Issuu

Beyond t he MoVING Box es: OSR Check- in 2026

Th e Salvat ion Ar m y East er n Ter r it or y Of f icer Ser vices & Recor ds Depar t m en t USEOf f icer Recor ds@USE.Salvat ion Ar m y.or g

OFFICER SERVICES & RECORDS

OS RM OSR

ISS IO

NS Th e Of f icer TA TE Ser vices an d Recor ds M Depar t m en t is r espon sible

EN T

f or t h e adm in ist r at ion of act ive an d r et ir ed of f icer per son n el r ecor ds an d ben ef it s in Th e Salvat ion Ar m y East er n Ter r it or y. Ou r m ission is t o pr ovide excellen ce in adm in ist r at ive ser vice an d pr ayer su ppor t t o each of f icer f r om com m ission in g t h r ou gh r et ir em en t .

R IN E OS CK- ANC E L CH A- G AT

Beyond t he MoVING Box es: OSR Check- in ADDRESS UPDATES & ENROLL

Ch eck you r in f o in OM S Con t act s

Ch eck you r addr ess in UKG

Updat e/ t r an sf er ban k & f in an ical in st it u t ion s

En r oll in M OA Rot h 403(b)

FAMILY& HEALTH

Not if y Ch est er f ield of addr ess ch an ge

Fin d n ew h ealt h car e pr ovider s & t r an sf er pr escr ipt ion s

PERSONAL En r oll in OWP & ch eck st at u s of r equ ir ed ph ysical

Reach ou t t o Past or al Car e

WELL- BEING

Allow you r self a t r an sit ion per iod

Review an d u pdat e M et Lif e Ben ef iciar y For m s

OFFICER SERVICES & RECORDS

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OM S CON TACTS

WHAT DO I NEED TO KNOW? Check your information in OMS Contacts for accuracy. WHAT IS OM S CONTACTS? OMS Contacts is a directory of Officers and Department Heads for the four USA Territories. HOW DO I ACCESS THE SITE? There are two ways to access OMS Contacts: 1. Via SA In f or m in the Usef u l Lin k s section 2. Or type: h t t ps:/ / om scon t act s.salvat ion ar m y.or g into your web browser HOW DO I LOG IN? Log into OMS with your M365 credentials. Your M365 credentials are your email and password to log on to your work computer. CAN I EDIT M Y INFORM ATION IN OM S CONTACTS? No. If you notice incorrect information in OMS Contacts, please send an email to: USEOf f icer Recor ds@u se.salvat ion ar m y.or g. HOW DO I UPDATE M Y PHOTO? Send an email with an updated photo to USEOf f icer Recor ds@u se.salvat ion ar m y.or g. WILL M Y CONTACT INFORM ATION BE UPDATED WHEN I M OVE TO A NEW APPOINTM ENT? Yes. However, we encourage you to verify that the information in OMS Contacts is correct after you have moved. WHAT IF I M OVE TO A NEW ADDRESS BUT STAY IN THE SAM E APPOINTM ENT? Please email your new address to USEOf f icer Recor ds@u se.salvat ion ar m y.or g and OSR will update your contact information in OMS. WHO SHOULD I CONTACT IF I HAVE M ORE QUESTIONS? The OSR Team is here to help! Please reach out to us via email or call! USEOf f icer Recor ds@u se.salvat ion ar m y.or g | 845-620-7430

ED ET PL M CO TE: DA

UKG OFFICER PAYROLL

WHAT DO I NEED TO KNOW? Check your information in UKG for accuracy. WHAT IS UKG? UKG is your one-stop shop for officer allowance and payroll. Think of it as your personal work toolkit, keeping you informed and in control. LOGIN URL: h t t ps:/ / saeast -dl.u lt ipr o.com or scan QR code User n am e: Fir st In it ial+Last n am e@TSAR (or @TSAR1) Passw or d: em ployeeDOB(m m ddyyyy)+ZIPCODE(5 digit s)

CHANGE PASSWORD After your first login, you will be prompted to: - Change your password - Verify method(s) for password ...........reset (email and/or phone)

EM PLOYEE SUM M ARY Em ployee Su m m ar y: Overview of your personal and job information Pay Tab: Pay statements, direct deposit information, and W-2 Im por t an t ! You can n ot edit you r in f or m at ion in UKG. Con t act OSR t o su bm it ch an ges: USEOfficerRecords@use.salvationarmy.org

UKG Of f icer Payr oll Qu ick St ar t Gu ide PAPERLESS W-2 OPT-IN When you log in for the first time, a pop-up appears to select if you would like to receive a paperless W-2. Select an option and save. To change your selection: -

Go to the Pay Tab Select Taxes Select Ch an ge paper less pr ef er en ces Make your selection and Save

Please note that if you select to receive an electronic copy only, you will not be mailed a paper copy and must obtain your W-2 through your UKG account. There are several benefits to opting for a paperless W-2: Con ven ien ce an d Speed: You will get your W-2 much faster than waiting for it in the mail. It is typically available earlier and accessible 24/7 through UKG. Secu r it y: There is less chance of your W-2 getting lost, stolen, or damaged in the mail. Or gan izat ion : It is easier to access and store electronically. You can download multiple copies if needed and can access past years' W-2s. PASSWORD RESET If you are locked out of your UKG account, please email: USEOf f icer Recor ds@u se.salvat ion ar m y.or g

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DIRECT DEPOSIT

WHAT DO I NEED TO KNOW? If you change your bank or banking details following a move, it is critical to update and submit a new Dir ect Deposit form. Your allowance, reimbursement checks, and healthcare reimbursements are deposited into the bank account currently on file. If your banking information is outdated or incorrect, it could result in delays or failed deposits. To avoid disruption to your financial support or benefits, it?s important to ensure that your direct deposit details are always accurate and up to date.

