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Home My WebLink About01-3132NM r MAXINE D. PIPAN, : IN THE COURT OF COMMON PLEAS Plaintiff : CUMBERLAND COUNTY, PENNSYLVANIA v. : No. 2001-3132 =' CYRIL F. PIPAN, : CIVIL ACTION - LAW a-rn Defendant : IN DIVORCE cn r' STIPULATION FOR ENTRY OF QUALIFIED DOMESTIC RELATIONS ORDER IT IS HEREBY ORDERED AS FOLLOWS: 1. Effect of This Order as a Qualified Domestic Relations Order: This Order creates and recognizes the existence of an Alternate Payee's right to receive a portion of the Participant's benefits payable under an employer-sponsored defined contribution plan that is qualified under Section 401 of the Internal Revenue code (the "Code") and the Employee Retirement Income Security Act of 1974 ("ERISA"). It is intended to constitute a Qualified Domestic Relations Order("QDRO") under Section 414(p) of the Code. 2. Participant Information: The name, last known address, social security number and date of birth of the plan "Participant" is: Name: Cyril F. Pipan, Jr. ("Participant") Address: 1708 Josiah Chowning Way, New Cumberland, Pennsylvania, 17070 Social Security Number: See Addendum Birth Date: See Addendum Participant's Attorney Information: Name of Attorney: Susan M. Kadel, Esquire Address: Post Office Box 650, Hershey, PA 17033 Phone: (717) 533.3280 3. Alternate Payee Information: The name, last known address, social security number and date of birth of the "Alternate Payee" is: 1 r Name: Maxine D. Chocha-Pipan ("Alternate Payee") Address: 416 Allendale Way, Camp Hill, Pennsylvania 17011 Social Security Number: See Addendum Birth Date: See Addendum Alternate Payee's Attorney Information: Name of Attorney: Marylou Matas, Esquire Address: 26 W. High Street, Carlisle, Pennsylvania 17013 Phone: (717) 243-6222 The Alternate Payee shall have the duty to notify the plan administrator in writing of any changes in his/her mailing address subsequent to the entry of this Order. 4. Plan Name: The name of the Plan to which this Order applies is The Rite Aid 401(k) Plan (hereinafter referred to as "Plan"). Any changes in Plan Administrator, Plan Sponsor or name of the Plan shall not affect Alternate Payee's rights as stipulated under this Order. 5. Pursuant to State Domestic Relations Law: This Order is entered pursuant to the authority granted in the applicable domestic relations laws of the State of Pennsylvania. 6. For Provision of Marital Property Rights: This Order relates to the provision of marital property rights to the Alternate Payee as a result of the Order of Divorce between Participant and Alternate Payee. 7. Amount of Alternate Payee's Benefit(Percentage Basis): This Order assigns to Alternate Payee an amount equal to Fifty Percent(50%) of the Participant's Total Account Balance accumulated under the Plan as of December 31, 2012 (or the closest valuation date thereto),plus any interest/investment earnings or losses attributable thereon for periods subsequent to December 31, 2012, until the date of total distribution. The Alternate Payee's share of the benefits shall be allocated on a"pro-rata" basis among all of the accounts and/or investment funds maintained on behalf of the Participant under the Plan. 2 8. Commencement Date and Form of Payment to Alternate Payee: If the Alternate Payee so elects, she shall be paid her benefits as soon as administratively feasible following the date this Order is approved as a QDRO by the Plan Administrator by filing an election with the Plan Administrator in accordance with the terms of the Plan. Actual payments will begin as soon as administratively feasible thereafter. Benefits will be payable to the Alternate Payee in any form or permissible option otherwise available to participants and alternate payee's under the terms of the Plan, including, but not limited to, a single lump-sum cash payment. The Alternate Payee will not be permitted to obtain a loan from the Plan or take any hardship withdrawals from the Plan. If the Alternate Payee has not elected an earlier beginning date, the Alternate Payee's share will begin to be paid as of the earlier of the date as of which the Participant begins to receive a distribution of the Participant's share, or the latest date permitted under Section 401(a)(9) of the Code. 9. Alternate Payee's Rights and Privileges: On and after the date that this Order is deemed to be a Qualified Domestic Relations Order,but before the Alternate Payee receives her total distribution under the Plan, the Alternate Payee shall be entitled to all of the rights and election privileges that are afforded to plan beneficiaries, including,but not limited to, the rules regarding the right to designate a beneficiary for death benefit purposes. However, the alternate payee may not elect to receive her share of the benefits in the form of a qualified joint and survivor annuity. 