assume you are receiving a complete distribution of your benefit which totals $12,000, of which $2,000 is after-tax contributions. In this case, if you roll over $10,000 to an IRA in a


104A-4 11/09

60-day rollover, no amount is taxable because the $2,000 amount not rolled over is treated as being after-tax contributions. You may roll over to an employer plan all of a payment that includes after-tax contributions, but only through a direct rollover (and only if the receiving plan separately accounts for after-tax contributions and is not a governmental section 457(b) plan). You can do a 60-day rollover to an employer plan of part of a payment that includes after-tax contributions, but only up to the amount of the payment that would be taxable if not rolled over. If you miss the 60-day rollover deadline Generally, the 60-day rollover deadline cannot be extended. However, the IRS has the limited authority to waive the deadline under certain extraordinary circumstances, such as when external events prevented you from completing the rollover by the 60-day rollover deadline. To apply for a waiver, you must file a private letter ruling request with the IRS. Private letter ruling requests require the payment of a nonrefundable user fee. For more information, see IRS Publication 590, Individual Retirement Arrangements (IRAs). If your payment includes employer stock that you do not roll over If you do not do a rollover, you can apply a special rule to payments of employer stock (or other employer securities) that are either attributable to after-tax contributions or paid in a lump sum after separation from service (or after age 59½, disability, or the participant’s death). Under the special rule, the net unrealized appreciation on the stock will not be taxed when distributed from the Plan and will be taxed at capital gain rates when you sell the stock. Net unrealized appreciation is generally the increase in the value of employer stock after it was acquired by the Plan. If you do a rollover for a payment that includes employer stock (for example, by selling the stock and rolling over the proceeds within 60 days of the payment), the special rule relating to the distributed employer stock will not apply to any subsequent payments from the IRA or employer plan. The Plan administrator can tell you the amount of any net unrealized appreciation. If you have an outstanding loan that is being offset If you have an outstanding loan from the Plan, your Plan benefit may be offset by the amount of the loan, typically when your employment ends. The loan offset amount is treated as a distribution to you at the time of the offset and will be taxed (including the 10% additional income tax on early distributions, unless an exception applies) unless you do a 60-day rollover in the amount of the loan offset to an IRA or employer plan. If you were born on or before January 1, 1936 If you were born on or before January 1, 1936 and receive a lump sum distribution that you do not roll over, special rules for calculating the amount of the tax on the payment might apply to you. For more information, see IRS Publication 575, Pension and Annuity Income. If your payment is from a governmental section 457(b) plan If the Plan is a governmental section 457(b) plan, the same rules described elsewhere in this notice generally apply, allowing you to roll over the payment to an IRA or an employer plan that accepts rollovers. One difference is that, if you do not do a rollover, you will not have to pay the 10% additional income tax on early distributions from the Plan even if you are under age 59½ (unless the payment is