HOW TO SUBM IT To update your banking information, complete a new Direct Deposit form and submit it to Of f icer Ser vices an d Recor ds as soon as your new bank account is active. Submit updated forms securely via: -

En cr ypt ed em ail to USEOf f icer Recor ds@USE.Salvat ion Ar m y.or g -orUSPS to Th e Salvat ion Ar m y | Of f icer Ser vices & Recor ds Depar t m en t 440 West Nyack Road | West Nyack , NY 10994 -orRequest a secu r e lin k from OSR

For m or e in f or m at ion abou t secu r ely su bm it t in g docu m en t s, scan t h e QR Code. QUESTIONS? If you have any questions, please contact OSR for guidance at USEOf f icer Recor ds@USE.Salvat ion Ar m y.or g.

OFFICER DIRECT DEPOSIT FORM For t h e Payr oll Depar t m en t (via USE Of f icer Ser vices & Recor ds Depar t m en t ) Complete, sign, and submit the direct deposit form to the Territorial Officer Services & Records Department via encrypted email, secure link, or USPS.

Dir ect Deposit : I authorize The Salvation Army and the financial institution(s) listed below to automatically deposit my net pay into my account(s) each payday. Ret u r n ed Fu n ds Au t h or izat ion : If funds to which I am not entitled are deposited into my account, I authorize The Salvation Army to direct the bank to return said funds. Can cellat ion : The allocations indicated below will remain in effect until I have canceled them in writing. Im por t an t Not es: - For account verification, attach a voided check or bank letter on letterhead with account information. - Direct deposit takes up to 2 pay cycles. You will receive a live check until the process is complete. - Return this form securely to Officer Services and Records via encrypted email, secure link, or USPS. NAM E ADDRESS SA EM AIL

COM M AND

DEPOSIT ACCOUNT (1) TYPE

Checking

ACTION ?

ADD

TYPE

Checking

DISTRIBUTION $ ___________ or Percentage _____ %

ACTION ?

ADD

TYPE

Checking

CANCEL

DISTRIBUTION $ ___________ or Percentage _____ %

ACTION ?

ADD

CHANGE DISTRIBUTION

CANCEL

Savings ACCOUNT # ____________________________ ROUTING # ________________________

FINANCIAL INSTITUTION

CHANGE DISTRIBUTION

Savings ACCOUNT # ____________________________ ROUTING # ________________________

FINANCIAL INSTITUTION

DEPOSIT ACCOUNT (3)

CANCEL

Savings ACCOUNT # ____________________________ ROUTING # ________________________

FINANCIAL INSTITUTION

DEPOSIT ACCOUNT (2)

CHANGE DISTRIBUTION

DISTRIBUTION $ ___________ or Percentage _____ %

REQUIRED NOTIFICATIONS! SM ART DATA: Of f icer s ar e r espon sible f or n ot if yin g t h eir Com m an d Accou n t s Payable Depar t m en t w it h dir ect deposit ch an ges f or SM ART DATA r eim bu r sem en t s. CHESTERFIELD: Of f icer s m u st con t act Ch est er f ield t o u pdat e ban k accou n t f or m edical r eim bu r sem en t s.

SIGNATURE

________________________________________________________

DATE

_______________________________

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M UTUAL OF AM ERICA

WHAT DO I NEED TO KNOW? The Salvation Army offers a valuable opportunity for officers to invest in their future through the M u t u al of Am er ica Rot h 403(b). This benefit allows you to contribute after-tax dollars, so your withdrawals in retirement, including earnings, are tax-free, provided certain conditions are met. Enrolling in the Rot h 403(b) helps build long-term financial security and gives you greater flexibility in your retirement years. The earlier you begin contributing, the more time your money has to grow through compounding interest. Even small, consistent contributions can make a significant impact over time. Planning for retirement today ensures that you are better prepared for the future. The Rot h 403(b) is an excellent way to take ownership of your financial future while still serving in full-time ministry. HOW TO SUBM IT To enroll in the M u t u al of Am er ica Rot h 403(b) plan, you will need to complete an en r ollm en t f or m and a salar y r edu ct ion agr eem en t (included). St ep 1: Complete the Rot h 403(b) en r ollm en t f or m St ep 2: Complete the Salar y Redu ct ion f or m St ep 3: Submit both forms via: - En cr ypt ed em ail to USEOf f icer Allow an ce@USE.Salvat ion Ar m y.or g -or- USPS to Th e Salvat ion Ar m y | Of f icer Ser vices & Recor ds Depar t m en t Of f icer Allow an ce & Gr an t s Adm in ist r at or | 440 West Nyack Road West Nyack , NY 10994 For m or e in f or m at ion abou t secu r ely su bm it t in g docu m en t s, scan t h e QR Code. QUESTIONS? Call (845) 620-7248

M UTUAL OF AM ERICA

M u t u al of Am er ica Fin an cial Gr ou p is the service provider for The Salvation Army?s 403(b) Roth Retirement Savings Plan. Saving for tomorrow may be easier than you think? that?s why enrolling in and contributing to your employer ?s retirement plan is a good opportunity to prepare for a more financially secure future. Putting money aside in a retirement account means getting ready for what?s next in life; The Salvation Army?s Roth 403(b) Retirement Savings Plan is designed to help you look ahead with confidence. A Few Plan High ligh t s - Roth and Rollover contributions permitted - A wide range of savings and investment options for your tax-advantaged contributions - Tax-free distributions after 59 ½ and 5 years* * - Loans permitted - Access to educational resources made available by your Participant Account Representative including webinars, one-on-one consultations, and Retirement Readiness tools at w w w.m u t u alof am er ica.com * from first Roth Contribution Get On lin e VISIT: m u t u alof am er ica.com / sign u p The entire process will take just a few minutes. As long as your employer has created your profile with Mutual of America, you?ll first be prompted to verify your identity. After the verification process is complete, you?ll be able to review plan details and align your contribution allocations to your unique investment risk profile. You r local M u t u al of Am er ica Repr esen t at ive For help with joining The Salvation Army?s 403(b) Roth Retirement Savings Plan, please reach out to your local Mutual of America representative, Christina Maietta. Christina is available to answer questions about your retirement plan and meet with you in person, by phone or virtually to help you get the most out of your retirement benefits. (914) 594-7016 | ch r ist in a.m aiet t a@m u t u alof am er ica.com Sch edu le a m eet in g via h t t ps:/ / calen dly.com / ch r ist in a-m aiet t a

320 PARK AVENUE NEW YORK NY 10022-6839 800 468 3785 OR CALL YOUR LOCAL REGIONAL OFFICE

u Employee Enrollment Form for

403(b) Thrift Plans With Designated Roth Contributions

TO BE COMPLETED BY PLAN ADMINISTRATOR

EMPLOYER’S NAME

EMPLOYER NUMBER

The Salvation Army

081-000-I

______________________________________________________________________________________________ this employee ever worked on a part-time basis, enter the date on c FULL-TIME Ifwhich the 1,000-hour requirement was met, in accordance with plan specifications. / / PART-TIME c ______________________________________________________________________________________________ DATE EMPLOYEE HIRED

EMPLOYMENT STATUS

PART-TIME SERVICE

PRIOR TAX-EXEMPT SERVICE

If during the last three years this employee had service with another eligible organization that is to be counted toward meeting eligibility requirements, enter the number of months of such service that are to be counted.

