District Court BOULDER COUNTY , COLORADO
1777 6th Street, Boulder, CO 80302
In re the Marriage of:
Petitioner: DWIGHT CORNWELL
Co-petitioner: KARI CORNWELL
COURT USE ONLY
QUALIFIED DOMESTIC RELATIONS ORDER
Hewlett Packard Enterprise 401(k) Plan
This Order is intended to be a Qualified Domestic Relations Order (“QDRO”) as defined in Section
206(d) of the Employee Retirement Income Security Act of 1974, as amended (“ERISA”) and
Section 414(p) of the Internal Revenue Code of 1986, as amended (the “Code”).
REQUIRED BACKGROUND INFORMATION
Identification of the Plan
This Order applies to benefits under the Hewlett Packard Enterprise 401(k) Plan
Identification of Participant
1288 Redwood Ave., Boulder CO 80304
Participant will keep the Plan advised at all times of Participant’s current
Identification of Alternate Payee
Alternate Payee’s Name:
406 E. Curling Dr. Boise ID 83702
Alternate Payee will keep the Plan advised at all times of Alternate Payee’s
current mailing address.
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Alternate Payee’s Beneficiary
Alternate Payee may designate a beneficiary at any time following entry of this
Order by following the Plan’s beneficiary designation procedures. If Alternate
Payee fails to make a valid beneficiary designation or if Alternate Payee’s
designated beneficiary is not living when any payment is to be made on Alternate
Payee’s behalf, then payment will be made in equal shares to Alternate Payee’s
survivor(s) in the first surviving class among the following: (1) spouse (including
domestic partner as defined by the Plan), (2) children, (3) parents, (4) brothers and
sisters, and (5) estate.
Statement of Confidential Information
The Social Security number and date of birth of Participant and Alternate Payee
must be entered on a separate form supplied by the Plan entitled “Statement of
Confidential Information”. The form must be completed and returned to the
Plan’s QDRO administrator at the address listed on the form with a copy of this
Order, or as soon as possible thereafter. This information is required for tax and
identification purposes. The form is not a public record and must not be filed as
part of these proceedings.
DETERMINATION OF ALTERNATE PAYEE’S COMMUNITY/MARITAL PROPERTY INTEREST IN
The Court finds that during all or a portion of the period from the parties’ Date of
Marriage 08/08/2004 to their Date of Dissolution or Separation 10/06/2016
Participant earned Plan benefits that are marital property of Participant and
In satisfaction of Alternate Payee’s marital property interest, the Court awards
Alternate Payee, as Alternate Payee’s sole and separate property,
ONE HUNDERD TWENTY-SIX THOUSAND NINEHUNDRED SIXTY-SIX DOLLARS
($126,966) from Participant’s Plan vested account balance, plus any investment
earnings, gains or losses thereon accruing from the valuation date1 closest to
10/6/2016 (the “Determination Date”) to the valuation date closest to the date of
distribution to Alternate Payee (the total amount shall hereinafter be referred to as
“Alternate Payee’s Interest”). The calculation of earnings, gains or losses will be
determined in accordance with the Plan’s procedures. Notwithstanding the
preceding, Alternate Payee’s award shall not exceed the amount of Participant’s
entire vested account balance as of the valuation date closest to the date of
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As soon as administratively practicable following the date the Plan administrator
determines that this Order is a QDRO, Alternate Payee’s Interest will be handled
The Plan administrator will establish a separate account for Alternate
Payee’s Interest in accordance with the Plan’s QDRO procedures.
Alternate Payee may direct the investment of his/her separate account in
accordance with the rules applicable to investments under the Plan.
However, until a separate account is established, Alternate Payee’s
Interest will remain subject to the same investment options as elected by
The Plan will pay Alternate Payee’s Interest to Alternate Payee as soon as
administratively practicable following the date Alternate Payee elects a
distribution in accordance with the Plan’s procedures.
The Alternate Payee may elect to receive Alternate Payee’s Interest in any
form in which such benefit may be paid under the Plan to the Participant
(other than in the form of a joint and survivor annuity with respect to
Alternate Payee and his or her subsequent spouse).