RS‐31234‐00

from a separate account holding rollover contributions that were made to the Plan from a tax-qualified plan, a section 403(b) plan, or an IRA). However, if you do a rollover to an IRA or to an employer plan that is not a governmental section 457(b) plan, a later distribution made before age 59½ will be subject to the 10% additional income tax on early distributions (unless an exception applies). Other differences are that you cannot do a rollover if the payment is due to an “unforeseeable emergency” and the special rules under “If your payment includes employer stock that you do not roll over” and “If you were born on or before January 1, 1936” do not apply. If you are an eligible retired public safety officer and your pension payment is used to pay for health coverage or qualified long-term care insurance If the Plan is a governmental plan, you retired as a public safety officer, and your retirement was by reason of disability or was after normal retirement age, you can exclude from your taxable income plan payments paid directly as premiums to an accident or health plan (or a qualified long-term care insurance contract) that your employer maintains for you, your spouse, or your dependents, up to a maximum of $3,000 annually. For this purpose, a public safety officer is a law enforcement officer, firefighter, chaplain, or member of a rescue squad or ambulance crew. If you roll over your payment to a Roth IRA If you roll over the payment to a Roth IRA, a special rule applies under which the amount of the payment rolled over (reduced by any after-tax amounts) will be taxed. However, the 10% additional income tax on early distributions will not apply (unless you take the amount rolled over out of the Roth IRA within 5 years, counting from January 1 of the year of the rollover). For payments from the Plan during 2010 that are rolled over to a Roth IRA, the taxable amount can be spread over a 2-year period starting in 2011. If you roll over the payment to a Roth IRA, later payments from the Roth IRA that are qualified distributions will not be taxed (including earnings after the rollover). A qualified distribution from a Roth IRA is a payment made after you are age 59½ (or after your death or disability, or as a qualified first-time homebuyer distribution of up to $10,000) and after you have had a Roth IRA for at least 5 years. In applying this 5-year rule, you count from January 1 of the year for which your first contribution was made to a Roth IRA. Payments from the Roth IRA that are not qualified distributions will be taxed to the extent of earnings after the rollover, including the 10% additional income tax on early distributions (unless an exception applies). You do not have to take required minimum distributions from a Roth IRA during your lifetime. For more information, see IRS Publication 590, Individual Retirement Arrangements (IRAs). If you roll over your payment to an in-plan Roth Rollover

If the distributee rolls over the payment to a designated Roth account in the plan, the amount of the payment rolled over (reduced by any after-tax amounts directly rolled over) will be taxed. However, the 10% additional tax on early distributions will not apply (unless the distributee takes the amount rolled over out of the designated Roth account within the 5-year period that begins on January 1 of the year of the rollover). For payments from the plan in 2010 that are rolled over to a designated Roth account in the plan (and that are not distributed from that account until after 2011), the taxable amount of the rollover will be taxed half in 2011 and half in 2012, unless the distributee elects to be taxed in 2010. If the distributee rolls over the payment to a designated Roth account in the plan, later payments from the designated Roth account that are qualified distributions will not be taxed (including earnings after the rollover). A qualified distribution from a designated Roth account is a payment made both after the distributee attains age 59½ (or after the distributee’s death or disability) and after the distributee has had a


104A-6 11/09

designated Roth account in the plan for a period of at least 5 years. The 5-year period described in the preceding sentence begins on January 1 of the year the distributee’s first contribution was made to the designated Roth account. However, if the distributee made a direct rollover to a designated Roth account in the plan from a designated Roth account in a plan of another employer, the 5-year period begins on January 1 of the year the distributee’s first contribution was made to the designated Roth account in the plan or, if earlier, to the designated Roth account in the plan of the other employer. Payments from the designated Roth account that are not qualified distributions will be taxed to the extent allocable to earnings after the rollover, including the 10% additional tax on early distributions (unless an exception applies). If you are not a plan participant Payments after death of the participant. If you receive a distribution after the participant’s death that you do not roll over, the distribution will generally be taxed in the same manner described elsewhere in this notice. However, the 10% additional income tax on early distributions and the special rules for public safety officers do not apply, and the special rule described under the section “If you were born on or before January 1, 1936” applies only if the participant was born on or before January 1, 1936.

If you are a surviving spouse. If you receive a payment from the Plan as the surviving spouse of a deceased participant, you have the same rollover options that the participant would have had, as described elsewhere in this notice. In addition, if you choose to do a rollover to an IRA, you may treat the IRA as your own or as an inherited IRA. An IRA you treat as your own is treated like any other IRA of yours, so that payments made to you before you are age 59½ will be subject to the 10% additional income tax on early distributions (unless an exception applies) and required minimum distributions from your IRA do not have to start until after you are age 70½. If you treat the IRA as an inherited IRA, payments from the IRA will not be subject to the 10% additional income tax on early distributions. However, if the participant had started taking required minimum distributions, you will have to receive required minimum distributions from the inherited IRA. If the participant had not started taking required minimum distributions from the Plan, you will not have to start receiving required minimum distributions from the inherited IRA until the year the participant would have been age 70½. If you are a surviving beneficiary other than a spouse. If you receive a payment from the Plan because of the participant’s death and you are a designated beneficiary other than a surviving spouse, the only rollover option you have is to do a direct rollover to an inherited IRA. Payments from the inherited IRA will not be subject to the 10% additional income tax on early distributions. You will have to receive required minimum distributions from the inherited IRA.