______________________________________________________________________________________________

EMPLOYEE’S DEPARTMENT # (IF APPLICABLE) c (A)nnual c (B)iweekly c (M)onthly c (W)eekly $ (S)emimonthly c ______________________________________________________________________________________________ EMPLOYEE’S SALARY RATE

EFFECTIVE DATES

Enter the effective date and the percentages of salary or dollar amount for Traditional Pre-tax and Designated Roth Contributions (after-tax) in the applicable areas.

TRADITIONAL PRE-TAX CONTRIBUTIONS PERCENT OF SALARY DOLLAR AMOUNT EFFECTIVE DATE

% OR $

EMPLOYER CONTRIBUTIONS EMPLOYER MATCHING EMPLOYER NON-MATCHING EFFECTIVE DATE EFFECTIVE DATE

DESIGNATED ROTH CONTRIBUTIONS (AFTER-TAX) PERCENT OF SALARY DOLLAR AMOUNT EFFECTIVE DATE

% OR $

SECTION 1 - EMPLOYEE INFORMATION u________________________________________________________________________________________________________ SOCIAL SECURITY NUMBER

EMPLOYEE’S NAME

First

Initial

Last

________________________________________________________________________________________________________ MAILING ADDRESS

Street and Number

City

State

Zip Code

________________________________________________________________________________________________________ c MALE ) ( ) c FEMALE ( / / ________________________________________________________________________________________________________ IF FOREIGN RESIDENT Province

7159(NY)-2020

Country

DATE OF BIRTH

TELEPHONE NUMBERS HOME

OFFICE

5/25

SECTION 2 - ALLOCATION OF CONTRIBUTIONS

Show the percentage of your contributions you want to place in the Interest Accumulation Account of our General Account and/or Separate Account investment funds. Use whole numbers only, and make sure the percentages total 100%. Amounts placed in the Interest Accumulation Account will be credited with the rate of interest applicable to that account. Your balance in any investment fund will fluctuate to recognize investment results.

Interest Account

_____% Mutual of America Interest Accumulation Account

Separate Account Investment Funds

Separate Account – Equity Funds (24) _____% MoA Equity Index Fund _____% MoA All America Fund _____% MoA Small Cap Value Fund _____% MoA Small Cap Growth Fund _____% MoA Small Cap Equity Index Fund _____% MoA Mid Cap Value Fund _____% MoA Mid-Cap Equity Index Fund _____% MoA International Fund _____% Fidelity® VIP Mid Cap Portfolio _____% Fidelity® VIP Equity-Income Portfolio _____% Fidelity® VIP Contrafund® Portfolio _____% Vanguard VIF Diversified Value Portfolio _____% Vanguard VIF International Portfolio _____% Goldman Sachs VIT US Equity Insights Fund _____% Goldman Sachs VIT Small Cap Equity Insights Fund _____% Lincoln Financial LVIP American Century Capital Appreciation Fund _____% American Funds Insurance Series® New World Fund® _____% Macquarie VIP Small Cap Value Series _____% DWS Capital Growth VIP _____% Invesco V.I. Main Street Fund® _____% MFS® VIT III Mid Cap Value Portfolio _____% Neuberger Berman AMT Sustainable Equity Portfolio _____% T. Rowe Price Blue Chip Growth Portfolio _____% Victory RS Small Cap Growth Equity VIP Series Separate Account – Asset Allocation Funds (3) _____% MoA Conservative Allocation Fund _____% MoA Moderate Allocation Fund _____% MoA Aggressive Allocation Fund

Separate Account – Fixed Income Funds (5) _____% MoA US Government Money Market Fund _____% MoA Intermediate Bond Fund _____% MoA Core Bond Fund _____% PIMCO VIT Real Return Portfolio _____% Vanguard VIF Total Bond Market Index Portfolio Separate Account – Real Estate Fund (1) _____% Vanguard VIF Real Estate Index Portfolio Separate Account – Retirement Funds (12) _____% MoA Retirement Income Fund _____% MoA Clear Passage 2020 Fund _____% MoA Clear Passage 2025 Fund _____% MoA Clear Passage 2030 Fund _____% MoA Clear Passage 2035 Fund _____% MoA Clear Passage 2040 Fund _____% MoA Clear Passage 2045 Fund _____% MoA Clear Passage 2050 Fund _____% MoA Clear Passage 2055 Fund _____% MoA Clear Passage 2060 Fund _____% MoA Clear Passage 2065 Fund _____% MoA Clear Passage 2070 Fund Separate Account – Balanced Funds (3) _____% MoA Balanced Fund _____% Fidelity® VIP Asset Manager 50% Portfolio _____% Calvert VP SRI Balanced Portfolio

