Rollover Election Form

Election/Rollover Form Login

This Rollover Form is ONLY for Settlement Class Members who would like to elect to receive their Settlement payment through a rollover to a qualified retirement account through direct deposit or by paper check. To do so, Settlement Class Members must complete a Rollover Form on or before November 5, 2026. Please review the instructions below carefully.

Former Participants who do not complete and timely submit a Rollover Form, will receive their Settlement payment by a check payable to themselves (subject to applicable tax withholding). If you have questions regarding this form, you may contact the Settlement Administrator at (833) 421-7346 or info@NHESOPSettlement.com.

Instructions for Completing Former Participant Rollover Form.

  1. If you would like to receive your Settlement payment through a rollover to a qualified retirement account, complete a Rollover Form. It is your responsibility to ensure the Settlement Administrator has timely received your Rollover Form by November 5, 2026.

  2. You must provide all required information (including Date of Birth and Social Security Number) and sign your form where indicated.

  3. If you omit to provide all necessary information or fail to sign your form, payment will be made to you by check.

  4. If you change your address after sending in your Rollover Form, please provide your new address to the Settlement Administrator as soon as possible.

To start your online Rollover Form, please login with your LoginID and PIN found on your Notice.

Questions? If you have any questions about this Rollover Form or need assistance finding your LoginID and PIN, please call the Settlement Administrator at (833) 421-7346. 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.

Note: The timing of the distribution of the Settlement payments is conditioned on several matters, including the Court’s final approval of the Settlement and any approval becoming final and no longer subject to any appeals in any court. If the Settlement is approved by the Court, and there are no appeals, the first Settlement distribution likely will occur within sixty days of the Court's Final Approval Order.