Payments under a qualified domestic relations order. If you are the spouse or former spouse of the participant who receives a payment from the Plan under a qualified domestic relations order (QDRO), you generally have the same options the participant would have (for example, you may roll over the payment to your own IRA or an eligible employer plan that will accept it). Payments under the QDRO will not be subject to the 10% additional income tax on early distributions. If you are a nonresident alien If you are a nonresident alien and you do not do a direct rollover to a U.S. IRA or U.S. employer plan, instead of withholding 20%, the Plan is generally required to withhold 30% of the payment for federal income taxes. If the amount withheld exceeds the amount of tax you owe (as may happen if you do a 60-


RS‐31234‐00

day rollover), you may request an income tax refund by filing Form 1040NR and attaching your Form 1042-S. See Form W-8BEN for claiming that you are entitled to a reduced rate of withholding under an income tax treaty. For more information, see also IRS Publication 519, U.S. Tax Guide for Aliens, and IRS Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities. Other special rules If a payment is one in a series of payments for less than 10 years, your choice whether to make a direct rollover will apply to all later payments in the series (unless you make a different choice for later payments). If your payments for the year are less than $200 (not including payments from a designated Roth account in the Plan), the Plan is not required to allow you to do a direct rollover and is not required to withhold for federal income taxes. However, you may do a 60-day rollover. Unless you elect otherwise, a mandatory cashout of more than $1,000 (not including payments from a designated Roth account in the Plan) will be directly rolled over to an IRA chosen by the Plan administrator or the payor. A mandatory cashout is a payment from a plan to a participant made before age 62 (or normal retirement age, if later) and without consent, where the participant’s benefit does not exceed $5,000 (not including any amounts held under the plan as a result of a prior rollover made to the plan). You may have special rollover rights if you recently served in the U.S. Armed Forces. For more information, see IRS Publication 3, Armed Forces’ Tax Guide.

FOR MORE INFORMATION This notice summarizes only the federal (not state, local or U. S. possession) tax rules that might apply to your payment. You may wish to consult with the Plan administrator, or a professional tax advisor, before taking a payment from the Plan. Also, you can find more detailed information on the federal tax treatment of payments from employer plans in: IRS Publication 575, Pension and Annuity Income; IRS Publication 590, Individual Retirement Arrangements (IRAs); IRS Publication 570, Tax Guide for Individuals With Income From U.S. Possessions; and IRS Publication 571, Tax-Sheltered Annuity Plans (403(b) Plans). These publications are available from a local IRS office, on the web at www.irs.gov, or by calling 1-800-TAX-FORM.

* * * * * * * * * * * * * * *

(c) 2012 - Massachusetts Mutual Life Insurance Company, Springfield, MA. All rights reserved. Effective 10/1/2012 RS 07262.pdf v 6.14 RS 18096-08

State Tax Information

The information contained in this document is not intended or written as specific legal or tax advice and may not be relied on for purposes of avoiding any state tax penalties. Neither MassMutual nor any of its employees or representatives are authorized to give legal or tax advice. You must rely on the advice of your own independent tax counsel. State tax withholding is based on your legal state of residence. MassMutual will not withhold state taxes if the amount of withholding is less than $10. Mandatory state withholding State taxes that are required to be withheld per state tax regulations. In some states, a payee can opt out of mandatory state withholding if requested in writing. (Your distribution form constitutes a request “in writing.”) Voluntary state withholding State taxes that are not required to be withheld but may be requested by the participant. What is a periodic payment? A series of payments made at regular intervals over a certain term of years, for example, annuities or installments payments. What is a non-periodic payment? A single-sum payment that is paid at one time.