SECTION 3 - BENEFICIARY DESIGNATIONS

If you are married, you must name your Eligible Spouse (as defined in the Plan and federal law) as your only beneficiary unless your Eligible Spouse signs the Spouse’s Waiver of Death Benefits below in the presence of a Plan (employer) representative or a notary public after you designate the beneficiaries you wish below. Whenever you want to change your beneficiaries, your Eligible Spouse must sign a new waiver unless you name your Eligible Spouse as your only beneficiary. If you are younger than 35 when you name alternative beneficiaries with the consent of your Eligible Spouse, your beneficiary designation will automatically terminate when you attain age 35 and your Eligible Spouse will be your beneficiary unless you again designate alternative beneficiaries with a new signed waiver from your Eligible Spouse. If you are unmarried, you may name any beneficiaries you wish. If you marry in the future, your beneficiary designation under the retirement plan will be automatically voided. At that time, you should complete Mutual of America’s “Beneficiary Designation” form and follow the instructions applicable to married participants. In the event of your death, and subject to the Eligible Spouse Waiver requirements, the total value of your account will be paid to the person or persons you name as your primary beneficiary. If no one you have named as a primary beneficiary survives you, the person(s) you name as your secondary beneficiary will receive the death benefit. If there is no living designated beneficiary at your death, the amount payable will be paid to the first surviving class of the following: (a) your surviving spouse (as determined under state law), (b) your surviving children in equal shares, (c) your surviving parents in equal shares, (d) your surviving brothers and sisters in equal shares, or (e) the executors or administrators of your estate. If you name more than one primary beneficiary, or more than one secondary beneficiary, the death benefit will be paid in equal shares to the primary beneficiaries who survive you, or if none, to the secondary beneficiaries who survive you, unless you show below the percentage you want each of them to receive. If you specify percentages you want each beneficiary to receive, be sure your percentages for all beneficiaries in each beneficiary type total 100%. 7159(NY)-2020

5/25

Name your primary and secondary beneficiaries in the space provided. If you need more space, attach a page showing for each beneficiary the information asked for below. Please add your Employer’s name and Employer number, your signature and the date. Beneficiary Type: c X Primary Relationship: c Spouse

FULL NAME

DATE OF BIRTH

c Child

First

c Parent

Initial

c Estate

c Other

ADDRESS

First

DATE OF BIRTH

TELEPHONE NUMBER

City

State

IF FOREIGN RESIDENT

Province

Country

Initial

SOCIAL SECURITY #

Street

State

IF FOREIGN RESIDENT

BENEFIT PERCENT

c Other

TELEPHONE NUMBER

City

Zip Code

c Estate

Last

ADDRESS

Street

c Secondary c Child c Parent

Relationship: c Spouse FULL NAME

Last

SOCIAL SECURITY #

Beneficiary Type: c Primary

Province

Country

Zip Code

BENEFIT PERCENT

% Beneficiary Type: c Primary

Relationship: c Spouse FULL NAME

First

DATE OF BIRTH

/ ADDRESS

c Secondary c Child c Parent Initial

c Estate

c Other

Relationship: c Spouse FULL NAME

Last

SOCIAL SECURITY #

Beneficiary Type: c Primary

/ ADDRESS

Street

City

IF FOREIGN RESIDENT

First

DATE OF BIRTH

TELEPHONE NUMBER

/ State

Province

Country

c Secondary c Child c Parent c Estate c Other Initial

Last

SOCIAL SECURITY #

TELEPHONE NUMBER

/ Street

City

Zip Code

State

IF FOREIGN RESIDENT

BENEFIT PERCENT

Province

Country

Zip Code

BENEFIT PERCENT

% Are you married?

c Yes

c No

NOTE: Mutual of America and/or your employer may require evidence that you are not married if their records indicate that you are or were previously married. If you are married and have not designated your spouse as primary beneficiary, the Spouse’s Waiver Section below must be completed.

SPOUSE’S WAIVER (Witnessed by a Notary Public or Authorized Representative of Employer) My spouse is a participant in a Mutual of America Thrift Plan under which I am entitled to be the beneficiary. As the beneficiary, I would receive a death benefit after my spouse’s death. However, I agree to waive my right to be the beneficiary. I agree to let my spouse designate the beneficiary or beneficiaries named on this form. _______________________________________________________ Spouse’s Name

______________ Date of Birth

_______________________________________________________ Signature of Spouse

______________ Date

______________________________________________________ _____________ Signature and Seal of Notary Public or Signature of Authorized Representative

Date

Mutual of America employees are not authorized to sign as Plan representatives. Notary’s acknowledgment may be added below:

4 - STATEMENT AND SIGNATURE uI have readSECTION the current prospectus and other materials describing the plan and after careful consideration I have found the plan to be suitable for my financial needs. Therefore, I elect to participate in the Thrift Plan. EMPLOYEE’S SIGNATURE

7159(NY)-2020

DATE

5/25

___________________________________________________________________________________________ (OFFICER NAME)

401(k), 403(b) or TAX-DEFERRED ANNUITY PLAN SALARY REDUCTION AGREEMENT ______________________________________________________________

XXX-XX- ___ ___ ___ ___ __________________________

EMPLOYEE NAME

LAST 4 DIGITS OF SOCIAL SECURITY NUMBER

The Plan has been explained to me, and I have been given a Summary Plan Description. I understand that I may voluntarily choose to have my pay reduced for contributions to the Plan. ELECTION TO CONTRIBUTE I elect to designate my contributions as Traditional Pre-Tax Contributions and/or Designated Roth Contributions (after-tax contributions) as follows:

• • Designated Roth Contributions (after tax): I elect to contribute ______% or $________________ of my pay, and I authorize my employer to deduct that amount each pay period.

I am aware that: 1) My contribution may be reduced in order to comply with Federal tax rules and limits, including any higher limits that apply to participants age 50 or older. 2) This election will take effect with the first pay period beginning on or after the first day of the next month, or as soon as it is administratively feasible for my employer to begin deductions from my pay after I file this Salary Reduction Agreement with my employer. I may stop or change my election for future pay periods by giving my employer written notice, which will take effect as soon as administratively feasible. 3) My contributions and earnings cannot be withdrawn or paid until I attain age 59½ or upon my death, disability or termination of employment. My contributions may be available for withdrawal in the event of serious financial hardship (according to the Plan and IRS rules). 4) Any portion of my contributions that I elect to be Designated Roth Contributions are after-tax and will be subject to regular income tax as part of my regular taxable pay. Distributions of Designated Roth Contributions will not be taxable when distributed from the Plan, but distributions of earnings may be subject to tax or penalty if not qualified. A qualified distribution is a distribution made (a) at least five years after I began Designated Roth Contributions and (b) after I have attained age 59½, become disabled or died. 5) Any election to treat all or part of my contribution as Designated Roth Contributions is irrevocable once the contributions are deducted from my pay. 6) This election generally applies to all compensation payments that I receive, as described in my employer’s Plan document. ______________________________________________________________

