At a Session of Court Held in the Courthouse in ______, Michigan, on Date . Present: Honorable

[Insert caption.]

At a session of court held in the courthouse in ______, Michigan, on [date]. Present: Honorable ______Court Judge

[Caution: This sample QDRO is offered only to legal counsel for the parties. It awards either a percentage or a dollar amount of the Participant’s account to the Alternate Payee and treats the amount awarded to the Alternate Payee as a separate benefit under the plan. It does not include all choices available to the parties and the court and may not be appropriate in all circumstances. This sample QDRO should be used only to the extent determined appropriate by legal counsel.]

This order constitutes a component of the property settlement provisions of the judgment of divorce in this matter. It is entered for the purpose of awarding to [Plaintiff / Defendant] an interest in [Defendant’s / Plaintiff’s] account under the qualified retirement plan specified below (Plan) pursuant to IRC 401(a)(13) and 414(p) and 29 USC 1056(d).

1. Identity of plan and parties.

a. Plan. The Plan subject to this order is ______.

b. Plan Administrator. The Plan Administrator is [name and address]. Communications to the Plan Administrator should be addressed: “Attention: [name].”

c. Participant. The Participant in the Plan is [Plaintiff / Defendant]: [name, address, date of birth]. The Social Security number will be provided to the Plan Administrator in separate correspondence that will not be part of the court record.

d. Alternate Payee. The Alternate Payee is [Defendant / Plaintiff]: [name, address, date of birth]. The Social Security number will be provided to the Plan Administrator in separate correspondence that will not be part of the court record. Until all amounts payable under this order have been paid in full, the Alternate Payee must notify the Plan Administrator of any change in address. All notices must be sent to the address in paragraph 1b.

e. Relationship of the Participant and the Alternate Payee. The Alternate Payee is the former spouse of the Participant. The Participant and the Alternate Payee were married on [date], and divorced by a judgment dated [date].

2. Qualified domestic relations order. It is the intent of the court, the Participant, and the Alternate Payee that this order be a qualified domestic relations order (QDRO) described in IRC 401(a)(13) and 414(p) and 29 USC 1056(d). This court retains jurisdiction to modify this order or enter further orders as necessary to establish or maintain the qualified status of this order and to carry out the intent of the judgment of divorce. The court may enter any modification or supplemental order with retroactive effect.

3. Benefits awarded to Alternate Payee.

[Note: The valuation language used in 3a and 3b may not be appropriate for a Plan that does not have daily valuation or that includes investments in employer securities that are not publicly traded on a daily basis.]

a. Amount; Separate benefit.

[Option 1—Percentage that shares in investment experience] The Alternate Payee is awarded [number] percent of the Participant’s vested account balance under the Plan, including the outstanding balances of all loans to the Participant, determined as of the valuation date that coincides with or most recently precedes [[date] / the date of this order]. Until distributed or segregated into a separate account for the Alternate Payee, the amount awarded to the Alternate Payee will share, on a pro rata basis, in the actual investment experience of the Participant’s account. Although loans will be considered in determining the amount awarded to the Alternate Payee, all loans remain assets of the Participant’s account, are solely the responsibility of the Participant, and are not subject to this award.

[Option 2A—Dollar amount that shares in investment experience] The Alternate payee is awarded $[amount] from the Participant’s vested account balance under the Plan as of the valuation date that coincides with or most recently precedes [[date] / the date of this order]. Until distributed or segregated into a separate account for the Alternate Payee, the amount awarded to the Alternate Payee will share, on a pro rata basis, in the actual investment experience of the Participant’s account. Although loans may be considered in determining the amount awarded to the Alternate Payee, all loans will remain assets of the Participant’s account, will be solely the responsibility of the Participant and are not subject to this award.

[Use this paragraph with Options 1 or 2A] Unless the Alternate Payee elects distribution as soon as feasible, Alternate Payee’s benefit will be segregated, as of the first feasible valuation date after the Plan Administrator determines that this is a qualified order, into a separate account for the Alternate Payee. On segregation, the Alternate Payee’s account will continue to be invested in the same manner as the Participant’s account (excluding any loans) until other investment directions are provided by the Alternate Payee. The Alternate Payee’s segregated account will be subject to investment direction by the Alternate Payee to the same extent allowed for other Participants under the Plan and will be credited and debited with expenses, earnings, gains and losses (but not credited with any contributions), in the same manner as any other account, until distributed.

[Option 2B—Dollar amount that does not share in investment experience] The Alternate Payee is awarded $[amount] from the Participant’s vested account balance under the Plan as of the valuation date that coincides with or most recently precedes [[date] / the date of this order]. The benefit awarded to the Alternate Payee will not share in the investment experience of the Participant’s account. Although loans may be considered in determining the amount awarded to the Alternate payee, all loans will remain assets of the Participant’s account, will be solely the responsibility of the Participant, and are not subject to this award.