LEGAL STATE OF RESIDENCE

STATE TAX WITHHOLDING REGULATIONS

ALABAMA

Alabama state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a dollar amount or percentage. If you select “Voluntary State Income Tax Withholding” and do not enter a dollar amount or percentage, MassMutual will not withhold any state taxes.

ALASKA

Alaska does not have personal income tax. State tax will not be withheld from any distribution.

ARIZONA

Lump-sum/non-periodic payments: There are no state tax provisions for non-periodic distributions. State tax will not be withheld from these distributions. Periodic payments (installment payments): Arizona state withholding on periodic payments is voluntary; you may elect to have state taxes withheld only if federal taxes are withheld. If you request to have state taxes withheld, select “Voluntary State Income Tax Withholding.” You must enter one of the following percentages: 0.8%, 1.3, 1.8%, 2.7%, 3.6%, 4.2% or 5.1%. If you select “Voluntary State Income Tax Withholding” and do not enter one of these percentages, MassMutual will not withhold any state taxes.

ARKANSAS

Arkansas state tax withholding is mandatory if your distribution is eligible for rollover and will be calculated as 5% of the taxable distribution. Special rules apply for distributions that are not eligible for rollover. You may also request an additional amount to be withheld by selecting ‘Additional State Income Tax Withholding’ on your distribution form and entering a dollar amount.

CALIFORNIA

California state tax withholding is mandatory if federal taxes are withheld. If no federal taxes are withheld, no state taxes will be withheld. State taxes are calculated as 10% of the federal amount withheld. You may elect to have state taxes withheld even if there is no federal withholding by selecting “Voluntary State Income Tax Withholding” and entering a dollar amount. You may elect not to have state taxes withheld even if there is federal withholding by selecting “No State Tax Withholding Election.” You may also request an additional amount to be withheld by selecting ‘Additional State Income Tax Withholding’ on your distribution form and entering a dollar amount.

COLORADO

Colorado state withholding voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a dollar amount or percentage. If you select “Voluntary State Income Tax Withholding” and do not enter a dollar amount or percentage, MassMutual will not withhold any state taxes.


CONNECTICUT

Connecticut state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a whole dollar amount. If you select “Voluntary State Income Tax Withholding” and do not enter a whole dollar amount, MassMutual will round to the nearest whole dollar.

DELAWARE

Delaware state tax withholding is mandatory if federal taxes are withheld. If no federal taxes are withheld, no state taxes will be withheld. The amount withheld is calculated as 5% of the taxable distribution. You may elect to have 5% state taxes, or greater, withheld even if there is no federal withholding by selecting “Voluntary State Income Tax Withholding.” You may also request an additional amount to be withheld by selecting ‘Additional State Income Tax Withholding’ on your distribution form and entering a dollar amount.

DISTRICT OF COLUMBIA

The District of Columbia state withholding is mandatory on all lump sum distributions of a participant's entire account balance. For such distributions state taxes are withheld at 8.95%. For periodic and partial distributions state tax withholding is voluntary.

FLORIDA

Florida does not have personal income tax. State tax will not be withheld from any distribution.

GEORGIA

Lump-sum/non-periodic payments: Georgia state withholding is voluntary for non-periodic payments. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” on your distribution form, but do not enter a percentage or dollar amount. Georgia taxes are withheld at a predetermined percentage depending on the amount of your distribution: If distribution is withholding is under $8,000 2% $8,000 - $10,000 3% $10,001 - $12,000 4% $12,001 - $15,000 5% Over $15,000 6% Periodic payments: Georgia state tax withholding is mandatory if federal taxes are withheld. If no federal taxes are withheld, no state taxes will be withheld. You may elect to have state taxes withheld even if there is no federal withholding by selecting “Voluntary State Income Tax Withholding/based on my state's tax table formula.” You may elect not to have state taxes withheld even if there is federal withholding by selecting “No State Tax Withholding Election.” The amount withheld on periodic payments will be based on your state’s wage tables. MassMutual will use your state’s default allowance. You may also request an additional amount to be withheld by selecting ‘Additional State Income Tax Withholding’ on your distribution form and entering a dollar amount.


