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February 20, 2014

NEW  YORK  NY 10022­6839 
800 468 3785  
212 224 2516  FAX

Lutheran Social Services of Illinois 
Ms. Karen Gapinski, Benefits Manager 
1001 E Touhy Ave Ste 50A 
Des Plaines, IL 60018 
Dear Authorized Representative:
Re: Ms. Ma Asuncion San Ramon 
403B Plan Request ER No. 428­014­C
In accordance with the provisions of the Lutheran Social Services of Illinois retirement plan, the employee referenced 
above has applied for a loan. Enclosed are the following documents:

Employee Letter  
Loan Fact Sheet 
Transfer Form 
Loan Agreement 
Payroll Deduction Agreement  

Please give your employee the entire packet of information and have them complete and sign the Loan Application and 
Payroll Deduction Agreement. You will also need to sign the Payroll Deduction Agreement. Please retain your copy of 
the Payroll Deduction Agreement, provide your employee with a copy, and have your employee return the original to us. 
After the loan check is mailed to the employee, the Billing Statement produced for your next payroll deduction period will 
include the initial loan repayment amount to be deducted for this new loan. Subsequently, at the beginning of each payroll 
period, you will be presented with a Billing Statement of scheduled loan repayments to be deducted from the employee's 
salary for that payroll period. The total amount deducted should be remitted to Mutual of America as soon as possible. 
When using our Hotline Plus Online Loan Billing System to remit payments, please remember to include the Loan 
Payment Number to expedite processing. 
If you have any questions, please feel free to contact us at our toll free number 1­800­468­3785 (Option 3). 

Loan Administration 
PS  Please advise your employee that they can check the status of their loan application online at 
by first logging into their account, then selecting Loan Center.

If you have any questions.  Important:  If you are married.  This is a variable rate loan with a current interest rate of 4. your spouse must sign the consent portion of the Loan Application. San Ramon: Re: 403B Loan Request ER No. please check the box on the loan agreement and  provide us with an original.MUTUAL OF  AMERICA  LIFE  INSURANCE  COMPANY February 20. After we receive your completed paperwork. Please complete and sign the Loan Application and Payroll Deduction Agreement. One copy of the Payroll Deduction  Agreement is for your employer and one copy is for your records.00%. .  Loan Administration  PS  You can check the status of your loan application online at mutualofamerica. Funds held in the Interest Accumulation Account are restricted with respect to withdrawals and transfers while the loan is outstanding. your signature  and that of your spouse must be witnessed by a notary or a plan administrator. Only the portion of such account that is in excess of the amount owed plus a 20%  reserve will be available for withdrawal or transfer to the Separate Account investment alternatives. 2014 MUTUAL OF AMERICA 320 PARK  AVENUE  NEW  YORK  NY 10022­6839  800 468 3785   212 224 2516 FAX LOAN  ADMINISTRATION   Ms. The interest rate is reevaluated each calendar quarter. Sincerely. 428­014­C As per your by first logging into your account. The maximum loan you may request is subject to final verification upon receipt  of your Loan Application. Also. IL 60016    Dear Ms. enclosed are the following documents: l l l l Loan Fact Sheet  Transfer Form  Loan Agreement  Payroll Deduction Agreement   The maximum loan you may request to be secured by your retirement account cannot be determined without additional  information from your Plan Administrator. Ma Asuncion San Ramon  9648 Golf Ter  Des Plaines. voided bank check. If you would like to have your loan proceeds sent via wire transfer.  then selecting Loan Center. and have your Plan Administrator sign  the Payroll Deduction Agreement and Loan Application to approve the loan. a check will be mailed to you within five (5) business days. please feel free to contact us at our toll free number 1­800­468­3785 (Option 3). Return the original signed documents in the envelope  provided.


