Incoming Rollover Contribution Application

Tenet Healthcare Corporation 401(k) Retirement Savings Plan 25100

If you have a balance in a former employer’s retirement plan, you may want to consider consolidating your assets in the
Tenet 401(k) Plan. Keeping your retirement savings in a single plan can help simplify performance tracking, provide
greater convenience in making investment changes, and minimize paperwork. Rolling money into the Tenet 401(k) Plan
is a three-step process. Please follow these instructions to ensure that your rollover is completed in a timely and
accurate manner.
• Personal checks are not acceptable. Fidelity does not accept wire transfer of funds.
• Failure to follow these instructions may result in a delay in the processing of your request and may
jeopardize your ability to roll over your distribution.

1. Request Your Distribution

There are two ways to make a rollover contribution:
DIRECT ROLLOVER
If you choose a direct rollover, your distribution will be made payable directly to the Plan. This type of rollover ensures
that your distribution will not be taxable to you in the current year, and allows you to avoid automatic federal income
tax withholding on your distribution. In order to make a direct rollover, your distribution check must be made payable
to “FIIOC for the benefit of (your name)”. The check must be from the distributing trustee or custodian. (FIIOC
stands for Fidelity Investments Institutional Operations Company, Inc.)
If you elect a direct rollover you must request a check from your previous employer’s plan. The check you receive
from the prior trustee or custodian must be submitted to Fidelity with your completed Incoming Rollover Contribution
Application.
INDIRECT ROLLOVER
If you choose an indirect rollover, your distribution will be made payable to you. The distributing trustee or custodian
will be required to withhold 20% federal income tax from your distribution. If applicable, state income tax will also be
withheld. You can rollover all or a portion of the distribution within 60 days by sending a certified check or money
order to Fidelity. If your distribution is not rolled over within 60 days, the taxable portion of the payment will be taxed in
the current year. In addition, if you are under age 59 1⁄2, you may also be subject to a 10% early withdrawal penalty tax.
If you elect an indirect transfer, you must submit a certified check or money order to Fidelity with your completed
Incoming Rollover Contribution Application.

2. Complete Your Rollover Application

Please complete the Incoming Rollover Contribution Application (attached).
Use Section 3: Investment Elections to select the investment options into which you elect to invest your rollover
contribution. You may choose as many investment options as you wish from the options in the plan. The quantity and
selection of available investment options are determined by the Plan Sponsor. Indicate a percentage for each
investment option chosen. The percentage must be in whole numbers and total 100%. If your investment elections do
not total 100%, your documentation and check will be returned to you. If you do not make investment elections on the
Rollover Application, your rollover contribution will be invested in your current investment elections for the Plan, or in the
SM
absence of investment elections, the appropriate Dow Jones Target Date Fund based on your year of birth, as
directed by the Plan sponsor.
Information about the types of acceptable and unacceptable rollover funds is in Section 2 of the Application.

3. Mail The Information

Mail the Incoming Rollover Contribution Application and the check in the enclosed return envelope or mail to:
Tenet Healthcare Corporation 401(k) Plan Overnight Address: Tenet Healthcare Corporation 401(k) Plan
PO Box 770003 100 Crosby Parkway, KC1F-L
Cincinnati, OH 45277-0065 Covington, KY 41015

Please include all of the information requested. Incomplete forms and the accompanying check may be
returned and may jeopardize your ability to roll over your distribution.
Once your contribution is accepted into the Tenet 401(k) Plan, you can log on to Fidelity NetBenefits ® at www.401k.com
to view your rollover contribution and investment election(s). If you have any questions about rollover contributions, call
800-372-4015. Please allow time for your check and application to reach Fidelity.
®
To establish or change your beneficiary designation for the Tenet 401(k) Plan, log on to Fidelity NetBenefits at
www.401k.com, click Tenet 401(k), then Plan Information and Documents and Printable Forms/Literature. If you do not
have Internet access, call the Tenet Healthcare 401(k) Retirement Savings Line at 800-372-4015 and request a
Beneficiary Designation Form.