If Participant has an outstanding loan balance under the Plan, Alternate
Payee’s assigned share of the benefits will be calculated after the loan
balance is subtracted from the total account balance. In no event will
Alternate Payee receive an amount that is greater than Participant’s nonloan account balance.
If Alternate Payee dies before receiving Alternate Payee’s Interest, then Alternate
Payee’s Interest will be distributed to Alternate Payee’s beneficiary in accordance
with the terms of this Order and the Plan.
DETERMINATION OF PARTICIPANT’S BENEFIT
Participant is entitled to (i) the remainder of the Participant’s account balance as
of the valuation date closest to the Determination Date, plus any investment
earnings, gains or losses thereon accruing after the Determination Date, and
(ii) one-hundred percent (100%) of any contributions or forfeitures allocable to
Participant under the Plan after the Determination Date, plus any investment
earnings, gains or losses thereon.
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Interpretation of Order
This Order will not be construed to:
Provide to Alternate Payee any type or form of benefit, or any option, not
otherwise provided under the Plan;
Provide a benefit to Alternate Payee which could have the effect of
increasing Participant’s total accrued benefit; and
Provide Plan benefits to Alternate Payee that are required to be paid to
another alternate payee under another order previously determined to be
enforceable against the Plan.
This Order is made pursuant to the domestic relations law of the State of
Participant’s Cooperation Required
Participant must cooperate fully with Alternate Payee and the Plan to carry out
the conditions of this Order.
Correcting or Terminating Payments
The Plan will retain any rights it may have under its terms to suspend or
terminate payments to Alternate Payee and Participant provided that
either Participant or Alternate Payee may contest such suspension or
termination through any administrative remedies available under the Plan.
Payments by the Plan pursuant to this Order will be without prejudice to
any right the Plan has under applicable law to seek recoupment or offset
If the Plan pays one party a portion of the other party’s benefits under the
Plan and this Order, the party receiving the overpayment will return that
portion to the Plan, which in turn, will pass that portion on to the other
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This Order does not revoke or affect in any way any prior beneficiary designation
made by Participant on file with the Plan. Following entry of this Order,
Participant may designate a beneficiary, including Alternate Payee, or revoke any
beneficiary designation with respect to benefits payable under the Plan without
Alternate Payee’s consent, in accordance with the Plan’s beneficiary designation
Effect of Plan Changes
If changes in the terms of the Plan prevent the Plan from making any payment
expressly provided for in this Order, the Plan is authorized to interpret the Order
in a manner that is consistent with this Order and the Plan as changed. Any such
interpretation by the Plan is subject to review by the Court in accordance with
Section 5 by petition of either party.
Alternate Payee is not eligible to take a loan from the Plan. Once Alternate Payee’s
Interest is segregated by the Plan administrator, such amount will not be treated
as Participant’s benefits for any purpose under the Plan’s loan provisions.
QDRO Processing Fee:
Participant will be charged a $300 QDRO processing fee for this QDRO. This fee
will be assessed against the Participant’s account balance at the time the initial
paperwork is submitted to QDRO Consultants.
RESERVATION OF JURISDICTION
The Court reserves jurisdiction over this asset to make such further orders as are appropriate
to enforce or clarify the provisions of Sections 1 through 4.
IT IS SO ORDERED:
_________________________________________ Date: __________
District Court or Magistrate
AGREED BY THE PARTIES:
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Statement of Confidential Information
(Regarding Social Security Numbers and Dates of Birth)
DO NOT SUBMIT THIS FORM TO THE COURT.
Instructions: For tax reporting purposes, the Plan requires the social security number of any
person who receives Plan benefits. However, to avoid having the social security numbers of the
parties involved become part of the public record in a court order, the Plan uses this separate
form to obtain the parties’ social security numbers. Accordingly, please:
1. Enter the name and social security number of each party in the appropriate space
below. Please print or type.
2. Submit the completed form, along with a file-marked copy of the court order dividing
the participant’s Plan benefits, to the Plan’s QDRO administrator at the following
QDRO Consultants Co.
3071 Pearl Road
Medina, Ohio 44256
Attn: Hewlett Packard Enterprise
QDRO Compliance Team
Telephone: (800) 527-8481
3. Do not submit this form to the court.
SOCIAL SECURITY #
DATE OF BIRTH
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