[Use this paragraph with Options 1, 2A, or 2B] The amount awarded to the Alternate Payee will be separate from and independent of the benefits of the Participant under the Plan.

b. Payment to the living Alternate Payee.

i. Form of payment. The amount awarded to the Alternate Payee will be paid to the Alternate Payee in a lump-sum payment. Payment will be made by a check payable to the Alternate Payee or to a rollover IRA or plan as directed by the Alternate Payee.

ii. Time of payment. [Use this paragraph only with options 1 or 2A in 3a.] The amount awarded to the Alternate Payee will be paid at the time elected by the Alternate Payee following the Plan Administrator’s determination that this is a qualified order. [The value of the Alternate Payee’s account for payment will be determined as of the valuation date that coincides with or most recently precedes the date of distribution and will be adjusted by all applicable fees and expenses.]

[Use this paragraph only with option 2B in 3a.] The amount awarded to the Alternate Payee will be paid as soon as administratively feasible following the Plan Administrator’s determination that this is a qualified order.

iii. Place of payment. Payments under this order will be paid by check and mailed to the address of the Alternate Payee provided in paragraph 1d or another personal address provided to the Plan Administrator in writing by the Alternate Payee.

iv. Required minimum distributions. The time and form of payment to the Alternate Payee must comply with all applicable minimum distribution rules of IRC 401(a)(9).

c. Benefits on the death of the Alternate Payee. If the Alternate Payee dies before all benefits of the Alternate Payee have been paid under this order, the remaining benefits payable to the Alternate Payee will be distributed in a single lump sum, as soon as administratively feasible following the Alternate Payee’s death, to the beneficiary or beneficiaries designated by the Alternate Payee in writing to the Plan Administrator. If no written beneficiary designation form has been filed by the Alternate Payee, the benefits will be paid to the default beneficiary determined under the terms of the Plan as if the Alternate Payee is a Participant in the Plan at the time of death. [Note: This language refers to the default beneficiary language in the Plan and may be difficult for the Plan Administrator to apply. An alternative would be to make the default beneficiary the estate of the Alternate Payee, which also may be difficult to apply. Either way it is important to try to avoid a default situation by obtaining a beneficiary designation form from the Alternate Payee.]

d. Benefits on the Death of the Participant. The death of the Participant will not affect payment of benefits to the Alternate Payee under this order. The Alternate Payee will not be the surviving spouse of the Participant for any purpose under the Plan and will not be entitled to any survivor benefits attributable to the Participant’s interest under the Plan unless the Participant designates the Alternate Payee as a beneficiary in accordance with the terms of the Plan in a written designation made after the date of this order.

4. Limitation on benefits of the Alternate Payee. This order does not require

a. the Plan to provide any type or form of benefit, or any optional form of payment, not otherwise provided under the Plan (no new form of benefit);

b. the Plan to provide benefits greater than would otherwise be payable to the Participant in the absence of the order (no additional benefits); or

c. the payment of any benefits to the Alternate Payee that are required to be paid to another Alternate Payee under another order previously determined to be a QDRO (no conflicting benefits).

5. Separate right of the Parties. Except as provided in paragraph 3, this order is permanent and final. From the date of this order, the Participant has no further right or interest in the amount awarded to the Alternate Payee, and the Alternate Payee has no further right or interest in the portion of the Participant’s account balance under the Plan that is not awarded. Nothing in this order restricts the Participant’s ability to obtain a distribution under the Plan or designate a beneficiary under the Plan with respect to the Participant’s account balance not awarded to the Alternate Payee.

6. Payment of Plan fees. If administrative fees or costs are to be assessed to the Participant’s account for the processing of this order, such fees will be shared [equally / proportionately / [other]] by the Participant and the Alternate Payee. [Note: Modify language if fees are not to be shared by the parties.] The Alternate Payee’s share of the fees will be deducted from the amount awarded in paragraph 3a before payment. The Participant’s share will be charged to the Participant’s account.

7. Tax treatment of benefits to the Alternate Payee. Any payment to the Alternate Payee pursuant to this QDRO will be taxable to the Alternate Payee and not taxable to the Participant.

8. Application of state law. This order is entered pursuant to the authority granted by the applicable domestic relations laws of the state of Michigan.

9. Facilitation of order. The parties will execute any documents and take any actions necessary to fulfill the terms of this order. The Participant may not take any action that impairs or impedes the rights of the Alternate Payee to receive the awarded benefits.

10. Notice to the Plan Administrator. The Alternate Payee will deliver an original or verified copy of this order to the Plan Administrator as soon as feasible.

/s/______
______Court Judge

[Note: If this is a stipulated order, it should be signed by the Participant and the Alternate Payee and their counsel.]

Dated: ______/ /s/______
[Typed name of Plaintiff]
Plaintiff
Dated: ______/ /s/______
[Typed name of Defendant]
Defendant
Dated: ______/ /s/______
[Typed name of attorney (P____)]
Attorney for Plaintiff
[Address, telephone]
Dated: ______/ /s/______
[Typed name of attorney (P____)]
Attorney for Defendant
[Address, telephone]