6301.000 docs jb250801.002 4/3/20
SAMPLE QDRO FOR THE
NORTHWEST GMP PENSION PLAN
DIVORCE BEFORE RETIREMENT
The following sample QDRO has been developed for the Northwest GMP Pension Plan. It is
intended to provide sample language to assist parties in preparing a “separate interest” QDRO for
this plan. This type of QDRO is commonly used when a divorce occurs before retirement. Under a
separate interest QDRO, both the participant and his or her former spouse get an annuity payable
over their own lifetimes.
The document is a sample only. It does not:
1. Contain all of the provisions that may be included in a QDRO; or
2. Address all of the issues that may arise in the course of preparing a QDRO.
In short, the use of the sample QDRO is not a substitute for competent legal counsel who is familiar
with defined benefit pension plans. This sample order does not constitute legal advice regarding the
terms of any QDRO and should not be relied upon as such.
Whether or not you use the sample language, you should provide a draft of your QDRO for review
prior to submitting the order to the court. The draft order should be sent to the Trust Office. A
sample transmittal letter is provided.
Please note that before any benefits are payable to either party, proof of age will be required for
both parties.
ADVANCE REVIEW OF A DRAFT QDRO WILL SAVE TIME AND MONEY FOR ALL PARTIES.
6301.000 docs jb250801.002 4/3/20
[SAMPLE TRANSMITTAL LETTER]
[Date]
Board of Trustees
Northwest GMP Pension Plan
PO Box 34203
Seattle, WA 98124
Re: QDRO – [Participant] and [Alternate Payee]
Dear Plan Administrator:
Enclosed is a [draft] [court approved] Qualified Domestic Relations Order (“Order”)
impacting the benefits of [Participant] under the Northwest GMP Pension Plan.
As noted in the Order, the social security number and date of birth of the Participant and
Alternate Payee will be provided separately. They are as follows:
Participant
Participant: [Participant’s Name]
Social Security Number: [Participant’s SSN]
Date of Birth: [Participant’s Birth Date]
Alternate Payee
Alternate Payee: [Alternate Payee’s Name]
Social Security Number: [Alternate Payee’s SSN]
Date of Birth: [Alternate Payee’s Birth Date]
If further information is needed in connection with this QDRO, please contact [name] at
[number].
Sincerely,
[name]
Counsel for [Participant] [Alternate Payee]
cc: [name], Counsel for [Participant] [Alternate Payee]
QUALIFIED DOMESTIC RELATIONS
ORDER – 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
6301.000 docs jb250801.002 4/3/20
[Sample Separate Interest QDRO – Pre-Retirement Divorce]
IN THE SUPERIOR COURT OF THE STATE OF [STATE]
IN AND FOR THE COUNTY OF [COUNTY]
IN RE THE MARRIAGE OF:
[PETITIONER’S NAME],
Petitioner,
v.
[RESPONDENT’S NAME],
Respondent.
WHEREAS, the Court has jurisdiction over all parties and over the subject matter in
this dissolution action; and
WHEREAS, the parties to this Order and the Court intend this Order to be a Qualified
Domestic Relations Order (hereinafter referred to as “Order” or “QDRO”) as that term is
used in the Retirement Equity Act of 1984, as amended, and interpreted in accordance with
that Act; and
WHEREAS, the parties have stipulated that the Court shall enter this Order as an
Addendum to the Decree of Dissolution of Marriage filed herein on [date filed with court];
NOW, THEREFORE,
IT IS HEREBY ORDERED by the Court as follows:
1.
Definitions. The following are the definitions used in this Order:
1.1
“Participant”: [Participant’s Name]
Address: [Address]
QUALIFIED DOMESTIC RELATIONS
ORDER – 2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
6301.000 docs jb250801.002 4/3/20
The Participant’s social security number and date of birth will be
provided separately to the Plan Administrator.
1.2
“Alternate Payee”: [Alternate Payee’s Name]
Relationship to
Participant: [Relationship to Participant
(e.g. former spouse)]
Address: [Address]
The Alternate Payee’s social security number and date of birth will be
provided separately to the Plan Administrator.
1.3
“Plan”: Northwest GMP Pension Plan
1.4
“Plan Administrator”: Board of Trustees
Northwest GMP Pension Plan
Address: PO Box 34203
Seattle, WA 98124
2.
Division of Marital Property. This Order is entered pursuant to [describe
applicable state domestic relations law]. This Order hereby creates and recognizes the
existence of the Alternate Payee’s right to receive a portion of the Participant’s benefits
under the Plan.
3.
Factual Basis for Order. This Order is based on the following facts:
3.1
Participant is vested;
3.2
Participant is [age] years of age; and
3.3
Participant at the time of entry of this order is not receiving retirement
benefits under the Plan.
4.
Amounts Awarded to Alternate Payee.
4.1
Retirement Benefits Assigned to Alternate Payee
Alternate Payee is awarded a portion of the Participant's accrued benefit in the Plan, as
calculated on the Alternate Payee’s benefit commencement date.
QUALIFIED DOMESTIC RELATIONS
ORDER – 3
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
6301.000 docs jb250801.002 4/3/20
(a)
Division of Amounts Earned During the Marriage
The Alternate Payee is awarded 50% of the benefit earned by
the Participant between [date of marriage] and [date of separation/divorce].