HAWAII

Hawaii state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a dollar amount or percentage. If you select “Voluntary State Income Tax Withholding” and do not enter a dollar amount or percentage, MassMutual will not withhold any state taxes.

IDAHO

Idaho state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a dollar amount or percentage. If you select “Voluntary State Income Tax Withholding” and do not enter a dollar amount or percentage, MassMutual will not withhold any state taxes.

ILLINOIS

Illinois state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a dollar amount or percentage. If you select “Voluntary State Income Tax Withholding” and do not enter a dollar amount or percentage, MassMutual will not withhold any state taxes.

INDIANA

Indiana state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a whole dollar amount. If you select “Voluntary State Income Tax Withholding” and do not enter a whole dollar amount, MassMutual will round to the nearest whole dollar. If you provide a percentage, MassMutual will not withhold taxes.

IOWA

Iowa state tax withholding is mandatory if federal taxes are withheld. If no federal taxes are withheld, no state taxes will be withheld. State taxes are withheld at 5% of the taxable distribution. You may elect to have 5%, or higher, state taxes withheld even if there is no federal withholding by selecting “Voluntary State Income Tax Withholding.” You may also request an additional amount to be withheld by selecting ‘Additional State Income Tax Withholding’ on your distribution form and entering a dollar amount.

KANSAS

Kansas state tax withholding is mandatory if federal taxes are withheld. If no federal taxes are withheld, no state taxes will be withheld. State taxes are withheld at 5% of the taxable distribution. You may elect to have 5%, or higher, state taxes withheld even if there is no federal withholding by selecting “Voluntary State Income Tax Withholding.” You may also request an additional amount to be withheld by selecting ‘Additional State Income Tax Withholding’ on your distribution form and entering a dollar amount.

KENTUCKY

Kentucky state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a dollar amount or percentage. If you select “Voluntary State Income Tax Withholding” and do not enter a dollar amount or percentage, MassMutual will not withhold any state taxes.

LOUISIANA

Louisiana state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a dollar amount or percentage. If you select “Voluntary State Income Tax Withholding” and do not enter a dollar amount or percentage, MassMutual will not withhold any state taxes.


MAINE

Maine state tax withholding is mandatory if federal taxes are withheld. If no federal taxes are withheld, no state taxes will be withheld. The amount withheld is 5% of the taxable distribution. You may elect to have 5%, or higher, state taxes withheld even if there is no federal withholding by selecting “Voluntary State Income Tax Withholding.” You may also request an additional amount to be withheld by selecting ‘Additional State Income Tax Withholding’ on your distribution form and entering a dollar amount.

MARYLAND

Maryland state tax withholding is mandatory on periodic and non-periodic distributions that are eligible for rollover. The amount withheld is 7.75% of the taxable distribution. Special rules apply for distributions that are not eligible for rollover.

MASSACHUSETTS

Massachusetts state tax withholding is mandatory if federal taxes are withheld. If no federal taxes are withheld, no state taxes will be withheld. State taxes are withheld at 5.25% of the taxable distribution. If you want a different amount withheld, please provide your marital status and the number of exemptions you wish to claim on your distribution form. You may also request an additional amount to be withheld by selecting ‘Additional State Income Tax Withholding’ on your distribution form and entering a dollar amount.

MICHIGAN

Michigan state withholding is mandatory on periodic and non-periodic distributions. The amount withheld is 4.25%. All or some of the distribution may be exempt from Michigan state tax withholding, but you must provide a Michigan Form W-4P in those instances. For more information regarding exemptions that may be available to you, please consult your tax advisor and/or the Michigan Department of Treasury.

MINNESOTA

Lump-sum/non-periodic payments: Minnesota state withholding on non-periodic payments is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a dollar amount or percentage. If you select “Voluntary State Income Tax Withholding” and do not enter a dollar amount or percentage, MassMutual will not withhold any state taxes. For periodic payments: Minnesota state withholding on periodic payments is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding/ based on my state's tax table formula.” The amount withheld on periodic payments will be based on your state’s wage tables. MassMutual will use your state’s default allowance.

