Sweda et al. v. Univ. of Pennsylvania et al.

Case No. 16-cv-4329

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If you did not receive a personalized Notice in the mail or via email, click below to complete a Claim Form.

FORMER PARTICIPANT CLAIM FORM

Please click the link for GENERAL INSTRUCTIONS

This Former Participant Claim Form is ONLY for Class Members who are Former Participants, or the beneficiaries, alternate payees or attorneys-in-fact of Former Participants (all of whom will be treated as Former Participants). A Former Participant is a Class Member who did not have an account in the Plans (as defined below) with a balance greater than $0 as of January 14, 2021.

This form must be completed, signed and filed electronically through this claims portal by October 17, 2021 or mailed with a postmark date no later than October 17, 2021 to the Settlement Administrator in order for you to receive your share of the Settlement proceeds. Former Participants who do not complete and timely return this form will not receive any Settlement payment. Please review the instructions below carefully. If you have questions regarding this Claim Form, you may contact the Settlement Administrator as indicated below.


PART 1: INSTRUCTIONS FOR COMPLETING FORMER PARTICIPANT CLAIM FORM

  1. Complete this claim form and keep a copy of all pages of your Former Participant Claim Form, including page 1 with the address label, for your records.
  2. If you wish to file your completed Former Participant Claim Form by mail, it must postmarked no later than October 17, 2021 to the Settlement Administrator at the following address:

    Univ. of Pennsylvania 403(b) Settlement Administrator
    Sweda v. University of Pennsylvania
    c/o Angeion Group
    1650 Arch St. Suite 2210
    Philadelphia, PA 19103
    Info@upenn403bsettlementclaim.com

    If you prefer to file your claim electronically, you may use this claims portal.

    It is your responsibility to ensure the Settlement Administrator has timely received your Former Participant Claim Form.

  3. Other Reminders:
    • You must provide date of birth, signature and a completed Substitute IRS Form W-9, which is Part 5 of this form.
    • If you desire to do a rollover and you do not complete in full the rollover information in Part 4 Payment Election of the Settlement Distribution Form, payment will be made to the Former Participant.
    • If you change your address after sending in your Former Participant Claim Form, please send your new address to the Settlement Administrator.
    • Timing Of Payments To Eligible Settlement Class Members. Please note that Settlement payments are subject to the Settlement Agreement’s receiving final Court approval. If the Settlement Agreement is approved and if you are entitled to a Settlement payment under the terms of the Settlement, such payments will be distributed no earlier than early to mid-year 2022 due to the need to process and verify information for all Settlement Class Members who are entitled to a payment and to compute the amount of each payment. Payments may be further delayed if any appeals are filed.
  4. Questions? If you have any questions about this Former Participant Claim Form, please call the Settlement Administrator at 1-855-516-9339. The Settlement Administrator will provide advice only regarding completing this form and will not provide financial, tax or other advice concerning the Settlement. You therefore may want to consult with your financial or tax advisor. Information about the status of the approval of the Settlement, Settlement administration, and claim processing is available on this website.

You are eligible to receive a payment from a class action settlement. The Court has preliminarily approved the class settlement of Sweda et al. v. Univ. of Pennsylvania et al., No. 16-cv-4329 (E.D. Pa.). That settlement provides allocation of monies to the individual accounts of Settlement Class Members who had plan accounts with a positive balance in the University of Pennsylvania Matching Plan, Supplemental Retirement Annuity Plan, or Basic Plan (the “Plans”) as of January 14, 2021 (“Current Participants”). Settlement Class Members who are entitled to a distribution but who did not have a plan account with a positive balance in the Plans as of January 14, 2021 (“Former Participants”) will receive their allocation in the form of a check or rollover if and only if they mail a valid Former Participant Claim Form to the Settlement Administrator at the address atop this form postmarked no later than October 17, 2021 or electronically filed online no later than October 17, 2021. For more information about the Settlement, call 1-855-516-9339.

Because you are a Former Participant (or beneficiary of a Former Participant) in one or more of the Plans, you must decide whether you want your payment (1) sent payable to you directly or (2) to be rolled over into another eligible retirement plan or into an individual retirement account (“IRA”). To make that choice, please complete and mail this Former Participant Claim Form to the Settlement Administrator at the address atop this form postmarked no later than October 17, 2021. Claim Forms may also be completed and submitted to the Settlement Administrator electronically. Electronic Claim Forms must be submitted no later than October 17, 2021. If you do not indicate a payment election, your payment will be sent payable to you directly.

PART 2: PARTICIPANT INFORMATION
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* Required Fields
PART 3: BENEFICIARY OR ALTERNATE PAYEE INFORMATION (IF APPLICABLE)
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PART 4: PAYMENT ELECTION

Rollover Information:

PART 5: SIGNATURE, CONSENT, AND SUBSTITUTE IRS FORM W-9

UNDER PENALTIES OF PERJURY UNDER THE LAWS OF THE UNITED STATES OF AMERICA, I CERTIFY THAT ALL OF THE INFORMATION PROVIDED ON THIS FORMER PARTICIPANT CLAIM FORM IS TRUE, CORRECT, AND COMPLETE AND THAT I SIGNED THIS FORMER PARTICIPANT CLAIM FORM.

  1. The Social Security number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
  2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and


Your Claim Form has been submitted successfully.

HOWEVER, it appears one or more of the documents you uploaded were not successfully received. Please see below for which file(s) had errors and log back in to your existing Claim online to re-upload your document(s). Alternatively, you can send your documents with your Submitted Claim ID to the Settlement Administrator by email to: Info@upenn403bsettlementclaim.com.

Please print this page for your records.

Your Claim Details

Submitted Claim ID:
Confirmation Code:
You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
CLAIM INFORMATION
First Name
Middle
Last Name
Mailing Address
City
State
Province
Zip Code
Postal Code
Country
Home Phone
Work Phone or Cell Phone
Email Address
Signature
Date

If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at Info@upenn403bsettlementclaim.com

Click here to edit your Claim.