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Available Investment Options for the Tenet 401(k) Plan:
Investment Options Fund Code Investment Options Fund Code
(VRS) (VRS)
Strategy 1 – Lifestyle Funds Strategy 2 – Extended Choice Funds (continued)

Dow Jones Target Today Fund 42703 Fidelity Balanced Fund 00304
®
Dow Jones Target 2015 Fund 42705 Fidelity Puritan Fund 00004
Vanguard Balanced Index Fund –
Dow Jones Target 2025 Fund 42707 45372
Admiral Class
Vanguard Value Index Fund –
Dow Jones Target 2035 Fund 42709 91864
Institutional Class
Legg Mason Value Trust Fund –
Dow Jones Target 2045 Fund 42711 93732
Institutional Class
® American Beacon Small Cap Value Fund
Fidelity Freedom Income Fund 00369 47694
– Institutional Class
® Vanguard Small-Cap Value Index Fund –
Fidelity Freedom 2000 Fund 00370 49993
Institutional Class
® Davis New York Venture Fund, Inc. –
Fidelity Freedom 2005 Fund 01312 47309
Class Y
®
Fidelity Freedom 2010 Fund 00371 Fidelity Dividend Growth Fund 00330
®
Fidelity Freedom 2015 Fund 01313 Fidelity Growth & Income Portfolio 00027
® ® †
Fidelity Freedom 2020 Fund 00372 Fidelity Magellan Fund 00021
® Vanguard Institutional Index Fund –
Fidelity Freedom 2025 Fund 01314 93556
Institutional Class
® TCW Galileo Value Opportunities Fund –
Fidelity Freedom 2030 Fund 00373 23698
Class I
® Vanguard Mid-Cap Index Fund –
Fidelity Freedom 2035 Fund 01315 21348
Institutional Class
® Vanguard Small-Cap Index Fund –
Fidelity Freedom 2040 Fund 00718 44553
Admiral Class
®
® American Funds Growth Fund of
Fidelity Asset Manager 20% 00328 ® 46606
America – R5**
®
Fidelity Asset Manager 50% 00314 Fidelity Blue Chip Growth Fund 00312
®
Fidelity Asset Manager 70% 00321 Fidelity Growth Company Fund 00025
® ®
Fidelity Asset Manager 85% 00347 Fidelity Nasdaq Composite Index Fund* 01282
Vanguard Growth Index Fund – Admiral
Strategy 2 – Extended Choice Funds 21443
Class
Fidelity Retirement Money Market Victory Institutional Diversified Stock Fund
00630 40429
Portfolio – I Shares
Fixed Income Fund 98057 Fidelity Mid-Cap Stock Fund* 00337
The Bond Fund – JP Morgan Investment
93719 Baron Growth Fund 93894
Management Inc.
Vanguard Total Bond Market Index Fund Managers Special Equity Fund –
44511 47312
– Institutional Class Institutional Class
Western Asset Core Bond Fund – Vanguard Small-Cap Growth Index Fund
91399 45456
Institutional Class – Investor Class
Fidelity High Income Fund* 00455 Fidelity Diversified International Fund* 00325

*Shareholders may be subject to certain short-term trading fees. Please consult the prospectus for further information.
®
**American Funds Growth Fund of America® – R5 was formerly known as Growth Fund of America – R5.
†
Effective 7/1/05, the Plan does not offer the Magellan Fund as an investment option for new contributions to the Plan.

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 Strategy 2 – Extended Choice Funds (continued)
Investment Options Fund Code
(VRS)
LKCM Small Cap Equity Fund 48251
Fidelity Mid-Cap Stock Fund* 00337
®
Spartan International Index Fund* 00399
Templeton Foreign Fund – Advisor* 47339
Templeton Growth Fund –
94584
Advisor Class*
Fidelity Real Estate Investment
00303
Portfolio
Vanguard REIT Index Fund –
49961
Institutional Class
Janus Mid-Cap Value Fund 44992
*Shareholders may be subject to certain short-term trading fees. Please consult the prospectus for further information.