______________________

EMPLOYEE SIGNATURE

DATE

______________________________________________________________

______________________

EMPLOYER REPRESENTATIVE

DATE RECEIVED

ELECTION NOT TO CONTRIBUTE I do not wish to contribute to the Plan at this time. I understand that if the plan provides for matching employer contributions, I will not be entitled to such contributions during the time I am not contributing. I also understand that I may elect to contribute in the future by completing a Salary Reduction Agreement and an Enrollment Form and filing them with my employer. ______________________________________________________________

______________________

EMPLOYEE SIGNATURE

DATE

______________________________________________________________

______________________

EMPLOYER REPRESENTATIVE

DATE RECEIVED

NOTE TO EMPLOYERS THIS FORM SHOULD BE RETAINED WITH THE EMPLOYER’S RECORDS OF THE PLAN. EMPLOYERS SHOULD REVIEW THIS SAMPLE PAYROLL AUTHORIZATION FORM WITH LEGAL COUNSEL, IN PARTICULAR REGARDING ANY APPLICABLE STATE LAW THAT MAY AFFECT THIS DOCUMENT. MUTUAL OF AMERICA LIFE INSURANCE COMPANY, 320 PARK AVENUE, NEW YORK, NY 10022-6839 7160.H (MUTUAL OF AMERICA)

12/17

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CHESTERFIELD RESOURCES

WHAT DO I NEED TO KNOW? Contact Ch est er f ield Resou r ces to ensure your address has been updated in their system. Ch est er f ield Resou r ces (800) 321-0935, M on day-Fr iday, 8 am - 5 pm East er n Tim e M ailin g addr ess: P.O. Box 1884 Ak r on , OH 44309 w w w.ch est er f ieldr esou r ces.com

ED ET PL M CO TE: DA

FIN D A PROVIDER

WHAT DO I NEED TO KNOW? When you move to a new appointment, it?s important to establish care with new healthcare providers for yourself and your family as soon as possible. A change in location often means your previous doctors, dentists, or specialists may no longer be accessible. Finding new providers ensures continuity of care, timely access to prescriptions, routine check-ups, and support in case of emergencies. Don?t wait until you?re sick! Take proactive steps to get settled with local providers. ANTHEM BLUE CROSS & BLUE SHIELD w w w.ANTHEM .com 800-810-BLUE AETNA DENTAL ADM INISTRATORS w w w.AETNA.com / den t aladm in ist r at or s VISION SERVICE PLAN* w w w.VSP.com TRUHEARING* w w w.Tr u Hear in g.com 866-344-7756 EXPRESS SCRIPTS w w w.EXPRESS-SCRIPTS.com * Vision Service Plan and TruHearing do not have in/out network providers. PUERTO RICO & VIRGIN ISLANDS (PRV): Health insurance coverage is provided through the Triple-S health plan. Please contact the PRVI Divisional Headquarters Human Resources Department for your health insurance card and plan information. QUESTIONS? Em ail Of f icer Healt h Ser vices at USEOf f icer Healt h @u se.salvat ion ar m y.or g.

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M ETLIFE BEN EFICIARY FORM UPDATE

WHAT DO I NEED TO KNOW? When you move due to a change in appointment, it?s a perfect time to review and update your M et Lif e Ben ef iciar y form. Life changes, such as relocation, can bring new circumstances that may affect who you want to designate as your MetLife beneficiaries. Keeping your MetLife beneficiary information current ensures your benefits are distributed according to your wishes and helps prevent delays or complications for your loved ones.

HOW TO SUBM IT -

Review an d u pdat e M et Lif e Ben ef iciar y For m s

Complete all sections marked with a r ed ch eck m ar k . If additional space is needed, at t ach a separ at e sh eet and include your signature and date on the attached sheet. Sign and date the form by hand. Typed sign at u r es ar e n ot accept ed. Scan the completed, signed form and submit it using the secu r e lin k below. - Secu r e Su bm ission Lin k (https://tsaeshare.egnyte.com/ul/N4GZmmeeTp) Or mail your completed form to: The Salvation Army Attention: Officer Health Services | OSR 440 West Nyack Road West Nyack, NY 10994 Do not submit completed forms by email. Use t h e secu r e su bm ission lin k or m ail you r com plet ed f or m t o t h e addr ess above.

QUESTIONS? If you have any questions or need assistance completing the form, please contact Ter r it or ial Of f icer Healt h Ser vices at 845-450-3002 or USEOf f icer Healt h @u se.salvat ion ar m y.or g.

MetLife

Complete sections with RED CHECK mark.

Metropolitan Life Insurance Company, New York, NY 10166

ENROLLMENTICHANGEFORM

-------

------------------------

---------------------

Address (Street, City, State, Zip Code) Phone#

-------

Date of Birth (MM/DD/YY

D New Enrollment D Change in Enrollment

Email Address

If due to a Qualif in Event, enter event date MM/DD/YYYY

I have read my enrollment materials and I request coverage for the benefits for which I am or may become eligible. I understand that no contributions are required for Basic Life, Basic AD&D, Dependent Child Life and Dependent Child AD&D. I understand that contributions are required for the benefits I select below.

► If you are currently enrolled and increasing your Voluntary Life amount by more than one level, you must complete a Statement of Health form. ► If you are enrolling after the initial enrollment period and enrolling in Voluntary Life for the first time for an amount more than $10,000, you must also com lete a Statement of Health form.

Term Life Insurance & Accidental Death & Dismemberment (AD&D) Insurance � Basic Life 1 and Basic AD&D D Voluntary Life 1 and Voluntary AD&D 0 $10,000 0 $25,000 0 $40,000 0 $75,000 0 $100,000 0 $150,000 0 $200,000 0 $250,000 0 $300,000 0 $350,000 D Voluntary Dependent Spouse 2 Life 1, 3 and Voluntary Dependent Spouse AD&D � Dependent Child Life 3 and Dependent Child AD&D D Voluntary Dependent Child Life 3 and Voluntary Dependent Child AD&D Have you smoked cigarettes, pipes or cigars or used tobacco in any form in the past one year?