This maximum is reduced by any outstanding plan loans you may have had in the past 12 months. Failing to repay loans may have a negative impact on the ability of participants to meet their retirement savings goals. LOAN TERM The maximum loan term is five years. Mutual of America does not encourage participants to take loans. Rather. LOAN SECURITY Mutual of America requires that 120% of the outstanding loan balance be maintained as collateral in the Interest Accumulation Account of the General Account. You should be careful not to make financial commitments on the assumption that you will receive a loan in the amount you requested. However.F (PD) 3/12 . Funds held in the Interest Accumulation Account are restricted with respect to withdrawals and transfers while the loan is outstanding. the maximum loan plus the reserve amount cannot exceed 1/2 of the account balance. Only the portion of such account that is in excess of the amount owed plus a 20% reserve will be available for withdrawal or transfer to the Separate Account investment alternatives. the loan plus an additional 20% must be held in the Interest Accumulation Account. the amount). We encourage you to carefully evaluate these issues before applying for a loan. This effectively caps the loan at 41-2/3% of the balance. We will notify you whether the loan is approved or not (and. NEW YORK.00 or 5% of the payment that was due. These fees are the lesser of $15. if your loan is being repaid via Home Billing (as opposed to Payroll Deduction). certain fees will be assessed for payments received 30 days after the due date.320 PARK AVENUE NEW YORK NY 10022-6839 • 1 800 468 3785 • 212 224 2516 FAX Pension/Thrift Loan Fact Sheet Please note that employer-sponsored retirement plans are intended to enable and encourage employees to save for retirement. If the loan is approved. if approved. INTERNAL REVENUE CODE RESTRICTIONS The maximum amount permitted by the Internal Revenue Code is the lesser of $50. Your employer will receive a repayment schedule indicating the amount to be deducted from your salary. NY 10022-6839 6720. the proceeds may be sent to you either by check or via Electronic Funds Transfer. DEPARTMENT OF LABOR REGULATIONS Pension/Thrift loans are generally subject to Department of Labor Regulations regarding adequate security. The total amount collected will be remitted to Mutual of America. Under these regulations. REPAYMENT SCHEDULE Loans from your retirement plan must be repaid in substantially equal installments on a payroll period basis. Although your Plan contains a loan provision. MUTUAL OF AMERICA LIFE INSURANCE COMPANY. and your Plan savings are not intended to be used for current expenses. It is recommended that you consult with your own tax or legal adviser before taking any action. The amount you borrow is not withdrawn from your account. INTEREST CALCULATION The Loan Rate is 3% higher than the interest rate we credit to amounts held in the General Account as collateral for the loan and there are no origination and maintenance fees.000 or 1/2 of the vested account balance under all plans with your present employer. A loan term of up to ten years may be selected if the loan proceeds are to be used for the purchase of your principal residence. There are participant charges for loans and loan servicing and significant adverse tax consequences to participants who do not repay loans on a timely basis. LOAN DETERMINATION PROCESS It is important to understand that approval of your loan request is not automatic upon submission of the completed application to Mutual of America. 320 PARK AVENUE.

New York.Tax-Deferred Annuity. 320 PARK AVENUE. Please Print or Type FROM MUTUAL OF OF AMERICA MUTUAL AMERICA Money Market Fund Mid-Term Bond Fund Bond Fund Composite Fund Conservative Allocation Fund Moderate Allocation Fund Aggressive Allocation Fund Equity Index Fund All America Fund Small Cap Value Fund Small Cap Growth Fund Mid Cap Value Fund Mid-Cap Equity Index Fund International Fund Retirement Income Fund 2010 Retirement Fund 2015 Retirement Fund 2020 Retirement Fund 2025 Retirement Fund 2030 Retirement Fund 2035 Retirement Fund 2040 Retirement Fund 2045 Retirement Fund 2050 Retirement Fund ????????? FIDELITY FIDELITY INVESTMENTS® VIP Asset ManagerSM Portfolio VIP Mid Cap Portfolio VIP Equity-Income Portfolio VIP Contrafund® Portfolio VANGUARD VARIABLE INSURANCE FUND VANGUARD VIF Diversified Value Portfolio VIF International Portfolio VIF REIT Index Portfolio AMERICAN CENTURY AMERICAN CENTURY VP Capital Appreciation Fund AMERICAN FUNDS AMERICAN FUNDS Insurance Series New World Fund® CALVERT CALVERT VP SRI Balanced Portfolio DWS DWS Variable Series I Capital Growth VIP ??????? OPPENHEIMER OPPENHEIMER Main Street Fund®/VA PIMCO PIMCO VIT Real Return Institutional Portfolio T. In order to properly secure your loan.INT DATE MUTUAL OF AMERICA LIFE INSURANCE COMPANY. ROWE ROWEPRICE PRICE Blue Chip Growth Fund … TO DOLLARS OR PERCENTAGES Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR % % % % % % % % % % % % % % % % % % % % % % % % Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account $ $ $ $ OR OR OR OR % % % % Interest Accumulation Account Interest Accumulation Account Interest Accumulation Account $ $ $ OR OR OR % % % Interest Accumulation Account $ OR % Interest Accumulation Account $ OR % Interest Accumulation Account $ OR % Interest Accumulation Account $ OR % Interest Accumulation Account $ OR % Interest Accumulation Account $ OR % Interest Accumulation Account $ OR % I have read the current prospectus and am familiar with the objectives of the Investment Funds. NY 10022-6839 8/13 . NEW YORK. If you want to transfer your entire account balance in an investment fund to the Interest Accumulation Account. You may express the amount as a dollar figure or a percentage of your balance. Thrift Plan and Defined Contribution Plan Transfer Form To Secure a Retirement Plan Loan mutualofamerica. an amount equal to 120% of your requested loan amount must be maintained in the Interest Accumulation Account. NY 10022-6839 EMPLOYER’S NAME EMPLOYER NUMBER EMPLOYEE’S NAME CUSTOMER IDENTIFICATION NUMBER __ __ -__ __ __ __ __ __-__ EMPLOYEE’S ADDRESS Number and Street City State Zip Code TRANSFERS You may transfer any part of your balance in any investment fund to the Interest Accumulation Account. express the amount as 100%.Q .com Send this form to the attention of the Loan Administration Department Mutual of America. SIGNATURE 6757. 320 Park Avenue.