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 For Fidelity Use Only: NIGO

Incoming Rollover Contribution Application

Tenet Healthcare Corporation 401(k) Retirement Savings Plan 25100

Section 1 Participant Information Please Print

– –
Participant’s Name (First, Middle Initial, Last) Social Security Number

( ) –
Street Number Street Name Daytime Phone Number

City State Zip Country

/ / / /
Birth Date Hire Date

Section 2 Rollover Contribution Information

Please complete the 3 boxes at the end of this section. If you are not sure of the plan type, please contact your prior Plan
Sponsor for verification. An incorrect plan type could invalidate your Rollover.
ACCEPTABLE ROLLOVER FUNDS
The Tenet 401(k) Plan will accept taxable distributions made to participants from the following types of employer-sponsored plans:
• qualified plans (such as 401(k), profit-sharing and money purchase • 403(b) plans (i.e., plans of tax-exempt
pension plans) organizations)
Non-taxable (or after-tax) distributions from qualified plans, may also be rolled into the Plan. Please note that all non-taxable rollovers
must be processed as direct rollovers. (See Step 1 in the instructions.)

UNACCEPTABLE ROLLOVER FUNDS

The Tenet 401(k) Plan cannot accept distributions from the following types of plans or accounts:
• Governmental 457(b) plans • Coverdell Education IRAs
• Roth IRAs • SIMPLE IRA
• Simplified Employee Pension Plan (or SEP IRA) • Conduit IRA (or Rollover IRA)
• Non-Conduit (or non-rollover) IRAs (i.e., a traditional IRA into which you made either deductible or non-deductible IRA
contributions)
In addition, distributions to a beneficiary, distributions to a former spouse under a qualified domestic relations order (QDRO),
distributions made over life expectancy or a period of ten or more years, hardship distributions, and mandatory age 701⁄2
distributions, are not eligible for rollover into the Plan. If you hold employer stock in your prior employer’s plan, the stock must
be sold and the proceeds rolled over in cash.

Your Enclosed Contribution Amount: The distribution being rolled over was paid to me as:
Pre-tax dollars $ _______________ Plan participant
After-tax dollars $ _______________
Total $ _______________

Plan type of the origin of this rollover (please check one). If you are not sure of the plan type, please contact your prior
Plan Sponsor for verification. An incorrect plan type could invalidate your Rollover.
Qualified plan (such as 401(k), profit-sharing and money purchase pension plan) 403(b) plans

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Section 3 Investment Elections
Please indicate your investment election in whole percentages among the investment options shown below (total
percentage must equal 100%). Your investment election below will apply only to this rollover contribution. If you make
no election on this form, your rollover will be invested in your current investment mix, if established. If you do not have
a current investment mix, then your rollover will be invested in the Dow Jones Target Date Fund based upon your age
on file as it relates to the Plan’s target retirement ages. Be sure to read the mutual fund(s) prospectus(es) before
choosing your investment option(s). Prospectuses for the funds are available on NetBenefits at www.401k.com or
the Tenet Healthcare 401(k) Retirement Savings Line by calling 1-800-372-4015.

Investment Option Fund Code Percentage Investment Option Fund Code Percentage
% %
% %
% %
% %
% %
% %
% %
% %
% %
% %
% %
% %
% %
% %
% %
% %
% %
% %
% %
% %
% %
% %
% Total 100 %

Note: Any investment election chosen on this form will take precedence over any other investment election that
Fidelity Investments may have on its system for a rollover contribution.
*Shareholders may be subject to certain short-term trading fees. Please consult the prospectus for further information.
Section 4 Participant Certification
I authorize the investment election for this rollover and acknowledge that I have received information detailing my
available investment options. I also acknowledge that if I do not already have rollover investment elections on file at
Fidelity, and I have not made rollover investment elections above, my rollover contribution will be invested in the Dow
SM
Jones Target Date Fund based on my age on file as it relates to the Plan’s target retirement ages. If my target
retirement age is not on file at the time of the rollover, my rollover will be invested in the Dow Jones Target Today Fund.
I certify that this rollover amount is composed only of money from acceptable sources listed under Section 2 above,
and I have completed the information regarding the source of this money to the best of my knowledge. Also, if the
distribution check was made payable to me, I understand that this rollover must be received and deposited to my
account within 60 days of my receipt of the distribution. I understand that once invested, these moneys will be subject to
the terms that govern the Tenet 401(k) Plan.

Signature of Participant Date

Fidelity Investments Institutional Operations Company, Inc.

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