Employee: D Yes � No

Dependent Information If you are applying for coverage for your Spouse and/or Child(ren), please provide the information requested below: Name of your Spouse (First, Middle, Last) Name(s) of your Child(ren) (First, Middle, Last)

Date of Birth (MM/DD/YYYY) Date of Birth (MM/DD/YYYY)

Full Time Student 4?

□ Yes D No □ Yes D No □ Yes D No □ Yes D No

□ Male D Female □ Male D Female □ Male D Female □ Male D Female □ Male D Female

D Check here if you need more lines. Provide the additional information on a separate piece of paper and return it with your enrollment form.

1 Life Insurance may include an Accelerated Benefits Option under which a terminally ill insured can accelerate a portion of his or her life insurance amount. An interest and expense charge may be deducted from the accelerated payment. Receipt of accelerated benefits may affect eligibility for public assistance. This benefit may be taxable and you are advised to seek assistance from a personal tax advisor. 2 For Vermont and Washington State residents, Spouse includes your registered Domestic Partner if you and your Domestic Partner are registered as domestic partners, civil union partners or reciprocal beneficiaries with a government agency or office where such registration is available. 3 Amounts will be subject to state limits, if applicable. 4 Full Time Student means your dependent child, age 18 or older, enrolled as a full-time student in an accredited college, university, secondary school, or a vocational or trade school. Age limits will be subject to state limits, as applicable.

GEF02-1 ADM

(The form number above applies to residents of all states except as follows: Form number GEF09-1 applies to residents of Montana;

GEF02-1 ADM applies to residents of Connecticut, North Dakota and Utah)

Return form to Territorial Officer Health Services | OSR 440 West Nyack Road | West Nyack, NY 1994 or via secure link Page 1 of 2

The Salvation Army - Eastern Territory (Officers) EF-XDP101M-NY (08/22)

enrollment form. With such designation any previous designation of a beneficiary for such coverage is hereby revoked. I understand I have the right to change this designation at any time. I also understand that unless otherwise specified in the group insurance certificate, insurance due upon the death of a Dependent is payable to the Employee. D Check if you need more space for additional beneficiaries and attach a separate page. Include all beneficiary information, and sign/date the page. Share% Full Name (First, Middle, Last) Social Security# Date of Birth (Mo./Day/Yr.) Relationship Address (Street, City, State, Zip)

Phone#

Full Name (First, Middle, Last)

Social Security#

Share%

Date of Birth (Mo./Day/Yr.) Relationship

Address (Street, City, State, Zip)

Phone#

Full Name (First, Middle, Last)

Social Security#

Share%

Date of Birth (Mo./Day/Yr.) Relationship

Address (Street, City, State, Zip)

Payment will be made in equal shares or all to the survivor unless otherwise indicated.

Phone#

If all the primary beneficiary(ies) die before me, I designate as contingent beneficiary(ies): Full Name (First, Middle, Last) Social Security# Date of Birth (Mo./Day/Yr.) Relationship Address (Street, City, State, Zip)

TOTAL:

100% Share%

Phone#

Full Name (First, Middle, Last)

Social Security#

Date of Birth (Mo./Day/Yr.) Relationship

Address (Street, City, State, Zip)

Share%

Phone#

Payment will be made in equal shares or all to the survivor unless otherwise indicated.

TOTAL:

DECLARATIONS AND SIGNATURE

100%

By signing below, I acknowledge: 1 . I have read this enrollment form and declare that all information I have given is true and complete to the best of my knowledge and belief. 2 . I declare that I am actively at work on the date I am enrolling and, if I am enrolling for any contributory life insurance, that I was actively at work for at least 20 hours during the 7 calendar days preceding my date of enrollment. I understand that if I am not actively at work on the scheduled effective date of insurance, such insurance will not take effect until I return to active work. 3. I understand that, on the date dependent insurance for a person is scheduled to take effect, the dependent must not be confined at home under a physician's care, receiving or applying for disability benefits from any source, or Hospitalized. If the dependent does not meet this requirement on such date, the insurance will take effect on the date the dependent is no longer confined, receiving or applying for disability benefits from any source, or Hospitalized. Hospitalized means admission for inpatient care in a hospital; receipt of care in a hospice facility, intermediate care facility, or long term care facility; or receipt of the following treatment wherever performed: chemotherapy, radiation therapy, or dialysis. 4. I understand that if I do not enroll for life coverage during the initial enrollment period, or if I do not enroll for the maximum amount of coverage for which I am eligible, evidence of insurability satisfactory to MetLife may be required to enroll for or increase such coverage after the initial enrollment period has expired. Coverage will not take effect, or it will be limited, until notice is received that MetLife has approved the coverage or increase. 5. I authorize my employer to deduct the required contributions from my earnings for my coverage. This authorization applies to such coverage until I rescind it in writing. 6. I affirmatively decline coverage for any benefits for which I am eligible which I do not request on this enrollment form. 7. I have read the Beneficiary Designation section provided in this enrollment form and I have made a designation if I so choose. 8. I have read the applicable Fraud Warning(s) provided in this enrollment form.

New York (only applies to Accident and Health Insurance): Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a ivil pe lty not to exceed five thousand dollars and the stated value of the claim for each such violation. l

Sign � Here

Signature of Employee

Print Name

_____________

Date Signed (MM/DD/YYYY)

Return to The Salvation Army | Territorial Officer Health Services | OSR 440 West Nyack Road | West Nyack NY 10994 or via secure link https://tsaeshare.egnyte.com/ul/N4GZmmeeTp Page 2 of 2

The Salvation Army• Eastern Territory (Officers) EF-XDP101 M-NY (08/22)

ED ET PL M CO TE: DA

EN ROLL IN OWP TODAY! ARE YOU DUE FOR A REQUIRED PHYSICAL?

WHAT DO I NEED TO KNOW? Relocating for a new appointment is an ideal time to reinvest in your overall well-being by joining the Of f icer Welln ess Pr ogr am (OWP). OWP offers valuable resources and support to help you maintain your physical, mental, and spiritual health. This adjustment time following you move is also a great opportunity to review whether you are due or overdue for your r equ ir ed ph ysical exam. Complete all necessary paperwork and begin accessing up to an extra $650 in wellness benefits, setting yourself up for a healthier year ahead!