10. Death of Alternate Payee: In the event of Alternate Payee's death prior to her receiving the full amount of benefits called for under this Order, her remaining share of the benefits shall be paid to her designated beneficiary. If no beneficiary designation is in effect at the Alternate Payee's death, any remaining amount of the Alternate Payee's share of the benefits shall be paid in accordance with the Plan rules that apply when no beneficiary designation is in effect for a Participant. 11. Death of Participant: In the event of the Participant's death, his death shall in no way affect Alternate Payee's right to the portion of her benefits as stipulated herein. However, the Alternate Payee will not be entitled to any survivor benefits attributable to the remaining portion of the Participant's benefits under the Plan unless the Participant, independently of the Order, has designated the Alternate Payee as a beneficiary. However, if the Participant remarries, any such designation would be subject to the spousal rights of the subsequent spouse provided by ERISA, the Code and the terms of the Plan. 12. Savings Clause: This Order is not intended, and shall not be construed in such a manner as to require the Plan: 3 (a) to provide any type or form of benefit option not otherwise provided under the terms of the Plan; (b) to require the Plan to provide increased benefits determined on the basis of actuarial value; or (c) to require the payment of any benefits to the Alternate Payee which are required to be paid to another alternate payee under another order which was previously deemed to be a QDRO. 13. Certification of Necessary Information: All payments made pursuant to this Order shall be conditioned on the certification by the Alternate Payee and the Participant to the Plan Administrator of such information as the Plan Administrator may reasonably require from such parties to make the necessary calculation of the benefit amounts contained herein. 14. Tax Treatment of Distributions Made Under this Order: For purposes of Sections 402(a)(1) and 72 of the Internal Revenue Code, any Alternate Payee who is the spouse or former spouse of the Participant shall be treated as the distributee of any distribution or payments made to the Alternate Payee under the terms of this Order, and as such,will be required to pay the appropriate federal income taxes on such distribution. 15. Continued Jurisdiction: The Court shall retain jurisdiction with respect to this Order to the extent required to maintain its qualified status and the original intent of the parties as stipulated herein. 16. Correcting or Terminating Payments: The Plan will retain any rights it may have under its terms to suspend or terminate payments to Alternate Payee and Participant provided that either Participant or Alternate Payee may contest such suspension or termination through any administration remedies available under the Plan. Payments by the Plan pursuant to this Order will be without prejudice to any right the Plan has under applicable law to seek recoupment or offset for overpayment. If the Plan pays one party a portion of the other party's benefits under the Plan and this Order, the party receiving the overpayment will return that portion to the Plan, which in turn, will pass that portion on to the other Party. 17. QDRO Processing Fee: The Participant will be charged a $350 QDRO processing fee for this QDRO. This fee will be assessed against the Participant's account balance at the time the initial paperwork is submitted to QDRO Consultants. 4 •T BY THE COURT: Dated: k 0 \\(4, *'k J. CONSENTED TO: PARTICIPANT ATTORNEY FOR PARTICIPANT Cyril F. Pipan, Jr. Susan M. Kadel, Esquire ALTERNATE PAYEE ATTORNEY FOR ALTERNATE PAYEE Maxine D. Chocha-Pipan Marylou MaE Esquire Distribution: 4san M. Kadel, Esquire, Post Office Box 650, Hershey, PA 17033 - Marylou Matas, Esquire, 26 W. High Street, Carlisle, PA 17013 16/12/!3 5