MISSISSIPPI

Mississippi state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a dollar amount or percentage. If you select “Voluntary State Income Tax Withholding” and do not enter a dollar amount or percentage, MassMutual will not withhold any state taxes.

MISSOURI

Missouri state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a dollar amount or percentage. If you select “Voluntary State Income Tax Withholding” and do not enter a dollar amount or percentage, MassMutual will not withhold any state taxes.


MONTANA

Montana state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a flat dollar amount. If you select “Voluntary State Income Tax Withholding” and do not enter a flat dollar amount, MassMutual will not withhold any state taxes.

NEBRASKA

Nebraska state tax withholding is mandatory if federal taxes are withheld. If no federal taxes are withheld, no state taxes will be withheld. You may elect to have state taxes withheld even if there is no federal withholding by selecting “Voluntary State Income Tax Withholding/ based on my state's tax table formula.” Lump-sum/non-periodic payments: The amount withheld is 5% of the taxable distribution. Periodic payments The amount withheld on periodic payments will be based on your state’s wage tables. MassMutual will use your state’s default allowance. You may also request an additional amount to be withheld by selecting ‘Additional State Income Tax Withholding’ on your distribution form and entering a dollar amount.

NEVADA

Nevada does not have personal income tax. State tax will not be withheld from any distribution.

NEW HAMPSHIRE

New Hampshire does not have personal income tax. State tax will not be withheld from any distribution.

NEW JERSEY

New Jersey state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a whole dollar amount. If you select “Voluntary State Income Tax Withholding” and do not enter a whole dollar amount, MassMutual will round to the nearest whole dollar.

NEW MEXICO

New Mexico state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a dollar amount or percentage. If you select “Voluntary State Income Tax Withholding” and do not enter a dollar amount or percentage, MassMutual will not withhold any state taxes.

NEW YORK

New York state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a dollar amount or percentage. If you select “Voluntary State Income Tax Withholding” and do not enter a dollar amount or percentage, MassMutual will not withhold any state taxes.

NORTH CAROLINA

North Carolina state tax withholding is mandatory for distributions eligible for rollover if federal taxes are withheld. If no federal taxes are withheld, no state taxes will be withheld. Special rules apply for distributions that are not eligible for rollover. You may elect to have state taxes withheld even if there is no federal withholding by selecting “Voluntary State Income Tax Withholding.”


Lump-sum/non-periodic payments: The amount withheld on non-periodic payments is 4% of the taxable distribution. Periodic payments The amount withheld on periodic payments will be based on your state’s wage tables. MassMutual will use your state’s default allowance. You may also request an additional amount to be withheld by selecting ‘Additional State Income Tax Withholding’ on your distribution form and entering a dollar amount.

NORTH DAKOTA

North Dakota state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a dollar amount or percentage. If you select “Voluntary State Income Tax Withholding” and do not enter a dollar amount or percentage, MassMutual will not withhold any state taxes.

OHIO

Lump-sum/non-periodic payments: Ohio state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Tax Withholding” and enter a percentage (not less than 3.5%). If you select “Voluntary State Tax Withholding” and do not enter a percentage, MassMutual will not withhold any state taxes. If you enter a percentage less than 3.5%, MassMutual will withhold 3.5%, your state’s minimum. Periodic payments, Ohio state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding/ based on my state's tax table formula.” The amount withheld on periodic payments will be based on your state’s wage tables. MassMutual will use your state’s default allowance.

OKLAHOMA

Oklahoma state tax withholding is mandatory if federal taxes are withheld. If no federal taxes are withheld, no state taxes will be withheld. You may elect to have state taxes withheld even if there is no federal withholding by selecting “Voluntary State Income Tax Withholding.” Lump-sum/non-periodic payments: The amount withheld is 5% of the taxable distribution. Periodic payments The amount withheld on periodic payments will be based on your state’s wage tables. MassMutual will use your state’s default allowance. You may also request an additional amount to be withheld by selecting ‘Additional State Income Tax Withholding’ on your distribution form and entering a dollar amount.