HOW TO SUBM IT Please submit OWP and Requ ir ed Ph yscial forms via: -

En cr ypt ed em ail to USEOf f icer Healt h @USE.Salvat ion Ar m y.or g -orUSPS to Th e Salvat ion Ar m y | Of f icer Ser vices & Recor ds Depar t m en t Healt h Ser vices | 440 West Nyack Road | West Nyack , NY 10994

For m or e in f or m at ion abou t secu r ely su bm it t in g docu m en t s, scan t h e QR Code. QUESTIONS? If you have any questions, please contact Of f icer Healt h Ser vices for guidance at USEOf f icer Healt h @USE.Salvat ion Ar m y.or g.

Of f icer Wellness Program HOUSEKEEPING REM INDERS & TIPS AT-A-GLANCE -

Act ive an d Ret ir ed Of f icer s m ay r eceive u p t o $650 each year through the Officer Wellness Program (OWP). M ar r ied cou ples m ay com bin e t h eir OWP allow an ces for a total of up to $1,300 toward shared wellness equipment or memberships that exceed the individual allowance limit. A f it n ess t r ack er allowance of up to $150 every two years is permitted and is included within the annual OWP allowance. Appr oved f it n ess, n u t r it ion , an d w elln ess apps may also be eligible for reimbursement. Receipts should be submitted to Chesterfield Resources along with the Notice of Approval (NOA). Officers are encouraged to schedule physician appointments early to help avoid delays with reimbursement eligibility. A 6-Month Assessment is required during your first year in the program. Once you remain continuously enrolled, additional 6-Month Assessments are not required. A 12-Month Assessment must be completed each year to maintain active membership in the program. If participation lapses, re-enrollment will be treated as a new enrollment and a new 6-Month Assessment will be required.

Scan t h e QR-Code t o visit t h e OWP RESOURCE HUB

T h e Sa l vat io n A r my - Ea st er n T er r it o r y O fficer Ser v ices & R ecords D epar t ment

Officer Wellness Program (OW P) INITIAL ENROLLMENT APPLICATION Nam e ___________________________________________________________________ Ran k _____________________________ Appoin t m en t _______________________________________________________________________________________________ Qu ar t er s Addr ess _______________________________________________ __________________________ ______ _______ STREET

CITY

STATE

ZIP

Em ail _______________________________________ Of f ice Ph on e ________________ Cell Ph on e ___________________ STEP

STEP

Of f icer s applying for OWP must complete Page 1 and Page 2 (Healt h Risk Assessm en t Sect ion s A-G) of this form. Please supply your m edical pr ovider with Page 3 and Page 4 of this form to complete. A licensed healthcare professional must complete the forms on your behalf following your examination. Establish an accountability relationship with an individual of your choice who will hold you accountable for your goal and action plan. Officers may choose the Officer Health Coach as an accountablity partner. My accountability partner will be ______________________________________________________________ Continuation in the OWP and reimbursement for OWP expenses will depend upon the submission of a 6-month progress report, which shows progress made. Reimbursements for expenses through Chesterfield Resources require proper documentation/receipts. Officer Statement: If accepted into OWP, I will seek reimbursement for the following program option (agreed upon with my physician) up to $650.00 (maximum amount). This amount may include $150.00 toward a Fitness Tracker (every two years). Example: Weight Watchers,

Program _______________________________________________________________________ YMCA/YWCA, 24-Hour Fitness STEP

Completed OWP Enrollment Application forms (Pages 1-4) must be emailed to USEOFFICERHEALTH@USE.Salvat ion Ar m y.or g. Please ensure your email is encrypted. Follow the steps provided in the included instructions and/or video tutorial.

Of f icer St at em en t : I wish to participate in the Eastern Territory Officer Wellness Program. I understand that I am committing to improve my overall health and fitness and will comply with the program requirements as stated above. If, for whatever reason, I decide not to continue participating in the OWP, I will notify the Officer Wellness Program Administrator at Territorial Headquarters. I understand that the information provided by the Health Coach is intended for general knowledge and informational purposes only, and does not constitute medical advice or diagnosis. It is not a substitute for professional medical care. If you have any concerns about your health, please consult with a qualified healthcare provider.

Of f icer 's Sign at u r e _______________________________________________Dat e __________________________________ PAGE 1 - TO BE COM PLETED BY APPLYING OFFICER

5.2026

Health Risk Assessment - Initial Wellness Exam Applying Officer must complet e pages 1 and 2 (sect ions A - F) A

OFFICER INFORM ATION

Date of this Exam ________________________

Name _________________________________________________________ Date of Birth ________________ Age ________ Appointment ________________________________________________________________ Sex: Male

Female

Date of Last Physical Examination _________________________________________________________________________ Name of Physician Conducting Assessment _______________________________________________________________ PLEASE PRINT or TYPE

GENERAL HISTORY Complaints: No

Yes

Please Explain ____________________________________________________________

Present Illness _____________________________________________________________________________________________

C FAM ILY HISTORY (Ast h m a, Can cer , Diabet es, ot h er ) Mother _________________________________________________________________________________________________ Father _________________________________________________________________________________________________ Siblings _________________________________________________________________________________________________ Children _________________________________________________________________________________________________

PREVIOUS HISTORY (Diagn osis, dat e/ age, h ospit al an d/ or doct or ) Childhood _______________________________________________________________________________________________ Medical __________________________________________________________________________________________________ Surgical _________________________________________________________________________________________________ Traumatic _________________________________________________________________________________________________

E M EDICATION If you need more space to list medications, please provide additional information on a separate sheet attached to this form. M edical Con dit ion

M edicat ion

Dosage/ Fr equ en cy

HEALTH HISTORY Healt h Hist or y

YES

Alcoholism or Substance Abuse Cancer Heart Disease Diabetes or other Metabolic Disease Pulmonary Disease HIV/Aids or other STD Osteoporosis Thyroid or other Endocrine Disorder Stress-Related Illness PAGE 2 - SECTIONS A-F TO BE COM PLETED BY APPLYING OFFICER