This agreement is made as of the date set forth below between the Participant named above and the Plan of the Employer. and that any loan not within the limits imposed by ERISA and TEFRA will be considered a currently taxable distribution. please see #3 below. the parties named above hereto agree as follows: 1. plus the collateral.(L) (APPLICATION) 320 PARK AVENUE NEW YORK NY 10022-6839 212 224 1600 212 224 2500 FAX Pension/Thrift Loan Agreement CUSTOMER IDENTIFICATION NUMBER: __________________________________ NAME: _______________________________________________________ (Please include dashes) ADDRESS:__________________________________________________ CITY:_____________________________ STATE:______ ZIP: _____________ PH: (H)_______________________________ (W)____________________________________ SINGLE:________ MARRIED: _________ EMPLOYER NAME: ___________________________________________________ EMPLOYER NUMBER:_______________________ LOAN AMOUNT: ___________________________________________________ PLAN TYPE: TERM OF LOAN: 5 YRS. The Plan shall have a lien against the Participant’s account balance which shall be equal to the sum of: a) the outstanding principal loan balance. and b) any due and unpaid interest and penalties. Subject to the Participant’s account balance under the plan or contract specified in this Agreement. 2. (6 TO 10 YRS. Please verify with your bank the correct ACH routing number. and that the Participant’s account balance in the Interest Accumulation Account under such Group Annuity Contract will serve as the sole collateral security for the loan. Do you have an outstanding retirement plan loan that is in default with another company? Yes No Have you had any outstanding retirement plan loans over the past 12 months: with Mutual of America Yes No with any other company Yes No If yes. the maximum amount that the Participant may borrow.) PENSION THRIFT If proceeds of this loan are to be used for purchase of principal residence. and enclose a voided personal check with your application. 320 PARK AVENUE. There is no fee for this service. sign here _______________________________________. Any loan made pursuant to this Agreement must be repaid within five years from the date the loan is made unless the loan is to be used to acquire the principal residence of the Participant. 4 YRS. Please check the box on the left if you would like to receive your loan proceeds via electronic fund transfer using the ACH system (Automated Clearing House). NY 10022-6839 12/10 . The Participant understands that the Employee Retirement Income Security Act of 1974 (ERISA) and the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) permit participants to borrow from certain plans. Other ____________ YRS. 3..H MUTUAL OF AMERICA LIFE INSURANCE COMPANY. list highest loan balance for that period __________________________ . NEW YORK. 4. 3 YRS. The Participant accepts full responsibility for compliance with all applicable regulations. 2 YRS. Plans exempt from ERISA are not subject to this Department of Labor regulation. may not exceed one-half of the Participant’s vested interest under the plan. In consideration of the mutual promises herein contained. 1 YR. 6721. The Participant agrees that the loan terms shall be governed both by the terms of the Agreement and by the provisions of the Employer’s Group Annuity Contract.

