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Explains eligibility requirements, including which participant and asset types qualify and which are excluded, and states the election is irrevocable once the form is received. Describes how conversion works, key tax withholding and withdrawal conditions, and potential recapture tax rules. Includes participant information, plan type, conversion direction, signature, and submission instructions via mail, fax, or DocuSign.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/in-plan-roth-conversion-election-information-and-form/303665/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/in-plan-roth-conversion-election-information-and-form/303665.png","ImageObject",442,249,{"name":88,"@type":89},"Gloria","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-03","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":47},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is the purpose of the In-Plan Roth Conversion election form?","Question",{"text":108,"@type":109},"It provides information and a form to help plan participants submit an In-Plan Roth Conversion election, including key considerations related to income tax impacts.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Who is eligible to perform an In-Plan Roth Conversion?",{"text":113,"@type":109},"Only Plan participants, their surviving spouse, or their spousal alternate payee are eligible. Pre-tax contributions and/or rollover assets that meet the stated conditions qualify, while certain employer assets are not eligible.",{"name":115,"@type":106,"acceptedAnswer":116},"Once submitted, can the In-Plan Roth Conversion election be canceled or reversed?",{"text":117,"@type":109},"No. The election is irrevocable once the In-Plan Roth Conversion Election Form is received in good order.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},303665,1790359610,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},2336474459895,"https://ap-avatar.wpscdn.com/avatar/22000baeef7a5ed0655?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786071322749376916","In-Plan Roth Conversion Election Information Phone: (855) 616-4776 • [savingsplusnow.com](savingsplusnow.com)  \n1. Purpose  \nThis document includes information and a form to help you with your In-Plan Roth Conversion election. An In-Plan Roth Conversion from your pre-tax Plan account involves complex income tax matters. This document lists some, but not all, of the items you must consider before submitting the In-Plan Roth Conversion Election Form. You may wish to obtain the advice of a tax advisor to understand the impact this conversion may have on your estimated federal and state income tax payments, overall change in tax liability, and availability of funds to pay the taxes.  \n2. Eligibility for Roth Conversion  \n• Only Plan participants, their surviving spouse, or their spousal alternate payee are eligible for an In-Plan Roth Conversion.  \n• All pre-tax contributions and/or rollover assets, not included in an outstanding loan or as part of balances in the Personal Choice Retirement Account (PCRA) through Charles Schwab, are eligible for an In-Plan Roth Conversion. If you want to include assets in your PCRA account, you will need to transfer the assets back to your core account first.  \n• Assets identified as Employer Discretionary, or Employer Contributions, are not eligible for In-Plan Roth Conversion.  \n3. General Information  \nElection is Irrevocable  \nIt is important to note that an In-Plan Roth Conversion is an irrevocable event. Once the In-Plan Roth Conversion Election Form is received in good order, the election cannot be canceled nor can the In-Plan Roth Conversion be reversed. There are no exceptions.  \nHow the In-Plan Roth Conversion Works  \nYou may convert up to 100% of your assets in Employee pre-tax and/or Rollover pre-tax sources. The amount you elect will be converted and invested in the same manner it was distributed. Once the conversion is complete, the In-Plan Roth Conversion will be reported as a separate money source in your account and your investment allocations will remain the same.  \n4. Tax Information  \nTax Withholding at the Time of Conversion  \nTaxes will not be withheld at the time of the In-Plan Roth Conversion. You may wish to obtain the advice of a tax advisor to understand the impact this conversion may have on your estimated federal and state income tax payments, overall change in tax liability, and availability of funds to pay the taxes.  \nTax-Free Withdrawals  \nIn order for your In-Plan Roth converted assets to be reported as tax-free at the time of withdrawal, certain criteria must be met. Consult with your tax professional for additional information.  \nQualified Withdrawal  \nIn order for your In-Plan Roth converted assets to be considered a qualified withdrawal, you must have attained age 59½, become disabled, or have died AND it has been five years or more from January 1 of the calendar year in which your first Roth contribution or first In-Plan Roth Conversion was made. Withdrawal of your In-Plan Roth converted assets before requirements are met may result in taxation of your earnings.  \nRecapture Tax (401(k) only)  \nA 10% recapture tax may apply to your withdrawal if specific age and time requirements are not met. Each In-Plan Roth Conversion will have its own time requirements, so the recapture tax may apply to a portion of the withdrawal, even if the withdrawal is considered to be a qualified withdrawal.  \n5. Contact Information  \nVoice Response System: (855) 616-4776, 24 hours a day, 7 days a week  \nSavings Plus Solutions Center: (855) 616-4776, 5 a. m.– 8 p. m. (PT), Monday–Friday  \nTo speak with a Customer Service Representative, press *0  \nTo connect with us via TTY: (800) 848-0833  \nWebsite: [savingsplusnow.com](savingsplusnow.com)  \nNRN-1496CA-CA.5 Page 1 of 2 (01/2023)  \nIn-Plan Roth Conversion Election Form Phone: (855) 616-4776 • [savingsplusnow.com](savingsplusnow.com)  \nOnce this form is received in good order, the election is irrevocable.  \n1. Participant Information ","cbCaigk0eoGADuzq","https://ap.wps.com/l/cbCaigk0eoGADuzq","pdf",341649,"English","# Purpose\n# Eligibility for Roth Conversion\n# General Information\n## Election is Irrevocable\n## How the In-Plan Roth Conversion Works\n# Tax Information\n## Tax Withholding at the Time of Conversion\n## Tax-Free Withdrawals\n## Qualified Withdrawal\n## Recapture Tax (401(k) only)\n# Contact Information\n# Participant Information\n# Plan Type\n# Conversion Direction\n# Signature\n# Submission Instructions","[{\"question\":\"What is the purpose of the In-Plan Roth Conversion election form?\",\"answer\":\"It provides information and a form to help plan participants submit an In-Plan Roth Conversion election, including key considerations related to income tax impacts.\"},{\"question\":\"Who is eligible to perform an In-Plan Roth Conversion?\",\"answer\":\"Only Plan participants, their surviving spouse, or their spousal alternate payee are eligible. Pre-tax contributions and/or rollover assets that meet the stated conditions qualify, while certain employer assets are not eligible.\"},{\"question\":\"Once submitted, can the In-Plan Roth Conversion election be canceled or reversed?\",\"answer\":\"No. The election is irrevocable once the In-Plan Roth Conversion Election Form is received in good order.\"}]","In-Plan Roth Conversion Election Information and Form | PDF",1789806016]