5.2026

Health Risk Assessment - Initial Wellness Exam Healt h Care Provider must complet e pages 3-4 (sect ions G - J) G EXAM INATION PROCEDURES (REQUIRED) As part of, or in addition to, your routine exam, please conduct the following: Exam in at ion Blood Pressure Height / Weight / BMI Cholesterol: HDL / LDL /TRI * CBC-SMAC * A1C (if applicable) Thyroid Function Test EKG (if none on file)

Nu m ber H: HDL:

W: LDL:

High / Low / No Ch an ge BMI: TRI:

* Please at t ach all lab r epor t s. Exam Findings _____________________________________________________________________________________________ Comments ________________________________________________________________________________________________ ________________________________________________________________________________________________________________

REVIEW WITH PHYSICIAN: GOALS an d PROGRAM OPTIONS SHORT TERM GOALS (First 12 months) 1. __________________________________________________________________________________________________________ 2. __________________________________________________________________________________________________________ 3. __________________________________________________________________________________________________________ LONG TERM GOALS (Within 5 Years) 1. __________________________________________________________________________________________________________ 2. __________________________________________________________________________________________________________ 3. __________________________________________________________________________________________________________

PROGRAM OPTIONS RECOM M ENDED BY PHYSICIAN Release from participation in the Officer Wellness Program. ! Officer must send all pages of exam form to Officer Health Services for review. Continue participation in the Officer Wellness Program. ! Officer must send all pages of the exam form to Officer Health Services for approval to continue in the Officer Wellness Program.

PAGE 3 - SECTIONS G-J TO BE COM PLETED BY HEALTH CARE PROVIDER

5.2026

Health Risk Assessment - Initial Wellness Exam Healt h Care Provider must complet e pages 3-4 (sect ions G - J) J

PROGRAM OPTIONS RECOM M ENDED BY PHYSICIAN - PART TWO Hospital / Medical Center Wellness Program

Personal Equipment (specify) ____________________

Noom, Mayo Clinic Diet app or similar apps

Designing a sustainable nutrition plan

Water Aerobics

Gym Membership

Weight Watchers / Similar Program

Fitness Classes | Wellness Program Membership YMCA / YWCA

Other ___________________ Refer to the OWP Enrollment Guide for more options!

Limitations for physical activity or exercise. If checked, please provide an explanation: ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Other recommendations by physician: (Please be specific.) ________________________________________________________________________________________________________ ________________________________________________________________________________________________________

I h ave r eview ed an d en dor se t h e per son al goals set by t h e pat ien t f or t h e n ext 6 m on t h s, an d I h ave clear ed t h is of f icer f or ph ysical act ivit y.

________________________________________________________________________________________________________ Health Care Provider Signature

Print Health Care Provider Name

Date

________________________________________________________________________________________________________ Officer 's Signature

ATTENTION! This 4-page Risk Assessment form (sections A-J) ..and ordered test results must be sent by the officer by:

Print Officer Name

Date

PROVIDER #______________________________

ENCRYPTED EM AIL: useofficerhealth@use.salvationarmy.org ..CONFIDENTIAL FAX: (845) 620-7719 M AIL: The Salvation Army| Eastern Territory ..OWP Administrator | OSR Department ..440 West Nyack Road | West Nyack, NY 10994.. ..! Ref er t o en closed in st r u ct ion s f or m or e in f or m at ion .

AFFIX HEALTH CARE PROVIDER OFFICE STAM P HERE

PAGE 4 - SECTIONS G-J TO BE COM PLETED BY HEALTH CARE PROVIDER

5.2026

ED CET PAL NT M CO TE: DA

PASTORAL CARE LISTEN IN G - SUPPORTIN G CARIN G

WHAT DO I NEED TO KNOW? The Pastoral Care Department is here to support officers of the Eastern Territory. They offer confidential counsel, providing a safe space in times of confusion or crisis. They can help identify healthy options and suggest helpful tools to navigate challenges. The Pastoral Care Team supports officers in their relationships with Salvation Army Leadership and helps officers navigate these through the proper chain of command. The team encourages officer growth in emotional health and Christian discipleship, and can also help set meaningful wellness goals for yourself, your family, and your ministry. Our seasoned officers are ready to listen, offer prayerful guidance, and, if desired, assist you in accessing professional counseling.

Past or al Car e Team Past or al Car e Secr et ar y: Major B. Bryan Smith usepastoralcaresecretary@USE.SalvationArmy.org (845) 450-3007 Assist an t Past or al Car e Secr et ar y: Major Beverly Smith Beverly.Smith@USE.SalvationArmy.Org (845) 620-7448 Past or al Car e Dir ect or : Lt . Colon el Raph ael Jack son Raphael.Jackson@USE.SalvationArmy.Org (845) 620-7344 Past or al Car e Dir ect or : Lt . Colon el San dr a Jack son Sandra.Jackson@USE.SalvationArmy.Org (845) 620-7345

Past or al Car e Of f icer : Major Antonia Bedoya Antonia.edoya@USE.SalvationArmy.Org (845) 620-7385 Past or al Car e Of f icer : Major Diego Bedoya diego.bedoya@USE.SalvationArmy.Org (845) 620-7388 Adm in ist r at ive Assist an t : Dawn Imondi Dawn.lmondi@USE.SalvationArmy.Org (845) 620-7213

TIM E OF TRAN SITION

WHAT DO I NEED TO KNOW? Changing appointments is a significant life event for Salvation Army officers, often bringing a mix of excitement, anticipation, and perhaps a touch of trepidation. As you navigate this new chapter, remember to grant yourself a period of transition and grace. This isn't just about packing and unpacking boxes or learning new names; it's about honoring the emotional, spiritual, and practical adjustments that come with a new appointment. Allow yourself the space to grieve what's being left behind, to acclimate to new surroundings and congregational dynamics, and to rediscover your rhythm. It's okay if not everything falls into place immediately. This period of grace means releasing the pressure to be perfect from day one, trusting that God's plan unfolds in its own time, and recognizing that your well-being is paramount. Embrace the learning, lean into support systems, and know that this time of intentional transition will ultimately strengthen your ministry in your new appointment.