The Participant shall have the right to prepay the entire principal loan balance at any time. but in no case will payments be due less frequently than quarterly. and withholding. shall be paid to the Company on behalf of the Plan. the Interest Accumulation Account will be debited upon the earliest occurrence of an event which. If the Participant is married at the time this loan is made. would permit such a reduction to be made. The Plan shall release any lien that it may have pursuant to this Agreement after all amounts payable have either been paid by the Participant or withdrawn from the Participant’s account balance in the Interest Accumulation Account as specified herein. as of each quarter. Any such increase or decrease shall be upon notice to the Participant. Spousal signature must be witnessed by Plan Administrator or Notary Public. 9. The Participant agrees to make installment payments of principal and interest in accordance with the method and at the frequency set forth in this Agreement or any payroll deduction agreement executed in connection with this agreement. that the information shown is true. projected penalties that may be owed if a default in payment occurs. if applicable. ______________________ _________________________________________________ DATE BORROWER’S SIGNATURE _________________________________________________ SPOUSE’S SIGNATURE _________________________________________________ NOTARY OR PLAN ADMINISTRATOR’S SIGNATURE TO BE COMPLETED BY AUTHORIZED REPRESENTATIVE OF THE EMPLOYER This loan request is approved. The initial interest rate on the loan shall be the rate of interest declared by Mutual of America Life Insurance Company (The Company). The outstanding balance of the loan plus interest must be repaid on the earlier of the date of the Participant’s death or Annuity Commencement Date as defined in the contract. the total amount due under the plan may be required to be reported as a distribution from the Plan which is subject to taxation. transfers and withdrawals from the Participant’s account balance in the Interest Accumulation Account shall be permitted only to the extent that his balance exceeds the amounts specified above. inclusive of administrative expense charges. if then permitted by applicable law. The Participant understands that while any portion of the principal loan balance is outstanding. In the event the Participant is in default. in the event of a default. the Participant’s spouse must also execute this loan agreement. if the current loan interest rate differs from the rate applicable to this loan by 1/2% or more. the Participant’s account balance in the Interest Accumulation Account may be debited. All interest payments. AUTHORIZED REPRESENTATIVE’S SIGNATURE DATE ________________________________________________________________________________ AUTHORIZED REPRESENTATIVE’S NAME (Please Print or Type) 6721.An additional amount shall be set aside as a reserve to cover expense charges over the life of the loan. 10. The Company may increase or decrease the rate of interest payable on the outstanding principal loan balance. 5. for the amount payable inclusive of unpaid interest or other applicable charges. Furthermore.H TITLE (Please Print or Type) 12/10 . under applicable law. that by signing this form. If any installment payment under this Agreement is not paid when due and remains unpaid on the last day of the calendar month following the calendar month in which it was originally due.the Participant will be in default. 7. To the extent the reduction cannot then be made. 6. I certify. 8.

or (iii) my death. NEW YORK. ___________________ and my next payroll date is _________________________. NY 10022-6839 5/13 . hereby authorize ______________________________________________________________ (“Employer”) to deduct from my after-tax salary in each payroll period shown below the amounts necessary to make the repayments specified in my Loan Agreement dated __________________________ and executed by me and my spouse (as necessary) in connection with a loan granted to me against the security of my vested retirement plan account balance.LOAN REPAYMENT PAYROLL DEDUCTION AGREEMENT I.______________________________________________________________________. ________________________________________________________ EMPLOYEE’S SIGNATURE __________________________ DATE __________________________________________________ CUSTOMER IDENTIFICATION NUMBER ___________________________________________________ EMPLOYER’S SIGNATURE ________________________ DATE ___________________________________________________ EMPLOYER’S PLAN ACCOUNT NUMBER 6818. I am paid (payroll frequency. 320 PARK AVENUE. e. (ii) my termination of employment with my Employer. etc.. my Employer agrees to remit the specified installment amounts when due to the administrators of the loan program. I agree that my loan repayments will commence with the next payroll after my loan is issued.D MUTUAL OF AMERICA LIFE INSURANCE COMPANY. I understand that this Agreement will be terminated upon the earliest to occur of: (i) my satisfaction in full of the above-mentioned debt. or disability.). weekly. bi-weekly. retirement. Furthermore.g.