OREGON

Oregon state tax withholding is mandatory if federal taxes are withheld. If no federal taxes are withheld, no state taxes will be withheld. You may elect to have state taxes withheld even if there is no federal withholding by selecting “Voluntary State Income Tax Withholding.” You may elect not to have state taxes withheld when there is federal withholding by selecting “No State Tax Withholding Election.”


Lump-sum/non-periodic payments: The amount withheld is 8% of the taxable distribution and cannot be more than 10%. Periodic payments The amount withheld on periodic payments will be based on your state’s wage tables. MassMutual will use your state’s default allowance. You may also request an additional amount to be withheld by selecting ‘Additional State Income Tax Withholding’ on your distribution form and entering a dollar amount.

PENNSYLVANIA

Pennsylvania state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a dollar amount or percentage. If you select “Voluntary State Income Tax Withholding” and do not enter a dollar amount or percentage, MassMutual will not withhold any state taxes.

RHODE ISLAND

Rhode Island state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a dollar amount or percentage. If you select “Voluntary State Income Tax Withholding” and do not enter a dollar amount or percentage, MassMutual will not withhold any state taxes.

SOUTH CAROLINA

South Carolina state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding/ based on my state's tax table formula.” The amount withheld on periodic payments will be based on your state’s wage tables. MassMutual will use your state’s default allowance.

SOUTH DAKOTA

South Dakota does not have personal income tax. State tax will not be withheld from any distribution.

TENNESSEE

Tennessee does not have personal income tax. State tax will not be withheld from any distribution.

TEXAS

Texas does not have personal income tax. State tax will not be withheld from any distribution.

UTAH

Utah state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding/ based on my state's tax table formula.” The amount withheld on periodic payments will be based on your state’s wage tables. MassMutual will use your state’s default allowance.

VERMONT

Vermont state tax withholding is mandatory if federal taxes are withheld. If no federal taxes are withheld, no state taxes will be withheld. State withholding is based on the amount of federal taxes withheld. You may elect to have state taxes withheld even if there is no federal withholding by selecting “Voluntary State Income Tax Withholding.”


Lump-sum/non-periodic payments: The amount withheld is 27% of the federal amount withheld. Periodic payments The amount withheld on periodic payments will be based on your state’s wage tables. MassMutual will use your state’s default allowance. You may also request an additional amount to be withheld by selecting ‘Additional State Income Tax Withholding’ on your distribution form and entering a dollar amount.

VIRGINIA

Virginia state tax withholding is mandatory if federal taxes are withheld. If no federal taxes are withheld, no state taxes will be withheld. You may elect to have state taxes withheld even if there is no federal withholding by selecting “Voluntary State Income Tax Withholding.” Lump-sum/non-periodic payments: The amount withheld is 4% of the taxable distribution. Periodic payments The amount withheld on periodic payments will be based on your state’s wage tables. MassMutual will use your state’s default allowance. You may also request an additional amount to be withheld by selecting ‘Additional State Income Tax Withholding’ on your distribution form and entering a dollar amount.

WASHINGTON

Washington does not have personal income tax. State tax will not be withheld from any distribution.

WEST VIRGINIA

West Virginia state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a dollar amount or percentage. If you select “Voluntary State Income Tax Withholding” and do not enter a dollar amount or percentage, MassMutual will not withhold any state taxes.

WISCONSIN

Wisconsin state withholding is voluntary. If you elect to have state taxes withheld, select “Voluntary State Income Tax Withholding” and enter a flat dollar amount. If you select “Voluntary State Income Tax Withholding” and do not enter a flat dollar amount, MassMutual will not withhold any state taxes.

WYOMING

Wyoming does not have personal income tax. State tax will not be withheld from any distribution.

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