HomeMy WebLinkAbout92-3472/~
DEC 2 62DD7 ~'~
CHARLES L. DEBRUNNER,
Plaintiff,
vs.
ELYSA B. DEBRUNNER,
(now known as ELYSA G. BOFFO)
Defendant.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
. N0.3472 CIVIL 1992
CIVIL ACTION -LAW
IN DIVORCE
QUALTFIED DOMESTIC RELATIONS ORDER
AND NOW, this 3r day of ~,~.~ , 20~, it appearing to the Court that:
1. A Divorce was granted to the parties in this matter on March 16, 1995, in
this Court at the above-captioned number.
2. The parties to this action entered into a Property Settlement Agreement
dated August 16, 1994. The Divorce Decree, under the above caption and number by Order of
Court, incorporates the Property Settlement Agreement therein.
3. Charles L. DeBrunner (hereinafter referred to as the "Plaintiff' or "Primary
Participant") is a participant in The Health Alliance of Pennsylvania 401(k) Plan (hereinafter
referred to as the 401k Plan"). Further, any successor plan to the Plan shall also be subject to the
terms of this Order. The Plan Administrator, which is responsible for determining whether the
Order constitutes a qualified domestic relations order, is The Health Alliance of Pennsylvania.
4. Elysa B. DeBrunner, now using her prior surnanie of Elysa G. Boffo
pursuant to an Election to Resume Prior Name filed with the Court on Apri126, 1995, Social
Security Number 146-38-3842, hereinafter referred to as "Defendant" or "Alternate Payee," has
raised claims for inter alia, equitable distribution of marital property pursuant to the Pennsylvania
Divorce Code, P. S. Section 101 et seq., to the proceeds of Primary Participant in the 401k Plan.
5. Charles L. DeBrunner's current and last known mailing address is 2312
Valley Road, Harrisburg, Pennsylvania 17104.
6. Elysa G. Boffo's, formerly known as Elysa B. DeBrunner, current and last
known mailing address is 4 Riddle Road, Camp Hill, PA 17011.
IT IS HEREBY ORDERED, ADJUDGED AND DECREED AS FOLLOWS:
The Court intends this Order to be a qualified Domestic Relations Order
("QDRO") within the meaning of Section 414(p) of the Internal Revenue Code of 1986 ("Code")
This Order creates and recognizes the existence of the Alternate Payee's right to receive all of the
benefits payable with respect to the Primary Participant in the 401k Plan.
2. All of the account balance in the 401k Plan is marital property subject to
distribution by this Court.
3. The entire account balance, plus actual investment earnings, of the 401k
Plan is awazded to the Alternate Payee, Elysa G. Boffo, formerly known as Elysa B. DeBrunner.
4. In no event shall the Alternate Payee have greater rights than those which
were available to the Primary Participant in the 401 k Plan. The Alternate Payee and Primary
Participant are not entitled to any benefits not otherwise provided under the 401 k Plan.
On and after the date that this Order is deemed to be a QDRO, but before
the Alternate Payee receives her distribution under the 401k Plan, the Alternate Payee shall be
entitled to all of the rights and election privileges that are afforded to active participants in the
2
Plan, including, but not limited to, the rules regarding withdrawals and distributions and the right
to direct her Plan investments to the extent permitted under the Plan. Alternate Payee
acknowledges that the Plan prohibits alternate payees from taking plan loans.
6. All payments made pursuant to this Order shall be conditioned on the
certification by the Alternate Payee and Primary Participant to the Plan Administrator of such
information as the Plan Administrator may reasonably require from such parties in connection
with said payments.
7. It is the intention of the parties that this QDRO continue to qualify as a
QDRO under Code Section 414(p), as it may be amended from time to time, and that the Plan
Administrator shall reserve the right to reconfirm the qualified status of the Order at the time
benefits become payable hereunder.
8. In the event that the Primary Participant's benefits, or any portion thereof
become payable to the Primary Participant as a result of termination or partial termination, then
the Alternate Payee shall be entitled to commence her benefits immediately in accordance with the
terms of this QDRO and in accordance with the termination procedures of the 401k P1an.After
payment of the amounts required by this QDRO, the Alternate Payee shall have no further claim
against the Primary Participant's interest in the 401k Plan.
9. The Alternate Payee assumes sole responsibility for the tax consequences
of all distributions for the 401k Plan under this QDRO.
10. Until the 401k Plan complete segregation in the name of the Alternate Payee
of all benefits pursuant to this QDRO, the Plan shall treat the Alternate Payee as a surviving
spouse for purposes of Code Section 401(a)(11) and 417, but the Alternate Payee shall receive, as
surviving spouse, only the amount described in Paragraph 3 of this QDRO. The sole purpose of
this paragraph is to ensure payment to the Alternate Payee in case of Primary Participant's death
prior to segregation by the 401k Plan of the amount described in Paragraph 3 of this QDRO.
11. The Plan shall treat this QDRO in accordance with Code Section 414(p)(7).
While the Plan Administrator of the 401k Plan is determining whether this Order is a Qualified
Domestic Relations Order, the Plan Administrator shall separately account for the amounts which
would have been payable to the Alternate Payee while the Plan is determining the qualified status
of this QDRO.
12. The Plan Administrator promptly shall notify the Primary Participant and
the Alternate Payee of the receipt of this QDRO and shall notify the Primary Participant and the
Alternate Payee of the Plan's procedures for determining the qualified status of the QDRO and
shall notify the Primary Participant and the Alternate Payee of the determination within a
reasonable period of time after receipt of this QDRO.
13. The parties shall promptly notify the Plan Administrator of any change in
address from those set forth above and in all ways respond in a timely fashion to any Plan or
administrative policy requirements necessary to administer this Qualified Domestic Relations
Order.
14. The parties shall promptly submit this Order to the Plan Administrator of
the 401k Plan for determination and acceptance of its status as a Qualified Domestic Relations
Order.
4
1 ~~ ~ ~ . ~
15. The Qualified Domestic Relations Order issued in this matter on January 2,
2002, is hereby rescinded and shall have no legal or binding effect.
IT IS INTENDED that this Order shall qualify as a Qualified Domestic Relations
Order under the Retirement Equity Act of 1984 or any amendments thereto. The court retains
jurisdiction to amend this Order as might be necessary to establish or maintain its status as a
Qualified Domestic Relations Order pursuant to Section 414(p) of the Code, Section 206(d) of
the Employee Retirement Income Security Act of 1974 and the Retirement Equity Act of 1984, or
any amendments thereto.
BY THE COURT:
WITNESS:
72395.2
CHARLES L. DeBRUNNER, Plaintiff and
Primary Participant
~~ ~' .~ ~~
ELYSA . BOFFO, formerly as
Elysa B. DeBrunner, Defendant
Alternate Payee
5
~~~
~~~
~~
~r
w
i r +Y^ rte f~r'~
~ 0 ~ 11 ~~~ 1 E ~~a l~~l
/SCIY.~..l~i'i~.1i ~.U'v~'.+.7 ~~ ~Q