(b)
Separate Life Annuity for Alternate Payee
Alternate Payee's benefits shall be paid as a Modified Life
Annuity guaranteed for 60 months, based upon the lifetime of Alternate Payee (i.e., terminates
upon the later of Alternate Payee's death or a total of 60 monthly payments to Alternate Payee
and Alternate Payee's eligible beneficiary).
(c)
Alternate Payee’s Benefit Commencement Date
Alternate Payee's benefits shall commence upon application by
Alternate Payee at any time after Participant reaches the earliest retirement age under the
Plan as provided in Internal Revenue Code Section 414(p)(4), but not later than the
Participant's commencement of benefits and not later than the required beginning date under
the Plan.
(d)
Actuarial Assumptions Used to Calculated Alternate Payee’s
Monthly Benefit Payments
The level of benefit payments shall be calculated as the
actuarial equivalent as defined by the Plan.
In the case of any payment before Participant has retired,
Alternate Payee's benefits shall not take into account the present value of any subsidy for
early retirement; however, if Participant later takes early retirement following
commencement of Alternate Payee's benefits and receives a
.
subsidized early retirement
benefit, the amount payable to Alternate Payee shall be recalculated prospectively to reflect
the subsidized factors for early retirement at the Participant’s retirement age.
(e)
Post-Retirement Benefit Improvements
Alternate Payee [is/is not] entitled to share in "thirteenth"
benefit checks or any other post-retirement benefit improvements or ad-hoc benefit payments
(if any).
QUALIFIED DOMESTIC RELATIONS
ORDER – 4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
6301.000 docs jb250801.002 4/3/20
4.2
Pre-Retirement Death Benefit Provisions
(a)
Pre-Retirement Death of Participant
If Participant dies prior to commencement of Alternate Payee's
benefits, and Alternate Payee survives Participant, Alternate Payee shall not be entitled to
receive the benefit described in Section 4.1 of this order.
Instead, Alternate Payee shall be Participant's sole surviving
spouse for purposes of any pre-retirement death benefits earned from [date of marriage] to
[separation/divorce date].
(b)
Pre-Retirement Death of Alternate Payee
If Alternate Payee dies prior to commencement of her benefits,
her benefits shall revert to Participant for payment to Participant pursuant to the terms of the
Plan. Accordingly, if the Participant dies prior to commencement of Alternate Payee's
benefits and Alternate Payee has not survived Participant, pre-retirement death benefits
shall be payable to the Participant's designated beneficiary.
4.3
Supplemental Disability Benefits Awarded Solely to Participant
The Plan provides a supplemental disability benefit. In the event
Participant becomes disabled and is entitled to begin receiving disability benefits from the
Plan, such benefits are the separate property of Participant and do not affect the benefits
awarded to or the commencement date of Alternate Payee's benefits.
5.
Limitations on Order. Nothing contained in this Order shall be construed to
require the Plan:
5.1
To provide for any type or form of benefits, or any option, not
otherwise provided under the Plan at the time benefits commence to the Alternate Payee;
5.2
To provide increased benefits (determined on the basis of actuarial
value) not available to the Participant;
5.3
To provide benefits to the Alternate, Payee which are required to be
paid to another Alternate Payee under another order previously determined to be a QDRO;
or
5.4
To provide the payment to the Alternate Payee of benefits forfeited by
the Participant.
QUALIFIED DOMESTIC RELATIONS
ORDER – 5
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
6301.000 docs jb250801.002 4/3/20
6.
Action to Be Taken. The Plan Administrator shall be provided with a copy
of the Order by counsel for the Alternate Payee. Upon receipt, the Plan Administrator shall:
6.1
Immediately notify the Participant and the Alternate Payee of:
(a)
The receipt of this Order; and
(b)
The Plan's procedures for determining whether this Order is a
QDRO.
6.2
Within a reasonable period of time, determine if this Order is a
QDRO, and notify the Participant and Alternate Payee of such determination.
6.3
Pending determination of a proposed order's status as a QDRO,
separately account within the Plan for the amount ("segregated amounts") which would
have been payable to the Alternate Payee (if this order is established to be a QDRO) during
the determination period, as defined in Internal Revenue Code Section 414(p)(7). No
segregation is necessary if benefits are not payable during the determination period.
7.
Continuing Jurisdiction. The Court retains jurisdiction over this matter to
amend this order to establish or maintain its status as a QDRO under the Retirement Equity
Act of 1984, as amended.
DONE IN OPEN COURT this _____ day of [month], [year].
JUDGE/COURT COMMISSIONER
QUALIFIED DOMESTIC RELATIONS
ORDER – 6
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
6301.000 docs jb250801.002 4/3/20
Presented by:
[NAME OF ATTORNEY’S OFFICE]
By
[NAME OF ATTORNEY]
Bar No. [00000]
Attorney for Respondent
Copy Received, Approved for Entry,
Notice of Presentment Waived:
[NAME OF ATTORNEY’S OFFICE]
By
[NAME OF ATTORNEY]
Bar No. [0000]
Attorney for Petitioner